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Objective: To describe and synthesise the content of public-facing websites regarding the use of diagnostic imaging for adults with lower back pain, knee, and shoulder pain. Methods: Scoping review conducted in accordance with PRISMA guidance. A Google search was performed to identify public-facing websites that were either United Kingdom-based, or National Health Service affiliated. The DISCERN tool was used to appraise website quality before information regarding the use of imaging was synthesised using thematic analysis. Results: Eighty-six websites were included, with 48 making reference to the use of imaging. The information within the majority (n = 43) of public-facing websites aligns with best available evidence. Where there is inconsistency, this may be explained by lower website quality. Three themes were apparent regarding the use of imaging – imaging to inform diagnosis and management; imaging in context; patient experience and expectations. Conclusion: The recommendations and rationale for use of imaging contained within public-facing websites does not appear to justify the increase in imaging rates for musculoskeletal pain in the UK. Innovation: Publicly available information following a novel search strategy, is largely aligned with best evidence, further understanding is required to determine reasons for requesting imaging from a patient and clinician perspective.

Summary: Self-harm in young people is a serious international health concern that impacts on those providing informal support: the supporting individuals of young people. We aimed to highlight the experiences, views, and needs of these supporting individuals of young people. We conducted a systematic review and thematic synthesis: PROSPERO CRD42020168527. MEDLINE, PsycINFO, EMBASE, AMED, CINAHL, ASSIA, and Web of Science were searched from inception to 6 May 2020 with citation tracking of eligible studies done on 1 Oct 2021. Primary outcomes were experiences, perspectives, and needs of parents, carers, or other family members of young people aged 12–25. Searches found 6167 citations, of which 22 papers were included in synthesis. Supporting individuals seek an explanation for and were personally affected by self-harm in young people. It is important that these individuals are themselves supported, especially as they negotiate new identities when handling self-harm in young people, as they attempt to offer support. The GRADE-CERQual confidence in findings is moderate. Recommendations informed by the synthesis findings are made for the future development of interventions. Clinicians and health service providers who manage self-harm in young people should incorporate these identified unmet needs of supporting individuals in a holistic approach to self-harm care. Future research must co-produce and evaluate interventions for supporting individuals. Funding: FM was supported by a NIHR School for Primary Care Research GP Career Progression Fellowship (SCPR-157 2020–20) to undertake this review and is now funded by a NIHR Doctoral Fellowship (NIHR300957). CCG is part-funded by the NIHR Applied Research Collaboration West Midlands.

Background: Self-harm is the leading risk factor for suicide, with elevated rates reported amongst older populations. This study explores how older adults experience self-harm, identifying factors leading to self-harm. Methods: Semi-structured interviews with older adults (≥60 years) engaging in self-harm and support workers from third sector services in England. Older adults were invited to participate in a follow-up interview. Interviews were recorded, transcribed verbatim and data analysed thematically. Ethical approval obtained from Keele University's Ethics Review Panel. A Patient Involvement group contributed to study design, data analysis and interpretation. Outcomes: Between September 2017 to September 2018, 24 interviews were conducted involving 16 participants: nine older adults and seven support workers. Eight older adults consented to follow-up interviews. All older adults reported diagnoses of mental illness in addition to physical illness. Participants identified diverse stressors accumulating over the life-course leaving older adults particularly vulnerable to self-harm. Such stressors included adverse events, loss, interpersonal and health problems. A sense of shame and stigma amongst older people using self-harm to manage distress was also reported. Interpretation: Self-harm is often concealed due to stigma and shame, being further accentuated amongst older adults, which may result in low levels of medical help-seeking behaviour for self-harm. Self-harm occurred along a spectrum of no-suicidal intent to high-levels of intent, suggesting self-harm holds different functions to older adults. Clinicians should be aware of the existence of self-harm in this age-group, and the heightened risk amongst those with comorbidities so adequate assessment, support and/or referral is provided. Keywords: Self-harm, Qualitative, Suicide, Older adults