William Hodgson

Background/Objectives: Trauma-informed practice emphasises psychologically safe organisational environments, yet physical activity has received limited attention within it. This study examined whether frontline organisations recognise and enable physical activity, and whether its promotion and accessibility are associated with psychological safety and other trauma-informed organisational conditions.Methods: This secondary analysis used cross-sectional data from 270 UK frontline workers (67.4% women) who completed the physical activity section of a national survey of organisational readiness for trauma-informed practice. Bivariate analyses and multivariable logistic regression were conducted.Results: Most participants (80.7%) reported that physical activity often or always benefited their wellbeing, yet only 38.9% reported organisational promotion and 47.0% accessible opportunities. Psychological safety was associated with promotion (Cramér’s V = 0.50) and accessibility (V = 0.37) and remained associated with promotion after adjustment (aOR = 2.12, 95% CI 1.04–4.33), although not robustly across sensitivity analyses. Trauma-informed leadership and leadership advocacy for mental health resources were robustly associated with both outcomes.Conclusions: A clear gap separated workers’ recognition of the value of physical activity from organisational enablement. Physical activity should be considered within trauma-informed workforce practice rather than framed solely as individual self-care, with psychological safety and trauma-informed leadership as potential targets for organisational intervention.

BACKGROUND Background: Frontline workers are essential workers who keep the public safe, deliver care, and sustain the services on which society depends. Their work brings repeated exposure to trauma and chronic stress, making resilience building and timely support a workforce priority. Yet stigma, confidentiality concerns, and workload patterns and pressures deter help-seeking, and most digital mental health tools are generic rather than trauma-informed or occupationally tailored. Sentinel is a co-created, trauma-informed, self-guided digital intervention developed with frontline workers to build resilience and offer early support. OBJECTIVE We aimed to evaluate changes in mental health, well-being, burnout, and psychological safety outcomes following 6 weeks of access to Sentinel; to characterize acceptability and engagement; and to explore frontline workers’ experiences of using the intervention. METHODS In this 6-week single-arm convergent mixed methods study across multiple UK frontline sectors, participants, recruited from August 2025 to July 2026, completed pre- and postintervention measures of posttraumatic stress, depression, anxiety, stress, mental well-being, burnout, work engagement, psychological safety, quality of life, and posttraumatic growth. Acceptability and engagement were assessed using the User Version of the Mobile Application Rating Scale (uMARS) and participant-reported frequency of use. Semistructured interviews were analyzed using reflexive thematic analysis, and findings were brought together in an integrated results matrix. RESULTS Of 1178 individuals who accessed the survey, 438 (37.2%) provided baseline data and were enrolled; 109 (24.9%) completed a matched postintervention assessment, and 15 were interviewed. Participants were most commonly transportation workers (148/392, 37.8%) and paramedics or ambulance staff (71/392, 18.1%). In exploratory, unadjusted analyses of matched completers, improvements occurred on 11 of 14 outcomes, including posttraumatic stress symptoms (Cohen d=−0.31; P=.002), depression (d=−0.47; P<.001), stress (d=−0.40; P<.001), anxiety (d=−0.22; P=.02), burnout (d=−0.38; P<.001), mental well-being (d=0.42; P<.001), psychological safety (d=0.29; P=.003), and health satisfaction (d=0.39; P<.001). Work engagement, posttraumatic growth, and the psychological safety compassion subscale showed no statistically significant change. App quality was rated favorably (uMARS mean 4.03/5, SD 0.64), and 72 of 112 respondents (64.3%) used the app at least weekly. Six themes described in-the-moment support, reduced fear of judgment, accessibility, emotional validation, cultural barriers to engagement, and the importance of organizational endorsement. CONCLUSIONS Among matched completers, posttraumatic stress, depression, anxiety, stress, burnout, well-being, and psychological safety improved over 6 weeks of access to Sentinel, with small-to-medium effects, alongside favorable acceptability and regular engagement among most respondents. Qualitative findings suggest that private, occupationally relevant, in-the-moment support may help workers attend to their mental health where acknowledging distress carries professional risk. Given the single-arm design and substantial attrition, changes cannot be attributed solely to the intervention. These findings justify a prospectively registered randomized controlled trial of Sentinel as an early intervention and prevention tool within organizational mental health pathways. CLINICALTRIAL International Registered Report Identifier (IRRID): RR2-10.2196/72250 INTERNATIONAL REGISTERED REPORT RR2-10.2196/72250

Background: Frontline workers are routinely exposed to traumatic and highly stressful events. Although the psychological effects of occupational trauma are well established, evidence suggests that these effects extend beyond the family members, affecting their psychological health, relationships, and functioning. Reported outcomes include secondary traumatic stress, psychological distress, caregiver burden, relationship difficulties, disrupted family functioning, and broader social impacts. However, evidence remains fragmented across occupational groups, disciplines, methodological approaches, and sociocultural contexts, limiting understanding of how occupational trauma affects families and hindering the development of family-inclusive, trauma-informed policies and services. Objective: This scoping review aims to systematically map and synthesize evidence on family outcomes associated with occupational trauma exposure among civilian frontline workers. It will characterize psychological, relational, social, and family functioning outcomes; examine variation across occupations, family roles, and sociocultural contexts; explore how family impacts have been conceptualized and measured; identify methodological approaches; and identify evidence gaps to inform future research, policy, and family-inclusive, trauma-informed practice. Methods: The review will be conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), the Joanna Briggs Institute methodological framework, and relevant elements of the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension). Comprehensive searches will be conducted from database inception to the final search date in PubMed (MEDLINE), PsycINFO, CINAHL, Web of Science, and Scopus. Eligible qualitative, quantitative, and mixed methods primary research will examine psychological, relational, social, or family functioning outcomes among family members of civilian frontline workers. Two reviewers will independently screen studies and chart data using a standardized framework, with disagreements resolved through discussion or consultation with a third reviewer. Evidence will be synthesized using narrative synthesis and evidence mapping. Results: Protocol development was undertaken between December 2025 and July 2026, including preliminary scoping searches; refinement of the Population, Concept, and Context (PCC) framework and eligibility criteria; development of the search strategy; stakeholder consultation; and piloting of the data-charting framework. No specific external funding was received for this review. As this is a scoping review, participant recruitment is not applicable. At the time of protocol submission, formal database analysis had not commenced. Comprehensive database searches and study screening are projected to commence in August 2026, with data charting and evidence synthesis undertaken between September and October 2026. Completion of the review is anticipated by November 2026, with publication of the review findings expected by the end of 2026. Conclusions: This review will comprehensively map how family outcomes associated with frontline occupational trauma have been conceptualized, measured, and reported across diverse civilian frontline occupations. It will identify evidence gaps, inform future research priorities, and support the development of family-inclusive, trauma-informed policies, services, and interventions for frontline workers and their families.

BACKGROUND Background: Frontline professionals are routinely exposed to trauma and occupational stress yet face persistent barriers to help-seeking, including stigma, confidentiality concerns, and limited access to timely support. Despite these challenges, frontline professionals consistently demonstrate resilience and sustained functioning under pressure, highlighting the need for interventions that protect psychological wellbeing within demanding systems rather than locating distress solely at the individual level. Digital mental health interventions offer scalable and potentially discreet solutions; however, few undergo structured concept and design evaluation prior to feasibility testing. OBJECTIVE Objective: Guided by the UK Medical Research Council (MRC) framework for complex interventions, this study aimed to evaluate the concept and design of a trauma-informed digital mental health app for frontline professionals. Specifically, we examined perceived acceptability, visual appeal, content appropriateness, credibility, perceived usefulness, and preferred design features, alongside identifying barriers and facilitators to adoption. METHODS Methods: A cross-sectional mixed-methods survey was conducted with 1,125 frontline professionals across healthcare, emergency services, transportation, social care, military, and related high-risk sectors. Participants completed a structured prototype walkthrough followed by quantitative ratings of visual appeal, content appropriateness, content relevance, credibility, perceived usefulness, and current digital mental health behaviours. Open-text responses were analysed using the Framework Method to identify themes related to implementation, trust, and occupational fit. Quantitative data were summarised descriptively, and internal consistency of the prototype evaluation scale was assessed. RESULTS Results: Participants reported relatively low routine use of mobile apps for their own mental health but strong endorsement of the potential usefulness of a frontline-specific digital intervention. The prototype received favourable ratings across domains of visual appeal (M=3.82, SD=0.67), appropriateness for the target audience (M=4.34, SD=0.84), content relevance (M=4.15, SD=0.79), and credibility (M=4.29, SD=1.03), with appropriateness and credibility receiving the highest endorsement. The four-item evaluation scale demonstrated acceptable internal consistency (Cronbach’s α=.75). Preferred features prioritised personalised guidance and rapid-access support over AI-mediated or socially interactive functions. Framework analysis of free-text responses from 484 participants generated seven themes relating to human support, trust and confidentiality, occupational tailoring, in-the-moment coping tools, peer-informed elements, usability requirements, and organisational culture. CONCLUSIONS Conclusions: This large-scale formative evaluation provides strong early support for the acceptability, perceived relevance, and context fit of a trauma-informed digital mental health intervention tailored to frontline professionals. Findings identify clear user-informed priorities for refinement, particularly regarding privacy safeguards, occupational tailoring, integration with human support pathways, and low cognitive burden. Progression through the MRC development phase provides a strong foundation for feasibility testing and implementation research within frontline occupational settings.

Background: Type 2 diabetes affects 483 million adults worldwide, with rising prevalence and an estimated 6 million premature deaths annually. Low physical activity is a key risk factor, while increased activity can reduce disease onset and improve metabolic health. Consumer activity trackers, when paired with behavior change strategies, have shown potential to increase physical activity among adults with type 2 diabetes. Objective: This study explored the integration of consumer activity trackers into a community-based weight management intervention to support physical activity in adults at risk for or living with type 2 diabetes. Methods: A mixed methods design was used to generate a comprehensive understanding of implementation. Participants were recruited during registration for “Weigh to Go,” a community-based weight management program in Lanarkshire, Scotland. Health care professionals delivering the intervention were recruited by email. Participants received a Fitbit Charge 5 to monitor daily steps and moderate-to-vigorous–intensity physical activity. Semistructured interviews were conducted with 10 participants and 10 health care professionals. Qualitative data were analyzed thematically, and quantitative analysis examined changes in recorded Fitbit activity data. Findings were interpreted using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: Daily steps increased significantly between week 1 and week 7 (mean difference 5345 steps; P =.002). Qualitative findings highlighted 5 themes. First, providing devices free of charge enhanced reach by removing financial barriers. Second, educational classes were considered essential for effectiveness, particularly instruction on device use and interpretation of activity data. Third, staff expressed a need for greater understanding of device functionality and data outputs, supporting broader adoption of trackers within weight management services. Fourth, managers would benefit from a detailed protocol outlining tracker introduction, use, data analysis procedures, evaluation metrics, and costs to ensure efficient and consistent implementation. Fifth, extending compulsory attendance at intervention sessions was considered important for long-term maintenance of behavior change. The observed decline in moderate-to-vigorous–intensity physical activity after week 7 was attributed to challenges in sustaining engagement beyond the structured phase of the program. Conclusions: This study demonstrates the feasibility of integrating consumer activity trackers into a community-based weight management intervention. Applying the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework revealed that free device provision, participant and staff education, clearly defined implementation protocols, and structured attendance expectations can strengthen tracker-supported interventions. The use of the Fitbit device as both a measurement and intervention tool also raises methodological considerations, emphasizing the need for future research to differentiate these dual roles. Overall, activity trackers show promise for supporting physical activity among adults at risk for or with type 2 diabetes when embedded within well-designed community programs. These findings underscore the importance of aligning technological tools with supportive behavioral strategies to maximize health outcomes. The results also highlight opportunities for refining community programs through closer integration of digital health tools.

BACKGROUND Frontline workers are frequently exposed to traumatic and high-stress experiences through their occupational roles. While the psychological impacts for frontline workers themselves are well documented, far less attention has been given to the indirect effects of occupational trauma on their family members. Emerging evidence suggests that trauma exposure may extend beyond the individual worker, influencing the emotional wellbeing, relationships, and functioning of partners, children, and wider family systems. However, this literature remains fragmented across disciplines, occupational groups, and sociocultural contexts. OBJECTIVE The aim of this scoping review is to identify, map, and synthesise existing research on the impact of frontline worker trauma on family members. The review will examine how reported impacts vary across frontline occupations and sociocultural contexts, and will identify key gaps to inform future research, policy, and practice. METHODS This scoping review will be conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) methodological guidance. A comprehensive search will be undertaken in PubMed (MEDLINE), PsycINFO, CINAHL, Web of Science, and Scopus. Eligible studies will include qualitative, quantitative, and mixed-methods primary research published in English, with no time constrains. Title and abstract screening, followed by full-text screening, will be conducted independently by at least two reviewers, with discrepancies resolved through discussion or consultation with a third reviewer. Data will be charted using a structured extraction framework and synthesised narratively, with findings presented using tables and visual evidence mapping. RESULTS This review will produce an evidence map describing the range of psychological, relational, and social impacts of frontline worker trauma on family members, the populations and occupational groups studied, and the sociocultural contexts represented. Gaps in the literature will be identified to guide future research priorities. CONCLUSIONS By consolidating and mapping the existing evidence, this scoping review will contribute to an emerging but under-researched field and support the development of family-inclusive policies, services, and interventions for frontline worker populations.

BACKGROUND Globally 483 million adults are living with type 2 diabetes and, this number is increasing. It is estimated that annually 6 million people die prematurely from the disease. A major risk factor of developing type 2 diabetes are low levels of physical activity. Physical activity interventions can reduce the risk of developing type 2 diabetes and for those diagnosed with the disease improve metabolic health. Consumer activity trackers when combined with a behavioral change intervention have been shown to increase levels of physical activity in adults diagnosed with type 2 diabetes. OBJECTIVE To explore the integration of consumer activity trackers into a community weight management intervention to support physical activity in adults at risk or with type 2 diabetes. METHODS A mixed methods (quantitative and qualitative) approach used to allow for a more comprehensive analysis. Participants were recruited at registration for a community-based weight management intervention in Lanarkshire, Scotland, UK, called Weigh to Go. Health care professionals involved in the delivery of this intervention were recruited via email. Weigh to Go participants were provided with a Fitbit Charge 5 consumer activity tracker to record their physical activity data. The recorded activity data included daily steps and moderate and vigorous intensity physical activity. One to one semi-structured interviews were conducted with 10 Weigh to Go participants and 10 health care professionals. Qualitative thematic analysis was undertaken, and themes were identified. Quantitative statistical analysis was conducted on the participants recorded Fitbit data. The RE-AIM framework was used to interpret the data collected. RESULTS Overall, participants’ daily steps increased significantly (p = .002) between week 1 and week 7 (mean difference = 5345 steps, F(3, 45) = 5.93, p = .002, n2 = .19). The qualitative findings revealed that: (i) Providing devices for free was considered important especially for increasing the reach of such interventions; (ii) Educational classes could be beneficial for increasing the effectiveness of such interventions – and should focus on how to use the tracker and how to interpret the data it produces; (iii) Staff would also benefit from understanding more how the devices work, are used and what the data means – this could lead to the wider adoption of the trackers within weight management interventions; (iv) Management involved in the delivery of such interventions would benefit from developing a protocol which sets out in detail the introduction of activity trackers, their use, data analysis, measures of effectiveness and programme costs – this would ensure an effective and efficient implementation of activity trackers into weight management interventions; (v) Extending the compulsory attendance of participants to all weight management intervention classes was suggested – this could improve the long-term maintenance of such programmes. CONCLUSIONS Through this study we showed that it is possible to integrate consumer activity trackers into a community weight management intervention. By using the RE-AIM framework we have revealed that factors such as activity tracker provision and use, education, protocol development and compulsory attendance are likely to increase the success of the use of activity trackers in weight management interventions. CLINICALTRIAL N/A

Frontline professionals are routinely exposed to acute and cumulative occupational stressors that are associated with an elevated risk of psychological distress, burnout, and trauma-related difficulties. Digital mental health interventions offer scalable and flexible approaches to supporting psychological well-being in high-demand occupational environments. However, there remains limited empirical evidence regarding the feasibility and cultural adaptation of trauma-informed digital interventions across diverse international contexts. This protocol describes a multi-country feasibility study to co-create, translate, localize, and evaluate the usability and acceptability of Sentinel, a trauma-informed digital mental health intervention designed for frontline and trauma-exposed occupational groups. The study will be conducted across implementation sites in Saudi Arabia, South Africa, and Ukraine. Sentinel is delivered as a self-guided, modular digital intervention structured around 4 conceptual domains: recognize, remedy, recover, and resilience. Preparatory phases include stakeholder engagement, linguistic validation, and contextual localization. A 6-week single-arm feasibility pilot will be undertaken with approximately 100 frontline professionals recruited at each international site. Primary feasibility outcomes will focus on usability and acceptability, assessed through engagement analytics, Mobile App Rating Scale scores, and qualitative user feedback. Secondary exploratory outcomes will include preliminary indicators of psychological well-being, perceived psychological safety, and coping responses. Feasibility progression criteria will include recruitment and retention thresholds, patterns of intervention engagement, usability ratings, and qualitative indicators of cultural relevance to inform optimization prior to future controlled evaluation. Preparatory study activities commenced in early 2026, including the development of international research partnerships and planning for stakeholder engagement and translation procedures. Ethical approval applications are scheduled for submission between June and September 2026. Participant recruitment is anticipated to begin in October 2026, with feasibility pilot data collection expected between November 2026 and March 2027. Quantitative and qualitative analyses are planned for April to June 2027. No outcome data are available at the time of manuscript submission. This study will generate evidence regarding the feasibility, usability, and cultural adaptation of a trauma-informed digital mental health intervention for frontline professionals across diverse socio-cultural settings. Findings will inform the iterative refinement of the intervention and guide progression to future effectiveness trials and wider implementation.

Background: Informal carers are critical in looking after people with dementia. The value of all informal care as a total in the United Kingdom is now estimated to be £184 billion (US $249 billion). However, many carer groups are inadequately supported and face poor mental and physical health with limited opportunities for physical activity. There is a public health priority to address such challenges and a lack of innovation regarding approaches to promote physical activity. Objective: This study aimed to co-design, adapt, and explore the feasibility of a novel cross-platform approach to support physical activity among carers of people with dementia. Methods: Project stages included a co-design phase followed by a feasibility study guided by both the reach, effectiveness, adoption, implementation, and maintenance and Medical Research Council complex intervention frameworks. Co-design involved 3 development “sprints,” gaining feedback from a range of stakeholders (eg, carers, support professionals, charities, researchers, and developers) and identifying priority areas. Our feasibility study involved the evaluation of our recruitment, intervention, and outcome approaches over 8 weeks (target population: N=50) with participants. Participants were recruited from local community networks in Scotland as well as research study registries. Results: We successfully co-designed, developed, and user tested the CareFit app. Final app design included a simplified navigation system and increased delivery of video content as well as a more personalized delivery approach. In total, 41 carers of people with dementia were recruited, with 21 (51%) completing the 8-week study. Study retention was considerably lower for carers with higher levels of physical activity at baseline as opposed to those with lower levels (5/14, 36% vs 16/27, 59%, respectively). CareFit was rated as “acceptable” on the System Usability Scale, and we observed common user patterns of behavior (eg, an initial focus on the Learn section). The feasibility study results demonstrated that the intervention appeared safe for use (no adverse events reported) and the video content for carers was well received. A greater depth of social elements appears critical for future development. Although professional stakeholders did not reach consensus on the outcome of greatest utility, the outcome measures tested were largely suitable for future use in this group, including novel sedentary behavior and muscle and balance measures. Conclusions: Many carers of people with dementia do not have the same access to physical activity as noncarers. Our findings show key challenges regarding recruitment and retention. Although we cannot currently recommend progression to a randomized controlled trial, we conclude that further work is needed to better understand the “active ingredients” of the intervention outlined. This includes exploring the delivery of a preventative intervention earlier in the carer trajectory—something critical for adoption and long-term use. International Registered Report Identifier (IRRID): RR2-10.2196/53727

Background: The dementia landscape has evolved, with earlier diagnoses, improved prevention understanding (eg, modifiable factors), and new treatments. Emerging digital technologies (eg, wearables, smart home systems, and mobile apps) offer self‑management opportunities; yet, gaps persist regarding integration into the care needs and preferences of people with dementia. Broader gaps remain concerning intervention design; adaptation; and implementation, including effectiveness, study quality, and accessibility. Objective: This systematic review aims to synthesize and critically appraise existing literature on digital self-management technologies (wearables, smart home systems, and mobile apps) intended to reduce dementia-associated behaviors, enhance self-management, and improve quality of life (QoL). It evaluates intervention characteristics, effectiveness, accessibility, study design, and methodological quality according to international standards. Methods: A systematic search across 9 databases (PubMed, Scopus, ACM Digital Library, CINAHL, PsycInfo, Web of Science, IEEE Xplore, Embase, and MEDLINE) identified relevant English‑language studies published between January 1, 2013, and September 30, 2023. Search terms covered dementia, QoL, behavioral and self‑management strategies, and digital technologies. Eligible studies involved adults with dementia using wearable, smart home, or mobile technologies targeting QoL, behavior, and autonomy. Two reviewers independently appraised study design, hardware, and intervention purpose. Outcomes were mapped to the Nursing Outcomes Classification and benchmarked against National Institute for Health and Care Excellence quality standard 184. Accessibility was evaluated by availability, cost, usability, and context. Bias mitigation included a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)‑guided strategy and PROSPERO registration. Methodological quality and bias were assessed using the Mixed Methods Appraisal Tool, the Critical Appraisal Skills Program, and a bespoke characterization framework. Results: Twenty-four studies evaluated interventions based on wearables, smart home systems, or apps for people with dementia and carers. Outcomes centered on neurocognition (24/24, 100%), self-care (17/24, 71%), and health behavior (13/24, 54%). Identified needs included managing distress (15/24, 62%) and supporting carers (15/24, 62%). Technologies included commercial tools (activity trackers, health-based wearables, and digital prompters) but were often inaccessible due to complex setup requirements and ongoing support needs. Substantial methodological heterogeneity precluded meta-analysis, necessitating narrative synthesis. Study quality was generally good to excellent, but samples were small, reporting incomplete, and outcomes unblinded. Only 1 (17%) of 6 randomized controlled trials reported effect sizes, indicating moderate decline in QoL at 24 months; effectiveness in other studies remains uncertain. Conclusions: Research on digital technologies for dementia self‑management shows benefits, particularly with off‑the‑shelf devices and mobile apps supporting person‑centered outcomes. Notable limitations include inadequate participant diversity (eg, atypical dementias and minoritized populations) and insufficient high‑quality research on QoL and behavioral outcomes, such as symptom management and self‑control. Future research must prioritize innovative solutions enhancing accessibility and usability, emphasizing simplified configuration, personalized adaptability, and effective training and support structures. Trial Registration: PROSPERO CRD42023461841; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023461841