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Background: There is a growing international policy focus on involving those affected by healthcare safety incidents, in subsequent investigations. Nonetheless, there remains little UK-based evidence exploring how this relates to the experiences of those affected over time, including the factors influencing decisions to litigate. Aims: We aimed to explore the experiences of patients, families, staff and legal representatives affected by safety incidents over time, and the factors influencing decisions to litigate. Methods: Participants were purposively recruited via (i) communication from four NHS hospital Trusts or an independent national investigator in England, (ii) relevant charitable organizations, (iii) social media, and (iv) word of mouth to take part in a qualitative semi-structured interview study. Data were analyzed using an inductive reflexive thematic approach. Findings: 42 people with personal or professional experience of safety incident investigations participated, comprising patients and families (n = 18), healthcare staff (n = 7), legal staff (n = 1), and investigators (n = 16). Patients and families started investigation processes with cautious hope, but over time, came to realize that they lacked power, knowledge, and support to navigate the system, made clear in awaited investigation reports. Systemic fear of litigation not only failed to meet the needs of those affected, but also inadvertently led to some pursuing litigation. Staff had parallel experiences of exclusion, lacking support and feeling left with an incomplete narrative. Importantly, investigating was often perceived as a lonely, invisible and undervalued role involving skilled "work" with limited training, resources, and infrastructure. Ultimately, elusive "organizational agendas" were prioritized above the needs of all affected. Conclusions: Incident investigations fail to acknowledge and address emotional distress experienced by all affected, resulting in compounded harm. To address this, we propose five key recommendations, to: (1) prioritize the needs of those affected by incidents, (2) overcome culturally engrained fears of litigation to re-humanize processes and reduce rates of unnecessary litigation, (3) recognize and value the emotionally laborious and skilled work of investigators (4) inform and support those affected, (5) proceed in ways that recognize and seek to reduce social inequities. [ABSTRACT FROM AUTHOR]

Background: Healthcare organisations risk harming patients and their families twofold. First, through the physical, emotional and/or financial harm caused by safety incidents themselves, and second, through the organisational response to incidents. The former is well-researched and targeted by interventions. However, the latter, termed 'compounded harm' is rarely acknowledged. Aims: We aimed to explore the ways compounded harm is experienced by patients and their families as a result of organisational responses to safety incidents and propose how this may be reduced in practice. Methods: We used framework analysis to qualitatively explore data derived from interviews with 42 people with lived or professional experience of safety incident responses. This comprised 18 patients/relatives, 16 investigators, seven healthcare staff and one legal staff. People with lived and professional experience also helped to shape the design, conduct and findings of this study. Findings: We identified six ways that patients and their families experienced compounded harm because of incident responses. These were feeling: (1) powerless, (2) inconsequential, (3) manipulated, (4) abandoned, (5) de-humanised and (6) disoriented. Discussion: It is imperative to reduce compounded harm experienced by patients and families. We propose three recommendations for policy and practice: (1) the healthcare system to recognise and address epistemic injustice and equitably support people to be equal partners throughout investigations and subsequent learning to reduce the likelihood of patients and families feeling powerless and inconsequential; (2) honest and transparent regulatory and organisational cultures to be fostered and enacted to reduce the likelihood of patients and families feeling manipulated; and (3) the healthcare system to reorient towards providing restorative responses to harm which are human centred, relational and underpinned by dignity, safety and voluntariness to reduce the likelihood of patients and families feeling abandoned, de-humanised and disoriented. [ABSTRACT FROM AUTHOR]

Mothers of children with primary lymphoedema may be vulnerable to experiencing feelings ofhelplessness, frustration, grief, and excess stress that can lead to negative moods and child behavioural problems. This study aimed to gain an in-depth understanding ofthe lived experiences ofthese mothers. Data were collected using semi-structured interviews with mothers (n=26) of children with lymphoedema from seven countries. Qualitative data were coded using a codebook. Codes were then subject to discussion by the research team who identified a pattern of parenting approaches. Approaches to parenting fell along a continuum from unguarded, relaxed, and open to overprotective, anxious, and worried. These resulting typologies of these approaches provide insight into the unique challenges these mothers face that may be used by healthcare providers, social workers, child life specialists, and family life educators to ensure that mothers, fathers, and other caregivers are receiving the support they need. [ABSTRACT FROM AUTHOR]

Background: Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness.Objective: The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)-a DBCI that targets weight loss maintenance-over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience.Methods: An 18-month, 2×2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion.Results: The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements.Conclusions: The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content.Trial Registration: ISRCTN Registry ISRCTN88405328; https://www.isrctn.com/ISRCTN88405328.International Registered Report Identifier (irrid): RR2-10.1136/bmjopen-2019-029425. [ABSTRACT FROM AUTHOR]

The article presents facts regarding endometriosis, the presence of uterine lining outside the uterus. These include the prevalence of the disease in women during her reproductive years, the genetic link with the risk of having endometriosis, the association of the disease with mood disorders, and the way it increases the risk of pregnancy complications. Information on the nature of endometriosis as a chronic disease and its pharmacological and surgical treatment options.

Professional and community leaders in Washington, D.C. have expressed the need for more capacity building and increased resources to address health inequities in the city's underserved African American communities. Inequities ("food deserts," community decay, and limited youth opportunities) require equityinformed approaches. Disparities (disproportionate substance use/behavioral health disorders) also require system-level approaches. In response, the Wards 7 and 8 DC Prevention Center (DCPC), a community-based nonprofit, collaborated with residents, community partners, and academic institutions to provide trainings and certifications to its team and community stakeholders. Initially, DCPC staff members were trained through evidence-informed approaches including Certified Prevention Specialist (CPS) and Photovoice trainings. CPS training uses workshops and tools from the D.C. Department of Behavioral Health (DBH) to train staff to conduct assessments and build community partnerships. Photovoice provides a less intimidating process for vulnerable populations and professionals to collect data, identify social/environmental factors that impact health and well-being, share concerns, communicate with policymakers, and identify solutions to collectively address issues. In turn, DCPC staff trained youth and human services professionals to conduct Photovoice assessments to highlight the misuse of opioids and the negative effects on their communities. Community stakeholders continue to request the assistance of CPS staff and training for themselves. CPS and Photovoice training demonstrated the potential value of these approaches for students and professionals in the human services fields for supporting equity-informed initiatives. We present lessons learned and best practices in how to apply this multi-component approach as an effective strategy for preparing youth, graduate students in human services, and psychology professionals to engage in social action. [ABSTRACT FROM AUTHOR]