Hoarding disorder (HD) is a complex, multifaceted condition with lifelong progression that impacts physical, psychological and environmental wellbeing. Treatment and support are often hindered by disengagement, therapy-interfering behaviours and high drop-out rates. A wide range of professionals, such as counsellors, occupational therapists, support workers, community nurses, housing officers and social service staff, may encounter individuals who hoard. Yet housing officers are frequently among the first to identify hoarding and tasked with the challenge to respond. Many report frustration, limited knowledge and discomfort when working with hoarding individuals compared to those with other presenting issues. However, training and specialist guidance is often not accessible to professionals such as those in housing support, despite evidence that suggests that a psychologically informed understanding of the disorder is needed for successful outcomes. This study used interpretative phenomenological analysis (IPA) to explore the lived experiences of three tenancy officers from a housing association in South Wales. Semistructured interviews identified four superordinate themes: (i) hoarding behaviour results from an underlying cause; (ii) the duality of staff roles in both providing support and enforcing policy; (iii) conflicting goals and perceptions between staff and tenants and (iv) perceived barriers to collaboration. Officers recognised links between hoarding, mental health and the need for safety and comfort, but often felt frustrated by resistance to de-cluttering. While officers sought to build collaborative, trusting alliances, the dual supportive-enforcement role risked damaging trust, leading to moral conflict and professional isolation. Findings underscore the need for training, systemic support and multiagency collaboration to better equip non-mental health professionals with the appropriate knowledge and resources.
Background Traditional medicine (TM) remains widely used in Ethiopia, even among people living with HIV/AIDS (PLHIV) who are enrolled in antiretroviral therapy (ART). Despite improved ART accessibility, concomitant use of TM poses risks of herb-drug interactions, treatment failure, and toxicity. However, little evidence exists pertaining to TM use among PLHIV from semiurban and rural settings in Ethiopia. This study was conducted to assess the prevalence, types, reasons, and factors associated with TM use among PLHIV on ART.Methods A mixed-methods cross-sectional study was conducted in 2022 among 331 adults on ART. Structured, pretested questionnaires were used for quantitative data, analyzed with SPSS, and logistic regression identified predictors of TM use. Qualitative data were collected from 11 purposively selected patients via in-depth interviews and thematically analyzed to complement quantitative findings.Results The prevalence of TM use after initiating ART was 64.4%, while 28.7% reported use within the past 6 months. Herbal medicines were the most common forms (77.9%), Demakese (Ocimum lamiifolium), garlic (Allium sativum), ginger (Zingiber officinale), and black cumin (Nigella sativa) being frequently used. Spiritual therapies such as holy water (Tsebel) and Zemzem water were also reported. The main reasons for TM use were treatment of opportunistic infections or symptom relief (84%), immune boosting (36.6%), general well-being, and faith-based motivations. Factors significantly associated with TM use included age >= 61 years (AOR = 5.08, 95% CI: 1.01-25.45), history of opportunistic infection (AOR = 6.82, 95% CI: 3.02-15.39), viral load 50-1000 copies/mL (AOR = 6.66, 95% CI: 1.30-34.06), being on third-line ART regimens (AOR = 4.43, 95% CI: 1.32-14.91), presence of comorbidities (AOR = 3.97, 95% CI: 1.86-8.48), and trust in traditional healers (AOR = 3.68, 95% CI: 1.80-7.54). Qualitative findings revealed that TM use was shaped by accessibility, cultural beliefs, dissatisfaction with modern care, family influence, and religious guidance.Conclusion Despite expanded ART access, TM use remains common among PLHIV in rural Ethiopia, mainly for symptom relief and immune support. Cultural and religious beliefs, opportunistic infections, comorbidities, and limited counseling drive this practice. Strengthening patient education, training healthcare providers, and raising awareness of TM in HIV care are essential to reduce potential adverse outcomes.
Intergenerational caregiving among adults with serious mental illness (SMI), including care for children and parents, remains underrecognized. Using a convergent mixed‐methods design, this study examined how coresidence with children or parents was associated with the likelihood and days of caregiving in the past 30 days among adults with SMI in Beijing and whether age moderated these associations. Quantitatively, coresidence with children was positively associated with caregiving likelihood (OR: 2.63, 95% CI: 1.36–5.07, p < 0.01) and days ( b = 7.97, p < 0.001), but these associations weakened with increasing age (OR: 0.94, 95% CI: 0.90–1.00, p < 0.05; b = −0.33, p < 0.05). Coresidence with parents was not significantly associated with either outcome, although age positively moderated the association with caregiving days at a marginally significant level ( b = 0.34, p = 0.05). The qualitative study helped explain the quantitative pattern by revealing four themes: (1) caregiving to coresiding children was common, with care content and frequency varying among participants at different life stages; (2) caregiving to parents mainly depended on parents’ health conditions and geographical proximity; (3) caregiving to frail parents differed between coresiding and noncoresiding participants, with the former more available to provide frequent assistance with parents’ everyday life; and (4) caregiving was described by some participants as contributing to meaning, purpose, and hope, but may also lead to negative feelings in cases of inadequate support. In conclusion, adults with SMI engaged in intergenerational caregiving, with patterns differing by life stage and living arrangements. Mental health services should assess caregiving roles and provide individualized, strengths‐based support while avoiding excessive caregiving demands.
Background Social care services are essential for supporting vulnerable individuals to achieve the best possible quality of life. Social workers are central to this process, facilitating service delivery to improve well‐being. This study reports a realist review examining how, why and under what circumstances interactions with social workers impact adult service users in the United Kingdom. Methods Comprehensive literature searches were conducted in key databases in April 2025 (updated May 2026) to identify studies exploring service users’ perspectives on social worker interactions. Literature was appraised for relevance, rigour and richness to refine an initial programme theory. Interpretive and retroductive analyses were used to develop context–mechanism–outcome configurations (CMOCs). These CMOCs informed a refined programme theory (RPT) explaining how and under what circumstances interactions between service users and social workers influence outcomes. Results A total of 14,830 papers were screened, and 308 full texts were assessed for eligibility, with 56 documents informing CMOC development. We found that interactions between social workers and service users were often limited in both duration and frequency, leading to negative experiences of social care and often producing unfavourable short‐term outcomes. Five inter‐related mechanisms were identified: relationship building and ongoing interaction, social workers’ approach to needs assessment and care arrangements, clear and transparent communication, resource mobilisation and matching to needs and cross‐system collaborative working processes and coordination. The CMOCs suggest that contextual factors, including resource availability, care processes, continuity of interactions and changes in service users’ needs over time, can activate or constrain the mechanisms through which outcomes are produced. There was little evidence that short‐term changes in service users’ lives resulting from these interactions translated into longer‐term improvements in quality of life or sustained well‐being. Conclusion This review informs our understanding of how social worker interactions with adult service users are shaped and the short‐term outcomes they produce. However, it remains unclear whether changes resulting from contact with social workers lead to sustained improvements in service users’ quality of life and well‐being, highlighting the need to test the RPT in real‐world social care settings.
Background The coronavirus disease 2019 (COVID‐19) pandemic has disrupted healthcare and public health systems, even in Japan’s universal healthcare context, where administrative coordination and voluntary compliance are central to infection control. Difficulties, including delayed health observations and mismatched isolation arrangements, may have shaped individuals’ emotional memories of their illnesses. We aimed to identify the factors associated with distressing memories of COVID‐19 among adults in Japan. Methods In August 2022, a nationwide cross‐sectional web‐based survey was conducted among 956 adults who experienced COVID‐19 between January 2020 and August 2022. The participants provided information on their demographics, illness characteristics, isolation settings, and post‐COVID sequelae. Distressing illness memories were measured using a six‐item original scale based on cognitive appraisal theory (Cronbach’s α = 0.87). Multiple regression analysis examined the associations between distress scores and demographic, clinical, and contextual variables. Results On a total score of 6–24 points, higher distress scores were associated with younger age ( B = −0.06 per year, 95% CI −0.08 to −0.04), female sex ( B = 0.48, 0.22–0.75), coresidence with older adults ( B = 0.58, 0.27–0.90), risk factors for severe illness ( B = 1.07, 0.74–1.41), severe acute symptoms ( B = 0.27, 0.003–0.54), current post‐COVID sequelae ( B = 1.37, 0.88–1.87), and nonpreferred isolation setting ( B = 1.17, 0.65–1.69). Conversely, prompt health observation from public health centers or clinics was associated with lower distress ( B = −0.43, −0.80 to −0.06). Conclusions Distressing memories of COVID‐19 were associated with physical and contextual factors, including timeliness of the initial public health contact, persistent sequelae, and a mismatch between preferred and actual isolation settings. Early and consistent follow‐ups by health authorities, attention to individual isolation preferences, and integrated psychosocial care may help reduce distress and foster recovery during future public health emergencies.
