Aos Alaa

Background: Loneliness is a pressing public health concern with wide-ranging impacts on mental, physical and social wellbeing. Building on the Measuring Loneliness in England (INTERACT) Study which represents one of the largest volunteer-based studies of loneliness and social disconnection conducted in the United Kingdom (UK), we explore demographic, social and health-related factors associated with loneliness and social capital, using multiple validated measures. Methods: We analysed cross-sectional data from 135,725 community-dwelling adults across England. Loneliness was assessed using both the University of California, Los Angeles (UCLA) 3-item Loneliness Scale and the Office for National Statistics (ONS) Direct Measure of Loneliness (DMOL). Social capital was measured using a composite scale of neighbourhood trust, cohesion and reciprocity. Multivariable ordinal and binary logistic regression models were fitted to summarise mutually adjusted associations within the responding sample. The models were used as exploratory, sample-conditional descriptions and were not intended to estimate population parameters. Results: Younger age (particularly 16–25 years old), being single, unemployed or living with disability were consistently associated with higher loneliness across both scales. In contrast, respondents reporting nine or more friends had substantially lower odds of loneliness (UCLA: adjusted odds ratio (aOR) = 0.09, 95% model-based interval (MBI): 0.09–0.10; DMOL: aOR = 0.16, 95% MBI: 0.15–0.17). University education was associated with higher loneliness on the UCLA scale but lower loneliness on the DMOL. High social capital was more frequently reported among older, married and retired respondents. Respondents with long-term conditions or disability had reduced odds of high social capital (long-term conditions: aOR = 0.82, 95% MBI: 0.80–0.85; disability: aOR = 0.77, 95% MBI: 0.74–0.80). Conclusions: This study identified several sociodemographic, social and health-related factors associated with loneliness, although some associations varied according to the loneliness measure used. Because participants comprised a non-probability volunteer sample, the estimates should not be interpreted as population parameters, causal effects or confirmatory evidence. The findings are hypothesis-generating and require confirmation in representative, longitudinal and intervention-focused studies.

Background: Loneliness is increasingly recognised as a major public health challenge with significant implications for mental, physical and social wellbeing. While there were previous large scale studies including loneliness measures, few datasets capture loneliness across the full adult life course, integrate neighbourhood-level social capital and provide geospatial mapping at national scale. The Measuring Loneliness in England (INTERACT) Study was designed to address these gaps by characterising the distribution, intensity and sociodemographic patterning of loneliness within a large volunteer-based sample across diverse population groups in England. The aim of this paper is to describe the development, implementation and early findings of the INTERACT study. Methods: A total of 135,725 adults completed the online survey between March and July 2023. The instrument included validated measures of loneliness: the University of California Los Angeles (UCLA) 3 item loneliness scale and Office for National Statistics Direct Measure (DMOL), social capital indicators and demographic variables. Descriptive statistics were stratified by key subgroups. A geospatial analysis at Lower Super Output Area level was used to visualise clustering of loneliness across England. Results: 135,725 participants across the full adult life course (16+) were included. The cohort was predominantly female (61.6%), White (82.6%) and aged over 65 (32.4%). The sample over-represented highly educated individuals and under-represented minority ethnic groups. On DMLO, 16.5% of participants reported feeling lonely “often or always,” while the UCLA-3 indicated that 21% to 22.5% frequently felt a lack of companionship, left out, or isolated (median score=6, Interquartile Range (IQR) = 3-7). Social capital perceptions were mixed (median=4, IQR) = 2-6). The COVID-19 pandemic exacerbated feelings of loneliness for 44.0% of respondents and isolation for 48.2%. As a volunteer-based, non-probability sample, findings are descriptive of respondents and are not intended to estimate population prevalence. Conclusions: The INTERACT Study provides a comprehensive national dataset on loneliness and social disconnection in England. The scale, methodological rigour and spatial granularity of the INTERACT study offer indicative insights that may inform the design of targeted, place-based interventions, pending confirmatory analyses in representative samples to mitigate loneliness and promote social connection across communities.

Objectives This study examines awareness, perceived legitimacy, trust and readiness for the implementation of lifestyle medicine within National Health Service (NHS) prevention pathways among community-dwelling adults and healthcare professionals in England. A secondary objective was to assess how professional training and system factors relate to the provision and intended use of lifestyle medicine services within the NHS. Design Cross-sectional, self-administered online survey. Setting United Kingdom; online survey administered in January 2026. Participants Adults aged ≥ 18 years living in the UK, recruited via a closed online panel using quota sampling to approximate national distributions by age, gender and ethnicity. A subgroup of respondents self-identified as healthcare professionals. Main outcome measures Primary outcomes were perceived legitimacy of lifestyle medicine as a healthcare approach and intention to use an NHS lifestyle medicine service if available. Secondary outcomes included awareness and familiarity with the term “lifestyle medicine,” trust in different providers of lifestyle advice, perceived self-efficacy across lifestyle domains and - among HCPs - training, confidence, barriers and current provision of lifestyle-related advice. Results A total of 733 participants completed the survey, including 58 HCPs. Awareness of the term “lifestyle medicine” was limited in the general population (26.3%) but substantially higher among HCPs (62.1%). Despite this, there was broad agreement across groups regarding core lifestyle medicine domains; particularly nutrition, physical activity, sleep and stress management. Higher perceived legitimacy of lifestyle medicine was strongly associated with stated intention to use an NHS service. Trust in lifestyle advice was highest when delivered by clinicians with formal lifestyle medicine training and lower for non-medical professionals, even when formally trained. Among HCPs, formal training and greater confidence were strongly associated with provision of lifestyle-related advice, whereas perceptions of NHS support for lifestyle-based approaches were consistently low regardless of training status. Conclusions Lifestyle medicine is widely viewed as legitimate and potentially valuable when anchored within professional training and NHS delivery but its implementation is constrained by limited public familiarity, variable workforce capability and low perceived system readiness. Strengthening training pathways, clarifying professional standards and enhancing institutional support may be critical to embedding lifestyle medicine within NHS prevention and long-term condition strategies

Objectives To assess public and healthcare professional knowledge, attitudes, perceptions and behaviours regarding spatial computing technologies (virtual, augmented and mixed reality) in healthcare, with a focus on perceived benefits for self-care and barriers to adoption in primary care and community settings. Design Cross-sectional online survey. Setting UK-wide, web-based survey conducted between January 2025 and August 2025. Participants Community-dwelling adults aged ≥ 18 years residing in the UK, including healthcare professionals. A total of 405 respondents completed the survey; 41 were healthcare professionals. Interventions No intervention was delivered. Participants completed a structured questionnaire assessing familiarity with spatial computing, perceived utility across self-care domains aligned to the Seven Pillars of Self-Care and perceived barriers to adoption. Primary and Secondary Outcome Measures Primary outcomes were self-reported familiarity with spatial computing technologies and perceived benefit across self-care domains. Secondary outcomes included perceived barriers to adoption and associations between demographic characteristics and familiarity. Analyses used descriptive statistics and exploratory inferential tests (χ², Fisher’s exact, Friedman and Wilcoxon signed-rank tests with Bonferroni correction). Results Most respondents (71.4%) reported familiarity with spatial computing technologies, although regular use was uncommon (4.7%). Oculus Quest (57.5%) and Apple Vision Pro (46.9%) were the most recognised platforms. Participants perceived strong potential for supporting health literacy, mental wellbeing and physical activity, particularly through guided mindfulness, avatar-led exercise and immersive patient education. Perceived benefit was lower for medication management and dietary guidance. Familiarity was statistically associated with gender (p < 0.001), age (p = 0.002) and ethnicity (p = 0.006), with higher awareness among men, younger adults and some minority ethnic groups. The most frequently cited barriers to adoption were high cost (56.5% rating as critical), lack of training (67.4% rating 4–5) and data privacy concerns (63.5%). Conclusions Spatial computing is viewed positively by the public and healthcare professionals as a tool to support self-care and aspects of healthcare delivery, particularly health literacy, mental wellbeing and physical activity. However, high cost, training gaps and privacy concerns remain substantial barriers. Targeted investment in evidence generation, workforce training and inclusive governance will be necessary to support equitable and responsible implementation.

Background: Despite advancements in HIV prevention, barriers and disparities in accessing Pre-exposure Prophylaxis (PrEP) from specialist services persist. Community pharmacies, with their extensive reach, offer an opportunity to reduce these disparities and help end new HIV infections. Objective: This study aims to investigate the accessibility of HIV PrEP through community pharmacies and sexual health clinics (SHCs) across two London Integrated Care Systems (ICS) in the United Kingdom (UK). We also sought to assess the potential for community pharmacies to enhance access to PrEP and to address existing gaps in PrEP provision in the UK to gauge the potential for community pharmacies to facilitate easier access to PrEP. Methods: We mapped the distribution of pharmacies, PrEP clinics, and SHCs across 11 local authority areas in London, covering North West London ICS and three catchment areas from North Central London ICS using publicly available data, including postcode data. Our selection process for sources of evidence was guided by a set of predefined criteria aimed at identifying community pharmacies and SHCs within the targeted ICSs for their relevance to HIV PrEP accessibility. Two reviewers systematically charted data from each included source. Information extracted included the name of the pharmacy or clinic, address, contact details and operating hours. Results: Our data collection, spanning from April to July 2022, included 692 community pharmacies. The study revealed that 543 (78.5%) of these pharmacies offered sexual health services, with a significant proportion categorised at Tier 2 according to the Umbrella Sexual Health Model, indicating they are well-positioned to offer PrEP services. The mapping showed an uneven distribution of PrEP and sexual health clinics, with community pharmacies widely accessible and offering longer service hours. Conclusion: The findings highlight the critical role community pharmacies could play in providing PrEP, addressing gaps in accessibility, and reducing HIV transmission risks, thus potentially facilitating easier access to PrEP. This study supports the need for policy adjustments to enable community pharmacies to dispense PrEP, aligning with public health goals for broader access to HIV preventative measures.

Background: Workplace settings are linked to staff health and wellbeing, affecting sickness absence, presenteeism and productivity. With the growing prevalence of health issues among employees in the UK, including stress and long-term conditions, effective workplace health and wellbeing support by local government can play a crucial role in keeping people economically active and well. Objective: Identify and characterise workplace health and wellbeing programmes offered by local authorities within the United Kingdom. Methods: A scoping review involved a comprehensive search of Local Authority Districts (LADs) and county councils' websites followed by direct communications between 1 January 2024 and 30 April 2024. Initiatives were included if they were designed to enhance workplace health and wellbeing, actively ongoing and offered at no cost to workplaces. Data were extracted on the initiative name, provider, deprivation level, health focus, workplace eligibility and accreditation processes. Results: The review identified 61 active local government workplace health programmes across the UK in March 2024, reflecting a 21% provision among local authorities. These initiatives were homogenous in focus, scope of coverage and implementation methods, with all focusing on general health. Geographical mapping highlighted regional disparities in the provision of workplace health and wellbeing initiatives that are free at the point of access (WHISPAs). England had a higher number (Central, Southern, and Southeastern regions specifically) while the rest of England, Wales, Scotland and North Ireland had a lower number or no WHISPAs. Conclusion: There is a need for more coordinated efforts to increase the visibility and accessibility of local government workplace health initiatives that are free at the point of access. National workplace health accreditation could further encourage employers to adopt health and wellbeing programmes.

Testosterone deficiency (TD) remains underdiagnosed and undertreated, leading to diminished quality of life (QoL) for affected men. Previous quantitative studies showed that many men delayed treatment but ultimately reported high effectiveness of testosterone replacement therapy (TRT). The underlying reasons for these delays and the broader impact of TRT remain underexplored. The aim of this qualitative study was to explore systemic and individual determinants in shaping care‐seeking behaviours, factors influencing access to TRT, and its biopsychosocial impacts. Semi‐structured interviews were conducted with 21 UK men who were current or past TRT users, purposefully sampled to ensure diversity in age, TRT duration and symptom duration to reflect significant variables identified from prior quantitative study. Semi‐structured interviews explored motivations for starting TRT, pretreatment symptoms and the biopsychosocial impact of TRT. Each 60‐min online interview was audio recorded, transcribed verbatim and thematically analysed using NVivo software. The socioecological framework was used to contextualise the findings. Systemic barriers, including delays in diagnosis and the National Health Service's protocol‐based care, were perceived as major challenges. Participants expressed frustration with attribution of symptoms to ageing or stress, leading many to seek private care. A lack of awareness and stigma surrounding TD were significant barriers to treatment‐seeking behaviour. However, men overwhelmingly valued TRT, noting improvements in self‐confidence, professional success and social engagement. Participants also reported significant improvements in energy, fitness, mood and overall QoL, with few men reporting side effects. Our study reveals systemic barriers that delay timely diagnosis and treatment of TD, and highlighted substantial biopsychosocial benefits of TRT. There is a critical need for increased awareness of TD among healthcare providers and the public, alongside a shift toward more personalised, symptom‐based approaches in the healthcare system. Future research should explore the broader societal and economic impacts of TRT, including its potential to improve workforce productivity and reduce long‐term health risks associated with TD.

Background Self-care interventions for sexual and reproductive health and rights (SRHR) are critical to advancing individual wellbeing and achieving universal health coverage. This study assesses how three countries - Kenya, Nigeria and Uganda - have adapted and implemented the World Health Organization (WHO) Guideline on Self-Care Interventions for SRHR within their national policy and practice landscapes. Objectives The primary objective was to develop and pilot a novel policy mapping and implementation analysis tool. Secondary aims included using a mixed-methods approach comprising policy document review, surveys and interviews to evaluate the contextualisation and uptake of WHO recommendations at the country level. Methods We designed a Policy Mapping and Implementation Matrix (PMIM) to assess alignment with 24 WHO SRHR self-care recommendations. Data were collected from 316 stakeholders through surveys and interviews, and 47 policy documents were reviewed. Findings were synthesised using a Red-Amber-Green (RAG) matrix to assess implementation across the guideline’s five domains. Results Implementation varied by country and recommendation. Family planning and infertility services (Category 2) showed the strongest uptake, while areas such as unsafe abortion management and STI self-sampling (Categories 3 and 4) were less consistently addressed. Kenya demonstrated broad alignment through multiple policies, while Nigeria and Uganda showed promising progress, particularly with the development of dedicated national self-care guidelines. Key barriers included supply chain challenges, low health literacy and legal constraints; critical enablers were provider training and task shifting. Conclusion This study introduces a novel, pragmatic framework for assessing national self-care policy and practice. It highlights the importance of contextual adaptation rather than mechanical adoption of global guidelines. While study limitations are acknowledged, the methodology offers a replicable approach for monitoring and strengthening self-care integration in diverse settings. Key points Little is known about how countries are contextualising and adapting WHO Guideline on Self-Care interventions We present the first iteration policy mapping and implementation analysis tool and findings from three countries where there is an emergent self-care movement A key driver for contextual adaptation of the WHO Guideline includes the development of national guidelines and self-care advocacy groups The extent that the policy landscape supported self-care practices for SRHR could be used to objectively prioritise policy and advocacy opportunities in each country

Background: Prevalence of late-onset testosterone deficiency (TD) ranges between 6–30% depending on diagnostic criteria. Recent data highlights various benefits of testosterone replacement therapy (TRT), including increased libido, mood, bone mineral density, and lean body mass. This study investigated the personal experiences of men with TD around low testosterone and TRT, including barriers to accessing TRT. Methods: Previous or current TRT users were recruited via email from private clinics’ emailing lists, professional medical organisations and researchers’ professional networks. Participants completed a 52-item structured questionnaire on Qualtrics XM, exploring their perceptions and experiences of TRT on their symptoms and quality of life. Associations between demographics, duration of symptoms and effectiveness were assessed using logistic regressions. Results: Among the 905 men on TD treatment, 86% delayed treatment for at least a year, including 24% who experienced symptoms for over 5 years before seeking care. Older men (aged 51+ years) were 1.61 times more likely to delay treatment. The majority (85%) reported TRT as effective or very effective, with longer-term users 2.6 times more likely to report TRT as very effective compared to recent starters. Primary motivations for seeking TRT included improving personal relationships (79%) and physical appearance (53%). Most (81%) relied on online sources for information; fewer (18%) felt comfortable discussing hormonal health with their peers. Patient expectations during medical consultations focused on diagnosis (77%), treatment options (64%) and learning about potential side effects (51%). The most common side effects were acne (24%), testicular shrinkage (24%) and nipple itchiness/gynaecomastia (19%). TRT users reported notable improvements in overall quality of life (75%), mental wellbeing (71%), self-esteem and self-confidence (69%) and appearance (61%). Conclusions: A significant proportion of men aged over 50 years surveyed reported experiencing prolonged symptoms of TD prior to seeking care. There is a need for greater awareness and education regarding TD symptoms, including streamlining timely and equitable access to effective treatment options.