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Background: Adults with intellectual disabilities have historically been hindered, rather than supported, in their desire to form loving relationships. This paper sought to explore with them what kinds of support they wanted in the 21st Century. Method: Semi‐structured in‐depth interviews were conducted with 40 adults with intellectual disabilities in the United Kingdom. Results: Participants placed a high value on having a partner and being supported to maintain and develop a loving relationship. The factors which constrained them in achieving this included a lack of social opportunities, barriers created by social care services and limits on them exercising autonomy. Facilitating factors included access to specialist dating agencies, strong family and staff support and opportunities to learn about relationships. Conclusions: The importance of a loving relationship as a source of pleasure and meaning in the lives of adults with intellectual disabilities who are often disadvantaged in many other spheres of life is emphasised. [ABSTRACT FROM AUTHOR]

Introduction: The UK low‐risk drinking guidelines were revised in 2016. Drinkers were primarily informed about the guidelines via news media, but little is known about this coverage. This study investigated the scale and content of print and online textual news media coverage of drinking guidelines in England from February 2014 to October 2017. Methods: We searched the Nexis database and two leading broadcasters' websites (BBC and Sky) for articles mentioning the guidelines. We randomly selected 500 articles to code for reporting date, accuracy, tone, context and purpose of mentioning the guidelines, and among these, thematically analysed 200 randomly selected articles. Results: Articles mentioned the guidelines regularly. Reporting peaked when the guidelines revision was announced (7.4% of articles). The most common type of mention was within health‐ or alcohol‐related articles and neutral in tone (70.8%). The second most common was in articles discussing the guidelines' strengths and weaknesses, which were typically negative (14.8%). Critics discredited the guidelines' scientific basis by highlighting conflicting evidence and arguing that guideline developers acted politically. They also questioned the ethics of limiting personal autonomy to improve public health. Criticisms were partially facilitated by announcing the guidelines alongside a 'no safe level of drinking' message, and wider discourse misrepresenting the guidelines as rules, and highlighting apparent inconsistencies with standalone scientific papers and international guidelines. Discussion and Conclusions: News media generally covered drinking guidelines in a neutral and accurate manner, but in‐depth coverage was often negative and sought to discredit the guidelines using scientific and ethical arguments. [ABSTRACT FROM AUTHOR]

Accessible summary Self-Directed Support is the latest system of social care giving vulnerable people in the UK a budget instead of a service provided by local authorities., There is a lack of evidence to demonstrate how people with intellectual disabilities access information and make choices about Self- Directed Support., Self- Directed Support is not yet available to all individuals with an intellectual disability., There is a need for further education and training for professionals and support staff to ensure that people who have intellectual disabilities are assisted to make informed choices about care provision., Summary A systematic literature review was conducted between September 2010 and April 2011 and published earlier in this journal, paper 1. The findings indicated that few studies of Self- Directed Support focused specifically on people with intellectual disabilities. The range of individuals' ability and distinction between adults with or without legal capacity have not been addressed. It is clear that Self- Directed Support is not, as yet, a viable option for all individuals with an intellectual disability. However, some who have accessed it reported an improvement in their quality of life. For Self- Directed Support to succeed for people with a wide range of intellectual disabilities, the level of awareness of its existence, and the potential barriers in relation to uptake, must be identified and addressed. This paper suggests possible strategies to maximise access to Self- Directed Support and identifies areas in which further research is required. [ABSTRACT FROM AUTHOR]

The present paper outlines a perspective on Milgram's obedience experiments informed by rhetorical psychology. This perspective is demonstrated through a qualitative analysis of audio recordings and transcripts from two of Milgram's experimental conditions: 'voice-feedback' and 'women as subjects'. Analysis draws attention to the way in which participants could draw the experimenter into a process of negotiation over the continuation of the experimental session, something which could lead to quite radical departures from the standardized experimental procedure, and points to the ineffectiveness of Milgram's fourth prod (You have no other choice, you must go on). These observations are discussed in terms of their implications for theory and research on dis/obedience, with a specific focus on the concepts of choice and agency and the nature and meaning of dis/obedience. [ABSTRACT FROM AUTHOR]

This paper starts by introducing a tripartite conception of responsibility for health consisting of a moral agent having moral responsibilities and being held responsible, that is blamed, for failing to meet them and proceeds to a brief discussion of the nature of the blame, noting difficulties in agency and obligation when the concept is applied to health-threatening behaviours. Insights about the obligations that we hold people to and the extent of their moral agency are revealed by interrogating our blaming behavior, and to facilitate this, my own blaming attitudes and actions are analysed in respect of an imagined adult son who seeks thrills by jumping from a pier into the sea, an activity common around coastlines and intended to be analogous in varying degrees to a range of health-threatening behaviours. I consider my responses to this imagined act in relation to some features of moralism, the excess of morality, concluding that blame can be justified when it is proportionate and within interpersonal relationships. There is evidence that some nurses hold negative blaming attitudes towards groups of patients considered to have caused or contributed to their illness, but this is not justified, not only because of impaired agency, but also because if there is responsibility for health, associated obligations are owed to those who share our lives, and it is those people who are entitled to hold individuals responsible. Nurses who hold negative blaming attitudes towards groups of patients are invited to identify the status of moral agency, the precise natures of their (failed) obligations, and of the patient-nurse relationship. It is concluded that reflection on these matters and the difference between justified blame and moralism demonstrates that blaming behaviour in the context of professional health care is built on nothing stronger than prejudice. [ABSTRACT FROM AUTHOR]

The aim of this paper is to re‐examine nursing work from a Marxist perspective by means of a critique of two key concepts within nursing: autonomy and caring. Although Marx wrote over 150 years ago, many see continuing relevance to his theories. His concepts of capital, ideology and class antagonism are employed in this paper. Nursing's historical insertion into the developing hospital system is seen in terms of a loss of autonomy covered over by the development of cults of loyalty toward those institutions, while the concept of emotional labour is used to re‐examine nursing's high valuing of "caring" and to understand it as potentially exploitative of nurses. Raising awareness of this alternative way of understanding nursing work can become a first step toward change. [ABSTRACT FROM AUTHOR]

This paper develops a theoretical approach to children's rights in youth justice, located within a wider rights-based theory of criminal justice which emphasises the centrality of citizens' autonomy. Understanding what is special about children's rights in the youth justice system requires an understanding of how children's autonomy differs from that of adults. One difference is that within the legal system children are not considered to be fully autonomous rights-holders, because childhood is a time for gathering and developing the assets necessary for full autonomy. These assets should be protected by a category of 'foundational' rights. It is argued that an essential component of a rights-based penal system for children is that it should not irreparably or permanently harm the child's foundational rights. The concept of foundational rights can then underpin and strengthen international children's rights standards, including those relating to the minimum age of criminal responsibility, differential sentencing for children and adults and a rights-based system of resettlement provision. [ABSTRACT FROM AUTHOR]

This paper uses critical discursive psychology to examine expressions of dissatisfaction and complaint by people with learning disabilities. UK government policies stress that people with learning disabilities should have more control over their lives. Expressing dissatisfaction about services is an important aspect of this process. However, given that such individuals are often treated as incompetent, and given the delicate nature of complaining about services one might rely on for day-to-day support, this can be difficult to do. In building complaints, speakers drew on repertoires about competence and incompetence, the right to free choice as a principle, and tempered dissatisfaction to make contrasts between good and bad supporters and practice. While the complaints show many of the general features of complaints identified in previous work in the general population, they were crafted to the particular institutional context of social care, and attended both explicitly and implicitly to the particular issues of competence, power, and authority found in those services. Speakers positioned themselves as competent, and service workers as more or less competent in their roles. Issues of power in social care services were observed explicitly in the accounts, whereby people described staff as controlling and it being difficult to voice dissatisfaction. They were also implicit in the way speakers drew on the others with institutional authority for corroboration and comparison. [ABSTRACT FROM AUTHOR]

This paper considers the ideals and activism of the fin de siècle feminist organisation, the Women's Emancipation Union (WEU). Active between 1891 and 1899, the WEU held a prophetic vision of the future and an appraisal of women's subjection more comprehensive than any contemporary feminist group. Members were the first to link the possession by women of their bodily autonomy directly to the acquisition of the parliamentary vote, and thus redefined the terms upon which citizenship was constructed. One member raised the matter of armed insurrection in support of the women's franchise, an issue which would have serious implications for the future of suffragist campaigns. The political roots of WEU members lay chiefly within the utopian-socialist and Radical-liberal traditions, but it was an organisation which resisted party-political allegiance to become anchored in the Progressive movement. Adopting what has been defined as the ‘muckraking’ tradition associated with Progressive authorship, the WEU suffragists constructed a rhetoric of resistance to women's subjection from social, sexual, economic and political standpoints. Many points they raised, including for a woman's right to consent to maternity to be enshrined in law, were to become the bedrock of the philosophy of the militant suffragette movement. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to evaluate the impact and success of the United Kingdom centralized Research Management and Governance model. BACKGROUND: Research is crucial to the generation of new knowledge and for the development of nursing services. However, poor research conduct has prompted a growing international impetus to govern and monitor research activity. In 2004, a centralized Research Management and Governance Model aimed at fostering a quality research culture through streamlining bureaucratic management processes was implemented across 14 primary care provider organizations in the United Kingdom. METHODS: A questionnaire survey was undertaken in 2004 to explore researchers' experiences (n = 76) of the model across the 14 organizations, and semi-structured interviews were conducted with five research and development managers. The interview transcripts were independently thematically analysed. FINDINGS: Governance processes were seen as useful or very useful by 36.8% (n = 28) of researchers viewed, and 47.3% (n = 36) thought they were a hindrance or not useful. Managers suggested that the model supported the research infrastructure and had reduced paperwork. The benefits of centralization were balanced against managers' perceptions of reduced autonomy and control. CONCLUSIONS: Centralizing research governance is an effective way of maximizing research resources, but researchers still may not value the process. Partnership working can streamline research governance mechanisms, but needs to be adequately resourced and transparent. This model could be of benefit to international colleagues who are charged with the management of research. [ABSTRACT FROM AUTHOR]

The paper offers empirical insight into how traditional thinking can continue to dominate contemporary change initiatives, and suggests that the propensity to repackage and sell 'old' management theory as new techniques reflects the persistence of fundamental, insoluble dilemmas in the nature of organizing. Empirical evidence is drawn from a detailed qualitative study of two case study sites at the Royal Mail, the UK postal service. The analysis shows how the two different change initiatives of Total Productive Maintenance (TPM) and Technical Centers of Excellence (TECEN) are in competition through their methods and discourse, and how this reflects underlying and competing differences in ideologies of management. It vividly demonstrates how contemporary management thinking can involve repackaging old ideas in new rhetoric and a tendency for faddism. In organizations such as Royal Mail the consequence is that far from proving to be the solution to organizational problems, the techniques perpetuate a traditional management dualism in strategies of labor management between control and autonomy. [ABSTRACT FROM AUTHOR]

* Although autonomy and independence are widely held to be important goals of care for older people, these terms lack precise definition and operationalization in the literature. * This paper reports on observational data gathered as part of an evaluation of educational programmes in the nursing care of older people. * Strategies which appear both to promote and inhibit autonomy and independence of older patients in a range of care settings are described. * Recommendations are made for further research to explore the extent to which autonomy and independence are appropriate goals of care for older people with cognitive impairment. [ABSTRACT FROM AUTHOR]

This paper reviews the development of nursing in Britain in the light of an assumption that professional groups will seek to gain autonomy and control over others. Such an assumption is familiar to sociologists who tend also to argue that autonomy and control are gained via the creation of dependency. It is shown here that nurses have pursued a different occupational strategy, elements of which include subordination to doctors, acceptance of a wide range of tasks, and, in particular, routinization of their work. A range of reasons, both historical and contemporary, are suggested for this. Although not necessarily recognized in the form described here, the strategy of nursing is a coherent solution to a particular set of circumstances and eventualities. [ABSTRACT FROM AUTHOR]

Personal integrity is often seen as a core value for delivering ethical healthcare. This paper will explore what this might mean and particularly what place integrity has in a multi-professional healthcare system. Two opposing arguments can be made: the first is that the multi-professional nature of modern healthcare means that personal integrity is at best a futile luxury and at worst, an obstacle to delivering affordable high-quality care to large populations. The converse is that without personal integrity healthcare loses its humanity and becomes mere biological and social engineering. Part of the analysis rests on whether integrity is primarily a personally held moral framework or whether it is a social concept. Chester Calhoun's analysis, in which she identifies the integrated-self, personal identity, and (morally) clean-hands as three pictures of integrity, is used as the basis for suggesting that integrity is a rich and complex social virtue through which the individual is able to demonstrate their relationship with the values and mores of the communities of which they are members. In addition, I will argue that integrity is not a value itself, but is a framework through which one or more sets of those values that characterize the communities of which the person is a part, can be expressed. Because a person may belong to many communities - nation, gender, religion, family, profession, trade, sport, etc. - each individual has their own unique meta-set of values that informs their personal sense of integrity. However, in specific circumstances, conflicts may arise between this personal global sense and the set of values associated with one community. [ABSTRACT FROM AUTHOR]

Although conflict of interest is a problem endemic to representative institutions, it manifests itself in different ways from one system to the next. This paper examines how conflict of interest has been interpreted and managed in the United States Congress and in the British House of Commons. Differences in the regulatory systems are described, and the argument is made that the crucial distinction is the greater autonomy members of Parliament have in interpreting and resolving conflicts of interest. This autonomy (or the lack of it) arises, we suggest, out of fundamental institutional arrangements, specifically the theory of representation employed in each system and the degree of institutional autonomy enjoyed by each legislative body. [ABSTRACT FROM AUTHOR]

Background: Transitioning from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) raises novel ethical aspects for healthcare professionals, as well as for young people, their parents and carers. Method: Focus groups were conducted in Croatia, Ireland and the United Kingdom with youth mental health groups and youth representatives with no mental health (MH) remit. One hundred and eleven participants, aged from 16 to 60 years, contributed to discussions. Results: Perpetuation of stigma, autonomy and decision‐making were central themes as both enablers and deterrents of successful transition. The tension between professional (and at times parental) paternalism and young persons' growing autonomy was well captured in the themes; (a) desired practice, (b) who should decide, (c) the process of decision‐making and (d) potential harm(s). Conclusions: This study provides insight into the ethical values, particularly autonomy and collaboratively working, which people expect to underpin the transition between CAMHS and AMHS. Key Practitioner Message: Engaging young people early in making decisions about their future care can enhance trust between practitioner and the young person.In addition to diagnosis, a number of factors (such as moving home; waiting lists and stigma) may need to be taken into account when considering the direction of future health care.When possible, alternatives to AMHS should be considered if considered by the young person to be a less‐stigmatising treatment option. [ABSTRACT FROM AUTHOR]

This article discusses when it is ethically acceptable to withdraw consent for the storage and use of embryos and gametes. Currently, the law in the UK states that consent to use of a gamete or embryo can be withdrawn up to the point of the embryo's transfer to the recipient's uterus or when the gamete is used in providing treatment services; that is, the 'point of no return'. In this article, we will consider other points of no return and argue that having a single point of no return, a one size fits all form of consent can, in some cases, lead to restrictions on individuals' autonomy and cause particular types of harm. Therefore, having different points of no return that fit different circumstances could extend autonomy and allow people to enter into agreements that are tailored more to their own particular needs and circumstances. [ABSTRACT FROM AUTHOR]

The dominant approaches to public health policy on childhood obesity are based on the neoliberal emphasis of personal choice and individual responsibility. We study adolescents' (N = 81) beliefs about responsibility for childhood obesity as a public health issue, through an innovative participatory method, PlayDecide, organised in two countries: the UK and Spain. There is no evidence of a blanket rejection of individual responsibility, rather, a call for renegotiation of the values that inform adolescents' food choices. The findings suggest the need to broaden the framing of obesity-related policy to go beyond the nutritional paradigm and include other values that signal health. [ABSTRACT FROM AUTHOR]

This study draws on the concepts of relative standing to explain the post-merger performance of recently acquired European firms. We used a 2 x 3 sampling design where we surveyed top managers of British and French firms that were acquired by British, French, and U.S. firms as to their perceptions of cultural compatibility with the buying firms, their sense of loss of autonomy since the merger, and post-merger performance. While we found that the theory adequately explains the post-merger performance of both British and French firms, suggesting that this primarily "made-in-the-United States" organization theory extends beyond the cultural domain of the United States, we also found an aspect of the theory that reflects a possible cultural bias. [ABSTRACT FROM AUTHOR]

The focus of concern in the public conversation about the care of gender-diverse children and adolescents is to some degree a matter of politics: that is, the dynamics of power and 'voice' in our modern world. There are questions relating to child and parent autonomy in making identity-driven life decisions; the counterbalancing need to safeguard children when new technologies enable new life choices to be made; the role of professional 'experts' (e.g. in claiming to evaluate the 'authenticity' of a young person's gender identity); and the significance, and credibility, of different kinds of evidence in making treatment decisions. All these weighty and wide-ranging considerations come to the fore in the United Kingdom and elsewhere when discussing what might be an ethical, safe and just response to gender-diverse children in our changing society. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Overseas recruitment has been vital to the contribution of staff growth in the National Health Service (NHS). In 2011, high nursing vacancy rates within critical care required that overseas nurses were recruited. The recruited nurses were placed in an Overseas Nurses Program (ONP), a course designed to assist overseas nurses in adapting to the NHS. Aim To describe the experiences of nurses recruited from India who participated in an ONP. Design A qualitative, research approach was chosen to gather descriptions of the lived experiences of nurses from India transitioning to London, to work in critical care settings. Method A descriptive qualitative approach was taken using in-depth, semi-structured and audio-taped interviews. They were conducted over a 69-day period (30 November 2012 to 6 February 2013) with 16 nurses from India. The nurses were questioned about challenges, experiences and differences; they were also asked to make suggestions for other nurses undertaking an ONP in the future. Interviews were transcribed verbatim into a formal written style with NVivo 10. Results Eleven females and five males aged 25-33 years who had completed up to four years of university training participated in this study. The themes extracted were autonomy and responsibility, language, culture (food and climate), loneliness and work challenges (ONP and essay writing). Participants identified that they would have benefited if pre-allocated mentors from non-English speaking countries who had previously been through the transition process were available to assist them with their personal and professional integration into a new country. Conclusion Autonomy disparity, language barriers and cultural differences need to be recognised and acknowledged by multi-disciplinary teams, by allowing sufficient time and additional support for non-English nurses undergoing ONPs. Relevance to clinical practice Overseas nurses would benefit from being mentored by another nurse from a similar culture, with a non-English background. It may be feasible for overseas nurses to receive training in cultural competencies to improve disparities. [ABSTRACT FROM AUTHOR]

Background In the UK those paid to support adults with intellectual disabilities must manage two potentially conflicting duties that are set out in policy documents as being vital to their role: protecting service users (their duty of care) and recognising service users' autonomy. This study focuses specifically on the support of people with the genetically determined condition, Prader-Willi syndrome (PWS). Due to the behaviours associated with PWS, the support of this group of people vividly illustrates the tension between respect for autonomy and duty of care. This article explores how support workers working in a residential group home managed their competing duties of managing risk and promoting independence in practice. Methods An ethnographic study, comprising of qualitative observations, semi-structured interviews and documentary analysis, was undertaken to investigate the work of support workers in a UK residential group home specialising in the support of adults diagnosed with PWS. The study focused on how support workers attempted to reconcile the tension between protecting service users from the risks associated with the syndrome and acknowledging service users' autonomy by enabling independence. Results Findings demonstrate that risk was central to the structure of care delivery at the group home and support workers often adhered to standardised risk management procedures. The organisation also required support workers to promote service users' independence and many thought acknowledging service users' autonomy through the promotion of their independence was important. To manage tensions between their differing duties, some support workers deviated from standardised risk management procedures to allow service users a degree of independence. Conclusions There is a tension between the duty of care and the duty to recognise autonomy at the level of service delivery in residential homes. Support workers attempt to manage this tension; however, further work needs to be done by both residential services and policy makers to facilitate the reconciliation of the duty of care with the duty to recognise service users' autonomy in practice. [ABSTRACT FROM AUTHOR]

Objectives. This study investigated clinical psychologists' experiences of gifts offered by clients in therapeutic relationships. Since limited prior research of gifts has been undertaken, the study was informed by an inter-disciplinary approach, drawing on theories of 'the gift' from anthropology, sociology, and psychoanalysis. Design and method. A postal survey was undertaken on a 10% random sample of clinical psychologists living in the UK on the Register for Chartered Psychologists (Clinical Section) ( N= 441). Responses to three open-ended questions were analysed qualitatively, using thematic analysis. Results. The response rate to the questionnaire was 50.57% ( N= 223). Three main themes were identified: (1) acceptance as the 'correct' response to a gift, (2) potency of the gift, and (3) the impact of policy on professional autonomy. Conclusions. The findings suggested that many participants viewed the gift as a way of the client reciprocating something that was given in the therapy. Within a Maussian account, this notion of reciprocity positions the therapeutic contact as the 'first gift'. Few gifts were refused and frequently occasioned pleasure in the participants. Although some givers were understood as needing to give because of ascribed intra-individual characteristics or 'psychopathology', normative gifting practices were commonly held to apply in therapeutic relationships. Further research should explore clients' perspectives on gifting. [ABSTRACT FROM AUTHOR]

Factors influencing older patients' participation in care: a review of the literature. International Journal of Older People Nursing , 274-282 doi: Over the past 10 years, there has been an increase in the literature promoting patient involvement in health care at all levels of the decision-making process. To review the literature on factors influencing patient participation in care with a particular focus on the perspective of older people. Various search engines were used to conduct the review and articles were identified through the following databases; CINAHL, CSA ILLUMINA, Science Direct, Blackwell Synergy, the Cochrane Library, OVID, SAGE, AHMED, BNI and MEDLINE. Research studies ranging from 2000-2007 were selected for inclusion on the basis that they investigated patient participation and/or older peoples' involvement in health care. Seven key themes emerged from the literature: the concept of participation, the need for older people to be involved, autonomy and empowerment, patients' expectations, benefits of participation, factors influencing participation and precursors to participation. Although patient participation has received considerable attention in the literature, this review highlights the dearth of research from the perspective of older people. There is a general consensus that preference for participation should be assessed and not assumed, and the review offers a sobering reminder that participation should not be achieved at the expense of patient autonomy and choice. Quality care and the most productive use of resources are dependent on the public's engagement with health service providers. However, despite being central to contemporary nursing practice, this review suggests that the reality is not matched by the rhetoric. Future initiatives should focus on supporting nurses and other healthcare professionals to develop the competencies required to facilitate greater participation by older people who wish to become more involved in their care. [ABSTRACT FROM AUTHOR]

This essay considers the range of possible policy options that are available if we wish to attempt to treat people with cognitive disabilities as equal members of society. It suggests that the goal of policy should be to allow each disabled person to establish a worthwhile place in the world and sets out four policy options: cash compensation, personal enhancement, status enhancement, and targeted resource enhancement. The essay argues for the social policy of targeted resource enhancement for individuals with cognitive disabilities, in the form of providing cash, with some limits on its use. Taking the example from the United Kingdom of “self-directed support,” it argues that such policies can be cost-effective and advance the autonomy of people with cognitive disabilities, especially when compared with current policies of centrally provided services. [ABSTRACT FROM AUTHOR]

Sociotropy and autonomy are conceptualized as two personality dimensions that relate to an individual's vulnerability to depression. Sociotropy is characterized as an excessive investment in interpersonal relationships and autonomy is characterized as an excessive concern with personal achievement and control over the environment. The present research project consisted of two studies examining the relationships between sociotropy-autonomy and interpersonal patterns in close relationships. Data collected via self-report and behavioural observations suggested that highly sociotropic individuals have a tendency to be high in control and low in affiliation towards individuals who are close to them. In contrast, the data suggested that highly autonomous individuals may be low in both control and affiliation towards people who are close to them. These findings are discussed in the context of the literature regarding the interpersonal characteristics of sociotropic and autonomous individuals. [ABSTRACT FROM AUTHOR]

I estimate the effect of team production on labor productivity and product quality using a cross-section of British establishments, finding that the typical establishment enjoys statistically significant increases in labor productivity (but not product quality) from using teams, although there is no statistically significant difference between the predicted gains from autonomous versus nonautonomous teams. I show that standard methodological approaches that treat teams and autonomy as exogenous induce biases of two forms: (1) the benefits from teams are inflated, and (2) the benefits of autonomous teams relative to those of nonautonomous teams are inflated. [ABSTRACT FROM AUTHOR]

Despite increasing interest over the last 30 years in individual variations in clinical practice, various research studies have thrown only limited light on either understanding or changing doctors’ behaviour. This qualitative study explored a sample of British general practitioners’ accounts of the influences on their prescribing, and identified the locus of the problem in their defence of professional identity through clinical autonomy, a tactic that precluded use of more customary change agents such as line management and economic incentives. The study identified two mechanisms, clinical etiquette and clinical experimentation, however, that enabled change to occur within the constraints imposed by the commitment to clinical autonomy. [ABSTRACT FROM AUTHOR]

Accessible summary For a long time, people tried to stop women with intellectual disabilities from knowing about sex and from having sex., We talked to some women with intellectual disabilities to find out what they thought about sex., Many of the women told us that they thought sex is bad and that they should not do it., We want people to be able to help women with intellectual disabilities to feel confident to make choices about sex., Summary There is very little literature concerning how women with intellectual disabilities conceptualise their sexuality or develop a sexual identity. Semi-structured interview schedules were used to guide interviews with 10 women with intellectual disabilities. Thematic analysis was used to analyse the interview transcripts. Many of the women could not conceptualise themselves as sexual beings, and they tended to regard sex as a dirty and inappropriate activity for them. They generally believed that other people prohibited them from engaging in sexual activity. The women often considered themselves to be of little value, and the majority had no clear sense of identity. It is incumbent upon services to find the means to empower women with intellectual disabilities to acknowledge, welcome and take control of their own sexuality. [ABSTRACT FROM AUTHOR]