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We propose a bio-psycho-socio-anthropological (BPSA) model that mainstreams cultural formulation and power-aware practice across training, interventions and evaluation. Contrasting it with transcultural and community models, we show UK examples where embedding cultural insight in statutory decisions reduced detentions and improved engagement, aligning with national equality priorities.
Aims: Background: In 2021, in order to optimise the quality of informant questionnaires, the local memory service introduced the Brief Informant Questionnaire (BIQ), consisting of five short prompts that allow family members or carers to share their observations about memory changes, daily functioning, behaviour, and any potential risks such as safety concerns. As part of this, we asked the simple binary question “Do you think it is dementia”. Aim: • To evaluate the accuracy of a single item on the BIQ by comparing the informant’s response with the clinical diagnosis following comprehensive assessment. Methods: • Data was collected from the 50 randomly selected patients who attended the local memory clinic from 2022 to 2024. 5 informants did not provide the response to the question “Do you think it is dementia?” and they were not included. As such, 45 cases were included in the final analysis. • In scenario 1, only definite “Yes” and “No” responses were used to evaluate the diagnostic performance. • In scenario 2, “Not sure” responses were combined with “Yes” responses. Results: Scenario 1: Patient had dementia and informant agreed: 28/29 Sensitivity: 96.5% Patient did not have dementia and informant agreed: 5/5 Specificity: 100% Positive Predictive Value: 28/28=100% Negative Predictive Value: 5/6=83.3% Scenario 2: Patient had dementia and informant agreed or was not sure: Sensitivity: 34/35=97.1% Patient did not have dementia and informant agreed or was not sure: Specificity: 5/10=50% Positive Predictive Value: 34/39=87.1% Negative Predictive Value: 5/6=83.3% Conclusion: The BIQ demonstrates very high sensitivity in both analysis scenarios (96.5% and 97.1%) and a strong positive predictive value (100% and 87.1%), indicating that an affirmative response was highly indicative of a true dementia diagnosis. When “not sure” responses were grouped with “yes,” the specificity decreased, reflecting reduced ability to identify non-dementia cases. Although the number of negative cases was small, the findings suggest that the BIQ performs reliably within the current assessment pathway and is clinically useful. Completing this questionnaire prior to the initial assessment helps ensure that relevant information is available from the start, improves the quality and efficiency of the assessment process, and supports more person-centred assessments and care planning. Overall, these findings provide evidence to support the use of this single item from the BIQ across wider memory services as an aid to identifying possible dementia.
Background:Motor neuron disease (MND), also known as amyotrophic lateral sclerosis (ALS), is a rapidly progressive neurological condition that requires complex multidisciplinary care. Within the United Kingdom, specialist centers provide expert interventions, while day-to-day support often relies on local nonspecialist community health and social care professionals. This is due to the distance between people's homes and specialist centers, as well as the availability of specialist health and social care professionals. This can lead to fragmented communication and emotional, physical, and financial burdens, and it can be time-consuming for people living with MND, their carers, and the health care professionals involved in their care. Despite the recognized need for better care coordination, it remains inadequate in practice, with a current lack of specific evidence-based interventions for achieving this. Objective:The MND Together project aims to address these systemic gaps by (1) developing a national picture of care coordination in England and Wales, (2) identifying barriers and facilitators to coordination within specialist and nonspecialist settings, and (3) co-designing a practical care coordination tool with key stakeholders. Methods:This protocol outlines the co-design of an intervention underpinned by the Behavior Change Wheel and the Socioecological Model. First, a mixed methods, multicenter study will be conducted to develop a national picture, comprising focus groups with people living with MND, carers, and health and social care professionals. Second, focused ethnography will be conducted in 5 MND specialist centers and their catchment areas, involving 25 people living with MND, to explore the barriers and facilitators to coordination in practice. Finally, a series of co-design workshops will be conducted to identify key priorities for care coordination and to develop a new intervention, the MND Together tool. Results:The project started in September 2025 and will run until October 2027. Workstream 1 started in December 2025, with recruitment beginning at the first site in February 2026. To date, we have recruited 23 people living with MND and carers as well as 16 health and social care professionals across 4 of the 9 sites. Workstream 1 will end in August 2026, with results published at the end of 2026. Workstream 2 began in May 2026 and will run until February 2027, with results published in the summer of 2027. Workstream 3 will begin in March 2027 and conclude with the co-design intervention developed by late 2027. This will then be piloted in practice. Conclusions:By combining several methodologies with meaningful patient and public involvement and engagement, MND Together seeks to bridge the gap between specialist and community-based services. The MND Together tool aims to improve the quality of care and ensure that expert MND support is accessible as close as possible to every patient's home.
Abstract Background Chronic pregnancy-related pelvic girdle pain (PPGP) affects approximately 10–30% of postpartum women beyond 3 months. Such pain is typically recalcitrant to standard care. A dynamic elastomeric fabric orthosis (DEFO) is one option. A feasibility randomised controlled trial (fRCT) assessed the feasibility and acceptability of trial design, interventions and data collection. The aim of this qualitative sub-study was to explore the experience of women participating in the feasibility trial, and physiotherapists delivering the trial intervention. Methods An embedded qualitative study within a fRCT. The fRCT randomised participants to either control (standard care involving advice and exercise) or intervention (standard care and DEFO), across three healthcare trusts in three regions of England. Delivery of all interventions and data collection was undertaken remotely. Participants were encouraged to wear the DEFO for a maximum of 12 h a day over the 24-weeks of the trial. The qualitative approach involved online, semi-structured interviews supported by a topic guide. Data was recorded, transcribed verbatim, and analysed using thematic analysis. Results Seven ( n = 5 intervention, n = 2 control) of 24 participants recruited to the fRCT and five of the seven physiotherapists involved in the trial intervention delivery participated. Four main themes were identified: “acceptability of trial methods”, “intervention acceptability”, “impact of intervention” and “adherence to exercise”. Data collection methods were acceptable using the web-based app. The virtual nature of the trial was acceptable; however, women and physiotherapists would have preferred at least one face-to-face intervention session. The DEFO was acceptable to women, providing them with a sense of support “holding them together”. They felt it increased awareness of their ability to move, enabling them to be more physically active. Physiotherapists’ felt the process of delivery of the DEFO was acceptable but felt the range of available exercises they could prescribe was restrictive. Physiotherapists and participants found the advice component required further development. Participants struggled to maintain adherence to the prescribed exercise programme over the 24-week period. Conclusions The remote trial procedures and interventions were generally acceptable to both participants and physiotherapists, supporting the overall trial design and implementation, but a future design should incorporate an in-person treatment component. The participant’s experiences and suggestions will be considered in the design and delivery of a future definitive trial. Trial registration ISRCTN67232113.
Aims and method Services for people who are high users of emergency departments (EDs) have developed in a piecemeal fashion, including those embedded within liaison mental health services, over the past decade. We conducted a national survey of all 171 National Health Service hospitals in England with an ED to identify high user services, alongside 20 interviews from exemplar services to characterise the interventions offered. Results We had a 100% response rate. Of the 171 hospitals, 76 (44%) had a high user service in the ED without designated staff and 71 (42%) offered services with some designated staff time; 10 (6%) had community services, either separate or with hospital outreach; and 14 (8%) had no service. Interviews revealed great variability among services on most parameters, including staffing levels, entry criteria, case-load and types of intervention. Clinical implications There is a need for clarity on entry criteria, case-load and types of intervention, to improve consistency and effectiveness of these services to guide decision-making.
