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A growing body of literature has focused on issues of migration in career development and guidance, however typically this research has focused on international migration rather than migration within a country's borders. This paper presents a specific case study of internal migration in the UK context, focusing on young people from two island communities as they move through higher education and into the working world. The paper is specifically focused on the importance of cultural differences, including workplace cultures, with regard to students' career development. The findings demonstrate the relevance of internal migration pathways to career development and indicate that a culturally informed approach to career guidance practice is important when working with internal as well as international migrants. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents qualitative research findings from the evaluation of a Parkinson's Dance well-being venture in the UK. Methods: Qualitative data was gathered to see how bespoke dancing sessions helped people with Parkinson's (PwP) to manage their conditions and improve their lives and prospects. Principles of a participatory approach were incorporated and methods included semi-structured interviewing, researchers participant observation and an elicitation-based activity. Nineteen PwP, six carers, four dance artists and seven helpers participated in the study. Results: Participating in Parkinson's Dance sessions meant that PwP could experience the possibilities to dance, develop a "can do" attitude, experience fun, enjoyment, social connection, exercise, movement to music, improvement and/or maintenance of their balance, suppleness, coordination and confidence with movement, symptoms being pushed back and ability to learn new things. Conclusions: Our findings add to the evidence-base about the benefits of dance for people experiencing Parkinson's and through novel application of the Life-world based well-being framework of K. T. Galvin and Todres (2011) we propose a theoretical basis for Parkinson's Dance as a resource for well-being. There is scope to consider application of the well-being framework to other arts activities and as the basis of an arts and well-being evaluation tool. [ABSTRACT FROM AUTHOR]

Recent political processes have rendered people with dementia an increasingly surveilled population. Surveillance is a contentious issue within dementia research, spanning technological monitoring, biomarker research and epidemiological data gathering. This paper explores surveillance in the relationships of people affected by dementia, how older relatives both with and without diagnoses are surveilled in everyday interactions, and the importance of expectations in guiding surveillance. This paper presents data from 41 in-depth interviews with people affected by dementia living in the community in the United Kingdom. Agedness was a key contributor to expectations that a person may have dementia, based on previous experiences, media accounts and wider awareness. Expectations provoked surveillance in interactions, with participants looking for signs of dementia when interacting with older relatives. Older people also enacted self-surveillance, monitoring their own behaviour. Various actions could be attributed to dementia because interpretation is malleable, partly vindicating expectations while leaving some uncertainties. Expectant surveillance transformed people's experiences because they organised their own actions, and interpreted those of others, in line with pre-existing meanings. The ability to interpret behaviours to fit expectations can bring coherence to uncertainties of ageing, cognition and dementia, but risks ascribing dementia to many older people who straddle those uncertainties. [ABSTRACT FROM AUTHOR]

The recognition of disability as a social construct has aided in providing better access to the built environment for disabled people, through the implementation of accessible spaces. However, access to them is not straightforward for disabled people who do not match stereotypical representations of disability. Drawing on empirical data collected from semi structured interviews and photo elicitation exercises, conducted with people with dwarfism living in the UK, this paper shows how they are often challenged or denied access to accessible spaces, creating a hierarchy of impairments. Building on the notion of 'statuarized spaces' the paper demonstrates how access to accessible spaces is influenced by their representation, which differs from representations of dwarfism, leading to incongruous encounters. These incongruous encounters affect the spatial practices of people with dwarfism. A more varied representation of disability is required in order to provide people with dwarfism straightforward access to accessible spaces. The ideas explored in this paper are based upon research carried out with people with dwarfism living in the UK. Shows how people with dwarfism are told off or challenged by other people when they want to access to accessible spaces. The paper shows some of the ways people with dwarfism gain access to accessible spaces. The paper argues for a broader representation of disability in order for people with dwarfism to be recognised as disabled. [ABSTRACT FROM AUTHOR]

A combination of structural barriers, inadequate student welfare provision and the absence of psycho-social and academic support make higher education access for forcibly displaced students challenging. Many of these students will have experienced many stressful and potentially traumatic events that may have or may continue to impact their mental health and wellbeing. This article draws on reflections by educators and findings from eight interviews with students who participated in a twelve-week preparatory course for access to higher education for refugees and asylum seekers in the United Kingdom. The paper firstly problematizes trauma as an organizing concept and challenges the dominant deficit approaches in forced migration studies when working with displaced students. Then, based on qualitative data collected from students and educators, it explores how creative skills were integrated and the importance of the student's voice as a culturally sustaining pedagogical approach to strengthening trauma-informed teaching approaches. The programme was designed to strengthen individual agency and promote well-being and mental health. Finally, this paper argues that working collaboratively with forcibly displaced students from an asset-based stance appeared critical in creating and sustaining a welcoming higher education environment which could contribute to promoting mental health. [ABSTRACT FROM AUTHOR]

In 2023, the UK Government published its long-awaited reform strategy for England's children's social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular 'priority' was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England's child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media. [ABSTRACT FROM AUTHOR]

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Across the four UK jurisdictions, there are distinct disparities in exclusion rates of school students. Northern Ireland, alongside Scotland and Wales, has demonstrated over time, lower rates of permanent exclusions and temporary exclusions compared with England. This paper examines these disparities from the perspectives of representatives from various system-level educational bodies and third sector organisations representing children and families who experienced the exclusion process. The paper will also present policy and legal frameworks associated with exclusion in Northern Ireland. We interviewed 9 stakeholders, associated with practices of school exclusion in Northern Ireland, from a range of system-level education bodies and advocacy groups. Findings include positive strategies perceived to keep exclusion levels low, types of obstacles or resistance to anti-exclusion policy, participants' perspectives on unofficial exclusion practice, and perspectives on official exclusion data. What emerges from interviews is a series of tensions between implementing a child-centred approach and diminishing support services and resources. We conclude that those working within the Northern Ireland education system, are committed to an inclusive approach. However, the development and implementation of effective supporting frameworks take time and consultation, and there is evidence of tension between the perceptions of those working at a system-level and those working in schools. [ABSTRACT FROM AUTHOR]

Many migrant groups, particularly those that are politically and economically marginalised, such as asylum seekers and refugees (ASRs), face inequities in access to health care as well as poorer physical and mental health outcomes. The role of post-arrival experiences in contributing to these inequities is increasingly being explored, and it is suggested that being a migrant is itself a determinant of health outcomes. Drawing on the theoretical concept of structural vulnerability, this paper explores ASRs' experiences of health, wellbeing, and health practices in the context of their lived realities in Scotland. 24 semi-structured interviews were conducted with ASRs from Sub-Saharan Africa between January and December 2015. Data were explored using thematic analysis. Experience of the UK asylum system, both alone and in conjunction with other sources of vulnerability including racism, poverty, and language barriers had a negative and ongoing impact on the physical and mental health of ASRs. These impacts continued, even once refugee status was obtained. Efforts to engage ASRs in preventive health programmes and practices must take into account the ways in which the asylum system acts as a determinant of health, affecting both what it means to be healthy and what capacity individuals have to engage with their health. Political choices in how the asylum process is enacted have far-reaching implications for individual and population health. [ABSTRACT FROM AUTHOR]

In this paper, we use a UK case study to explore how the COVID-19 pandemic affected the mental health (emotional, psychological, social wellbeing) of farmers. We outline the drivers of poor farming mental health, the manifold impacts of the pandemic at a time of policy and environmental change, and identify lessons that can be learned to develop resilience in farming communities against future shocks. We undertook a survey answered by 207 farmers across the UK, focusing on drivers of poor mental health and the effect of the COVID-19 pandemic. We also conducted 22 in-depth interviews with individuals in England, Scotland and Wales who provide mental health support to farmers. These explored how and why the COVID-19 pandemic affected the mental health of farmers. These interviews were supplemented by 93 survey responses from a similar group of support providers (UK-wide). We found that the pandemic exacerbated underlying drivers of poor mental health and wellbeing in farming communities. 67% of farmers surveyed reported feeling more stressed, 63% felt more anxious, 38% felt more depressed, and 12% felt more suicidal. The primary drivers of poor mental health identified by farmers during the pandemic included decreased social contact and loneliness, issues with the general public on private land, and moving online for social events. Support providers also highlighted relationship and financial issues, illness, and government inspections as drivers of poor mental health. Some farmers, conversely, outlined positive impacts of the pandemic. The COVID-19 pandemic is just one of many potential stressors associated with poor farming mental health and its impacts are likely to be long-lasting and delayed. Multiple stressors affecting farmers at the same time can create a tipping point. Therefore, there is a need for long-term support and ongoing evaluation of the drivers of poor mental health in farming families. [ABSTRACT FROM AUTHOR]

Based on the Theory of Planned Behavior, this paper explores the perceptions of the COVID-19 vaccine among South Asian communities residing in the UK. Thirty-eight semi-structured interviews were conducted using a qualitative approach and analyzed using thematic analysis. Participants represented Indian, Pakistani, Bangladeshi, Sri Lankan, Afghani, and Nepali backgrounds. The participants revealed that family and community influence their perceptions of the COVID-19 vaccine. The results suggest that normalizing vaccine acceptance, addressing unknown side effects, and popularizing vaccine efficacy data will increase vaccine uptake within the South Asian community in the UK. [ABSTRACT FROM AUTHOR]

In order to combat the COVID-19 pandemic, policymakers around the globe have increasingly invested in digital health technologies to support the 'test, track and trace' approach of containing the spread of the novel coronavirus. These technologies include mobile 'contact tracing' applications (apps), which can trace individuals likely to have come into contact with those who have reported symptoms or tested positive for the virus and request that they self-isolate. This paper takes a critical public health perspective that advocates for 'genuine participation' in public health interventions and emphasises the need to take citizen's knowledge into account during public health decision-making. In doing so, it presents and discusses the findings of a UK interview study that explored public views on the possibility of using a COVID-19 contact-tracing app public health intervention at the time the United Kingdom (UK) Government announced their decision to develop such a technology. Findings illustrated interviewees' range and degree of understandings, misconceptions, and concerns about the possibility of using an app. In particular, concerns about privacy and surveillance predominated. Interviewees associated these concerns much more broadly than health by identifying with pre-existent British national narratives associated with individual liberty and autonomy. In extending and contributing to ongoing sociological research with public health, we argue that understanding and responding to these matters is vital, and that our findings demonstrate the need for a forward-looking, anticipatory strategy for public engagement as part of the responsible innovation of the COVID-19 contact-tracing app in the UK. [ABSTRACT FROM AUTHOR]

The experience of politicians leaving elected office is under-researched. This paper examines the experience of leaving political office drawing on empirical research in the United Kingdom with 30 elected politicians, including 20 who had left office, either having been defeated in election or having chosen not to stand for election, and where possible their partners. The sample also included 10 interviews with current politicians about their expectations of transition from elected office. The paper considers the findings from a psychological and a sociological perspective and suggests features that predict a problematic adjustment to the loss of political office. [ABSTRACT FROM AUTHOR]

'Complexity' is theorised as a characteristic of modern food systems that poses a challenge to improving population diets. This paper seeks to explore the discursive deployment of 'complexity' in the context of public health. Doing so helps inform a more critical assessment of commercial and political determinants of health, and of 'complexity' as a prevailing frame for public health issues. Qualitative methods were used to explore 'responsibility' for healthy eating in the food system in the United Kingdom. Discourse analysis was conducted on corporate and government documents, and interviews with industry and government stakeholders. The aim was to examine the implications of 'complexity' within discourses of dietary public health. 'Complexity' was used not only to characterise dietary public health problems but also as a rhetorical device in public health narratives. It performed two main discursive functions: firstly, to represent diet-health problems as so multi-layered and difficult that they are intractable. Secondly, and despite this acknowledged complexity, to deflect from food system actions for improving diet to 'simpler' and non-food interventions, by industry and government. These uses of 'complexity' serve to attribute primary responsibility to individuals for dietary choice and to obscure inaction by government and industry, who have most control over the determinants of those choices. In short, 'complexity' can be used discursively to generate a smokescreen masking policy inaction in addressing public health problems. [ABSTRACT FROM AUTHOR]

In programmes of assessment with both high and low-stakes assessments, the inclusion of open-ended long answer questions in the high-stakes examination can contribute to driving deeper learning among students. However, in larger institutions, this would generate a seemingly insurmountable marking workload. In this study, we use a focused ethnographic approach to explore how such a marking endeavour can be tackled efficiently and pragmatically. In marking parties, examiners come together to individually mark student papers. This study focuses on marking parties for two separate tasks assessing written clinical communication in medical school finals at Southampton, UK. Data collected included field notes from 21.3 h of marking parties, details of demographics and clinical and educational experience of examiners, examiners' written answers to an open-ended post-marking party questionnaire, an in-depth interview and details of the actual marks assigned during the marking parties. In a landscape of examiners who are busy clinicians and rarely interact with each other educationally, marking parties represent a spontaneous and sustainable community of practice, with functions extending beyond the mere marking of exams. These include benchmarking, learning, managing biases and exam development. Despite the intensity of the work, marking parties built camaraderie and were considered fun and motivating. [ABSTRACT FROM AUTHOR]

Despite growing evidence demonstrating the psychotherapeutic potential of reading and writing poetry for various mental health problems, there remains limited evidence in relation to psychosis. This paper explores the therapeutic potential of poetry for psychosis by exploring the narratives of people with experience of psychosis who read and write poetry and people who are using poetry therapeutically within their practice. Nineteen participants were recruited to the research and data was collected via narrative interviews. Interviews were audio recorded, transcribed, and subjected to Labovian narrative analysis. Four themes were identified: i) the unsayable becoming sayable; ii) poetry supporting discovery, play and meaning making; iii) relational expression through poetry; and iv) poetry and recovery. The research offers a poetic window into the way in which we might begin to understand the language of psychosis and the interpersonal communication challenge therein. The authors propose the concept of the "poetic wavelength" which can inform the education of practitioners who are working with people who experience psychosis. Understanding the "Poetic Wavelength" offers an alternative form of meaning making, developing the capacity of practitioners in being able to accurately detect emotional states, and to respond accordingly, ultimately improving the experience of service users. [ABSTRACT FROM AUTHOR]

Talking about death and dying is promoted in UK health policy and practice, from a perception that to do so encourages people to plan for their end of life and so increase their likelihood of experiencing a good death. This encouragement occurs alongside a belief that members of the public are reluctant to talk about death, although surveys suggest this is not the case. This paper describes findings from a research study in which people participated in deliberative discussion groups during which they talked about a range of topics related to death, including talking about death, the good death, choice and planning and compassionate communities. Here we report what they had to say in relation to talking about death and dying. We identified three themes: 1. The difference between talking about death as an abstract concept and confronting the certainty of death, 2. how death and dying presents issues for planning and responsibility, and 3. approaches to normalising death within society. For our participants, planning was considered most appropriate in relation to wills and funerals, while dying was considered too unpredictable to be easy to plan for; they had complex ideas about the value of talking about death and dying. [ABSTRACT FROM AUTHOR]

Alcohol marketing influences drinking practices, and this helps shape how gender identities are constructed. This paper presents research exploring how women who are sober manage and negotiate their non-drinking and sober identities in neo-liberal contexts that market alcohol products and consumption as a defining feature of feminine identities. Semi-structured in-depth interviews (n = 15) and online content produced by sober women active in the positive sobriety community on the social media platform Instagram were analysed using thematic analysis. Women negotiated marketing messages within their everyday experiences of sobriety, with associations between drinking and motherhood, female friendship and empowerment, discussed as impacting their drinking, lived experience and sense of self. They negotiated such messages, and created alternative ways of 'doing femininity' as sober women, through distancing themselves from their previous drinking identities; rejecting, reworking and countering marketing that links alcohol use to femininity; and alternative consumption practices. Instagram allowed women to publicly critique and counter marketing messages in ways that unlinked alcohol use, but not consumption more generally, from femininity, in traditional and news ways. Marketing regulation should consider how those experiencing problematic alcohol use may be particularly vulnerable to marketing messages, in ways that are gendered. [ABSTRACT FROM AUTHOR]

Controlled Organ Donation after Circulatory Death (DCD) was re-introduced in the UK in 2008, in efforts to increase rates of organs for transplant. Following reintroduction there were debates about the ethics of DCD, leading to production of legal and ethical guidelines. Today, DCD makes up 40% of deceased organ donors, leading to claims that the UK has 'overcome' its ethical challenges. However, there is little understanding of how DCD works in practice and the ethical implications of making DCD routine in the context of the NHS. This paper draws on data from an ethnographic study examining the practices of DCD in two acute NHS Trusts in England. Interviews with Intensive Care staff and Specialist Nurses in organ donation, observations of organ donation committee meetings and analysis of Trust documents were conducted. Findings reveal that the routinisation of DCD has created new ethical issues relating to interactions between organisational timeframes for DCD and (under)resourcing for, and de-prioritisation of, donation within an NHS subject to austerity. They include: the perceived burden on families and implications for consent when there are delays in the donation process, due to theatre space and retrieval team shortages; family and staff distress when death does not happen 'on time'; and the problem of where to take patients who do not die in time to donate. I argue these temporal-ethical issues are likely to become heightened as potential donor rates increase with the new opt-out legislation, unless the resourcing required to deal with these problems are also addressed. [ABSTRACT FROM AUTHOR]

Blended learning (BL) has been widely adopted across the higher education (HE) sector, with a growing body of literature exploring its impact on both students and faculty. However, to date, few studies have examined how students with Specific Learning Difficulties (SpLDs) experience BL. This paper presents the results of a qualitative case study investigating the BL experiences of students with SpLDs in a British HE institution. A thematic analysis of semi-structured interviews conducted with six participants revealed five major themes regarding the BL experience of students with SpLDs: (1) clarity of purpose and instruction; (2) ease of use; (3) accessibility; (4) fear of 'getting it wrong' in online spaces and (5) interaction and staff engagement. The findings underscore the significance of addressing these areas in order to increase the efficacy of BL to meet the learning needs of students with SpLDs. [ABSTRACT FROM AUTHOR]

This paper examines how, in the midst of changing political times, some characteristics of HIV activism are changing, and suggests the relevance of these shifts for other fields of health activism. Despite the UK achieving UNAIDS's '90–90-90ʹ testing and treatment goals, many in the UK lack up-to-date HIV knowledge and retain stigmatising attitudes, and some areas of testing failure remain. In response, people with HIV and HIV organisations are generating imaginative, collaborative projects that indicate effective contemporary forms of health activism may, as other critical health research suggests, be decentred, participatory, multimodal, affective, and implicit. The paper describes a 2016 HIV NGO-run comedy event directed at HIV awareness which was researched via qualitative pre- and post-measures, and two-month follow-up interviews. Findings pointed to strong effects of comedy, as enjoyment and 'break' in HIV thinking, feeling, and action; of a one-off event's emotionality and particularity; and of performance in generating collectivity and HIV citizenship. The paper discusses the potential transferability of these findings to other health activisms, particularly around stigmatised conditions. It argues that such strategies of emotionality, multi-modality, and solidarity in a performance event can work as implicit activism for changing times, generating social change via a doubled politics of resistance and alterity. [ABSTRACT FROM AUTHOR]

This paper explores the decision-making processes involved in giving physiotherapy students responsibility on clinical placement and the impact on their developing professional autonomy. The qualitative study, using semi-structured interviews, involved physiotherapy students and clinical educators (CEs) from two higher education institutions, one in Australia, and the other in the United Kingdom (UK). Findings led to the development of a heuristic framework of 'graduated supervision,' a process of progressively less direct observation and monitoring of students as clinical proficiency improved. By focusing on the measured exposure of students to increasing complexity and inverse levels of supervision, the framework captures tacit practices, and consistent, yet varied facilitation strategies adopted across specialties, and evident in clinical education settings in both countries. The framework formalizes, for the first time, assumptions and expectations previously unacknowledged. Factors identified as affecting students' progress toward autonomy include the student/CE relationship, the development of mutual trust through ongoing dialogue, and the importance of formal discussions at the commencement of a clinical placement to establish learning goals, preferred supervision styles and learner responsibilities. Insights have significance for the CE community, and students who at times have to second-guess what is required of them and how they might excel on clinical placement. [ABSTRACT FROM AUTHOR]

Global health donors increasingly embrace international non-governmental organisations (INGOs) as partners, often relying on them to conduct political advocacy in recipient countries, especially in controversial policy domains like reproductive health. Although INGOs are the primary recipients of donor funding, they are expected to work through national affiliates or counterparts to enable 'locally-led' change. Using prospective policy analysis and ethnographic evidence, this paper examines how donor-funded INGOs have influenced the restrictive policy environments for safe abortion and family planning in South Sudan and Malawi. While external actors themselves emphasise the technical nature of their involvement, the paper analyses them as instrumental political actors who strategically broker alliances and resources to shape policy, often working 'behind the scenes' to manage the challenging circumstances they operate under. Consequently, their agency and power are hidden through various practices of effacement or concealment. These practices may be necessary to rationalise the tensions inherent in delivering a global programme with the goal of inducing locally-led change in a highly controversial policy domain, but they also risk inciting suspicion and foreign-national tensions. [ABSTRACT FROM AUTHOR]

This paper revisits core family support messages for social work practice in working with children and families, linking to findings from high-profile child protection cases in the UK and the Republic of Ireland. Drawing on a comparative study where these identified practice messages were explored through the lens of testimony of family support workers in the UK and Ireland, these core messages are examined. Operating with hard-to-engage children and parents, we hear how families and family support worker colleagues now view the core functions of child and family work across both jurisdictions (Ireland and England). The authors argue that by naming a more detailed set of practices that are deemed as most useful by families, based on the benefits and challenges of intensive family support work, key messages arise that have major resonance for social work and multiagency practice into the future. A basic message from this study is that valuable lessons on engagement and intervention with families can be drawn for professionals by examining the practice elements of this group of paraprofessionals in the child and family arena. This paper adds to debates on the role of support and intervention in social work and family support work. [ABSTRACT FROM AUTHOR]

Moral thinking and communication are critical competencies for confronting social dilemmas in a challenging world. We examined these moral competencies in 70 college students and graduates from Taiwan, the United Kingdom, and the United States. Participants were assessed through semi-structured written interviews, Facebook group discussions, and a questionnaire. In this paper, we describe the similarities and differences across cultural groupings in (1) the social issues of greatest importance to the participants; (2) the factors influencing their approaches to thinking about social issues and communicating with others; and (3) the characteristics of their moral functioning in terms of moral awareness, moral judgment, moral discourse, and moral decision-making. [ABSTRACT FROM AUTHOR]

With the United Kingdom experiencing a series of 'lockdowns' in 2020 and 2021 that disrupted leisure and socializing, the COVID-19 pandemic presents a 'critical juncture' which has facilitated alterations to – and reflections on – drinking practices. Drawing on online semi-structured interviews and focus groups conducted between the first and second UK lockdowns, we highlight three stages in the development and maintenance of UK drinking practices using critical junctures as a theoretical framework. Firstly, we consider the antecedent conditions – such as dominant drinking cultures - that shape pre-pandemic drinking practices and form the backdrop against which changes to behaviors are made. Secondly, we explore the 'cleavage' or initial moment of disruption which gives rise to shifts in drinking practices and consider how this critical juncture stabilizes and is reproduced. Finally, we examine the possible 'legacy' of the critical juncture. The paper highlights implications for healthcare/policy including the importance of considering wider social context when seeking behavioral change. We also stress that alternative explanations – such as declining drinking rates and the growth of Temporary Abstinence Initiatives – must not be ignored when exploring people's shifting drinking behaviors, even during periods of unprecedented social change. [ABSTRACT FROM AUTHOR]

Recovery is experienced in both positive and negative ways and this paper attempts to integrate the 'pains of desistance' approach into a recovery capital framework. Pains experienced as a result of negative recovery capital are often thought to stimulate motivations for positive behavioral change, usually through a 'rock bottom' type moment. Whilst recovery capital and barriers to recovery have been explored in the literature, conceptualizing these as push and pull factors, and exploring their dynamic interaction, especially at distinct phases of recovery has not. Toward filling these gaps, we use the life-narratives of 30 people in recovery to explore how the pains of recovery (push factors) alongside different forms of recovery capital (pull factors) impact upon and are managed differentially at distinct phases of the recovery journey. Findings indicate the pains of recovery rarely led to positive changes. Rather, a range of pull factors created and promoted positive changes. However, the life narratives reveal that recovery capital cannot be accrued or sustained without managing (eliminating or reducing) the pains of recovery. Overall, this work highlights the need for policy and practice to help reduce the pains of recovery, especially during early recovery to accelerate transition to more stable phases of recovery. As recovery is neither a linear pathway nor a journey without residual challenges for many people, there is much to be learned about effective ongoing management strategies in preventing a return to problematic use that utilize a push and pull framework. [ABSTRACT FROM AUTHOR]

This article aims to advance knowledge of inclusive (social) citizenship, through an empirical analysis of the access work of persons with a dementia. Drawing on the notion of cognitive accessibility and empirical data collected in Southern England using a novel methodology of go-along walking interviews with 15 people with dementia followed by a sit-down interview that included a nominated family member, this paper examines how persons with dementia access the outside world. The study found that access work entailed three spheres of activity: 'access to location technologies', 'access to ordinary places', and 'consciously sharing the responsibility of access work'. Overall, this article contributes to the growing literature on cognitive accessibility by evidencing the mental demands of access work, as experienced by people with dementia, and need to share the responsibility of access work between humans and non-humans, and state and non-state actors. Access to the outside world is important for disabled people, including people with dementia. This study examined the outdoor experiences of 15 persons with dementia living at home in southern England, to find out what access means for someone with a neurological condition. This study found that access work involved 'access to location technologies', 'access to ordinary places', and 'consciously sharing the responsibility of access work'. The study shows how important it is to take account of cognition when promoting access rights for disabled people, including people with dementia. [ABSTRACT FROM AUTHOR]

Background: In 2009, St George’s University of London (SGUL) replaced their paper-based problem-based learning (PBL) cases with virtual patients for intermediate-level undergraduate students. This involved the development of Decision-Problem-Based Learning (D-PBL), a variation on progressive-release PBL that uses virtual patients instead of paper cases, and focuses on patient management decisions and their consequences. Methods: Using a case study method, this paper describes four years of developing and running D-PBL at SGUL from individual activities up to the ways in which D-PBL functioned as an educational system. Results: A number of broad issues were identified: the importance of debates and decision-making in making D-PBL activities engaging and rewarding; the complexities of managing small group dynamics; the time taken to complete D-PBL activities; the changing role of the facilitator; and the erosion of the D-PBL process over time. Conclusions: A key point in understanding this work is the construction and execution of the D-PBL activity, as much of the value of this approach arises from the actions and interactions of students, their facilitators and the virtual patients rather than from the design of the virtual patients alone. At a systems level D-PBL needs to be periodically refreshed to retain its effectiveness. [ABSTRACT FROM PUBLISHER]

To explore how the information-sharing context influences how speech and language therapy (SLT) and nursing staff interact on stroke units and what they discuss. Ethnographic methodology was used, with data collected during 40 weeks of fieldwork across three inner city stroke units in the UK. Data comprised field notes collected during 357 h of participant observation and 43 interviews. Interviews were conducted with 14 SLTs, 1 SLT assistant, 24 registered nurses and 4 nursing assistants. This paper is focused on informal information-sharing. SLTs and nurses had different experiences of time and space (the temporal-spatial context) with respect to ward presence and proximity to patients, influencing how they interacted, the content of their talk and their relationships. Most interactions had the quality of interruptions, in which SLTs seized moments in between nursing tasks. Conditions were less suited to sharing information about communication than swallowing and SLTs felt more allied to other therapists than nurses. The temporal-spatial context impeded information-sharing, particularly about patients' communication needs. Consideration should be given to developing relationships between SLTs and nurses as key partners for patient care and raising the profile of communication information in ways that are relevant and useful to nursing work. Strategic waiting for opportunities to interrupt nurses and gain their attention is central to how speech and language therapists manage their need to share information informally with nurses. The small "windows in time" available for interaction influence information-sharing, with a limiting effect on information about patients' communication. There is potential to improve information-sharing between speech and language therapists and nurses by considering how the relevance of information for patient care could be made clearer. [ABSTRACT FROM AUTHOR]

Complementary and alternative medicine (CAM) degrees in Australian and British universities have come under attack from sceptics who argue that such courses teach only 'pseudoscience'. Moreover, CAM academics have themselves been publicly labelled 'quacks'. Comparatively little is known about this group of health professionals who span the two worlds of CAM practice and academia. How do they navigate between these domains, and how are their collective and individual professional identities constructed? Drawing on 47 semi-structured interviews, this paper explores the professional identities of academics working in three university-based CAM disciplines in Australia and the UK: osteopathy, chiropractic and Chinese medicine. By analysing these individuals' accounts, and building on prior research on health professions in the academy, the paper contributes to understanding how contests about professionalism and professional knowledge take place against the academic-practice divide. By focussing on a domain where knowledge claims are conspicuously contested, it highlights the salience of navigating 'epistemic stress' for both group and individual professional identity. [ABSTRACT FROM AUTHOR]

This paper draws on UK data from an international, comparative project involving eight countries. The study examined how social workers' conceptions and definitions of family impact on the way they engage with complex families, and how social policies that frame social work context impact on the way social workers engage with families. Focus groups were held in which social workers from four service areas (child welfare, addictions, mental health and migration) were asked to discuss a case vignette. Several factors were embedded in the vignette to represent a realistic situation a social worker may come across in their day-to-day work. Social workers clearly identified the complexity of the family's situation in terms of the range of issues identified and candidate 'causes'. However, typical first responses were institutional, looking for triggers that would signify certainty about their, or other agencies' involvement. This resulted in a complicated story, through which the family was disaggregated into individual problem-service categories. This paper argues that understanding these processes and their consequences is critical for exploring the ways in which we might develop alternative, supportive professional responses with families with complex needs. It also demonstrates how organisational systems manifest themselves in everyday reasoning. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is often referred to as a complex problem embedded in a complex system. Despite this insight, interventions in AMR, and in particular in antibiotic prescribing, tend to be narrowly focused on the behaviour of individual prescribers using the tools of performance monitoring and management rather than attempting to bring about more systemic change. In this paper, we aim to elucidate the nature of the local antibiotic prescribing 'system' based on 71 semi-structured interviews undertaken in six local areas across the United Kingdom (UK). We applied complex systems theory and systems mapping methods to our qualitative data to deepen our understanding of the interactions among antibiotic prescribing interventions and the wider health system. We found that a complex and interacting set of proximal and distal factors can have unpredictable effects in different local systems in the UK. Ultimately, enacting performance management-based interventions in the absence of in-depth contextual understandings about other pressures prescribers face is a recipe for temporary solutions, waning intervention effectiveness, and unintended consequences. We hope our insights will enable policy makers and academics to devise and evaluate interventions in future in a manner that better reflects and responds to the dynamics of complex local prescribing systems. [ABSTRACT FROM AUTHOR]

This paper reports on an innovative interprofessional education (IPE) initiative conducted in three care homes across Greater Manchester in the United Kingdom (UK). Students from a variety of professions including nursing, physiotherapy, social work, podiatry, counseling, and sports rehabilitation worked collaboratively in the homes to address the residents' individual goals. We found that care homes provided students with many opportunities for interprofessional working and learning. Through better understanding the dimensions of different perspectives and approaches, students improved their education and transformed their perceptions of aged care. Having a diverse range of professionals allowed staff to gain insight into the latest evidence-based practice and address the multiple needs of the residents more holistically. Residents gained an enriched sense of meaning and purpose in their daily life by engaging in fulfilling and meaningful activities. The complexities of undertaking an IPE initiative in this setting are also considered and we conclude by proposing important avenues for future research. [ABSTRACT FROM AUTHOR]

To evaluate the usability and acceptability of the Mental Capacity Assessment Support Toolkit (MCAST) in healthcare settings and whether its use was associated with increased legal compliance and assessor confidence. A mixed methods convergence triangulation model was used. Multidisciplinary professionals used the MCAST during mental capacity assessments for UK hospital patients with diagnoses of stroke or acute or chronic cognitive impairment. Changes in legal compliance were investigated by comparing scores on case note audits before and after implementation of the MCAST. Changes in assessor confidence and professionals' perceptions of the MCAST's usability and acceptability were explored using surveys. Patients' and family members' views on acceptability were determined using semi-structured interviews. Data were integrated using triangulation. Twenty-one professionals, 17 patients and two family members participated. Use of the MCAST was associated with significant increases in legal compliance and assessor confidence. Most professionals found the MCAST easy to use and beneficial to their practice and patients. Patients and family members found the MCAST materials acceptable. The MCAST is the first toolkit to support the needs of individuals with communication disabilities during mental capacity assessments. It enables assessors to deliver high quality, legally compliant and confident practice. Mental capacity assessment practice needs to be improved to maximise patient autonomy, safety and well-being. The MCAST is a paper-based toolkit designed to facilitate and improve mental capacity practice in England and Wales. This study suggests the MCAST would be easy and acceptable to use in healthcare settings and could lead to improvements in assessment quality and assessor confidence. [ABSTRACT FROM AUTHOR]

Integrated working can be a means of providing efficient and cost-effective care, which benefits both service users and health professionals. However, it does require readiness of practitioners to work in new and innovative ways to achieve integration. This paper describes the findings of a qualitative study exploring the nature of practice-based education and training underpinning successful integrated care teams using an ecological systems theory lens. Nine teams in the West Midlands region of the United Kingdom (UK) participated in this study. A total of 27 participants were involved in semi-structured interviews during which they shared their views and experiences of learning in practice. Thematic analysis of interview transcripts highlighted the shifting context of working in integrated teams impacting on learning, the influence of leadership on education and training, the nature of in-service training, and the knowledge-sharing culture. The findings highlight that the learning climate is highly dependent on the leadership ethos in the practice context, which influences the allocation of time and resources for training and clinical supervision. Whilst formal education and training has an important role to play in fostering integrated working, informal learning is pivotal to successful integration and potentially has greater impact making it worthy of further study. [ABSTRACT FROM AUTHOR]

Pleasure as a component of sexualities and relationships education (SRE) has been subject to much recent discussion. Arguably, academic debate has been more prominent than practitioner perspectives, with theoretical articulations and critique superseding pragmatic attention to integrating pleasure into learning about sexualities and relationships. Though there are exceptions, sexuality education that recognises pleasure and desire for young people remains absent in many contexts, despite calls for its inclusion for more than two decades. This paper offers a synthesis of expert opinion to outline the importance of pleasure and positive SRE to sexual health, rights, equality and safeguarding against coercion and harm. The paper acknowledges the often uneasy associations between sexuality, education and youth by identifying key political and academic debates, before offering a rationale on ways forward that may help persuade curriculum gatekeepers of its merits. Analysis focuses mainly on young women with reflections on current knowledge and the need for more empirically based research and theorising on boys and men. Policy developments relate to the UK, though issues raised have direct relevance for contexts where SRE is similarly contested. [ABSTRACT FROM AUTHOR]

The concept of 'embodied' risk has been used to understand the experience of being at risk of cancer, yet there has been less engagement of the concept in relation to those who have been diagnosed and treated for the disease. In this paper, I draw on young women's accounts of living with breast cancer with the aim of developing analyses of embodied risk and expanding our understanding of the concept. Twenty women diagnosed with breast cancer while they were aged 18-44 took part in semi-structured interviews in the UK, and I analysed these interview data using social constructionist grounded theory. The findings illustrate how a sense of risk from within the body shaped the young women's experiences and perceptions of their bodies, and how their body as risky was relational, becoming salient in interactions with others. I also explore new dimensions of embodied risk related to the age and social circumstances of the young women. Although the fear of cancer recurrence is well documented, this paper explores it as an embodied experience. [ABSTRACT FROM AUTHOR]

This paper tells the story of how a group of teacher educators in a university education department used action research to examine their research situation, and what conclusions they reached. Some recent historical background puts the study in context, identifying tensions between university expectations and time-heavy teaching demands that operated as obstacles to research activity. This context is shared by many academics who provide training for practitioners in UK universities that seek substantial funding through their performance in national research quality assessments. The project was initially organised in Spring 2007 by new research staff who had investigated staff perceptions of and interests in research through semi-formal interviews, observations and documentation. An invited group turned to action research as a possible way forward. They asked the question 'What kind of research culture do we want, and how can we get it?' Over a year, all participants gathered at semi-formal meetings for collaborative reflection and discussion, engaged in a diversity of micro-researches that experimented with ways of researching around the barriers, and wrote a collaborative paper about what they had learned. This gave rise to a series of national and international conference presentations that drew several of the group members into the wider research community. The group members grew to realise that the kind of research that they perceived the institution to value was not necessarily a kind that was readily built into their identities as teacher educators. But this realisation itself was empowering, exposing previously opaque assumptions that had left a felt irreconcilability that had been difficult to articulate. [ABSTRACT FROM AUTHOR]

This paper illuminates the recent stages of e-Government facilitation in the UK local authorities and shows how British local authorities are improving their public service delivery and governing in the digital environment on the other side of the Atlantic. It explores congruence between user and provider perspectives on e-Government. Giddens's (1984) dimensions of the “duality of structure” are used as a “sensitising device” to analyse findings from an extensive literature survey, document analysis and semi-structured interviews with e-Government managers, Heads of IS and IS Project Managers. A rich picture is presented of differences between user and provider views. This paper argues for a greater understanding between the views of the providers and the users of technology in e-Government facilitation in local authorities. [ABSTRACT FROM PUBLISHER]

Background: This paper examines the introduction and operation of a number of support roles in mental health services. This is done in the context of concerns about the effectiveness of CMHTs. Aims: Three questions are addressed: the degree to which concern for the work of consultant psychiatrists informed the introduction of the new roles; what the reforms implied for the work of the psychiatrist and those in new roles; and the impact of any changes on the operation of CMHTs. Method: Data were collected as part of a national-level evaluation. The main means of collection was the semi-structured interview. Results: The study shows: that reform was underpinned by concerns about the workload of psychiatrists; and that while in principle the responsibilities of the psychiatrist were to be distributed across other team members, those in new roles felt themselves to be isolated. Conclusions: Despite the intentions of policy, the creation of the new roles did little to extend the idea of distributed responsibility in CMHTs. [ABSTRACT FROM AUTHOR]

This paper examines the impact of major social security reform on mental health claimants by analysing the transition to Personal Independence Payment in the UK. Personal Independence Payment was introduced in April 2013, replacing Disability Living Allowance as the main non-means tested disability benefit intended to assist with the additional costs associated with disability or long-term health conditions. It is important to gain a better understanding of how people with mental health problems have experienced this reform. Twelve service users were interviewed for this qualitative research. Analysis identified three main themes: problems with the Personal Independence Payment claims process; problems conveying mental health problems during the assessment process; and positive experiences associated with the transition to Personal Independence Payment. This research demonstrates that major changes in benefit policy are challenging for people with mental health problems, particularly when delivered in a climate of austerity. The UK Government has changed the main disability benefit for disabled adults. From April 2013, Disability Living Allowance (DLA) has been phased out and replaced by Personal Independence Payment (PIP). This research found that this significant change caused difficulties for people with mental health problems. Everyone who took part reported increased anxiety, problems with claiming PIP, communicating with benefit officials and the medical assessment. It is important to learn from these problems so that future benefit changes, both in the UK and in other countries, can be developed and rolled-out in ways which are more appropriate for people with mental health problems. [ABSTRACT FROM AUTHOR]

Evidence suggests that physical activity (PA) programmes promoted via healthcare settings worldwide may not currently meet the needs of many patients and healthcare professionals (HCPs). This paper describes the outcomes of a qualitative enquiry into the perspectives of patients and professionals from multiple healthcare services regarding the role of PA. 19 patients and 22 HCPs were purposively recruited from physiotherapy, podiatry, chronic pain, diabetes and continence services at a community-based healthcare clinic in the United Kingdom. Participants' views were explored using semi-structured interviews and analysed using thematic analysis. Results identified five themes: differences between the social and medical rationales underpinning PA promotion; the impact of the patient-professional relationship on patient activation, self-management and PA; a risk culture surrounding PA; challenges to meet variation in patients' needs and preferences; and lack of formal role for PA as a core part of routine healthcare. The study highlights tensions between needs and aspirations, and the reality of delivering advice and support for PA. Challenges resonated with patients and HCPs across different care groups and were not condition-specific. This highlights a need for sharing good practice across healthcare services and system-level interventions to address organisational barriers to the promotion of PA. [ABSTRACT FROM AUTHOR]

How are changing times impacting on the possibility of collective agency by actors and agencies responding to domestic violence against women in London? The struggle against the domestic abuse of women was grounded in the 1970s women's liberation movement under the rallying cry of 'the personal is the political'. Over time, the domestic violence (DV) response has become professionalised and mainstreamed, located in public sector agencies and charities, with small feminist groups challenging gender inequalities in different settings. These combined efforts are having no impact on the incidence of DV, and recent years have seen dramatic cuts in DV services. A snowball sample of 25 professionals, policy makers and activists across the DV response engaged in semi-structured interviews exploring their work experiences, particularly experiences of 'multi-sectoral collaboration', the professional instantiation of collective agency. Thematic analysis depicted an exhausted and divided sector. Nearly all informants saw DV as rooted in gender inequalities, and viewed collaborative working as essential for tackling its interlocking individual and social drivers. However, contemporary feminism was seen as completely irrelevant to the daily realities of professionals' work. The paper explores how the current economic, political and cultural contexts of interviewees' work experiences were hostile to the practice of multi-sectoral collaboration. Such contexts actively militated against collaborator solidarity, the inclusion of survivor voices and a social change orientation – preconditions for effective collective agency in tackling such a complex and multi-level social problem. [ABSTRACT FROM AUTHOR]

Within homelessness services recent policy developments have highlighted the need for integration and improved collaborative working and also, the need for 'Psychologically Informed Environments' (PIES) in which workers are better equipped to manage the 'complex trauma' associated with homelessness. Drawing on the findings of an evaluation of a multi-site development programme, this paper demonstrates how both these policy aspirations might be implemented through a single delivery vehicle (a community of practice). The paper describes how organizational, educational and psychosocial theory was used to inform programme design and reflects on the utility of these approaches in the light of the evaluation findings. It is reported that communities of practice can deliver significant performance gains in terms of building collaborative relationships and opening-up opportunities for interprofessional education and learning. Filling an important knowledge gap, it also suggested how (professional) participation in a community of practice might work to improve outcomes for service users. Most likely we see those outcomes as being linked to tackling exclusion by sustaining the workforce itself, that is in motivating workers to remain engaged and thinking positively in what is an emotionally challenging and stressful job role. [ABSTRACT FROM AUTHOR]

The study informing this paper set out to reframe evaluation as a collaborative, participatory, dialogical process with a focus on learning rather than accountability. Evaluation, much like reflective practice, has been shaped in terms of individual activity and deficit-based discourses. Using an ‘insider’ approach, an innovative methodology was developed and implemented in a voluntary youth organisation in the UK. Data gathered via semi-structured interviews before and after the implementation were analysed using an inductive thematic analysis approach. The findings suggest that collective spaces for reflection and dialogue are disappearing and yet practitioners highly valued this for its re-energising and restorative properties. Evidence is presented to suggest that narratives, in this case co-constructed stories, enabled collective critical reflection and the development of a shared understanding of practice which in turn supported and strengthened professional autonomy. This paper offers a significant contribution to knowledge in regard to the design and use of participatory evaluation. It is argued that the appreciative, collaborative and reflective aspects of the methodology enabled the learning and development functions to be realised. Evaluation based on collective, reflective dialogue has the potential to provide an evidence base of good practice, enhance staff well-being and improve practice outcomes. [ABSTRACT FROM PUBLISHER]

This paper illustrates key findings from a qualitative doctoral research project exploring women's experience of infertility. Six women maintained treatment diaries, reflecting on their experiences prior to, during and beyond infertility treatment. The following key themes are identified: hopefulness, adaptation, transitioning and shifting focus. The data suggest that treatment, clinic experience and living a life 'on hold' act as turning points within the individual life course. It is at the intersection between treatment and outcome that difficulties negotiating the expected and anticipated life course become illuminated, revealing limited connectivity and transitioning through and beyond the treatment process. This is a critical focus area and one that sets the scene for effective future adaptation. The data suggest that the accessibility of supportive care moving through and beyond treatment is limited. This paper argues that the infertility clinic is a critical space and place and one where effective supportive care may enable effective transitioning beyond the experience of infertility as an unanticipated life course disruption. [ABSTRACT FROM AUTHOR]

This paper reports on the findings of an ESRC-funded Knowledge Exchange project designed to explore the contribution of an innovative approach to supervision to social work practitioner's assessment and decision-making practices. The Cognitive and Affective Supervisory Approach (CASA) is informed by cognitive interviewing techniques originally designed to elicit best evidence from witnesses and victims of crime. Adapted here for use in childcare social work supervision contexts, this model is designed to enhance the quantity and quality of information available for decision-making. Facilitating the reporting of both 'event information' and 'emotion information', it allows a more detailed picture to emerge of events, as recalled by the individual involved and the meaning they give to them. Practice supervisors from Children's Services in two local authorities undertook to introduce the CASA into supervision sessions and were supported in this through the provision of regular reflective group discussions. The project findings highlight the challenges for practitioners of 'detailed looking' and for supervisors of 'active listening'. The paper concludes by acknowledging that the CASA's successful contribution to decision-making is contingent on both the motivation and confidence of supervisors to develop their skills and an organisational commitment to, and resourcing of, reflective supervisory practices and spaces. [ABSTRACT FROM AUTHOR]

This paper presents a new conceptual framework for the study of supervision, called a ‘semi-open supervision systems model’ or supervision model. It was developed for a research study funded by the Social Care Institute for Excellence (SCIE) in England, UK. The supervision model was needed because the evidence base for supervision was weak and under-developed, and the theoretical base insubstantial. The supervision model was developed using systems theory and was informed by policy developments, which are normally excluded from supervision research. The research team was tasked with collecting evidence of good and/or innovative supervision at a time of significant service transformation across adult care settings in England and Northern Ireland. The research design was informed by the supervision model and researchers used a mixed methodology for data collection and analysis. This paper examines how the supervision model was developed and used in the study, and concludes by reviewing its contribution to the field of supervision study. [ABSTRACT FROM AUTHOR]

This paper provides an account of young people's experiences of and perspectives on help and support in drug reducing interventions. It is based on interviews with young people age 14–25 who were in contact with the Criminal Justice System (CJS) and, at the same time, participated in a drug reducing intervention. The interview data forms part of the EU funded EPPIC project. Two main themes emerged from the young peoples' accounts that cut across different types of interventions and social systems in both countries. The first revolves around the 'system' of welfare, criminal justice, health and educational services and the barriers young people encountered in navigating the system to find help. The second revolves around the young people's experiences with professionals, including what they appreciated and what they found problematic in professionals' approach to them. Basing our analysis on data from two different countries, we are able to emphasize similarities in the young peoples' perspectives, despite being enrolled in different drug reducing and CJS interventions. The insights gained indicate a need for systems and service changes that can facilitate a better balance between building individual resilience and providing appropriate, timely and adequate support within a 'resilience-building' environment. [ABSTRACT FROM AUTHOR]