Riya Patel

Creative health interventions have been increasingly embedded in local and national public health strategies. More robust evidence is needed to inform implementation at scale. This study qualitatively explored experiences of attending and delivering a group-based creative programme in the United Kingdom and participant perspectives about the influence on health and wellbeing. A qualitative study of six programmes delivered between 2021 and 2023 was co-developed with researchers, creative health programme deliverers, and public health commissioners. Programmes targeted children with additional needs; adults living with mental health/physical health/other challenges; parents and infants; or adults with dementia and their carers. Interviews and focus groups with 62 participants included 49 programme attendees and 13 creative practitioners who delivered the programmes. Reflexive thematic analysis generated five themes: contributing to a journey of improved health and wellbeing, making connections and sharing experiences, creating conditions to promote engagement, finding enjoyment and opportunity in creativity, and practitioners’ experiences of current and future delivery. This qualitative study adds understanding about the holistic benefits and underpinning mechanisms of creative health group-based programmes. Findings revealed participant perspectives about how the creative health programmes influenced their health, wellbeing, and social connection in largely positive ways, and that these experiences were supported by skilled practitioners. The evidence was insufficient to assess how successfully the creative health programmes engaged diverse groups living with the greatest health and wellbeing challenges. Future work is needed to understand the acceptability and effectiveness of creative health programmes among diverse groups to ensure that programmes reduce rather than contribute to health inequalities.

Background: The prevalence of mental health and well-being problems among postgraduate researchers (PGRs) is concerning. Self-care is a protective factor; however, engagement can be low. Interventions to date are not theory-driven nor co-developed. This study assessed the feasibility and acceptability of a co-created, theory-driven digital yoga-based self-care intervention (Pause Grow Reflect). Methods: A 2:1 randomised feasibility trial of the 7-week Pause Grow Reflect intervention and embedded qualitative study was conducted in UK PGRs. Primary outcomes included rates of recruitment, retention, follow-up, adherence, and engagement. Secondary outcomes assessed fidelity, acceptability, adverse events, and preliminary signals of efficacy. Criteria determined progression to a definitive trial. An embedded qualitative study comprising 1:1 semi-structured interviews was guided by the Theoretical Framework of Acceptability (TFA) and data analysed using deductive thematic analysis. Results: PGRs were allocated to the intervention ( n = 24) or control ( n = 13) group. Progression criteria were met for recruitment, T1 assessments, and acceptability, whilst rates of retention, engagement, and T2 follow-up assessments were not. Marginal mean differences for stress were observed. The qualitative data ( n = 10 interviews) showed that all seven TFA domains were important, with issues mostly reported for the constructs of ‘burden’ and ‘opportunity costs’. Conclusion: Pause Grow Reflect was largely feasible to deliver and acceptable within a UK context, and may be a promising offer to promote self-care during doctoral programmes. Further intervention refinement would promote better rates of retention, adherence, and engagement. Preliminary observations were positive, though a larger RCT is needed to determine efficacy.

Background: One million people in England and Wales experience sexual violence and abuse each year, with nearly half experiencing serious sexual offences; around 30,000 survivors access sexual assault referral centres. Objectives: This research was commissioned by National Institute for Health and Care Research to evaluate access, interventions and care pathways for survivors, especially those provided through sexual assault referral centres. Design, setting, participants: The sexual assault referral centres care pathway was investigated through six sub-studies. There were two Cochrane Reviews (4274 participants). Seventy-two providers and 5 survivors were interviewed at eight sites; the children and young people study involved 12 participants from two sexual assault referral centres. A cohort study involving three-wave data collection over 1 year (21 sites; 2602 service users screened, 337 recruited) used a multilevel modelling framework to explore risk factors for burden of post-traumatic stress disorder symptoms at baseline and change at 1 year. We analysed costs and outcomes and conducted a narrative analysis (41 survivors). We worked closely with survivors and prioritised the safety/welfare of participants and researchers. Results: Cochrane Reviews identified large effects from psychosocial interventions for post-traumatic stress disorder and depression. Sexual assault referral centres delivered a high-quality frontline service for survivors but groups experiencing domestic abuse and some ethnic and cultural minorities were under-represented. The qualitative research emphasised inter-agency collaboration for survivor benefit. The cohort study identified a risk ‘triad’ of adverse childhood experiences, poor mental health and economic deprivation, which was associated with baseline trauma burden. There were important improvements in trauma symptoms a year later. These improvements were unrelated to different sexual assault referral centre models. Costs and other outcomes were also similar across models. Harmful policing and justice practices/procedures were identified by 25% of participants. In this context, trauma-competent interviewing techniques, regular/timely updates and conveying case decisions with care signalled good practice. Limitations: The cohort study lacked a comparison group, reducing confidence in the finding that access to sexual assault referral centres explained the reduction observed in post-traumatic stress disorder. Conclusions and future work: Barriers to access call for concerted efforts to implement trauma-informed universal health services. The risk ‘triad’ underscores the value of holistic approaches to care at sexual assault referral centres and timely follow-on care. Poor mental health was the main barrier to service access beyond sexual assault referral centres. The persistence of trauma symptoms a year after accessing sexual assault referral centres signals urgent need for tackling counselling wait-lists, expanding support options and commitment to lifelong care. Multidisciplinary evaluation of sexual assault referral centres for better health provides a foundation for advancing trauma-informed practices in the context of sexual violence and abuse. Study registration: This study is registered as ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825 Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/117/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 35. See the NIHR Funding and Awards website for further award information.

Introduction: Smoking in pregnancy is associated with negative health outcomes for both mothers and babies; e-cigarettes, which contain nicotine without hazardous tobacco, may offer an additional smoking cessation strategy for pregnant women. Although e-cigarettes are being increasingly offered within services, there is limited understanding about whether e-cigarettes can improve smoking cessation support for pregnant individuals. This study aimed to explore service users’ experiences of using e-cigarettes as a tool for smoking cessation during pregnancy. Methods: Semi-structured interviews were conducted with 14 women who had accepted one of two pilots and were analysed using inductive reflexive thematic analysis. The findings from each site were integrated to develop qualitative insight. Results: Participants largely had positive perceptions of the free and easy-to-use e-cigarette, preferring it to nicotine replacement therapies. The desire to have a healthy pregnancy and baby and the inclusion of non-judgemental behavioural support facilitated motivation to quit. Many participants reduced or quit tobacco use, with positive social and health implications reported. However, numerous barriers to quitting were present and intentions about long-term quitting of combustible cigarettes and e-cigarettes were mixed and uncertain. Conclusions: Providing e-cigarettes within smoking cessation services was indicated to be a positive and effective strategy for pregnant women trying to quit tobacco. However, numerous barriers to quitting and staying quit remained, suggesting scope for further improvements to smoking cessation support for pregnant women.

Smoking during pregnancy increases the risk of adverse maternal and foetal health outcomes, with effective smoking cessation support important. E-cigarette use in the general population has increased rapidly in recent years, with their use viewed as an alternate, additional offer to nicotine-replacement therapy and behavioural support. However, their use in pregnancy has limited investigation. This study aimed to understand how two e-cigarette pilots for pregnant women were delivered and implemented. Referrals to the general stop smoking in pregnancy service, as well as pilot enrolment, engagement and outcomes were recorded. Seven professionals involved in pilot 2 design, setup and/or delivery took part in semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR). Transcripts were deductively coded into CFIR. In total, 124 of 296 women accessed at least one visit after being contacted and offered the e-cigarette pilot (Pilot 1: N = 99, Pilot 2: N = 25). In Pilot 2, 13 (of 25) reached 4 weeks, and common reasons for withdrawal by 12 weeks included relapse, loss of contact and no further support wanted. Forty-five (36.3%) validated quits were reported (Pilot 1: 32 of 99 (32.3%); Pilot 2: 13 of 25 (52%)). Facilitators included regular communication and the advisors physically taking e-cigarettes to home visits. Barriers included misalignment between the pilot and the standard treatment offer and availability of the staff resource. Enrolment to both pilots was demonstrated, with greater enrolment in one pilot and notable quit rates among women across both pilots. The perceived role of e-cigarettes for pregnant women varied, and a lack of staff resources explained some challenges. Adaptations may be needed during scale-up, including additional resources and the alignment of the e-cigarette provision to standard treatment.