Victoria Riley

Background: Gambling-related harm is recognised as a public health concern, yet limited synthesis has examined how shame, stigma and indebtedness shape help-seeking and suicidality across gendered and cultural contexts. This review addressed the following question: among individuals experiencing gambling-related harms, how do cultural and gender-based understandings of shame and indebtedness influence suicidality and help-seeking across diverse settings? Methods: This rapid review searched MEDLINE, PsycINFO and CINAHL, alongside grey-literature and reference-list searches, for studies since 2000. Included studies were appraised (CASP, MMAT, or MQC-SP) and synthesised narratively. Results: Twenty-six qualitative, quantitative and mixed-methods studies were included. Gambling was portrayed as socially embedded and normalised, while gambling-related harm remained associated with judgement. Shame was linked to concealment, self-management and delayed disclosure. Indebtedness was associated with concealment, relationship strain, and sometimes made previously hidden gambling-related harm visible; however, the evidence did not allow firm conclusions about its relationship with crisis or suicidality. Help-seeking commonly occurred after harms had escalated and was facilitated by confidential, non-judgemental and culturally appropriate support. Gender and culture shaped meanings of responsibility, control, family reputation and disclosure, but were rarely examined analytically. Conclusions: Public health responses should improve early recognition of gambling-related harm through clear, non-judgemental messaging and stronger links between support services. Further research should clarify how shame, stigma and indebtedness relate to disclosure and suicidal distress, and should evaluate public health messaging, early-support routes, self-directed interventions and support for affected others.

Objectives Digital health interventions (DHIs) show considerable promise in supporting hypertension self-management by promoting preventative care and self-monitoring. While their efficacy is increasingly evident, the long-term uptake, acceptance and sustained engagement with these tools are frequently challenged by issues such as usability, trust and varying user experiences. This review aims to synthesise qualitative evidence to identify barriers and facilitators and the key factors that impact the adoption, acceptance and engagement with DHIs for hypertension self-management. Design Systematic review of qualitative literature using thematic analysis following Cochrane’s qualitative and implementation methods guidance. Data sources PubMed, PsycInfo, Web of Science and the Cochrane Library were searched in February 2025. Eligibility criteria for selecting studies The searches included relevant qualitative and mixed-methods studies on the use of digital devices for hypertension management, which described the barriers and facilitators associated with these tools. We included studies published from 2015 to 2025 to capture relevant evidence. Only studies published in English with a qualitative approach were included. Results From an initial 10 943 identified publications, 15 met our inclusion criteria, primarily originating from Europe and the USA, exploring diverse racial and ethnic group experiences. Our thematic synthesis revealed 7 analytical and 22 descriptive themes detailing barriers and facilitators encountered by patients with hypertension, healthcare providers (HCPs) and caregivers. These themes covered technology utilisation, design components, linguistic and cultural relevance, healthcare factors, trust and credibility and interpersonal interactions. Conclusion Our analysis underscores that factors such as the usability, design and relevance of social support profoundly influence the uptake and acceptance of DHIs in hypertension self-management among patients, caregivers and HCPs. PROSPERO registration number CRD42023480389.

Background: Smartphone apps offer a promising avenue for delivering scalable interventions for hypertension self-management. This study aimed to characterise the behaviour change technique ontology (BCTO) elements present in apps available on popular platforms, map the theoretical domains framework (TDF), and describe the apps’ functionalities. Methods: A comprehensive search of app stores was conducted to identify relevant hypertension self-management apps. The identified apps were then analysed for BCTO elements, which were subsequently mapped to TDF. App functionalities and quality were assessed as well. Results: Functionalities such as self-monitoring were consistently observed across all app types, aligning with established hypertension self-management strategies. However, other key functionalities, including goal setting via reminders, communication with healthcare professionals, and data export capabilities, were less prevalent. AI-empowered apps incorporated a broader range of behaviour change techniques compared to non-AI and RCT-tested apps, suggesting a potentially more comprehensive approach to supporting behaviour change. The domains of “Knowledge”, “Emotions”, “Behavioural regulation”, “Skills”, and “Beliefs about Consequences” were most frequently targeted by app developers. AI-empowered apps incorporated a broader range of BCTs compared to non-AI and RCT-tested apps, potentially offering more comprehensive support for behaviour change. Conclusions: While existing hypertension self-management apps incorporate a variety of BCTs, there is room for improvement in terms of incorporating a wider range of functionalities and BCTOs, particularly those targeting more intrinsic and habitual aspects of behaviour.

Background: NHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators. Methods: Qualitative, semi-structured video-stimulated recall interviews were conducted with patients (n = 40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n = 19) or JBS3 lifetime CVD risk calculator (n = 21). Interviews were transcribed and analysed using reflexive thematic analysis. Results: Analysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding. Conclusions: Effective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes. Trial registration: ISRCTN10443908. Registered 7th February 2017.

Background: It is well documented that individuals struggle to understand cardiovascular disease (CVD) percentage risk scores, which led to the development of heart age as a means of communicating risk. Developed for clinical use, its application in raising public awareness of heart health as part of a self-directed digital test has not been considered previously. Objective: This study aimed to understand who accesses England’s heart age test (HAT) and its effect on user perception, knowledge, and understanding of CVD risk; future behavior intentions; and potential engagement with primary care services. Methods: There were 3 sources of data: routinely gathered data on all individuals accessing the HAT (February 2015 to June 2020); web-based survey, distributed between January 2021 and March 2021; and interviews with a subsample of survey respondents (February 2021 to March 2021). Data were used to describe the test user population and explore knowledge and understanding of CVD risk, confidence in interpreting and controlling CVD risk, and effect on future behavior intentions and potential engagement with primary care. Interviews were analyzed using reflexive thematic analysis. Results: Between February 2015 and June 2020, the HAT was completed approximately 5 million times, with more completions by men (2,682,544/4,898,532, 54.76%), those aged between 50 to 59 years (1,334,195/4,898,532, 27.24%), those from White ethnic background (3,972,293/4,898,532, 81.09%), and those living in the least deprived 20% of areas (707,747/4,898,532, 14.45%). The study concluded with 819 survey responses and 33 semistructured interviews. Participants stated that they understood the meaning of high estimated heart age and self-reported at least some improvement in the understanding and confidence in understanding and controlling CVD risk. Negative emotional responses were provoked among users when estimated heart age did not equate to their previous risk perceptions. The limited information needed to complete it or the production of a result when physiological risk factor information was missing (ie, blood pressure and cholesterol level) led some users to question the credibility of the test. However, most participants who were interviewed mentioned that they would recommend or had already recommended the test to others, would use it again in the future, and would be more likely to take up the offer of a National Health Service Health Check and self-reported that they had made or intended to make changes to their health behavior or felt encouraged to continue to make changes to their health behavior. Conclusions: England’s web-based HAT has engaged large number of people in their heart health. Improvements to England’s HAT, noted in this paper, may enhance user satisfaction and prevent confusion. Future studies to understand the long-term benefit of the test on behavioral outcomes are warranted.

We present a case study ofspecialist welfare advice and advocacy for people experiencingmultiple disadvantage (i.e. a combination of homelessness, contactwith the criminal justice system, substance misuse, mental illhealth). Drawing primarily on qualitative interviews with staff andstakeholders, we demonstrate the need for, and success of, specialistbenefits advice for this customer group. Substantial financial gainswere awarded, providing a greater level of security and stability,which increased customers’ housing options. We highlight a need forgreater recognition across organisations that work with customersexperiencing multiple disadvantage, that welfare benefits are a legalentitlement. Implications for policy and practice are discussed,including the importance of: developing confidence and a ‘lawinformed’ mindset in frontline staff; advisors buildingrelationships with staff to achieve this; preparatory work withpartner organisations to develop a shared understanding of what isinvolved and expectations. Ultimately, a culture of legal literacymust be cultivated at the individual (frontline staff) andorganisational (partner host) levels. Stakeholders had concerns aboutthe future of such initiatives in the context of further fundingcuts; there is a risk that legal literacy development programmesbecome marginalised at a time when they are most needed.

Background: As part of a multifaceted approach to patient and public involvement and engagement (PPIE), alongside traditional methods, a closed Facebook group was established to facilitate PPIE feedback on various aspects of a project that used video‐recording to examine risk communication in NHS Health Checks between June 2017 and July 2019.Objective: To explore the process and impact of conducting PPIE through a closed Facebook group and to identify the associated benefits and challenges.Methods: Supported by reflections and information from project meetings used to document how this engagement informed the project, we describe the creation and maintenance of the Facebook Group and how feedback from the group members was obtained. Facebook data were used to investigate levels and types of engagement in the closed Facebook group. We reflect on the challenges of using this method of engaging the public in health research.Results: A total of 289 people joined the ‘Risk Communication of Cardiovascular disease in NHS Health Checks’ PPIE closed Facebook group. They provided feedback, which was used to inform aspects of the study, including participant‐facing documents, recruitment, camera position and how the methodology being used (video‐recorded Health Checks and follow‐up interviews) would be received by the public.Discussion: Using a closed Facebook group to facilitate PPIE offered a flexible approach for both researchers and participants, enabled a more inclusive method to PPIE (compared with traditional methods) and allowed rapid feedback. Challenges included maintaining the group, which was more labour intensive than anticipated and managing members' expectations. Suggestions for best practice include clear communication about the purpose of the group, assigning a group co‐ordinator to be the main point of contact for the group, and a research team who can dedicate the time necessary to maintain the group.Conclusion: The use of a closed Facebook group can facilitate effective PPIE. Its flexibility can be beneficial for researchers, patients and public who wish to engage in the research process. Dedicated time for sustained group engagement is important.Patient or Public Contribution: Patient representatives were engaged with the development of the research described in this paper and a patient representative reviewed the manuscript.