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Background Healthcare-associated infections (HCAIs) pose a significant threat to the health and safety of patients, staff, and visitors. Infection prevention and control (IPC) teams play a crucial role in ensuring that systems and processes are in place to keep everyone safe within the healthcare environment. Aim The aim of this study was to identify components of infection prevention services, priorities, indicators of successes and how they are measured, and facilitators and barriers to success. Methods A survey questionnaire was developed and circulated to infection prevention leaders and managers. Findings/results Seventy IPC leaders/managers completed the survey. Participants were responsible for a range of IPC services within and across healthcare organisations, with significant variations to IPC delivery components. Additionally, a range of budget availability was reported. Several IPC service requirements were considered core work of IPC teams, including providing IPC advice and support, surveillance and audit and education and training. Discussion An optimal IPC service needs to be in place to ensure HCAIs are minimised or prevented. In a post pandemic era, this is more important than ever before. This is also as crucial for the health and wellbeing of those working in IPC, who have endured unprecedented demand for their services during the pandemic.

This work was supported by Engineering and Physical Sciences Research Council [grant number EP/T025034/1]. Partnership is not a benign practice; it is culturally and ethically loaded. The way in which partnerships are construed in international research determines its design, ethics and impacts. Despite this, and the growing assumption of partnership practice in our field, the concept has become increasingly abstract and the practice under-analysed. This article provides critical perspectives of current understandings of partnership in international development research from three angles: the motivations behind partnership working; an epistemological perspective in relation to epistemic justice and the agency of language; and finally, the systems that mediate partnerships, and the range of resources that guide them. Publisher PDF

Shifting environmental conditions and poor or insufficient hygiene facilitates the transmission of bacteria and viruses between and within species of animals; between humans; and between humans and animals. Taking a One Health perspective, we used interviews to explore with 20 women living on low income in Kenya: their gendered hygiene practices and daily contact with animals; how and why they access water and sanitation facilities for themselves, their families, and any livestock; and their understandings of (zoonotic) health risks and disease transmission within their local environments. The women described how they worked every day to keep bodies and homes clean by washing bodies, surfaces and clothes. Women's hygiene practices focussed on removing visible dirt partly because of concerns for health but also to support their families' social standing in their community. While they were less aware of any 'invisible' risks to health through contact with animals or other hazards present in their daily living environments, most exercised care to source and manage water for drinking. Contaminated water was recognised as a risk to health suggesting that in this case, women accepted that there were 'invisible risks' to health, even in clear water, and took steps to mitigate them.

Rationale: \ud Research into mental health and wellbeing recognises the role of positive mental health to enable people to lead healthy and emotionally fulfilling lives. Mental health difficulties continue to be associated with high levels of disability worldwide, and refugees fleeing conflict are known to suffer from poor mental health for years after their forced migration.\ud \ud Method: \ud Informed by Sen's Capability Approach and as part of a wider research project, we used semi-structured interviews to engage with 60 men and women in two refugee communities in Uganda and Rwanda to explore their aspirations and what a ‘good life’ meant to them.\ud \ud Findings: \ud While aspects of what constituted a good life were gendered, both men and women struggled to achieve their aspirations within their communities. Following the basic needs of food and shelter, the complex needs of being dressed well and being clean were consistently associated with be able to achieve a ‘good life’ by women and men across age groups. Looking good and being clean were highly valued and associated with gaining the respect of others, achieving good relationships with neighbours, and avoiding conflict. Participants identified personal appearance and related social status as critical precursors to their successful engagement with other gendered dimensions of social and economic life in their communities, such as finding employment and being well regarded in their religious community.\ud \ud Conclusions: \ud Our findings suggest that without the means to present a good appearance, people living in refugee communities may experience feelings of shame and isolation and are unable to gain self-respect and the respect of others needed to achieve the positive mental and physical health they associate with leading ‘a good life’.

BackgroundNon-urgent emergency department (ED) attendances are common among children. Primary care management may not only be more clinically appropriate, but may also improve patient experience and be more cost-effective.AimTo determine the impact on admissions, waiting times, antibiotic prescribing, and treatment costs of integrating a GP into a paediatric ED.Design and settingRetrospective cohort study explored non-urgent ED presentations in a paediatric ED in north-west England.MethodFrom 1 October 2015 to 30 September 2017, a GP was situated in the ED from 2.00 pm until 10.00 pm, 7 days a week. All children triaged as ‘green’ using the Manchester Triage System (non-urgent) were considered to be ‘GP appropriate’. In cases of GP non-availability, children considered non-urgent were managed by ED staff. Clinical and operational outcomes, as well as the healthcare costs of children managed by GPs and ED staff across the same timeframe over a 2-year period were compared.ResultsOf 115 000 children attending the ED over the study period, a complete set of data were available for 13 099 categorised as ‘GP appropriate’; of these, 8404 (64.2%) were managed by GPs and 4695 (35.8%) by ED staff. Median duration of ED stay was 39 min (interquartile range [IQR] 16–108 min) in the GP group and 165 min (IQR 104–222 min) in the ED group (P4 hours before being admitted or discharged (OR 0.11; 95% CI = 0.08 to 0.13), but were more likely to receive antibiotics (OR 1.42; 95% CI = 1.27 to 1.58). Treatment costs were 18.4% lower in the group managed by the GP (PConclusionGiven the rising demand for children’s emergency services, GP in ED care models may improve the management of non-urgent ED presentations. However, further research that incorporates causative study designs is required.

Background: The devolution of health to Scotland in 1999, led for the first time in the NHS, to different priorities and success indicators for infection prevention and control (IPC). This project sought to understand, compare and evaluate the national IPC priorities and available indicators of success. Aim: To identify the national IPC priorities alongside national indicators of success. Methods: Critical analysis of nationally produced documents and publicly available infection-related data up to March 2018. Findings: For both NHS Scotland and England the local and national IPC priorities are evidenced by: (1) people being cared for in an IPC-safe environment; (2) staff following IPC-safe procedures; and (3) organisations continuously striving not just to attain standards, but to improve on them. If national agencies that produce data were also charged with using a Continuous Quality Improvement (CQI) model, then there would be further opportunities to detect and improve on successes.

BackgroundFever among children is a leading cause of emergency department (ED) attendance and a diagnostic conundrum; yet robust quantitative evidence regarding the preferences of parents and healthcare providers (HCPs) for managing fever is scarce.ObjectiveTo determine parental and HCP preferences for the management of paediatric febrile illness in the ED.SettingTen children’s centres and a children’s ED in England from June 2018 to January 2019.Participants98 parents of children aged 0–11 years, and 99 HCPs took part.MethodsNine focus-groups and coin-ranking exercises were conducted with parents, and a discrete-choice experiment (DCE) was conducted with both parents and HCPs, which asked respondents to choose their preferred option of several hypothetical management scenarios for paediatric febrile illness, with differing levels of visit time, out-of-pocket costs, antibiotic prescribing, HCP grade and pain/discomfort from investigations.ResultsThe mean focus-group size was 4.4 participants (range 3–7), with a mean duration of 27.4 min (range 18–46 min). Response rates to the DCE among parents and HCPs were 94.2% and 98.2%, respectively. Avoiding pain from diagnostics, receiving a faster diagnosis and minimising wait times were major concerns for both parents and HCPs, with parents willing-to-pay £16.89 for every 1 hour reduction in waiting times. Both groups preferred treatment by consultants and nurse practitioners to treatment by doctors in postgraduate training. Parents were willing to trade-off considerable increases in waiting times (24.1 min) to be seen by consultants and to avoid additional pain from diagnostics (45.6 min). Reducing antibiotic prescribing was important to HCPs but not parents.ConclusionsBoth parents and HCPs care strongly about reducing visit time, avoiding pain from invasive investigations and receiving diagnostic insights faster when managing paediatric febrile illness. As such, overdue advances in diagnostic capabilities should improve child and carer experience and HCP satisfaction considerably in managing paediatric febrile illness.

Background: \ud English Stop Smoking Services primarily deliver behavioural interventions to support abrupt quit attempts. Recent evidence suggests an alternative approach could be offered to clients involving a more gradual reduction of cigarettes smoked leading to complete abstinence, known as ‘Cut Down To Stop’ (CDTS). The purpose of this study was to explore the experiences of stop smoking practitioners and service users who participated in a pilot study of a CDTS service.\ud \ud Methods: \ud The CDTS intervention was pilot tested in a Stop Smoking Service in London, England. As part of the CDTS intervention clients who were still smoking 2 weeks after their quit date were offered tailored advice, medication and support to reduce their current smoking by half, with the aim to stop smoking altogether within a six-month period. A qualitative evaluation was conducted involving a focus group discussion with nine practitioners involved in the delivery of the CDTS intervention and telephone interviews with 18 CDTS service users. Thematic analysis was performed.\ud \ud Results: \ud Service users and practitioners were very positive about their experience with the CDTS intervention. The intervention was found to be an effective way of keeping clients engaged with the service and was felt to increase the likelihood they might quit and/or re-engage in service for future quit attempts. Elements that contributed to the attractiveness of the CDTS intervention included: 1) the trust and empathetic relationship developed between service users, practitioners and their referring primary care provider; 2) time and flexibility for service users to engage in the quitting process at their own pace; 3) setting progressive goals and building service user confidence; 4) the opportunity to experiment with quit smoking medications; and, 5) the on-going contact with the practitioner/service.\ud \ud Conclusions: \ud Service users who are not successful with quitting abruptly may benefit from a CDTS intervention. This study highlights the important role of ‘relationships’, time and ‘flexible’ service delivery models in engaging service users who are not initially successful with quitting. The findings of this study have the potential to inform decision-making regarding the value of the CDTS approach for the English Stop Smoking Service and cessation services worldwide.

This chapter demonstrates the application of three standard qualitative methods in reading research. Jude Robinson and Josie Billington illustrate how ethnographic inquiry can be used effectively in a specific (and highly controlled) reading context (prisons). Ellie Gray and Gundi Kiemle demonstrate the appropriateness of Interpretative Phenomenological Analysis in relation to reading and community mental health, while Melissa Chapple shows the application of Framework Analysis in relation to readers living with autism.

Competences for infection prevention and control (IPC) practitioners were first introduced by the Infection Control Nurses Association (ICNA) in 2000. In recent years, they have been revised by the Education and Professional Development Committee of the Infection Prevention Society (IPS). The competences are a multi-purpose tool to support and inform service and workforce development and management at an operational and strategic level. They can assist in designing education programmes, help with staff appraisal, personal development plans and support revalidation alongside developing team structures and requirements. They enable the practitioner to review their own current position of progression and clinical standing from the position of assisted, supervised and independent. These terms are designed to assist the user to express the level of competence at which they work. This may differ depending on the competences that are being explored. This current version of the IPS competences (2018) have been designed to reflect the current structures and practices within the health and social care economy. They have been redeveloped within an electronic interactive framework to encourage usability and assist with manageability and record keeping. The competency framework tool is intended as a guide; the idea is for the practitioner to focus on relevant aspects of the competences and combine with organisational and individual goals and revalidation where applicable.

Worldwide, many nonsmokers (often women and children) are exposed to second-hand smoke (SHS) in home settings, as men retain their traditional power and control within their family and women and children have limited agency to intervene. This study, set up to explore home smoking management in rural China, found that some women were able to positively intervene to restrict men's smoking at three key stages: prior to conception, during their pregnancy and at the early years of their children's lives. By utilizing dominant social, health and political narratives about the importance of raising a healthy child supported by the One-Child Policy in China, combined with the fear of health risks of SHS to young children, the women were able to use their elevated status as bearer and carers of the only children to subvert the pre-eminence of men in domestic environments, enabling them to positively influence home smoking. While this study highlights the possibility for future smoking cessation initiatives in China by incorporating family carers' elevated awareness of protection of children's health in key stages of childhood, there is also a need for further health education, as family members were unsure why they needed to keep children smoke-free, which may partially explain why few households were smoke-free.

In recent years teenagers have reported a decline in under-age drinking at the same time as their access to public space has been increasingly curtailed. In this paper we explore the spatial practices and drinking behaviours of a group of teenage girls and boys aged 13–14 years in Liverpool, UK. Our analysis considers how their use of space was bound up with experimentation with alcohol and how this varied by gender. We find in support of previous research that both boys and girls report nuanced experiences of public space, with some enjoying greater freedom while others have moved into more domestic and supervised leisure spaces in response to fears about their safety in public spaces. The boys also reported less alcohol consumption than the girls. These gendered experiences were mediated by social relationships and encounters with other young people, their parents and carers and also other adults in positions of authority.

Objectives: Our aims were to investigate discrepancies between depressed patients’ GlobalRating of Change (GRC) and scores on the Patient Health Questionnaire depression module (PHQ-9). Our objectives were to ascertain patients’ views on the source and meaning of mismatches and assess their clinical significance.\ud \ud Design: Qualitative study nested within a cohort, in a programme investigating the indications for prescribing antidepressants that will lead to a clinical benefit.\ud \ud Setting: Primary care practices in north-west England.\ud \ud Participants: We invited 32 adults with a recent diagnosis of depression and evidence of mismatch between GRC and PHQ-9 Scores to participate. Of these, 29 completed our interviews; most were women, identified as white British, had high school education or higher, were employed or retired and had been depressed for a long time.\ud \ud Main measures: We conducted semistructured interviews with a topic guide, focusing on experiences of depression; treatment experiences and expectations; effectiveness of the questionnaires; reasons for the mismatch; and social factors. Interviews were transcribed and subjected to interpretative phenomenological analysis.\ud \ud Results: We identified four themes as explanations for mismatch between GRC and PHQ-9: perceptions that GRC provided a more accurate assessment of current mental state than PHQ-9; impact of recent negative or positive life events on either measure; personal understanding of depression as normally fluctuating, and tendency to underscore on PHQ-9 as a means of self-motivation; and lack of recall.\ud \ud Conclusions: The combined used of the PHQ-9 and a more open question better captures the patient’s unique experiences of mental health. This approach ascertains the relevance of symptoms to the individual’s experience and influences treatment decisions.\ud \ud Study registration: This study was an element of NIHR Programme Grant RP-PG 0610 10048.

This article considers the significance of family context for intergenerational drinking practices. Socialisation approaches to drinking behaviours assume that people carry forward actions and ideals that are developed in formative settings during childhood, particularly the family, community or school. In this article, we consider how a more active interpretation of time as a creative force can challenge the deterministic principles of family socialisation. We consider how parents use their own childhood experiences of drinking not necessarily as a blueprint of how they should act towards their own children, but as accounts of how not to act and how they are able to reverse their childhood experiences. Our account of drinking across generations is based on an analysis of 21 biographical interviews with parents of teenage children and considers how their childhood experiences of alcohol and drinking influence their own parental strategies when regulating their children’s exposure to alcohol.

In primary care, patients are prescribed decolonisation treatment to eradicate meticillin-resistant Staphylococcus aureus (MRSA). This complex treatment process requires the patient to apply a topical antimicrobial treatment as well as adhering to rigorous cleaning regimens to ensure the environment is effectively managed. A pilot study was carried out that involved developing an enhanced, nurse-delivered education tool, training a community nurse to use it, then testing its use with a patient. Three interviews were carried out: one with a patient who received usual care, one with a patient who received the enhanced education and one with the community nurse who delivered the enhanced education tool. The patient who received the enhanced education reported better knowledge and understanding of the application of treatment than the patient who did not. These results are interesting and point the way forward for larger research studies to build on the learning from this limited exploration and develop more effective management of MRSA in primary care.

While the prevalence of smoking in Western countries has substantially reduced following the introduction of comprehensive tobacco control programs, reduction strategies such as the introduction of smokefree legislation, media campaigns, and individual and group support for people trying to quit have been less successful with people living on low incomes, suggesting the need for new ways to engage with people who smoke. We argue that rather than focusing solely on researching smoking behaviors to generate new understandings of why people smoke, people working in the broad area of public health should look more widely at peoples' lives in order to understand their smoking. Using a biographical, narrative perspective as part of a wider ethnographic study of 12 families living in one community within Liverpool in 2006, we argue that understandings that position smoking purely as a harmful, deviant behavior fail to capture the cultural complexity of the lives of smokers and the changing place and meaning of cigarettes over a person's lifetime, and may explain why smokers fail to engage with smoking cessation services and continue to smoke.

The media have framed obesity and climate change as problems the next generation will inherit. The two issues have overlapping causative factors and temporalities, and share pre-emptive approaches, focusing on children. The aim of our study was to develop an approach to explore children's perceptions of the interconnectedness of health and climate that avoids creating anxiety or apathy. Drawing on research with 10- and 11-year-old children living in urban areas, we reflect on our development of methods devised to engage children to talk about issues linking climate change and health, specifically their opportunities to participate in activities such as cycling or walking to school. Children were variously given photographic prompts, asked to draw and write about their thoughts and feelings, draw maps of their route to school, and create posters. We found that these methods enabled children to actively engage with climate change issues, evidencing individual and collective agency both in group work and the...

The key to empowering and supporting children and young people (CYP) with vision impairment (VI) to achieve their potential lies in the delivery of habilitation training. Evidence has revealed that provision of habilitation services across the United Kingdom was inconsistent, with CYP with VI not receiving services in some areas. This research explored the accessibility and quality of habilitation provision for CYP with VI via two studies: (1) 12 qualitative case studies of habilitation practice and (2) surveys of habilitation training experiences, with CYP with VI ( n = 43) and with parents of CYP with VI ( n = 68). Five themes were identified highlighting inconsistencies and variability in the delivery of habilitation training in recent years, a lack of focus on independent living skills training, on social inclusion and emotional well-being, a lack of support for parents and a lack of clarity with regard to the definition of habilitation, and who is responsible for providing training.

Purpose The purpose of this paper is to investigate whether Shared Reading (SR), a specific literature-based intervention, is transposable to a prison context and whether mental health benefits identified in other custodial and non-custodial settings were reported by women prisoners. Design/methodology/approach In all, 35 participants were recruited within an all-female maximum security prison and attended one of two weekly reading groups. Qualitative data were collected through researcher observation of the reading groups; interviews and focus group discussions with participants and prison staff; interviews with the project worker leading the reading groups; and a review of records kept by the latter during group sessions. Findings Attendance rates were good, with nearly half of the participants voluntarily present at =60 per cent of sessions. Two intrinsic psychological processes associated with the SR experience were provisionally identified, “memory and continuities” and “mentalisation”, both of which have therapeutic implications for the treatment of conditions like depression and personality disorder. Research limitations/implications Limitations included the small sample, lack of control for confounding variables, and constraints imposed on data collection by the custodial setting. Originality/value Although more controlled research is required, the findings indicate that women prisoners will voluntarily engage with SR if given appropriate support, and that the intervention has potential to augment psychological processes that are associated with increased well-being.

Purpose: The current project sought to examine whether delivery of lung cancer risk projections (calculated using the Liverpool Lung Project [LLP] risk model) predicted follow-up smoking status. Design: Two single-blinded randomized controlled trials. Setting: Stop Smoking Services in Liverpool (United Kingdom). Participants: Baseline current smokers (N = 297) and baseline recent former smokers (N = 216) were recruited. Intervention: Participants allocated to intervention groups were provided with personalized lung cancer risk projections, calculated using the LLP risk model. Measures: Baseline and follow-up questionnaires explored sociodemographics, smoking behavior, and lung cancer risk perceptions. Analysis: Bivariate analyses identified significant differences between randomization groups, and logistic regression models were developed to investigate the intervention effect on the outcome variables. Results: Lung cancer risk projections were not found to predict follow-up smoking status in the trial of baseline current smokers; however, they did predict follow-up smoking status in the trial of baseline recent former smokers (odds ratio: 1.91; 95% confidence interval: 1.03-3.55). Conclusion: The current study suggests that lung cancer risk projections may help maintain abstinence among individuals who have quit smoking, but the results did not provide evidence to suggest that lung cancer risk projections motivate current smokers to quit.

While the prevalence of smoking has declined in the UK in recent years, class differentials in smoking behaviour have become more marked and smoking is increasingly recognised as a causal factor in inequalities in health. Health education initiatives to support both smoking cessation and to teach children about the health risks of smoking remain key initiatives in reducing health inequalities. However, teaching children about the risks of smoking and the impact of parental smoking in their health is not straightforward for children from backgrounds who are more likely to encounter smoking at home and in their local communities. These children have to reconcile the key messages taught at school and reinforced in smoking cessation campaigns with the knowledge that their parents and other family members smoke. In this paper we consider how children from smoking homes make sense of these education and health campaigns as observed by their parents, and the impact that this has on both parental smoking and relationships within the home. The paper thus seeks to challenge assumptions about the delivery of health education and the need to acknowledge family diversity.

Objective: To thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs).\ud \ud Design: Systematic review and thematic synthesis.\ud \ud Data sources: Searches of MEDLINE, EBM Reviews (Cochrane Database of Systematic Reviews), PsycINFO, Global Health, CINAHL, Web of Science, Informit and EMBASE, combining terms for families, households and vulnerable populations; SFH and secondhand smoke; and qualitative research, were supplemented by searches of PhD theses, key authors, specialist journals and reference lists.\ud \ud Study selection: We included 22 articles, reporting on 18 studies, involving 646 participants. Inclusion criteria: peer-reviewed; English language; published from 1990 onwards (to week 3 of April 2014); used qualitative data collection methods; explored participants’ perspectives of home smoking behaviours; and the barriers, motivators and enablers to initiating and/or maintaining a SFH.\ud \ud Data extraction: 1 of 3 authors extracted data with checking by a second.\ud \ud Data synthesis: A thematic synthesis was performed to develop 7 core analytic themes: (1) knowledge, awareness and risk perception; (2) agency and personal skills/attributes; (3) wider community norms and personal moral responsibilities; (4) social relationships and influence of others; (5) perceived benefits, preferences and priorities; (6) addiction and habit; (7) practicalities.\ud \ud Conclusions: This synthesis highlights the complexity faced by many households in having a SFH, the practical, social, cultural and personal issues that need to be addressed and balanced by households, and that while some of these are common across study settings, specific social and cultural factors play a critical role in shaping household smoking behaviours. The findings can inform policy and practice and the development of interventions aimed at increasing SFHs.\ud \ud Trial registration number: CRD42014014115.

Aims To assess the feasibility and effectiveness of a new service using referral liaison advisers to increase the number of referrals of parents/carers at selected Children's Centres to National Health Service (NHS) Stop Smoking Services (SSS) and/or smoke-free families schemes (SFS). Design This mixed-methods pilot study collected numerical data on indicators of smoking behaviours and carried out face-to-face and telephone interviews. Settings Thirteen Children's Centres in Liverpool and Nottingham using local providers of smoking cessation services, from September 2010 to April 2011. Participants Parents and carers registered with, and staff working for, Children's Centres. Measures Number of smokers referred to smoking cessation services and/or smoke-free family schemes and the views of service providers and users on the new service. Findings In Liverpool, 181 referrals to NHS SSS were made from 331 identified smokers (54.7%); extrapolated to 12 months, this represents a 182% increase in referrals from baseline and a similar extrapolation indicates a 643% increase from baseline of referrals to smoke-free families schemes. There were no reliable baseline data for Nottingham; 31 referrals were made (30.7% of smokers) to SSS and 44 referrals to SFS from 52 contacts (84.6%). The interviews highlighted the need for sustained personal contact with parents/carers to discuss smoking behaviours and concerns and their willingness to be referred to SFS as part of caring for their child. Conclusions Routine recording of smoking status and appropriate follow-up by trained staff in Children's Centres can lead to significant numbers of clients attending stop-smoking services, although relatively few stop smoking.

There is increasing evidence for the efficacy of non-medical strategies to improve mental health and well-being. Get into Reading is a shared reading intervention which has demonstrable acceptability and feasibility. This paper explores potential catalysts for change resulting from Get into Reading. Two weekly reading groups ran for 12 months, in a GP surgery and a mental health drop-in centre, for people with a GP diagnosis of depression and a validated severity measure. Data collection included quantitative measures at the outset and end of the study, digital recording of sessions, observation and reflective diaries. Qualitative data were analysed thematically and critically compared with digital recordings. The evidence suggested a reduction in depressive symptoms for Get into Reading group participants. Three potential catalysts for change were identified: literary form and content, including the balance between prose and poetry; group facilitation, including social awareness and communicative skills; and group processes, including reflective and syntactic mirroring. This study has generated hypotheses about potential change processes of Get into Reading groups. Evidence of clinical efficacy was limited by small sample size, participant attrition and lack of controls. The focus on depression limited the generalisability of findings to other clinical groups or in non-clinical settings. Further research is needed, including assessment of the social and economic impact and substantial trials of the clinical effectiveness and cost-effectiveness of this intervention.

The impact of sight loss on everyday life changes over time, through further deterioration of vision, as well as a result of other physical changes and key events in people’s lives. As such, even the support needs of people with relatively stable visual impairment are likely to change throughout their life course. This article explores the long-term support needs of people with sight loss and the barriers they face when accessing services over time and at the time of need. Data from biographical interviews with 36 participants with sight loss is presented, with particular focus upon three illustrative case studies. The study reveals that many participants experienced problems gaining information about, and access to, services in the short and longer term. There is a need for systematic referral from clinical services to social and voluntary services and for regular follow-up to identify and respond to people’s changing needs.

A study using both qualitative and quantitative methods was undertaken to examine the impact of community-based health checks on men in Knowsley, UK. The main objective was to understand whether community-based health checks targeted at specific geographical and age groups were an effective way of improving health in men. Interviews were conducted with 50 service users, and a completed postal questionnaire was received from 178 men who had attended during the service's pilot period. Results indicated that men were generally satisfied with both the content and structure of the health checks. Men spoke favourably of the service they had received, particularly in comparison to their previous experiences of primary care. They reported enjoying using a service that allowed them to examine their own health in a comfortable environment. Knowledge was provided to a group whose awareness of health matters was often poor, and the vast majority of men reported making a variety of positive lifestyle changes as a result of attending. Reported improvements to health included giving up smoking, reducing alcohol consumption, increasing exercise and eating more healthily. The study suggests that services of this nature deserve careful consideration by health care professionals and policy-makers.

The protection of children from secondhand smoke in their homes remains a key objective for health agencies worldwide. While research has explored how parents can influence the introduction of home smoking restrictions, less attention has been paid to the role of wider familial and social networks as conduits for positive behaviour changes. In this article we explore how people living in Scotland have introduced various home smoking restrictions to reduce or eliminate children’s exposure to tobacco smoke, and how some have gone on to influence people in their wider familial and social networks. The results suggest that many parents are willing to act on messages on the need to protect children from smoke, leading to the creation of patterns of smoking behaviour that are passed on to their parents and siblings and, more widely, to friends and visitors. However, while some parents and grandparents apparently voluntarily changed their smoking behaviour, other parents found that they had to make direct requests to family members and some needed to negotiate more forcefully to protect children, albeit often with positive results.

Aims To explore how young people continue to access cigarettes following an increase of the age of sale to 18 years and the implications for future smoking prevention policy and practice. Design Qualitative study using 14 focus groups. Setting Schools and community projects in disadvantaged areas of Birmingham, UK. Participants Eightyfive smokers and non-smokers aged 12‐15 years. Measurements Focus group topic guides. Findings While young people did use social sources to access cigarettes, most obtained cigarettes from small local shops. Smoking and non-smoking participants knew which shops sold to underage children and what strategies to employ, suggesting a widespread acceptance of underage sales in some communities. Some young people bought directly from retailers, reporting that the retailers did not ask for identification. Some young people reported that retailers were complicit, knowingly selling to underage smokers.Young people waited outside shops and asked strangers to buy them cigarettes (proxy sales). Young people expressed cynicism about some shopkeepers’ motives, who they believed knew that they were selling to under-18s, but did not care as long as they made a profit. Conclusions The ban in selling cigarettes to thoseunder18intheUnitedKingdomappearstobeeasilycircumvented,andoneimportantrouteappearstobe‘proxy sales’ in which young people approach strangers outside retailers and ask them to purchase cigarettes on their behalf.

The introduction in March 2006 of legislation banning smoking in public places in Scotland raised concerns that smokers would smoke more at home and so increase the exposure of those living with them to tobacco smoke. Drawing on interviews from two qualitative studies conducted after the implementation of the legislation, this article uses a gendered analysis to explore where and why smokers, who lived with non-smokers including children, continued to smoke in their homes. Although very few people attributed any increased home smoking to being a direct consequence of the legislation, many who already smoked there continued, and most women reported little or no disruption to their home smoking post-legislation. Also, because of the changing social environment of smoking, and other life circumstances, a minority of women had increased their levels of home smoking. Compared to the men in these studies, women, particularly those who didn't work outside the home, had restricted social lives and thus were less likely to have smoked in public places before the legislation and spent more time socialising in the homes of other people. In addition, women with children, including women who worked outside their homes, were more likely to spend sustained periods of time caring for children compared to fathers, who were more likely to leave the home to work or socialise. Although home smoking was linked to gendered caring responsibilities, other issues associated with being a smoker also meant that many women smokers chose to keep smoking in their homes.

This article considers previously ignored aspects of verbal communication, humor and laughter, as critical components of social interaction within group discussions. Drawing on data from focus groups, Robinson uses a feminist perspective to explore how mothers living in areas of poverty in Liverpool, UK, use humor and laughter to discuss their experiences of smoking and caring for children. While laughter enabled some women to talk about sensitive and private issues, humor was also used by some women as a form of control, that is, to depress pretension in other women, to direct the flow of the discussion and to prevent the raising of ‘uncomfortable’ issues around their failure to prevent their children’s exposure to the health risks associated with breathing tobacco smoke. Robinson concludes with a discussion of how humor and laughter affected the dynamics of the groups and transformed the ‘neutral’ role of the moderator.

Despite what is known about gender inequalities and the links between smoking, smoke exposure, and poverty, mothers who fail to protect their children from exposure to environmental tobacco smoke (ETS), are often stigmatized as uncaring mothers by the media. Here I describe the process of talking to mothers of young children about the wider social context(s) within which the act of smoking takes place, and their reflections on the paradox of why many women caring for young children still expose their children to tobacco smoke in home environments. By articulating the complex interrelationship between smoking, the maintenance of social relationships, caring for children, and coping with poverty, the women present an alternative conceptualisation as to why and how mothers direct their agency to enable them to care for their children in poverty, which questions the timing, messages and ultimate effect of giving home smoking advice to mothers with young children.

BACKGROUND: Self-administered questionnaires, such as the Patient Health Questionnaire (PHQ-9), are regularly used in clinical practice to guide prescribing or to measure recovery and response to treatment. There are concerns that patients are not all interpreting the questionnaire items in the same way. Cognitive interviewing is a research technique that identifies 'interpretative measurement error' (IME). IME is distinct from traditional components of measurement error, such as not reading the question as worded, or recording answers inaccurately.AIM: To use cognitive interviewing techniques to explore patterns in answer mapping and comprehension of the PHQ-9 questionnaire to ascertain whether the measure captures meaningful symptoms of low mood.DESIGN AND SETTING: Qualitative study using cognitive interviewing techniques and card sorting in six GP practices in Bristol.METHOD: The study recruited 18 participants at the point of entry to a longitudinal primary care depression cohort study, PANDA (the indications for Prescribing ANtiDepressants that will leAd to a clinical benefit). Participants were interviewed 2, 4, and 6 weeks after their baseline visit. Cognitive interviews were digitally recorded. Analysis used the digital audio file, rather than verbatim transcripts, as it retained important features needed for analyses.RESULTS: Cognitive interviewing revealed that items on the PHQ-9 are interpreted in a range of ways, that patients often cannot 'fit' their experience into the response options, and therefore often feel the questionnaire is misrepresenting their experience of meaningful symptoms of low mood.CONCLUSION: The PHQ-9 may be missing the presence and/or intensity of certain symptoms that are meaningful to patients. Clinicians should adopt caution when using it.

Past research into smoking and motherhood has explained how smoking enables mothers to care in conditions of hardship and poverty. However, much of this research was conducted before the risks to the health of non-smokers of inhaling tobacco smoke were widely known, and so mothers' attitudes towards passive smoking and caring remain under explored. Children living with smokers are at risk of developing serious acute and chronic conditions during childhood and later life. Despite increased awareness of health messages among parents, young children are still exposed to environmental tobacco smoke (ETS) in the home, with maternal smoking identified as the primary source of exposure. In this paper, we present the findings from a project set up to explore the changing social and environmental context of smoking and motherhood. Using focus groups, 54 mothers of children aged under five years from the Merseyside area of England, who smoked, discussed their beliefs about smoking, passive smoking and the health of their children. Although mothers were aware of the messages linking ETS exposure to childhood illnesses they appeared to rely more on their own explanations for any ill health experienced by their children, discounting smoking as a primary cause and preferring alternative explanations including 'genetics' and 'pollution'. These alternative explanations were common both within and between groups, suggesting that they form part of a wider resistant dialogue constructed within families and communities, where information about smoking and child health is received, challenged, and reconciled with existing knowledge, before being either accepted or rejected. Crucially, this alternative dialogue supports the mothers' continued smoking, and is inevitably linked to their personal need to smoke while caring. These findings have implications for the development of future strategies for promoting the health of children with mothers who are reluctant, or feel unable, to accept that smoking can affect the health of their children.

Some people fare better than others when faced with adversity; they appear to be are more ‘resilient’. This article explores the concept of resilience in the context of vision impairment using two linked sets of narrative interview data from 2007 and 2010. Three case studies were analysed in detail using a framework approach based upon a social-ecological model of resilience and vision impairment. Within the model a range of assets and resources are identified which influence an individual’s capacity for resilience. A set of criteria were used to establish the extent to which each individual appeared to be resilient at each point in time. Analysis revealed that it is not merely the presence or absence of individual, social, and community resources – but how these resources interact with each other - that influences resilience and can create a risk to wellbeing. To possess only some of these resources is not sufficient; there is a co-dependency between these resources which requires the presence of other resources for resilience to be achieved. Resilience is not a fixed state; individuals can become more or less resilient as their circumstances and resources change over time. We suggest that the concept of resilience has much to offer the field of vision impairment as it allows the identification of enablers as well as areas of barriers to improving people’s health and wellbeing and suggests further opportunities for service providers to engage with clients, even those who appear to be supported, as people’s social, economic and emotional landscapes continue to change over time, rather than identifying deficit.

There has been a shift in the most recent UK Government's Alcohol Strategy (2012) from personal responsibility towards a model of shared responsibility for young people's drinking. On closer examination of the strategy, however, it appears that rather than exonerating young people from blame, governance is merely extended to include wider partners. Using findings from nine focus groups with young people in Liverpool, UK, we explore who they believe are responsible for their drinking behaviours and how they learn to become ‘good drinkers’. Our findings show that while teenagers were aware of dominant alcohol-related messages and maintained a moral position as responsible citizens; they also negotiated and resisted norms about teenage drinking. Although both boys and girls agreed that parents were the primary responsible authority for regulating their drinking, there was gendered disagreement about personal responsibility. The girls described how they were ultimately responsible for any adverse consequences if they drank too much whilst the boys considered a wide range of partners who would be implicated. However, unlike the girls, the boys described a willingness to either abstain or moderate their alcohol intake in order to remain in control and avoid any alcohol-related trouble or harm.

As leg ulcer research has generally focused on aspects of treatment, the psychosocial impact of leg ulceration remains understudied. This article reports the findings of a study exploring the prevalence of anxiety and depression in 190 patients with chronic venous ulceration across 9 Trusts in the northwest of England. The hospital anxiety and depression scale (HADS) was used to screen patients for the presence of anxiety and depression using a cut-off point of 9 for level of ‘caseness’. A total of 52 (27%) people scored as depressed while 50 (26%) scored as anxious. The two symptoms which appeared to be associated with anxiety and depression were pain and odour while there was no association found between living alone, mobility and exudate. These findings suggest that the focus of care needs to be redirected for many patients for whom cure is not an option, but who are left to live with a chronic wound. Furthermore, psychosocial factors, including depression, should be a focus in assessment and ongoing review of patients with leg ulceration.

The British government has called on all NHS staff to help promote good psychological wellbeing in the population. This article reports results from a survey conducted in Merseyside, England, into the prevalence of poor psychological wellbeing across a large part of the region. People registered with one of five Merseyside primary care trusts were stratified by age group and deprivation, and a questionnaire was mailed to 28000 who had been randomly selected from those aged 15 or over. A total of 11168 (45%) completed questionnaires were returned. Of these, 2442 (21.9%) respondents rated their psychological wellbeing as fairly poor or very poor. Mean levels of psychological wellbeing were significantly worse in a number of readily identifiable groups within the population, but overall, the lowest wellbeing ratings were concentrated in the most socioeconomically deprived quartile. We make a number of practical suggestions for the role of the community nurse in promoting good psychological wellbeing in patients. We also highlight our finding that socioeconomic deprivation was strongly associated with poor psychological wellbeing, which was in turn associated with a lifestyle high in risk factors for non-communicable diseases.