Paul Flowers

Background: Residents of care homes for older people are at risk of illness and hospitalisation from respiratory infections. Care home industry pay and conditions may contribute to the risk that staff will transmit infection to residents at times when respiratory viruses are circulating. We sought to understand post-pandemic care home providers’ policies and practices on care home testing for COVID-19, sickness absence due to respiratory infections and consequent shift backfill in English care homes, and to explore the costs to providers of outbreaks of respiratory infections. Methods: In mid-2024, we interviewed 11 senior managers from 10 privately owned care homes or care home groups across England providing services to older people. The sample was diverse in terms of region, size of provider and Care Quality Commission rating. Interview transcripts were analysed using the framework approach and findings tabulated. Results: At the time of the interviews, none of the care homes conducted asymptomatic COVID-19 testing. A minority required staff with respiratory infection symptoms to test for COVID-19. Policy for most providers was to only pay Statutory Sick Pay (SSP) to symptomatic staff. Few offered enhanced sickness pay. Care homes backfilled vacant shifts by offering other employed staff the extra shifts, calling in internal bank staff, zero-hours contractors, or care agency staff. Outbreaks of respiratory illness could increase costs for providers in replacement staffing, personal protective equipment, cleaning hours and equipment, additional administrative duties, and loss of income from new residents due to home closure. Conclusions: Care homes’ COVID-19 testing and sickness pay policies were in line with current public health guidance on COVID-19 testing and SSP regulations. Pay and conditions have been linked to presenteeism in the social care sector and may contribute to the risks of staff transmission to residents at times when respiratory infections are highly prevalent. Although regular staff testing combined with self-isolation for those who test positive may be effective in reducing transmission of infection, such policies require careful design given the important financial implications for care workers, care home providers and for the wider public health and care sector.

This paper examines the biopolitics of public health science concerning antibiotic prophylaxis and queer bodies. Some experts recommend that antibiotic prophylaxis should be used to curb the growing burden of sexually transmitted infections among queer people. Other experts caution that antibiotic prophylaxis will contribute to the rise of antibiotic resistance. Prescribers and patients therefore face a dilemma about the use of antibiotics that is yet to be resolved. With reference to queer sociomaterialism, we examine the antibiotic prophylaxis-resistance problem to understand its historical situatedness and the (mis)representation of queer bodies. By drawing on immunity and the body scholarship developed in this journal and elsewhere, we consider the epistemic elisions in the scientific practices of prophylaxis knowledge generation and how experts and advocates have attempted to build consensus with this partial evidence. We identify an agenda for building queer sociomaterial knowledge to help address the antibiotic prophylaxis-resistance nexus.

BACKGROUND Increasing reliance on digital health interventions (DHIs) may inadvertently deepen some health inequalities, as access to digital technologies and online services remains unequal across populations. Public libraries offer wider access and support to digital technology and are frequently used to support health in the community, particularly for underserved populations. Hence, public libraries are ideally positioned to improve access to DHIs, mitigating the inequalities resulting from the increasing digitalization of health care. Despite this potential, systematic ways of optimizing DHI implementation in public libraries remain under-explored. OBJECTIVE This study addressed two research questions: 1) What are the barriers and facilitators to implementing DHIs in public libraries in the published literature? 2) How can the behaviour change wheel (BCW) approach be applied to systematically develop recommendations to optimize the implementation of DHIs in public libraries? METHODS 1) Verbatim barriers and facilitators from a scoping review were synthesized into barrier/facilitator themes and organized into 3 levels: the system, organizational and individual levels of influence. 2) A multi-level BCW analysis was conducted on selected synthesized barrier/facilitator themes to develop actionable recommendations for implementation at the system, organizational and individual levels. The analysis was iteratively refined with input from behavior change experts. RESULTS 1) Synthesized barriers/facilitators themes (n = 15) were highly varied. System-level barrier/facilitator themes (n = 4) primarily related to structural challenges, including financial constraints and the availability of essential IT components for implementation of DHIs; organizational-level barrier/facilitator themes (n = 7) centered implementation challenges within the library including staff workload, skills and confidence, and private space; individual-level barrier/facilitator themes (n = 4) related to library staff perceptions and beliefs, including concerns around, and motivations for, supporting access to DHIs in libraries. 2) Recommendations from the BCW (n = 26), were organized into recommendation themes (n = 11). System-level recommendation themes included promoting libraries as trustworthy public-serving spaces. Organizational-level recommendation themes included introducing implementation champions, providing minimal, tailored staff training, and employing practical strategies to reduce workload burden. Individual-level recommendation themes included communicating to library staff their expected role of facilitating technological access to DHIs, and the benefits offered by library–based DHI delivery. CONCLUSIONS This study is the first to synthesize barriers and facilitators to the implementation of DHIs in public libraries, and to offer evidence-based and theory-informed recommendations optimizing implementation. By advancing the literature beyond description of implementation to offering actionable and practical recommendations, this study lays the groundwork for future implementation efforts, tailored to local contexts. This paper therefore represents a practical roadmap for positioning public libraries as a crucial avenue to advance digital health equity amidst the increasing digitalization of health care intervention delivery. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1101/2024.12.12.24318940

Purpose: Chronic pain impairs work participation. Psychological interventions can support people with chronic pain to work, yet little is known about which components are most effective. A systematic review and meta‐analysis assessed the effectiveness of interventions targeting sick leave, return to work, work ability and work‐related self‐efficacy in chronic pain populations. Intervention content was analysed to identify effective components. Methods: A search strategy was developed and applied to six databases from inception until 2nd March 2023, being updated in December 2024: PsychInFO, Medline, Cinahl, Web of Science, Cochrane Library and Embase. Intervention descriptions were coded for intervention functions, theoretical domains and behaviour change techniques. Risk of bias was assessed using the ROB‐2 tool. Results: 51 randomized controlled trials were identified. Study quality was poor overall. Meta‐analysis showed that psychological interventions were complex, that is, contained multiple components delivered alongside other interventions, which together were associated with reduced sick leave (SMD −.41, 95% CI: −.64 to −.18) and a small increase in those working at long‐term follow‐up (>12 months) (RR 1.03, 95% CI: 1.01–1.06; I ² = 0%) but not work ability/capacity (SMD −.02, 95% CI: −.12–.08, I ² = 0%) or return to work (RR .98, 95% CI: .91–1.05, I ² = 0%). No intervention components appeared most effective, but five common components were identified: education, skills/training, social support, emotional regulation, and confidence building. Conclusion: Complex psychological interventions can positively influence work outcomes for people with chronic pain. Future research should prioritize high‐quality studies and incorporate the five components to enhance work‐focussed support.

Scaling up hepatitis C virus (HCV) testing and treatment for people who inject drugs (PWID) is essential to achieve HCV elimination. We report a retrospective systems‐informed qualitative process evaluation of HCV care across multiple community‐based settings in a region in Scotland, UK. Using secondary data from 71 semi‐structured interviews with HCV service providers ( n = 40) and service users ( n = 31) from across the whole system, we identified universal barriers and facilitators of delivering HCV care (access, testing, treatment, support) within four settings (i.e., enhanced needle and syringe programme services, prisons, pharmacies and drug treatment centres). HCV care had been delivered. We report only one, universal barrier (staff skills and confidence in HCV testing). Systemic HCV care can be delivered through coordinated, multi‐levelled actions across a given service ecology within a geographical area. Such systemic approaches are needed to achieve HCV elimination targets for the whole PWID population.

Background: Regular severe acute respiratory syndrome coronavirus 2 testing of care home staff was introduced to reduce transmission following significant morbidity, mortality and disruption for residents early in the pandemic. However, evidence was lacking on benefits relative to disadvantages. Objectives: The VIVALDI-Clinical Trial aimed to investigate whether regular asymptomatic staff testing for severe acute respiratory syndrome coronavirus 2, alongside funding for sick pay and agency backfill, was feasible and effective in reducing severe coronavirus disease discovered in 2019-related outcomes in residents. Design and methods: VIVALDI-Clinical Trial comprised five interlinking work packages. A cluster randomised controlled trial was conducted from January to August 2023. The ‘Test to Care’ intervention was coproduced with the care sector. Settings and participants: Eighty-one residential/nursing homes in England providing care to adults aged ≥ 65 years. Forty-one homes were randomised to intervention and 40 to control. Interventions: Care homes were randomised 1 : 1 to intervention (twice weekly staff testing, staff sick pay and agency backfill) or control arm (national testing guidance at time of trial). Main outcome measure: Primary outcome was incidence of coronavirus disease discovered in 2019-related hospital admissions in residents. Data sources: Health data from routine national data sets were used alongside aggregate data from participating homes. Health economic and modelling analyses evaluated costs and cost-effectiveness of staff testing. Interviews with care home managers explored post-pandemic policies on staff testing, sickness pay and absence. A process evaluation was conducted to understand intervention roll-out. A mixed-study design investigated the impact of coronavirus disease discovered in 2019 outbreaks on care home residents’ quality of life. Stakeholder engagement was undertaken to enable the sector to coproduce recommendations for policy-makers. Results: The trial stopped early for futility due to site recruitment and primary outcome incidence being lower than expected. There was no significant difference in resident coronavirus disease discovered in 2019-linked hospital admission incidence between intervention and control arms (incidence rate ratio 1.19, 95% confidence interval 0.55 to 2.58; p = 0.66). The process evaluation found that changing epidemiology, policy and social norms around coronavirus disease discovered in 2019 shaped the uptake and maintenance of testing. Interviews with care home managers suggested most homes no longer test staff, even when symptomatic, and do not pay for sickness absence outside of statutory sick pay. Modelling concluded that regular staff testing, when combined with non-pharmaceutical interventions preventing transmission among residents, is an effective strategy to reduce cases and deaths among care home residents that could also lead to significant cost savings. There was lower-than-expected quality of life for 43 residents from 9 care homes without outbreak and 1 home with recent coronavirus disease discovered in 2019 outbreak, with older residents experiencing greater benefits from social care support. Limitations: Intervention acceptability was initially high, but waned because of the changing epidemiological, policy and social context. Conclusions: Contextual changes undermined our ability to evaluate the intervention’s impact. However, trial set-up was achieved in < 3 months, and we present findings on the feasibility and economic implications of routine testing and impact of disease control measures on residents’ quality of life. Costs associated with severe acute respiratory syndrome coronavirus 2 testing including support payments for care home staff and for care homes to fund agency staff backfill were funded by the United Kingdom Health Security Agency. Future work: Our approach provides a model for agile interventional studies in care homes. Research training and capacity building for care home staff are important to ensure that future trials can be delivered efficiently in this setting. Funding: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR154310.

This is a very soft, non-systematic review that synthesises key points across a broad literature. There is no clear account of how the review was accomplished and how the search strategy was operationalised. It summarises a few points from the literature in a list-like way and may be good to support students as discussion points, but it's hard to see how it could be useful for the future of designing health communication campaigns. I think the same results could have been gathered by using a large language processor (maybe this would have been more systematic).

Services delivered by peer workers (people with lived/living experience) are recommended to find, test, and treat those at risk of hepatitis C (HCV). However, there is a lack of knowledge around the characteristics and underlying mechanisms of existing HCV peer interventions and how these drive effectiveness and impact. This systematic scoping review aimed to identify the activities of peer interventions, their reported outcomes, and mechanisms of change. We systematically searched five databases (Scopus, PubMed, Embase, PsycINFO and Web of Science) for peer‐reviewed papers which described HCV peer interventions in OECD countries published between 2012 and 2022, informed and structured by the PRISMA extension for scoping reviews and scoping review reporting guidance. All identified studies were double screened at title and abstract and full text stage. Twenty‐nine studies met our inclusion criteria. In 23 studies, peer workers delivered interventions, mostly focused on outcomes for intervention recipients. Peer workers improved HCV care linkage, testing, treatment and SVR12 rates. Peer workers themselves reported increased confidence, job satisfaction, improved mental wellbeing, employability and social integration into communities. Key activities and peer intervention elements were occasionally documented, but more often omitted. None of the included studies explicitly documented or theorised underlying mechanisms, that is, how or why peer interventions work. The lack of details and mechanistic descriptions of peer interventions negatively impact the ability to optimise and enhance peer‐led HCV care. This potentially undermines the elimination of HCV at population level.

Introduction: People from underserved groups experience disproportionately poor sexual health and challenges accessing care. Asynchronous online consultations (a user completes a health questionnaire online, which is reviewed by a clinician) are being used within sexual healthcare to prescribe chlamydia treatment. Users require sufficient health and digital literacy to access online services and use them safely. Methods: We used the PROGRESS-Plus (PROGRESS: Place of Residence, Race/Ethnicity, Occupation, Gender/Sex, Religion, Education, Socio-economic Status, Social Network; Plus: e.g., Age, Sexual Orientation, Disability) framework to guide purposive recruitment of 35 participants from diverse underserved groups, from community settings and sexual health services in contrasting areas of the UK (15 October 2021–18 March 2022). We conducted qualitative semistructured interviews and thematic analyses to derive key barriers and facilitators to using asynchronous online consultations. We applied the Behaviour Change Wheel to specify recommendations to address them. Results: Over half of participants were from the most deprived areas and 40% were from minoritised ethnic groups. Key barriers included: lack of familiarity with online healthcare; perceived need to see a healthcare professional in person; privacy concerns; concerns about difficulty interpreting the questions; discomfort answering personal questions online. Key facilitators included: familiarity with online consultations; perceived low sexually transmitted infection risk; perceived increase in convenience, control and privacy; simple wording and design; and support while completing them. Recommendations included: increasing awareness and familiarity by promoting them offline and online and providing demonstrations and instructions on how to use them; encouraging people to choose them by highlighting available support, equivalence to in-person consultations and privacy and convenience; and reducing attrition by using simple wording and design, providing additional explanations and offering audio and visual alternatives to text. Conclusions: Incorporating these evidence-based, theoretically informed recommendations could widen access to underserved groups and increase the usability and safety of asynchronous online consultations for chlamydia treatment. Recommendations are likely to benefit all users and could be of use across health more broadly.

Lesbian, gay, bisexual, trans, queer, questioning, intersex, and other sexual orientation and gender-diverse (LGBTQI+) youth face a disproportionate burden of poor sexual and reproductive health, i...