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Objective: Despite the recognition that refugees should have equitable access to healthcare services, this presents considerable challenges, particularly in rural and regional areas. Because general practitioners (GPs) are critical to resettlement for refugees and play a crucial role in understanding their specific health and social issues, it is important to know more about the needs of GPs. Methods: In-depth interviews were conducted with 14 GPs and GP registrars who trained with a New South Wales regional training provider with the aim of assessing the needs and attitudes of GPs in treating refugees and the perceived effect that refugees have on their practice. Results: The interviews, while acknowledging well-recognised issues such as language and culture, also highlighted particular issues for rural and regional areas, such as employment and community support. International medical graduates identified with resettlement problems faced by refugees and are a potential resource for these patients. A need for greater information for GPs regarding services available to help manage refugees in rural and regional areas and greater access to those services was demonstrated. Conclusions: Issues such as time, costs, language and culture were recognised as challenges in providing services for refugees. GPs highlighted particular issues for rural and regional areas in addressing refugee health, such as finding jobs, problems with isolation and the effect of lack of anonymity in such communities. These social factors have implications for the health of the refugees, especially psychological health, which is also challenged by poor resources. What is known about the topic?: Providing refugees equitable access to healthcare services presents considerable challenges, particularly in rural and regional areas. Time, language and culture are commonly reported barriers in providing services for this population group. What does this paper add?: There are particular issues for rural and regional areas in addressing refugee health, including finding jobs, problems with isolation and the effect of lack of anonymity in rural communities. These social factors have implications for the health of refugees, especially psychological health, which is also challenged by a paucity of services. The findings of this study suggest that international medical graduate doctors identified with resettlement problems faced by refugees and may be an important resource for these patients. This study highlights the awareness, empathy and positive attitudes of GPs in regional and rural areas in their approach to treating patients with a refugee background. What are the implications for practitioners?: International medical graduates often identify with resettlement problems faced by refugees and are an important resource for these patients. A need for greater information for GPs regarding services available to help manage refugees in rural and regional areas and greater access to those services was demonstrated. [ABSTRACT FROM AUTHOR]

Practitioners' preconceived ideas about service users can lead to prejudice and labelling, and ultimately may result in biased services. This paper reports on a UK‐based qualitative research study exploring the views and experiences of practitioners working with adult victims and perpetrators of domestic violence. It examines whether or not practitioners believe that childhood experiences of witnessing domestic violence indicate the likelihood of domestic violence in adulthood. It further explores practitioners' perceptions of factors contributing to the experiences of domestic violence amongst their service users. Twelve semi‐structured interviews were conducted with practitioners working in the domestic violence field, and thematic analysis was used to analyse their responses. The data did not indicate a general consensus on the matter of children becoming victims or perpetrators based on their childhood experiences of domestic violence. Participants' responses indicated that they thought the issue was more complex. Common themes that participants consider important to children's development of healthy/unhealthy relationships in this context were identified in the data. These included: an awareness of service users' individuality; the importance of meaningful support networks; and an understanding of the risk amongst their service users to normalise abusive behaviour. '[Explores] the views and experiences of practitioners working with adult victims and perpetrators of domestic violence' Key Practitioner Messages: Not all children witnessing domestic violence will inevitably become victims or perpetrators of abuse in adulthood.Perpetrating domestic violence in adulthood is often associated with a combination of various factors and circumstances, and can rarely be attributed to just one past experience.Assessments and holistic and judgement‐free services provided by practitioners are vital for children to develop positive and healthy future relationships. [ABSTRACT FROM AUTHOR]

Abstract This study documents the perceptions and experiences of immigrant women and men in the US related to female genital cutting (FGC). This paper examines the effects of migration on these perceptions, with the goal of optimizing health services and informing public policy to support women who have undergone FGC. This qualitative study consisted of individual interviews conducted from 2014 to 2015 with 42 women and men living in Boston, Massachusetts, who immigrated from a variety of communities where FGC has been practiced. Most participants felt strongly against the continuation of the practice, describing a change in their personal and community viewpoints over time, which they attributed to education, religion and immigration. The men in our study collectively took a stand against FGC and believed that they had a particular duty to raise awareness in their families and their communities about its physical and emotional harms. Our study provides strong support for the inclusion of men, religious leaders, and immigrants in FGC-related efforts. Our unique preliminary exploration of the role of members of the diaspora provides some support for initiatives that would involve emigrants in the effort to curb FGC in their home countries. Changing views in the diaspora could play a significant role in affecting opinions and practices in contexts where FGC is prevalent. Finally, our findings do not support the fear that "vacation cutting" might be common among US immigrants. We should therefore exercise caution in our promotion of legislation and clinical practices that target this fear. Highlights • Unique qualitative study of immigrant men and women from various ethnicities on FGC. • Migration journeys and education provide strong catalysts for rejection of FGC. • Argues for the involvement of religious leaders and men in advocacy efforts against FGC. • Offers a novel exploration of the effect of the diaspora on FGC practices back home. • Undermines the theory that vacation cutting is prevalent among US immigrants. [ABSTRACT FROM AUTHOR]

The mental health of migrant communities is an important public health concern. A growing body of literature suggests that social and cultural determinants of health significantly contribute to the mental health and wellbeing of older migrants in their host countries. Despite the increasing population of older Nepalese migrants in the UK, there is little research exploring the mental health needs of this community. This article explores older Nepalese women’s experiences of drivers of mental distress in London. Data was collected using in-depth interviews with 20 older Nepalese women living in the London Borough of Greenwich. Grounded thematic analysis of women’s narratives identified six overarching factors contributing to their emotional distress that pose potential risks to their mental health: absence of family, language barriers, housing problems, physical illness, lack of appropriate support, fears of death, and inadequate financial resources. In many cases, the impact of these factors was experienced in combination rather than isolation, often influenced by cultural dynamics. Findings highlight that re-settlement in the absence of family is at the heart of emotional challenges for older Nepalese women. The paper concludes with a series of recommendations for supporting processes of settlement to mitigate this risk among older Nepalese women in the UK. [ABSTRACT FROM AUTHOR]

This paper scrutinises the concepts of moral reasoning and personal reasoning, problematising the binary model by looking at young women’s pregnancy decision-making. Data from two UK empirical studies are subjected to theoretically driven qualitative secondary analysis, and illustrative cases show how complex decision-making is characterised by an intertwining of the personal and the moral, and is thus best understood by drawing on moral relativism. [ABSTRACT FROM AUTHOR]

This study examines the relationship between state policies, religion, reproductive politics, and competing understandings of embodied sexual and reproductive morality. Using ethnographic and life history interviews, this study looks at the lives of Filipino urban poor women and how they interpret, follow and resist Catholic Church doctrines and practices as these relate to sexuality and reproduction. Taking everyday morality as embedded in social practice, this paper argues that women’s subjective reinterpretations of Catholic teachings regarding contraception and abortion render religion pliant in a way that restores moral equilibrium in women’s lives. It is in this process of adjusting and re-adjusting this moral order that women are able to construct their moral worlds. Further, this article investigates how social class, gender and religion work in tension with one another in women’s everyday decisions and how the constraints and opportunities that poor women encounter in their everyday lives are enabled by the state and its institutions. [ABSTRACT FROM AUTHOR]

Background: This paper explored the health beliefs and behaviours of families towards the health needs of children with intellectual and developmental disabilities (IDD) in Accra, Ghana. The aim was to inform health promotion strategies for the children and their families. Method: Twenty‐two parents of children with IDD participated in this study. Semi‐structured interviews were the primary means of data collection. The interviews were analysed using constant comparison. Results: The signs that alerted the parents that the children might be ill included high temperature, vomiting and excessive sleep. The parents explained that some children expressed feelings of ill‐health through verbal or non‐verbal communication. Most of the parents self‐prescribed medication for the children or waited for symptoms to persist for a while before accessing health care because they experienced difficulties managing the behavioural challenges associated with the IDD of the children in public and attitudinal barriers when accessing health care. The parents did not often patronise health facilities in their neighbourhoods due to private health insurance requirements for accessing care at designated facilities, poor confidence in neighbourhood facilities and long‐term established relationships with facilities elsewhere. Further, many parents did not patronise religious interventions for the children. However, some parents explained that in addition to seeking medical care to address the physical symptoms of the children's disabilities and/or illnesses, they sought religious interventions because they believed that there could be a spiritual dimension to the situation. Conclusion: The findings highlight key areas to address in health promotion for children with IDD and their families in Accra, Ghana. [ABSTRACT FROM AUTHOR]

Young people's sexting is an area of increasing concern amongst parents, educationalists and policy makers, yet little research has been conducted with young people themselves to explore their perspectives on the support they need to navigate relationships in the new digital media landscape. To address this absence, an inter-disciplinary team of researchers undertook a participatory study with students, aged 13 to 15, in a UK secondary school. This paper outlines key study findings, including young people's views on sexting, their recommendations for improved education around sexting in schools, their preferred sources of support, and their perspectives on the way adults should respond to young people's sexting. Findings indicate that sexting education needs to be developed within the context of wider relationship issues, such as gender, power dynamics and trust between peers, and improved communication between students and teachers or other responsible adults. Findings may be used to consider ways of designing and communicating messages around sexting to young people within and beyond educational settings. [ABSTRACT FROM AUTHOR]

Background: Aphasia can have major consequences for participation. In line with other initiatives around the world, in the Netherlands aphasia centres provide support to people with aphasia and their relatives in the chronic phase to bridge the gap between therapy, rehabilitation, and participation in daily life. Although there is greater focus on participation in health care, the concept of participation is complex and not well-defined. Aims: The purpose of this paper is to understand the value and meaning of the aphasia centres in the Dutch context. We focus on the emic perspectives of people with aphasia and their relatives: how do aphasia centres contribute to building up a meaningful life with aphasia in the chronic phase and how do the centres support them to participate? Hence, this study also contributes to the understanding of the concept of participation and its meaning. Methods and procedures: This qualitative study used a naturalistic case study design in order to get an rich and multi-layered understanding of the context of aphasia centres. Within this context we focused on the experiences and perspectives of people with aphasia and their relatives. To secure involvement of people with aphasia themselves, research methods were attuned to their abilities to participate, and included participant observations, interviews, focus group meetings, and creative methods. Outcomes and results: Aphasia centres help people with aphasia to overcome isolation. They bring new goals and perspectives and help people find new meaning in life. They are experienced as a safe place to learn, overcome shame, and build self-confidence. Working in groups is a valuable element, providing a mutual sense of belonging. Also, people experience they can have a meaningful contribution by helping others. Relatives underscore these values and also feel supported in building up their life with their partner. Conclusions: Aphasia centres are a first step to overcome isolation and bear a first step towards participation in itself. They contribute to overcome barriers to relate to others by building self-confidence and overcome shame. This is a big step stone towards participation in the context outside the centre. From the perspectives of clients and relatives, participation is linked to the concept of being and belonging. At the same time, clients feel it is hard to meet societal norms of participation, framed as paid work, independency and self-reliance. This makes it harder to overcome shame. In this societal context, aphasia centres become even more relevant. [ABSTRACT FROM AUTHOR]

Background: For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline. Aim: We aimed to identify factors influencing maternal decision‐making about post mortem examination after late stillbirth. Methods: In the New Zealand Multicentre Stillbirth Study, 169 women with singleton pregnancies, no known abnormality at recruitment, and late stillbirth (≥28weeks gestation), from seven health regions were interviewed within six weeks of birth. The purpose of this paper was to explore factors related to post mortem examination decision‐making and the reasons for declining. We asked women if they would make the same decision again. Results: Maternal decision to decline a post mortem (70/169, 41.4%) was more common among women of Māori (adjusted odds ratio (aOR) 4.99 95% confidence interval (CI) 1.70–14.64) and Pacific (aOR 3.94 95% CI 1.47–10.54) ethnicity compared to European, and parity two or more (aOR 2.95 95% CI 1.14–7.62) compared to primiparous. The main reason for declining was that women 'did not want baby to be cut'. Ten percent (7/70) who declined said they would not make this decision again. No woman who consented regretted her decision. Conclusion: Ethnic differences observed in women's post mortem decision‐making should be further explored in future studies. Providing information of the effect of post mortem on the baby's body and the possible emotional benefits of a post mortem may assist women faced with this decision in the future. [ABSTRACT FROM AUTHOR]

Context: Competency‐based medical education has spurred the implementation of longitudinal workplace‐based assessment (WBA) programmes to track learners' development of competencies. These hinge on the appropriate use of assessment instruments by assessors. This study aimed to validate our assessment programme and specifically to explore whether assessors' beliefs and behaviours rendered the detection of progress possible. Methods: We implemented a longitudinal WBA programme in the third year of a primarily rotation‐based clerkship. The programme used the professionalism mini‐evaluation exercise (P‐MEX) to detect progress in generic competencies. We used mixed methods: a retrospective psychometric examination of student assessment data in one academic year, and a prospective focus group and interview study of assessors' beliefs and reported behaviours related to the assessment. Results: We analysed 1662 assessment forms for 186 students. We conducted interviews and focus groups with 21 assessors from different professions and disciplines. Scores were excellent from the outset (3.5–3.7/4), with no meaningful increase across blocks (average overall scores: 3.6 in block 1 versus 3.7 in blocks 2 and 3; F = 8.310, d.f. 2, p < 0.001). The main source of variance was the forms (47%) and only 1% of variance was attributable to students, which led to low generalisability across forms (Eρ2 = 0.18). Assessors reported using multiple observations to produce their assessments and were reluctant to harm students by consigning anything negative to writing. They justified the use of a consistent benchmark across time by citing the basic nature of the form or a belief that the 'competencies' assessed were in fact fixed attributes that were unlikely to change. Conclusions: Assessors may purposefully deviate from instructions in order to meet their ethical standards of good assessment. Furthermore, generic competencies may be viewed as intrinsic and fixed rather than as learnable. Implementing a longitudinal WBA programme is complex and requires careful consideration of assessors' beliefs and values. Are assessment practices ethical? This paper shows that longitudinal assessment of competencies may be complicated by assessors' beliefs [ABSTRACT FROM AUTHOR]

It is an oft-repeated trope that the recent medical advances in the field of assisted reproduction have radically transformed the ways in which we can achieve, practice and imagine parenthood. This development has enabled new forms of non-heterosexual family constellations, including same-sex nuclear families and solo-parents by choice, and as a result an increasing number of groups are mobilising politically for access to fertility treatments. Swedish transgender patients are one of these groups; after many years of political mobilisation, they are no longer required by law to go through sterilisation as a compulsory part of gender corrective surgery, and instead today, all transgender patients are offered fertility preservation through gamete freezing. This, in turn, has meant not only that Swedish fertility clinics have faced an entirely new patient group - the transgender fertility patient - but also that the cultural imagination of who can become a parent and what a family might look like is becoming further destabilised. Building on interviews with medical staff, LGBTQ-advocates and complementing qualitative data, this paper seeks to shed light on the very process by which these new rights are translated in the practical context of the fertility clinic, and also what it means, more generally, for cultural imaginations of parenting when a group whose reproductive futures were previously considered either impossible or undesirable are now 'anticipating infertility' and engaging in 'family planning' as central parts of their lifecourse and medical engagements. [ABSTRACT FROM AUTHOR]

Abstract The literature on death expectation in ill old age is mostly medical. A social science standpoint (especially quantitative) is practically absent. However, whether families, social and healthcare services can anticipate, support and prepare for the deaths of ill old adults is not reducible to the biomedical paradigm. Yet it is critical for end of life care (EOLC) policy. This study's aim is to investigate relatives' perception of death as unexpected in relation to both disease-related and care-related factors. Using the English Longitudinal Study of Ageing End-of-life Interviews Wave 6 this paper draws on probit regression analysis of unexpected (vs. expected) death in ill adults aged 50+. Findings are interpreted considering the containment of sudden death and the trajectories of dying in ill old age. The latter display overall visible decline preceding death. On this basis, EOLC literature and policy evidence death's uncertain timing as much as death's certain emergence in the horizon of expectation. Therefore, unexpected death in ill old age was interpreted as a failure to acknowledge dying, rather than the impossibility of discerning its approach. Very old age, dementia diagnoses and supported care environments were found to shape unexpected death. Highlights • Relatives' expectations of death in ill old age are crucial to end of life care. • Amongst old ill adults the very old are less expected to die than the younger old. • Deaths from cancer and Alzheimer's disease are expected by relatives. • On the contrary, deaths from other types of dementia are unexpected. • Institutional care is associated with a higher likelihood of unexpected death. [ABSTRACT FROM AUTHOR]

The current study addresses the lack of research exploring the social and emotional impact of anti-immigrant policy on Latino communities, and the intersection of anti-immigrant climates with other family stressors, like domestic violence (DV). In this paper we describe a qualitative study led by the participatory action research group La Voz Juvenile de Caminar Latino. Youth researchers conducted semi-structured interviews with Latino men, women, and youth participating in a domestic violence program. Using an inductive approach to thematic analysis, researchers identified themes that reflect how Latino families with histories of DV experience an increasingly anti-immigrant climate. All participants in this study described emotional stress, fear, and restrictions in their day-to-day life attributed to the anti-immigrant sociopolitical climate, and adults also spoke to work-related stress and economic insecurity. Both adults and children described harassment by strangers, coworkers, and/or peers. With regard to DV, women tended to describe immigration stress as exasperating family conflict, while men viewed these external stressors as discouraging DV. Distrust of police and other formal supports was a key theme underlying adult and youth perceptions of help-seeking for DV. The findings of this study suggest that anti-immigrant sentiment and policy creates undue stress for Latino families and barriers to formal help-seeking for DV. The participatory research process provided a corrective experience for youth witnesses of DV and prioritizes the voices of those most affected by immigration policies and violence. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Recovery‐oriented care is a means of providing mental health treatment, focused on the patient's individual needs and active involvement in one's own care. However, this approach presents with challenges, particularly in psychiatric hospitals, which tend to be focused on symptom reduction. What does the paper adds to existing knowledge?: This study examines the influence of three different recovery‐oriented training programmes/interventions (namely, illness management and recovery, peer support, and psychiatric advance directives) on the attitudes and practice of mental health staff (including nurses) in an inpatient setting, using a mixed‐methods methodology. We quantitatively assess the knowledge, attitudes and practices developed following recovery‐oriented training, compared to staff not trained in these interventions. We interviewed staff exposed to the different interventions to learn about their personal views and characterized the benefits and challenges they experienced.Mainly, the illness management and recovery training created a positive change in the work attitude and some work‐related practices of mental health staff and the increased presence of a person‐centred approach supporting patient autonomy. However, and contrary to expectations, there was no increase in practices that support personal goals or provide individually tailored services.Peer support had an experiential impact among mental health staff, initiating a more humane, positive approach to patients.Psychiatric advance directives were reported as more challenging to implement and with limited impact. What are the implications for practice?: Recovery‐oriented trainings can be internalized and implemented by staff in medical model psychiatric settings.Despite recovery‐oriented training, challenges do occur—notably, they are hardest to implement in acute wards/patient states and by psychiatric nurses.Using multiple recovery‐oriented programmes/interventions can accelerate the momentum for change in traditional settings and promote positive practice.Ongoing comprehensive mental health staff training on recovery‐oriented care programmes is essential in order to sustain change over time.Training is not enough in itself—hospital administrations need to be actively involved in promoting recovery‐oriented policies. Introduction: Developing person‐centred recovery‐oriented care is a challenge in mental health systems, particularly psychiatric hospitals. Aim: To assess the knowledge, attitudes and practices developed following recovery‐oriented training of nurses and other staff; to identify the benefits and challenges involved in the implementation of recovery‐oriented intervention in psychiatric wards. Method: A mixed‐methods study compared recovery knowledge, attitudes and practices of 37 mental health ward staff trained in recovery‐oriented intervention, against 35 staff not trained. Fifteen staff were interviewed about their experiences, and protocols were qualitatively analysed. Results: The quantitative outcomes partially confirmed positive changes in attitudes and some practices. Qualitative interviews complemented these findings, revealing greater use of a person‐centred approach and support for patient autonomy. However, we did not find differences between groups in quantitative outcomes pertaining to personal goals or providing individually tailored services. Discussion: This study validates the implementation of recovery training and practices in psychiatric settings, and identifies the challenges involved. We discuss psychiatric nurse conflicts in implementation in acute wards. Implications for practice: Our findings support the need for broader staff training in recovery‐oriented interventions. Recruiting the support of the hospital administration for recovery‐oriented intervention programmes is key, both ethically and structurally. [ABSTRACT FROM AUTHOR]

The Unaccompanied Refugee Minor (URM) Foster Care Program annually serves about 1,300 foreign-born youth with legal eligibility. This paper shows results from a cross-sectional, descriptive pilot study (n = 30 interviews) in the domains of education, employment, health, mental health, risky behaviors, and social connections. Results show that most URM youth (86.7%) had graduated from high school, 50.0% were in college, and 86.7% were employed. Many youth (60%) reported being in optimal health, 76.7% were happy, and 96.7% had a positive outlook for the future. Most URMs (83.3%) had a best friend, and 70.0% had people to talk to when feeling low, however 76.7% (n = 23) worried about being abandoned. Additionally, one URM reported engaging in multiple risky behaviors. Comparisons are made to youth in foster care who were born in the United States and show for example, that URMs are enrolled in higher education and satisfied with foster care services at statistically significant higher rates—but that they are insured at significantly lower levels than domestic youth exiting foster care. Future research is needed to examine economic security for young adults who are refugees and immigrants. Longitudinal research is also needed to see how independent living skills are developed and utilized over time. URMs could benefit from some contact with case managers or foster care alumni after discharge. [ABSTRACT FROM AUTHOR]

This paper describes the implementation of an educational intervention to enhance sexual health among homeless people by including sexual and reproductive health and rights (SRHR) as a part of social work provision with this group. Adult service users in different forms of temporary accommodation were provided with the opportunity to participate in three group sessions. Seventeen sessions, six with women and eleven with men, took place at six different housing facilities in Gothenburg. The intervention implementation process (which involved preparation, creation, realisation and evaluation) is described, and factors of importance are identified. Service users appreciated the opportunity to receive information and discuss sexual health, rights and norms. The success of the work may be related to the fact that the project was anchored both in social services and among service users, constantly adjusted, and delivered using a respectful approach. Social work organisations and professionals have an important role to play in acknowledging and promoting service users’ sexual health and rights, especially among disadvantaged and socially excluded groups including homeless people. [ABSTRACT FROM AUTHOR]

A uniquely Islamic theoretical framework for an Islamic psychology has yet to be established. To do so requires that we understand how human beings are conceptualized within the cosmology that characterizes the Islamic tradition. This paper presents a model of the soul from within an Islamic paradigm, generated through a grounded theory analysis of interviews with 18 key informants with relevant academic or religious expertise. The model elaborates aspects of a mechanism for the development of the soul that constitutes a potential foundation for an Islamic theory of human psychology and has particular relevance for Islamic approaches to psychotherapy. [ABSTRACT FROM AUTHOR]

Background: This paper has attempted to explore views of patients with severe mental illness and their care providers about sharing sexual problems with care providers in these patients within the context of Iran. Method: A total of 17 in‐depth semi‐structured interviews were conducted in one of the psychiatric hospital in Tehran: 4 with patients, 2 with patient's family, and 11 with health providers who had been employed for 5 years in psychiatric wards at least. All participants were selected by purposive sampling. Using conventional qualitative content analysis data reduction was done. Findings: A total of 89 codes about the reasons for lack of communication between clinician and patients, about sexuality were extracted. These are classified in two categories. The first is "Clinicians avoidance from addressing sexual issues" and second is "Patients avoidance from expressing their sexual problems." Conclusion: Despite having sexual needs, severe mental illnesses patients do not disclose it due to poor communication between clinician and patients, about sexuality. So, physician had to be pioneer in communicating with them. Therefore, to enhance clinicians' sexual knowledge and effective communication skills with patients, especially those with severe mental illnesses, training is completely necessary. [ABSTRACT FROM AUTHOR]

Objective There is growing recognition among health care providers and policy makers that when things go wrong, the patient or their families should be heard and participate in the incident investigation process. This paper explores how Dutch hospitals organize patient or family engagement in incident investigations, maps out incident investigators’ experiences of involving patients or their families in incident investigations and identifies the challenges encountered. Methods Semi-structured interviews were conducted with managers and incident investigators in 13 Dutch hospitals. Study participants (n = 18) were asked about the incident investigation routines and their experiences of involving affected patients or family members. Interview transcripts were coded and analysed using thematic content analysis. Results Our findings reveal that patient or family involvement in incident investigations is typically organized as a one-time interview event. Interviews with patients or their families were considered to be valuable and important in their own right and seen as a way to do justice to the individual needs of the patient or their family. Yet, the usefulness and validity of the patient or family perspective for incident investigations was often seen to be limited, with the professional perspective afforded more weight. This was particularly the case when the patient or their family were unable to provide verifiable details of the incident under investigation. Study participants described challenges when involving patients or family members, including in relation to the available timeframe for incident investigations, legal issues, managing trust and working with intense emotions. Conclusions We propose that by placing patient and family criteria of significance at the centre of incident investigations (i.e. an ‘emic’ research approach), hospitals may be able to expand their learning potential and improve patient-centeredness following an incident. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Substance abuse, poor lifestyle and side effects of medication often occur and cause oral health problems in patients diagnosed with severe mental illness (SMI). Oral health in SMI is related to quality of life, self‐esteem, and daily functioning. Despite its importance, oral health in mental health care is still a postponed healthcare pathway. Treatment guidelines on patients after a first episode psychosis (FEP) indicate that interventions are recommended, but clinical advice is lacking. However, no research on the experiences of young adults' oral health after FEP has been conducted. What does this paper add to existing knowledge?: This study is the first study to gain insight into most important experiences in patients after FEP regarding oral health. After FEP, participants experience many risk factors, for example substance use, poor diet and financial problems, and participants are not able to adequately attend to their oral health. There is a lack of awareness among participants after FEP about oral health and participants do have high burden. After FEP, participants need support and help from their environment to maintain their oral health. What are the implications for practice?: In FEP, oral health needs more attention to avoid the negative consequences in a later phase of the illness. To fill the gap between patients' needs regarding oral health care and the attention of mental healthcare professionals, the awareness of patients and mental health professionals concerning oral health should be heightened, and clinical interventions to support these needs should be developed. Introduction: Oral health affects quality of life, self‐esteem, physical health and daily functioning. Treatment guidelines on patients after first episode psychosis (FEP) recommend interventions, but clinical interventions are lacking. No research on the experiences of young adults' oral health after FEP has been conducted. Aims: This study aimed to explore the lived experiences and needs of patients after FEP with regard to their oral health. Design and Methods: Single‐centre phenomenological study using open interviews (N = 30). Data were analysed using the Colaizzi method. Results: Patients reported oral health problems since their FEP. The problems that patients encountered were dental care in general (e.g., a lack of awareness), risk factors (e.g., substance use, poor diet and financial problems), overall experiences with dentists/dental hygienists and the gap between needs and interventions. Discussion: There is a lack of awareness among patients after FEP about oral health while patients are not able to adequately attend to their oral health and patients have high burden on this topic. Implications for mental health nursing: To bridge the gap between patients' needs regarding oral health, the awareness of patients and mental health professionals should be heightened, and patients should be better supported by mental health professionals. [ABSTRACT FROM AUTHOR]

This paper reports on a study that examined the grief and coping of 29 parents whose child has hypoplastic left heart syndrome using the Dual Process Model. The study employed a secondary thematic analysis of interviews at key times of treatment and recovery for the child. After the diagnosis, parents experienced intense loss (LO), but focused upon restoration-orientated tasks (RO) to support their child. Over time, most parents employed a healthy oscillation between LO coping and RO coping, with waves of grief and with some grieving suppressed. There are some specific grief and coping and gender patterns employed by parents. [ABSTRACT FROM AUTHOR]

Abstract: Improving infant and young child feeding practices is critical for improving growth and reducing child mortality and morbidity. This paper aims to compare predictors of minimum dietary diversity, an important indicator of adequate complementary feeding practices, in Bangladesh in 2011 and 2014. The 2011 and 2014 Bangladesh Demographic and Health Survey were used to examine predictors of minimum dietary diversity among 6–23 months. An additional analysis was conducted for the 18–23‐month group, because a significant increase in meeting minimum dietary diversity recommendations was seen in this age group only. Factors found to be associated with practices were compared across time points. In 2011, minimum dietary diversity was 23.8% and increased to 28.8% in 2014. Among children 18–23 months, in 2011, minimum dietary diversity was 32.5% and increased to 42.8% in 2014. Among all children, wealth, education, exposure to media, and antenatal care were significant predictors of dietary diversity. In the 18–23‐month age group, significant predictors in 2011 were wealth and decision making. In 2014, significant predictors were education and exposure to media. Demographic trends indicated a significant increase in education and exposure to media between 2011 and 2014. As these were significant for minimum dietary diversity in 2014 overall and for 18–23 months, they might be important targets of future interventions, specifically utilizing media channels and tailoring special strategies for women with low education and limited exposure to media. [ABSTRACT FROM AUTHOR]

In this research article, we discuss the social construction of public services within the conceptual and theoretical framework provided by Lipsky. We are interested in what it means if/when street-level bureaucrats (SLBs) have an active role in the construction of a service system. We argue that there are multiple realities in terms of the construction of public services and we approach the question by deploying Lipsky’s notion on SLBs by empirically analysing middle managers’ views on how SLBs act and their role in this construction process. This paper is based on empirical interviews (N=100) collated in 2012 from Barcelona, Den Bosch, Glasgow, Melbourne, Toronto, Vancouver, the Greater London area, and the US state of Vermont. The research collation strategy was to include reform-oriented cities and countries in terms of developing and delivering public services. We found that SLBs have three different kinds of strategies in the construction process: policy-making, working practices, and professionalism. We found that there are no conflicts arising from SLBs’ beliefs, organisational demands, and rules and regulations. Instead, SLBs try to solve conflicts or bridge gaps between policy-making and practical work in the boundaries between SLBs and service users. Based on this research, the role of SLBs and the built-in flexibility and agility of public service leadership and organisations must be addressed and developed further. The role of organisational learning and changing organisational cultures must also be scrutinized in the context of public service systems. The analysis of professional resilience in the context of public services planning needs more theoretical and empirical attention. The resilience of organisations and the capacities of SLBs need to be researched more. Finally, there is the need for better cultivation of the role of the SLBs and service users with regard to accountability aspects (horizontal and vertical). [ABSTRACT FROM AUTHOR]

Care-home residents with dementia can experience behavioural and psychological symptoms such as aggression, agitation, anxiety, wandering, calling out and sexual disinhibition. Care-home staff have a duty to keep residents safe. However, residents with dementia can pose particular challenges in this area. In this paper, we draw on a study which explored how care-home staff manage dementia-related behaviours. In-depth ethnographic case studies at four separate care homes were conducted in England. These involved interviews with 40 care-home staff and 384 hours of participant observation. Our analysis showed that some residents with dementia experience behaviours which can either create risks for, or negatively impact on, themselves and/or other residents or staff members. It emerged that the consequences of the behaviours, rather than the behaviours themselves, created difficulties for staff. To cope with the risk and impact of behaviours, staff employed multiple strategies such as surveillance, resident placement, restrictions and forced care. Using the data, we explore how actions taken by staff to manage the risk and impact of behaviours in these communal settings relate to residents’ human rights. Our findings have particular relevance for care-home staff who need support and guidance in this area, for service development worldwide and for the global ageing population whose valued human rights may become under threat, if they require long-term care. [ABSTRACT FROM AUTHOR]

Older people living in long-term facilities (nursing and residential homes providing 24-hour care) spend the majority of their time inactive, despite the known health and wellbeing benefits of physical activity and reduced time spent sedentary. In order to successfully embed interventions that aim to increase physical activity or reduce sedentary behaviour, it is necessary to understand the features of the care environment that influence residents’ routine patterns of movement. Drawing on an organisational perspective, this paper explores the structures and mechanisms that shaped different care practices concerning residents’ movement in two contrasting care homes in the north of England. This study adopted an ethnographic approach, using a combination of qualitative observations, informal conversations and interviews. A grounded theory approach to data analysis was adopted. The findings illustrate the importance of translating espoused values of care into tangible and acceptable care practices, systems of management, staff training and development, and the use of care planning in residents’ routine patterns of movement. Understanding how organisational factors shape routine movement among care home residents will help inform the development of embedded and sustainable interventions that enhance physical activity and reduce sedentary behaviour. This study is part of a wider programme of research developing and testing a complex intervention, embedded within routine care, to reduce sedentary behaviour among care home residents. [ABSTRACT FROM AUTHOR]

What are the prospects for a cross-cultural, interdisciplinary and methodologically plural approach to wellbeing? This question is addressed using Self-Determination Theory (SDT), a psychological theory based on quantitative empirical methods, to structure qualitative analysis of wellbeing in life history interviews in Chiawa, rural Zambia. Enquiry goes beyond simply reading across methods, disciplines and contexts, to consider fundamental differences in constructions of the human subject, and how these relate to understandings of wellbeing. Field research took place in two periods, August–November, 2010 and 2012. Analysis draws primarily on 46 individual case studies, conducted through open-ended interviews. These were identified through a survey with an average of 390 male and female household heads in each round, including 25% female headed households. As SDT predicts, the interviews confirm its key elements of autonomy, competence and relatedness as vital to wellbeing. However, these are expressed in ways that highlight material and relational, rather than psychological, factors. Key findings are: the mutual constitution of autonomy, competence and relatedness; the appreciation of autonomy as independence in action; the importance of social competence; and the centrality of relatedness. People appear as social and above all moral subjects. The paper concludes by endorsing SDT's utility in interdisciplinary approaches to wellbeing, but only if it admits its own cultural grounding in the construction of a psychological subject. This would go beyond recognising that autonomy, competence and relatedness may take socially and culturally distinctive forms, to questioning their universal status as basic psychological needs. Implications for organisations working on wellbeing are discussed. [ABSTRACT FROM AUTHOR]

Body image issues associated with eating disorders involve attitudinal and perceptual components: individuals’ dissatisfaction with body shape or weight, and inability to assess body size correctly. While prior research has mainly explored social pressures produced by the media, fashion, and advertising industries, this paper focuses on the effects of personal networks on body image, particularly in the context of internet communities. We use data collected on a sample of participants to websites on eating disorders, and map their personal networks. We specify and estimate a model for the joint distribution of attitudinal and perceptual components of body image as a function of network-related characteristics and attributional factors. Supported by information gathered through in-depth interviews, the empirical estimates provide evidence that personal networks can be conducive to positive body image development, and that the influence of personal networks varies significantly by body size. We situate our discussion in current debates about the effects of computer-mediated and face-to-face communication networks on eating disorders and related behaviors. [ABSTRACT FROM AUTHOR]

Objective: This paper investigated patients’ experiences of disease and self-care as well as perceptions of the general practitioner’s role in supporting patients with impaired self-care ability. Design: Qualitative interviews with 13 patients with type 2 diabetes, concurrent chronic diseases, and impaired self-care ability assessed by a general practitioner. We analyzed our data using systematic text condensation. The shifting perspectives model of chronic illness formed the theoretical background for the study. Results: Although most patients experienced challenges in adhering to recommended self-care activities, many had developed additional, personal self-care routines that increased wellbeing. Some patients were conscious of self-care trade-offs, including patients with concurrent mental disorders who were much more attentive to their mental disorder than their somatic diseases. Patients’ perspectives on diseases could shift over time and were dominated by emotional considerations such as insisting on leading a normal life or struggling with limitations caused by disease. Most patients found support in the ongoing relationship with the same general practitioner, who was valued as a companion or appreciated as a trustworthy health informant. Conclusion: Patient experiences of self-care may collide with what general practitioners find appropriate in a medical regimen. Health professionals should be aware of patients’ prominent and shifting considerations about the emotional aspects of disease. Patients valued the general practitioner’s role in self-care support, primarily through the long-term doctor-patient relationship. Therefore, relational continuity should be prioritized in chronic care, especially for patients with impaired self-care ability who often have a highly complex disease burden and situational context. Key points:   Little is known about the perspectives of disease and self-care in patients with a doctor-assessed impaired ability of self-care.   • Although patients knew the prescribed regimen they often prioritized self-care routines that increased well-being at the cost of medical recommendations.   • Shifting emotional aspects were prominent in patients’ considerations of disease and sustained GPs’ use of a patient-centred clinical method when discussing self-care.   • Relational continuity with general practitioners was a highly valued support and should be prioritized for patients with impaired self-care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine Family Development Centre (FDC) staff’s[1] perspectives on their roles and capacity to promote early childhood language learning through good parenting.Design/methodology/approach This research employed in-depth interviews with 30 FDC coordinators and volunteer staff, supported by limited field observations.Findings Identifying risk, surveillance of at-risk families, building community solidarity and activities to support parenting and children, emerged as key components of FDC work. Volunteers softened their surveillance role by emphasising their social support function and personal links to local communities. Most activities aimed to strengthen family bonding and relationships, with fewer specifically addressing early childhood language deficits. Volunteers found the latter challenging, and generally sought to work in cooperation with education, public health and child care staff where projects involved language development.Practical implications Most volunteers said they lacked the capacities to promote early language development effectively and required additional training in such areas as partnerships and collaboration, family and parenting support, and project management. The authors argue that the importance given to partnerships reflects volunteers’ recognition that they need to draw on outside expertise to address children’s language problems. Given resource constraints, volunteers will remain central to family support work for the immediate future. Even with training lay volunteers will not become language experts, and future policy should centre on building a framework of professional support for the community teams.Originality/value This study fills a gap in knowledge about FDC volunteer roles and suggests a need for training that focuses on teamwork rather than specialist language expertise. [ABSTRACT FROM AUTHOR]

New York City (NYC) is considered to be one of the world’s most progressive cities and gender and sexuality diversity (GSD)-inclusive education departmental policies appear to reflect these values. However, even within such a context, NYC educators report challenges in their work to meet the needs of trans/gender-diverse students and the visibility of trans/gender diversity more generally within their pre-K - 12 school communities. This paper reports on interview data from 31 school staff members from nine public and independent schools located in the NYC metro region, with a specific focus on their framing of inclusivity and bullying, and reported support of trans/gender-diverse students. Based on educators’ representations of their schools, the nine schooling environments fell into two broad clusters: (1) those framing trans/gender inclusivity as an anti-bullying initiative and working at the minimum policy requirements, and (2) those working beyond bullying discourses and policy frameworks to conceptualise trans/gender inclusivity as integral to the school’s mission and as offering clear whole-community benefit. Findings support the constraints of bullying discourse on even supportive educators’ curricular ‘translation’ of GSD-inclusive policies, reinforcing the need for relevant policy reframing and targeted of professional development opportunities, particularly for school leaders. [ABSTRACT FROM AUTHOR]

The World Health Organization Regional Office for Europe (WHO EURO) and the German Federal Centre for Health Education (BZgA) published the Standards for Sexuality Education in Europe in 2010. The standards were developed to provide an overview of those sexuality education issues that should be addressed in school at various specific age levels. They were intended to guarantee that sexuality education teaching is age-appropriate and of uniformly good quality throughout Europe. In the context of the present survey, Austrian teachers and parents or guardians were asked about the importance of the topics covered by the WHO standards and about any aspects they would like to see for such sexuality education to be successful. The paper concludes that parents and teachers agree on the sexuality education topics they find important for coverage in Austrian primary schools, although teachers find sexuality education in general to be of greater importance than do parents. Teacher’ wishes for sexuality education in practice correlate highly with parents’ ideas of quality. Overall, qualifications and support for work in this field are viewed as essential, with survey respondents perceiving the need for high-quality initial training and continuing education and appropriate frameworks for implementation in school. [ABSTRACT FROM AUTHOR]

Experiences of autism-spectrum disorder are now increasingly studied by social scientists. Human-animal relations have also become a major focus of social inquiry in recent years. Examining horse-assisted therapy for autistic spectrum disorders, this is the first paper that brings these fields together. Drawing on participant observation and interviews at a UK horse therapy Centre, this article examines how staff and the parents of riders account for the successes and limitations of equine therapy. To the respondents, horses ‘open up’ autistic children and make possible interactions that seemed impossible before. Horses were regarded as facilitating the emergence of apparently social behaviours, which included eye contact, pointing, and speech. Three key explanations emerged for therapeutic success: the sensorial, embodied experience of riding the horse; the specific movements and rhythms of the horse; and, the ‘personality’ of the horse. Equine therapy can be regarded as enabling a form of multispecies intersubjectivity, with the resonance between rider and horse seeming to make possible a new attunement between humans. Practices of equine therapy, and perceptions of its efficacy, serve in turn to attune social scientists to a version of empathy constituted through lively and sensorial interactions, as opposed to one that is restricted to particular kinds of humans. [ABSTRACT FROM AUTHOR]

Developing quality relationships is recognised as an active ingredient for effective interventions with young people in care. Essentially, care staff has the opportunity and capacity to positively influence the young person's experiences in care, through the positive relationships they form. This paper presents selectively on the findings of two separate but related qualitative Irish studies exploring relationship-based approaches in residential child care practice, from the perspectives of both residential child care workers and young care leavers. Thirty-two professionals and four care leavers participated in either focus group or individual interviews. The findings are integrated in this paper with the wider literature on young people leaving care, with the aim of identifying core knowledge that is needed by service providers who are tasked with the support of young people making the transition out of care and towards independent living. In this paper we attempt to identify the knowledge base on relationship-building which is needed by care staff in order to carry out their role. It is argued that an explicit knowledge base is overdue now that the complex needs of young people in care are increasingly visible through advances in research and more recently the emerging literature concerning the personal testimonies of care graduates. [ABSTRACT FROM AUTHOR]

Blood transfusions belong to standard and commonly utilised biomedical procedures. Jehovah's Witnesses' transfusion refusals are often referred to in bioethical and medical textbooks. Members of this globally active religious organisation do not, however, challenge biomedical diagnosis and treatment as such. A result of both their trust in and their interpretation of the Bible, they question only this medical treatment. In spite of the global presence of this religious community and its uniformly practised teachings, including those pertaining to blood, experiences and choices of Jehovah's Witness patients have been understudied. Drawing on a nine-month fieldwork with Jehovah's Witnesses and physicians in Germany (mainly in Berlin) between 2010 and 2012, the paper addresses treatment choices made by Witness patients and their relationship with physicians. In light of the long tradition of 'medical heterodoxy' established in German culture and society, Germany constitutes an ideal point of departure for such a study. By utilising the concept of 'medical landscape' it is argued that Jehovah's Witnesses in my field site find themselves at the intersection of different medical landscapes: in the 'immediate' surroundings of the German healthcare system that is open to different 'treatment modalities', and that of the United States, which favours biomedicine. The paper also argues that Jehovah's Witnesses' position towards blood transfusions can further be used as a lens to shed light on the German (bio)medical landscape itself. [ABSTRACT FROM AUTHOR]

Village dwellers in Central Ukraine have access to various types of therapy that comprise diverse medical landscapes. Patients' movements within these landscapes are possible thanks to each person's web of relations. Medical landscapes are not fixed, but vary and dynamically change for each person, depending on their fluid and interchanging, hierarchical webs of mutual relations with other people, personal bodies, institutions, discourses, political powers, other non-human organisms, or objects such as medicines. This paper was inspired by the medicoscape concept (H€orbst and Krause 2004) as well as Ingold's idea of meshwork analyses of relations between various actors: in this case, patients, healers, a weak state, official healthcare providers, pharmacists and medicinal plants, in the context of patients' therapeutic choices. Self-medication based on herbal remedies is a very important feature of people's medical landscapes in Central Ukraine and usually the first therapy choice for most interlocutors. That is why this paper is focused on the presentation of the means through which people acquire knowledge about medicinal plants, and the ways they interact with plants and plants interact with them. In this way, showing the complexity of villagers' webs of relations is possible. The analysis is based on ethnographic research conducted between 2009 and 2013 in the Vinnytsia region (Central Ukraine). [ABSTRACT FROM AUTHOR]

This paper introduces the notion of 'risky encounters', referring to the way in which contacts with doctors are commonly perceived by the inhabitants of Bishkek, the capital city of Kyrgyzstan. The author's research conducted between 2011 and 2013 revealed that most people were extremely critical of biomedical personnel, despite positive assessments of healthcare reforms expressed by experts. Owing to the prevailing distrust of doctors, their interventions are often considered risky to one's health, which strongly influences people's health-related strategies in the context of medical diversity. This perception of risk is deeply embedded in feelings of uncertainty and anxiety, which should be viewed from the more general perspective of the political, economic and social uncertainties resulting from the difficulties of the period of post- Soviet transformation. It is evident that medical diversity in Bishkek provides people in need with many non-biomedical treatment options, and a distrust of doctors significantly contributes to the popularity of complementary medicine. Economic constraints and local concepts of health, illness and efficacy are among the many other factors that play a role in therapeutic choices. However, the current paper focuses on risk, uncertainty and trust, as emotions that are central to an understanding of the health-related strategies and tactics used by the inhabitants of present-day Bishkek. [ABSTRACT FROM AUTHOR]

Grandparents whose grandchildren are exposed to domestic violence are faced with some unique challenges in their grandparenting, which have thus far been little discussed in research. This paper discusses the narratives of 10 Swedish grandparents whose grandchildren have been exposed to violence towards their mother. The aim was to explore grandparents' narrations of their responses in the face of violence, and their understanding of the role they play in their grandchildren's social networks. Two significant responses are discussed: ‘being there’ and ‘acknowledging the independence and self‐determination of the adult children’. Grandparents experienced these responses as contradictory and felt powerless when it came to their possibilities to protect their grandchildren. The paper suggests that grandparents could be a resource for domestic violence services, and social work practice needs to assess the roles of grandparents of children exposed to domestic violence. Social workers should consider the challenges these grandparents are facing and what support they may need in order to support their grandchildren. [ABSTRACT FROM AUTHOR]

Little is known about how children themselves understand their moves to and between foster homes. The data presented in this paper come from a study that sought children's views on becoming and being a foster child. A key finding of that study was how children's accounts of being fostered illustrated a high level of anxiety and concern about their moving to live with a foster family. This paper firstly explores the key issues about looked‐after children's moves. It then describes the research study undertaken, before exploring the data generated from children's accounts of their moves to a new foster home. Lastly, there is a discussion of the implications for social work practice in this area. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an exploratory account of the links between devolution, homelessness and health in the UK. Specifically, it focusses on the policy context and governance structures that shape the systems of healthcare for homeless people in London, Scotland, Wales and Northern Ireland.Design/methodology/approach Empirically the paper draws on semi-structured interviews with a small sample of policy and practice actors from the devolved territories. Qualitative interviews were supplemented by a comparative policy analysis of the homelessness and health agenda within the devolved regions. Theoretically, it takes inspiration from Chaney’s concept of the “issue salience of homelessness” and explores the comparative character of healthcare as pertains to homeless people across the devolved territories.Findings The paper provides clear evidence of areas of divergence and convergence in policy and practice between the devolved regions. These features are shown to be strongly mediated by the interplay of two factors: first, the scope and scale of national and local homelessness prevention strategies; and second, intra-national variation in public health responses to homelessness.Originality/value The paper offers considerable insight from a comparative policy perspective into the nature of healthcare provision for homeless people in the devolved regions. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Standardized patient ( SP) simulation is an internationally recognized learning strategy that has proven effective in enhancing nursing students' competencies necessary for mental health practice., What does this paper add to existing knowledge? A deeper exploration of the process from the perspective of SPs and more particularly drama students, revealed the complexity they need to navigate and the personal vulnerability they are exposed to when creating an authentic learning opportunity for nursing students., What are the implications for practice? Their vulnerability justifies deeper consideration of support, as well as research on the ethical implications of SP simulation., Nursing students need to be well grounded in therapeutic communication before engaging with mental health users. This should include opportunities to question personal frames of reference that could hinder therapeutic engagement with diverse others., In future, the drama students can be involved in scenario development to enhance the authenticity of simulations., Abstract Introduction The effectiveness of Standardized patient ( SP) simulation in enhancing students' mental health nursing competencies is well published. Nevertheless, the believable and accurate portrayal of a patient with a mental health issue during SP simulation is complex. Though vital to the creation of safe authentic learning experiences, the perspectives of SPs and particularly of drama students involved in SP simulation are unknown. Aim The aim of this paper is therefore to explore and describe the experiences of 11 drama students engaged in mental health simulations for nursing students. Method A qualitative approach was taken and data were gathered using various techniques. Findings The content analysis revealed that these SPs negotiated three roles during this interdisciplinary learning experience, namely of a facilitator of learning, a drama student and the person within. Discussion The study provided valuable insight into the world of an SP, including the complexities they navigate and the vulnerability they experience. Implications for Practice Nurse educators are alerted to SP's need for support and the necessity of establishing good interpersonal skills before nursing students enter the practice setting. Involvement of SPs in scenario development could enhance the authenticity of future simulations. The ethical implications of SP simulation requires further exploration. [ABSTRACT FROM AUTHOR]

Despite the increased diversification of Australian families, the nuclear family formed through reproductive heterosex continues to be treated as the norm. This paper argues that this norm impacts negatively upon families formed in other ways, by exposing them to increased scrutiny. Drawing on interviews with 60 participants from four cohorts (families formed through reproductive heterosex, intercountry adoption, long-term foster care, or surrogacy), a comparative thematic analysis is presented in which two key themes are elaborated: (1) the impact of government policies and practices, and (2) the degree to which families are treated as public property. Findings suggest that families formed through reproductive heterosex were the least regulated and scrutinised; families formed through either adoption or surrogacy received a considerable degree of regulation and scrutiny; and foster families were the most scrutinised and negatively impacted by government policies. The paper concludes by considering what is required to engender more inclusive and supportive responses to all families. [ABSTRACT FROM AUTHOR]

Adherence to medication has been identified as a key issue in the treatment of many chronic illnesses, however such a perspective fails to account for the lived experience of medication usage and its effects on the body as lived. Parkinson's Disease, a neurological disease predominantly affecting movement and mobility, and which is treated via a wide range of medications provides a useful opportunity to explore experiences of medication usage in chronic illness. Reporting on findings of a study exploring men's experience of living with Parkinson's Disease, this paper adopts a lived body perspective to explore lived experiences of medication usage and adherence in PD. Findings are reported from 30 narrative in depth interviews with 15 men of various ages living with Parkinson's disease of mild to severe intensity. Findings first discuss PD's effects on men's sense of the lived body, in which a fluctuating embodiment is linked to medication regimes and their bodily effects. Second, as PD disrupts the body's place with the everyday and habitual experience of lived time, medication regimens come to place new structures upon the men's everyday experience of time. Finally, the paper explores the role medications play in men's attempts to create and sustain narratives for the individual progression of their illness, and how these narratives differ from clinical narratives associated with PD's treatment. This paper concludes by discussing debates around adherence to medication within the treatment of PD and the need to consider lived experience of medication usage and their effects at the level of the lived body. [ABSTRACT FROM AUTHOR]

The term sandwich generation describes individuals who are caught between the competing demands of caring for at least one dependent child and one or more aging parents. Of the approximate 8.1 million caregivers in Canada, 28 % were considered 'sandwiched'. Similar trends were found in the United States, with 15 % of middle-aged adults being sandwiched financially. Currently, little is known about the unique experiences of those providing care at both ends of the generational ladder. The purpose of this qualitative investigation was to explore the lived experiences of two married sandwich generation caregivers through the use of a case study. A married male and female who were caring for two dependent children and three aging parents each completed two one-on-one interviews with the researcher. The aging parents had varying ailments and needs, and thus the level of care required for each senior fluctuated. Several salient themes emerged from the data, but the following will be the focus of this paper: (1) Ebbs and Flows and (2) Stresses of Being Sandwiched. Notably, the participants' discussed how their lived experience differed depending on their current situation, as was also evident when the two interviews were compared. During difficult times, the participants' faced a number of challenges which will be discussed within the paper. As such, future research being conducted with this population should be conducted at multiple time points in order to fully capture the dynamic lived experiences of sandwich generation caregivers. [ABSTRACT FROM AUTHOR]

Background: There is worldwide debate regarding the appropriateness and safety of different birthplaces for well women. The Evaluating Maternity Units (EMU) study's primary objective was to compare clinical outcomes for well women intending to give birth in either a tertiary level maternity hospital or a freestanding primary level maternity unit. Little is known about how women experience having to change their birthplace plans during the antenatal period or before admission to a primary unit, or transfer following admission. This paper describes and explores women's experience of these changes-a secondary aim of the EMU study.Methods: This paper utilised the six week postpartum survey data, from the 174 women from the primary unit cohort affected by birthplace plan change or transfer (response rate 73%). Data were analysed using descriptive statistics and thematic analysis. The study was undertaken in Christchurch, New Zealand, which has an obstetric-led tertiary maternity hospital and four freestanding midwife-led primary maternity units (2010-2012). The 702 study participants were well, pregnant women booked to give birth in one of these facilities, all of whom received continuity of midwifery care, regardless of their intended or actual birthplace.Results: Of the women who had to change their planned place of birth or transfer the greatest proportion of women rated themselves on a Likert scale as unbothered by the move (38.6%); 8.8% were 'very unhappy' and 7.6% 'very happy' (quantitative analysis). Four themes were identified, using thematic analysis, from the open ended survey responses of those who experienced transfer: 'not to plan', control, communication and 'my midwife'. An interplay between the themes created a cumulatively positive or negative effect on their experience. Women's experience of transfer in labour was generally positive, and none expressed stress or trauma with transfer.Conclusions: The women knew of the potential for change or transfer, although it was not wanted or planned. When they maintained a sense control, experienced effective communication with caregivers, and support and information from their midwife, the transfer did not appear to be experienced negatively. The model of continuity of midwifery care in New Zealand appeared to mitigate the negative aspects of women's experience of transfer and facilitate positive birth experiences. [ABSTRACT FROM AUTHOR]

Interviews with survivors of intimate partner violence were conducted to gain information on the transition from violent relationships to new non‐violent relationships. A subset of this data was re‐analysed using Social Relational Theory to gain further insight into the roles of children and important others who were identified as impacting this transition for mothers who had exited violent relationships. This paper reviews two major themes discovered during the SRT analysis that were inherent in the women's experiences: (i) agency of children, family, peers and community and (ii) power. In addition, this paper suggests implications for research, intervention and psychotherapeutic practice. [ABSTRACT FROM AUTHOR]

Twenty academic psychologists and neuroscientists, with an interest in autism and based within the United Kingdom, were interviewed between 2012 and 2013 on a variety of topics related to the condition. Within these qualitative interviews researchers often argued that there had been a ‘turn to infancy’ since the beginning of the 21st century with focus moving away from the high functioning adolescent and towards the pre-diagnostic infant deemed to be ‘at risk’ of autism. The archetypal research of this type is the ‘infant sibs’ study whereby infants with an elder sibling already diagnosed with autism are subjected to a range of tests, the results of which are examined only once it becomes apparent whether that infant has autism. It is claimed in this paper that the turn to infancy has been facilitated by two phenomena; the autism epidemic of the 1990s and the emergence of various methodological techniques, largely although not exclusively based within neuroscience, which seek to examine social disorder in the absence of comprehension or engagement on the part of the participant: these are experiments done to participants rather than with them. Interviewees claimed that these novel methods allowed researchers to see a ‘real’ autism that lay ‘behind’ methodology. That claim is disputed here and instead it is argued that these emerging methodologies other various phenomena, reorienting the social abnormality believed typical of autism away from language and meaning and towards the body. The paper concludes by suggesting that an attempt to draw comparisons between the symptoms of autism in infant populations and adults with the condition inevitably leads to a somaticisation of autism. [ABSTRACT FROM AUTHOR]

Generations of parents lost to AIDS and other causes have created a vacuum of care for the orphaned children they leave behind. This crisis has resulted in rapid changes in caregiving and family life, with extended family members, having to care for orphaned children. As a result of high numbers of vulnerable orphaned children residing with kinship carers, and the fundamental importance of the relationship between carers and orphaned children, we need to understand more about these relationships. This paper explores the nature of orphaned children-kinship carer relationships in Botswana. Interview guides were used to collect data from 15 caregivers and 15 orphaned children. The results indicate that the nature of relationships between orphaned children and caregivers is influenced by the way the parties communicate, how adolescents behave and the competing responsibilities of caregivers. Lastly, the paper recommends how positive relationships can be developed and nurtured between orphaned children and their caregivers in an African setting. [ABSTRACT FROM AUTHOR]

Aim To describe reduction as a method in methodological and hermeneutic reduction and the hermeneutic circle using van Manen's principles, with the empirical example of the lifeworlds of multiple-birth families in Finland. Background Reduction involves several levels that can be distinguished for their methodological usefulness. Researchers can use reduction in different ways and dimensions for their methodological needs. Data sources Open interviews with public health nurses, family care workers and parents of twins. Review methods The systematic literature and knowledge review shows there were no articles on multiple-birth families that used van Manen's method. Discussion This paper presents reduction as a method that uses the hermeneutic circle. The lifeworlds of multiple-birth families consist of three core themes: 'A state of constant vigilance'; 'Ensuring that they can continue to cope'; and 'Opportunities to share with other people'. Conclusion Reduction allows us to perform deep phenomenological-hermeneutic research and understand people's lifeworlds. It helps to keep research stages separate but also enables a consolidated view. Social care and healthcare professionals have to hear parents' voices better to comprehensively understand their situation; they also need further tools and training to be able to empower parents of twins. Implications for research/practice The many variations in adapting reduction mean its use can be very complex and confusing. This paper adds to the discussion of phenomenology, hermeneutic study and reduction. [ABSTRACT FROM AUTHOR]

Simulated patient encounters, in which a trained layperson role-plays a patient, have become increasingly important in medical education. One such type is the gynecological teaching associate (GTA), who teaches medical students how to perform the pelvic examination using her own body. This paper considers the role that simulation like the GTA session plays in medical students' professional socialization. Drawn from interviews and archival sources gathered from medical students, medical faculty, and GTAs, this paper explores the tensions between artificiality and authenticity in order to understand how, through pedagogical practice, medical students come to embody medical culture through simulation. This paper uses the theoretical framework of the medical habitus to understand the role of emotion in medical student socialization. It argues that simulation is an example of affective practice: any rehearsal of techniques or styles of expressing, experiencing, or managing emotion that reshape the body's capacity to feel. [ABSTRACT FROM AUTHOR]