Sarah Hanson

Aim: People seeking asylum and with refugee status (ASR) often face worse health outcomes compared to host populations. Despite this, ASR are underserved in healthcare and research, resulting in a knowledge gap about what promotes their health and resilience. The aim of this review is to define what ASR communities express makes them well despite adversity by looking at the assets of individuals and communities identified in community-based research. Method: A scoping review of peer-reviewed papers and grey literature documenting patient-centred holistic health, wellbeing and social outcomes in community-based research with ASR. Results: In total, 24 papers met the inclusion criteria. Wellbeing was primarily defined by safety, empowerment and a sense of purpose. Three things matter most for wellbeing: gaining knowledge and skills (like language and education), having meaningful things to do (like work or volunteering) and access to connections you care deeply about (like family, culture and faith). Conclusion: The study demonstrates that wellbeing for ASR is multifaceted, encompassing psychological, social and cultural dimensions. Asset-based approaches support holistic wellbeing in underserved populations by shifting the focus from identifying problems and deficits to recognising and building upon strengths, capabilities and existing resources. Although there are challenges in measurement, qualitative and participatory research approaches are proving effective in capturing the complex needs and outcomes for this population.

Acquired brain injury (ABI) encompasses a heterogeneous group of conditions characterized by damage to the brain that is acquired after birth, including traumatic brain injury (TBI), stroke, tumour...

Multimorbidity (having more than one long‐term condition) is common for people with dementia and leads to increased healthcare needs and poorer outcomes for those individuals and also their informal carers. In the United Kingdom, part of the management of comorbidities occurs through annual long‐term condition reviews in primary care. To date, there has been little research on the experiences of people with dementia and their informal carers with regard to these reviews. A qualitative study of people with dementia and informal carers recruited across England was undertaken, exploring their experiences of long‐term condition reviews in primary care. Semistructured interviews with 16 participants (two people with dementia, 10 informal carers, and 2 informal carer/people with dementia dyads) were conducted via telephone, and the principles of reflexive thematic analysis were used to analyze the data. We identified four main themes from the data: (1) What matters to people (identifying and meeting both medical and holistic needs), (2) the experience of the review (the wide range of experiences), (3) the importance of communication (the desire for better communication), and (4) the involvement of people with dementia and carers in decisions (their wish to be involved, the lack of opportunity for this, and how this reduces shared decision‐making and patient‐led care). Our findings suggest that current long‐term condition reviews are frequently not meeting the needs of people with dementia and their informal carers. Initial strategies to improve long‐term condition review should include ensuring that patients and informal carers (including informal carers of people with dementia in residential homes) are able to participate in the reviews. Further research with key stakeholders is now needed to improve our understanding of current organizational and clinician perspectives and to aid in optimizing long‐term condition reviews.

Purpose: Community behaviour change interventions are a promising strategy for addressing unhealthy eating and physical activity behaviours in underserved populations. This review explores these interventions' characteristics by focusing on behaviour change techniques, evaluates their behaviour change effectiveness and examines participant experiences. Methods: A mixed‐methods rapid review was conducted. Five databases and the grey literature were searched and supplemented by hand searching. Results were screened, assessed for methodological quality and data extracted using the Behaviour Change Techniques Ontology. A convergent segregated approach was used to synthesize the results. Results: Twenty‐one studies were included. Commonly used behaviour change techniques were social support, guidance on how to perform the behaviour and monitoring. Intervention effects on healthy eating and physical activity behaviour change were small, but outcomes that measured influences on behaviour change (e.g., social support) improved. Participants reported largely positive experiences, mostly attributed to the intervention's tailoring to the target population's contexts and the engagement and expertise of those who delivered the intervention. Conclusions: Evidence of direct behaviour change remains limited; there is stronger evidence for improvements in factors that influence behaviour change. Qualitative evidence highlights the value of tailoring interventions to participants' lives and using relatable, knowledgeable sources for delivery. This could enhance engagement and contribute to improved outcomes over time. Further research is needed on how contextual tailoring is implemented and how the characteristics of those delivering interventions influence effectiveness and experience. Findings support the potential of community‐centred approaches, but long‐term evaluations in underserved contexts are needed.

Intimate partner abuse (IPA) conducted solely on a subtle level has not previously been studied, inhibiting therapist recognition and leading to potential further victim harm. This qualitative study explored the experience of subtle abuse amongst women of high educational and socioeconomic status (HESES) and therapists who had worked with similar women, to aid recognition. One over-arching theme of incongruence occurred in all a victim’s relationships, including with themselves and with therapists. Victims’ abuse-responding behaviours and abuse-related shame linked with their HESES. Identification of incongruence among victims and others, such as therapists, is central to the recognition of subtle abuse.

Objectives: Investigate the use of machine learning to expedite thematic analysis of qualitative data concerning factors that influenced health behaviours and wellbeing during the COVID‐19 pandemic. Design: Qualitative investigation using Machine‐Assisted Topic Analysis (MATA) of free‐text data collected from a prospective cohort. Methods: Free‐text survey data (2177 responses from 762 participants) of influences on health behaviours and wellbeing were collected among UK participants recruited online, using Qualtrics at 3, 6, 12 and 24 months after the COVID‐19 pandemic started. MATA, which employs structural topic modelling (STM), was used (in R) to discern latent topics within the responses. Two researchers independently labelled topics and collaboratively organized them into themes, with ‘sense checking’ from two additional researchers. Plots and rankings were generated, showing change in topic prevalence by time. Total researcher time to complete analysis was collated. Results: Fifteen STM‐generated topics were labelled and integrated into six themes: the influences of and impacts on (1) health behaviours, (2) physical health (3) mood and (4) how these interacted, partly moderated by (5) external influences of control and (6) reflections on wellbeing and personal growth. Topic prevalence varied meaningfully over time, aligning with changes in the pandemic context. Themes were generated (excluding write‐up) with 20 h combined researcher time. Conclusions: MATA shows promise as a resource‐saving method for thematic analysis of large qualitative datasets whilst maintaining researcher control and insight. Findings show the interconnection between health behaviours, physical health and wellbeing over the pandemic, and the influence of control and reflective processes.

Objectives To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of a pain management training intervention to support people with persistent musculoskeletal pain and their informal carers. Design Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study. Setting National Health Service (NHS) providers in four English hospitals. Participants Adults receiving NHS care for persistent musculoskeletal pain and their informal carers. Intervention Control: usual NHS care. Experimental: usual NHS care plus a carer-patient pain management training intervention (JOINT SUPPORT), comprising five, 1-hour, group-based sessions for patients and carers, delivered by trained physiotherapists or occupational therapists. Content included understanding pain, pacing, graded activity, fear avoidance, goal-setting, understanding the benefits of physical activity and medication management. This was re-enforced with a workbook. After the group-based sessions, patients and carers were supported through three telephone sessions. Randomisation Central randomisation was computer-generated (2:1 Experimental:Control), stratified by hospital and patient-participant age (≤65 years). There was no blinding. Main outcome measures Data collected at baseline and 3 months post-randomisation included screening logs, intervention logs, fidelity checklists and clinical outcomes on quality of life, physical and emotional outcomes, adverse events and resource use. Interviews with 14 patient-carer participants and six health professionals who delivered the intervention. Results A total of 76 participants (38 patients; 38 carers) were enrolled. Sixty per cent (312/480) of patients screened were eligible with 12% consenting to be randomised (38/312). Fifty-four per cent (13/24) of the experimental group reached minimal compliance with the JOINT SUPPORT intervention. There was no evidence of treatment contamination. For patient-participant outcomes, within-group differences from baseline to 3 months favoured the control group when assessed by EQ-5D and Generalised Self-Efficacy total score, but favoured the intervention group when assessed by numerical rating scale pain, fatigue and Centre for Epidemiologic Studies Depression Scaletotal score. Qualitative data demonstrated the acceptability of the trial design and JOINT SUPPORT intervention with modifications to improve trial processes. Conclusions The JOINT SUPPORT intervention was acceptable to patient-carer dyads and health professionals. Modifications to trial design, particularly enhanced recruitment strategies, are required. Trial registration number ISRCTN78169443. Data availability statement The data that support the findings of this study are available from the corresponding author (TS) on reasonable request. This includes access to the full protocol, anonymised participant-level dataset and statistical code.

Objectives: Women in the criminal justice system and women who have been subject to domestic abuse are at high risk of cancer but underrepresented in health promotion research. We aimed to co‐produce, pilot and evaluate a health promoting programme delivered on group walks.Design: A programme co‐produced by women, based on motivational interviewing, created the opportunity for supportive conversations about cancer prevention.Methods: Programme development in two workshops with women with lived experience using authentic vignettes to prompt help‐seeking conversations. A small pilot and a qualitative evaluation was done using framework analysis.Results: The programme appeared acceptable to women and the walk leaders. Women felt included and found it a safe space for sensitive conversations. They appeared empowered and more confident to seek help. Walk leaders expressed confidence in delivering this informal programme, which used prompts rather than delivering didactic training.Conclusion: Cancer prevention for high‐risk groups can be delivered in a personalised and novel way by creating informal opportunities for supportive conversations about cancer prevention. Careful co‐production of the programme of walks with women, using scenarios and quotes that were authentic vignettes, ensured that these came directly from the women's lived experience and enabled women to talk about change. Our findings indicate that this approach was practical, relevant and acceptable to them with some evidence of women feeling empowered to make informed decisions about their health. We recommend that future cancer prevention programmes for underrepresented groups take an asset‐based approach by utilising pre‐existing community organisations to increase reach and sustainability.Patient and Public Involvement: Women with lived experience co‐designed and tested the programme. Provisional findings were fed back to the women and the women's organisation that partnered with this research.

The number of displaced people, including asylum seekers and refugees, in the UK continues to rise. This article highlights findings from two participatory community listening exercises on the topic of health of displaced people.