Background: An active and engaged lifestyle is beneficial for older adults’ health. However, there are many potential facilitators and barriers of engagement in leisure activities.Methods: Twenty-two older adults aged 69-81 (59% female) participated in one of four focus groups approximately 2-3 years after their previous participation in an activity-based intervention study. Discussions explored the facilitators and barriers to continued engagement in: 1) activities people were supported to try during the intervention study, 2) leisure activities generally, 3) new activities, and 4) reengagement after a break of any duration.Results: Deductive thematic analysis grouped participants’ responses into internal and external facilitators and barriers relating to the four types of engagement.Discussion: The study helps in understanding why leisure activities are important to older adults and the purpose they fulfil. It is important that older adults have access to valued, fulfilling activities, and local authorities should prioritise increasing their provision.

Being and remaining active is reported to be positively associated with healthy ageing, though many older adults are not as active as they would like to be. Low Traffic Neighbourhoods have been identified as a possible solution to traffic-related activity barriers. This study aimed to explore this possibility, and the potential for these methods to support active ageing. 20 older adults aged between 60 and 91 (80 per cent women) took part in focus groups across low and high traffic areas. Discussions centred on experiences of staying active and perceptions of low traffic measures for facilitating activity. Six participants then took part in walking interviews across two areas, which explored some of the barriers and enablers to staying active. Staying active was found to be particularly important, though many participants suggested that a number of environmental barriers prevent them from being as active as they would like to be, in line with previous research. Many struggled to recognise the potential of low traffic measures, suggesting that there is a lack of consideration for older people within the planning process, particularly those with mobility issues. Future studies should focus on those with mobility issues in order to explore range of needs.

OBJECTIVES:As we age our cognitive abilities can change. However, the degree of change experienced is influenced by a range of factors. To understand what the public know about risk and protective factors for cognitive ageing, a systematic review was conducted of studies considering what people know about brain health. METHOD:The search strategy included quantitative and qualitative studies in English, including interviews, focus groups, questionnaires, surveys of beliefs about brain health (including predictions, opinions) in generally healthy adults. PubMed, PsycINFO, Scopus, and Web of Science were used for published peer-reviewed literature; and ProQuest Dissertations and Theses and National Grey Literature Collection, PsycExtra and Google searches for grey literature. RESULTS:From 37,197 records, one hundred and one were included, comprising 71 quantitative (22 grey literature), 27 qualitative (1 grey literature) and 3 mixed-methods (1 grey literature). Studies were grouped into three themes: Concerns about cognitive ageing, Opportunities to promote brain health and Understanding dementia risk reduction and prevention. DISCUSSION:Studies reported varying levels of knowledge of brain health, alongside some suggestions for brain health that were somewhat superficial and not always consistent with scientific consensus. There were differences between groups of participants who exhibited less knowledge of brain health, for example, men, older adults, those with lower education and incomes, and ethnic minorities. This review highlights the need for clear messaging around opportunities to promote brain health, including scientifically-endorsed lifestyle factors and more information on the mechanisms by which they operate.

Background and objectives: Being and remaining active is reported to be positively associated with healthy ageing, though many older adults are not as active as they would like to be. Low Traffic Neighbourhoods (LTNs) have been identified as a possible solution to traffic-related barriers to activity.Research design and methods: 20 older adults aged between 60 and 91 (80% women) took part in focus groups in one of five areas identified as low or high traffic. Discussions centred on experiences of staying active and perceptions of low traffic measures for facilitating activity. 6 of these participants then took part in walking interviews in one of two main areas, which explored some of the barriers and enablers to staying active.Findings: Reflexive thematic analysis (RTA) grouped participants’ responses into six key themes: staying active; enablers to staying active; barriers to staying active; traffic issues; concerns about low traffic measures; and possible solutions.Discussion and Implications: Staying active was found to be particularly important for participants, though many suggested that a number of environmental barriers (e.g., poor maintenance, lack of infrastructure, high levels of traffic) prevented them from being as active as they would like to be, in line with previous research. Many struggled to recognise the potential of low traffic measures, suggesting that there is a lack of consideration for older people, particularly those with mobility issues. Future studies should focus on those with mobility issues in order to explore range of needs.

IntroductionAn active and engaged lifestyle is supported as being beneficial for brain health. Activities comprising physical, mental and social demands, or combinations of those, are of particular interest, and have been the focus of specific interventions. Exploring how older people engage with such community-based activities, including facilitators and barriers to participation, may help improve the success of future translational activities. The purpose of this study was therefore to identify factors that enabled or hindered activity engagement by conducting focus groups with people who had been supported to take up a new activity as part of an intervention study.Materials and methodsTwenty-seven older adults aged 65-86 (56% female) who had completed an activity-based intervention study participated in three focus groups. Discussions explored their experiences of taking up a new activity, including facilitators and barriers to their engagement, and their perceptions of any benefits.ResultsThematic analysis grouped participants' responses into five themes: positive aspects and facilitators of engagement in a new activity; challenges and barriers to engagement; ageing being a facilitator and a barrier to engagement; differential effects of activities on participants' health and wellbeing; and general project feedback (including opinions on study design).Discussion and conclusionsParticipants' experiences and expectations included positive (e.g., enjoyment, socialisation) and negative factors (e.g., lack of confidence, other commitments, class costs and poor structure), consistent with previous research on social participation and engaging with new learning opportunities. Future studies should also consider those who do not readily participate in leisure activities to address earlier barriers. It is important that older adults have access to potentially beneficial activities and local authorities should prioritise increasing their provision.

Suicide is a gendered phenomenon, where male deaths outnumber those of women virtually everywhere in the world.Quantitative work has dominated suicide research producing important insights but only a limited understanding of why more men die by suicide.We conducted a qualitative meta-synthesis and systematic review of 20 years of narratives both from men who are suicidal and from people who are bereaved by male suicide to identify putative risk and recovery factors.We identified 78 studies that encapsulated insights from over 1,695 people.Using Thomas and Harden's Thematic Synthesis Method, our analysis is built on 1,333 basic codes, 24 descriptive themes, and four analytical themes.We noted an association between cultural norms of masculinity and suicide risk in 96% of studies.Norms relating to male emotional suppression, failing to meet standards of male success, and the devaluing of men's interpersonal needs appeared to be associated with dysregulated psychological pain and suicide risk.Although masculinity is not pathological, we speculate that the interaction and accumulation of cultural harms to men's emotions, self, and interpersonal connections may potentially distinguish men who are suicidal from men who are not.Supporting men to understand and regulate emotions and suicidal pain, expanding possibilities for masculine identity, and building meaningful interpersonal connections were reported as helping support recovery from suicidal crises.Though our sample was predominantly White, cis-gendered, and English speaking, and the underlying research designs prevent strong causal inferences, we discuss possible implications of these findings for male suicide intervention and suggestions for future research.

Suicidal behaviour is a complex phenomenon-its aetiology spans biological, psychological, environmental, social and cultural facets. Men's deaths by suicide outnumber women in every country in the world. This study explored the male experience of suicide attempts and recovery as well as factors which may be protective for men. Men (n = 12) participated in semi-structured face-to-face interviews which were subjected to Interpretative Phenomenological Analysis (IPA). Four master themes were identified: (1) "characteristics of attempt/volitional factors", (2) "dealing with suicidal thoughts and negative emotions", (3) "aftermath" and (4) "protective factors". The theoretical and clinical implications of this study are discussed, including help seeking, emotional expression, the long-term impact of suicide attempt as well as the applied contribution to established theories.

Background: In 2016, the World Health Organization (WHO) labelled 13% of the world's adult population as obese. This increase in obesity is accompanied by mortality and morbidity problems, with maternal obesity and its accompanying risk for mother and infant requiring to be carefully managed. Aim: To explore childbearing women with a high BMI (> 35 kg/m(2)) perceptions of risk and its potential impacts upon pregnancy and outcome. Method: Qualitative Interpretative Phenomenological Analysis (IPA) was used to gain deeper understanding of the lived experiences of childbearing women with a BMI > 35 kg/m(2) and perceptions of their risk and potential pregnancy outcome. Findings: One of the superordinate themes that emerged was (1) Risk or no risk, and its associated three subthemes of (1a) Emotional consequences of her risky position, (1b) Recognition of high-risk complicationsfinally sinking in, and (1c) Accepting the risk body. . Recommendations for practice: In general, health care professionals are uncomfortable about discussing obesity-associated risks with pregnant women. The participants in this study did not classify themselves as obese, with this absence of acknowledgement and 'risky talk' leaving participants' unaware of their obesity-associated risk. This downplaying of obesity related talk requires to be corrected, simply because women in denial will perceive no need to engage with health promotion messages. In response, directives are required to be embedded into policy and practice. Conclusion: Specific training is required to teach maternity care professionals how to have difficult, sensitive conversations about obesity related risks with childbearing women with high BMI's. In addition, this risk information needs to be accompanied by relevant advice and support. Crown Copyright (C) 2020 Published by Elsevier Ltd. All rights reserved.

BACKGROUND:In line with research highlighting the role of observer appraisals in understanding individuals' pain experience, recent work has demonstrated the effects of parental child- and self-oriented injustice appraisals on child pain-related outcomes. However, research on parental injustice appraisals is in its infancy and lacks a valid and context-specific operationalization of what parental injustice appraisals of child pain precisely entail. The current study presents an in-depth qualitative analysis of parental child- and self-oriented appraisals of injustice in the context of their child's chronic pain.METHODS:Twenty-one mothers of children living with chronic pain participated in one of five focus group interviews conducted in Ghent (Belgium), Glasgow (Scotland) and Indianapolis (USA).RESULTS:The interviews were subjected to interpretative phenomenological analysis, which revealed three key justice-related themes, labelled 'You shouldn't be in this much pain', 'The problem's probably with the mother' and 'At least it's not cancer'. Maternal injustice appraisals focused mainly on the child rather than the self and reflected various perceived barriers to their efforts to provide quality of life for their child. A fourth theme labelled 'Not everybody gets a healthy child' reflected maternal strategies to effectively cope with the child's condition and the associated appraisals of injustice.CONCLUSIONS:The current findings attest to the relevance of (child- and self-oriented) injustice in the parental experience of caring for a child with chronic pain and provides insight into the specific content and scope of these appraisals. As such, this study provides valuable insights to further research in this area.SIGNIFICANCE:The current study presents an in-depth qualitative analysis of parental appraisals of injustice in the context of their child's chronic pain condition. The findings provide valuable insights into the phenomenology of this construct and may inform future research and assessment methods. Furthermore, the themes reported in this study may contribute to clinical practice, as they may raise awareness of parental concerns regarding their child's pain management.

Objective: This study aimed to identify vulnerability and protective factors for suicidal histories among adults experiencing psychological trauma. Method: Adults seeking treatment for psychological trauma (N = 113) completed self-report questionnaires measuring childhood trauma history, self-concept, relational functioning, emotion regulation, living arrangements, employment status, marital status, and suicidal history. Independent samples t-tests were used to determine variables on which those with and without suicidal histories differed significantly. These variables were then entered into a binary logistic regression model to identify factors which independently distinguished between those with and without a suicidal history. Results: Univariate differences were found for childhood emotional abuse (CEA), childhood emotional neglect (CEN), emotion deactivation, and employment status, with those in the suicidal history group scoring higher on all of these. CEA (OR = 1.13, 95% CI = 1.01-1.27) and employment status (OR = 4.12, 95% CI = 1.23-13.73) remained significant predictors of suicidal status in the multivariable logistic regression. Conclusions: CEA was an independent vulnerability factor for suicidal risk, highlighting the need for clinicians to assess exposure to such trauma in those presenting with proximal traumatic experiences. Being in employment was an independent protective factor against suicidal risk, highlighting the importance of social buffers or networks when faced with traumatic situations.

People with intellectual disabilities (ID) experience significant barriers to diabetes self-management (DSM), yet there remains a paucity of research within this population. An overview of the literature on people with ID and their caregivers' experiences of living with and self-managing type 2 diabetes is provided. Meta-aggregative methods were adopted to synthesize results, and an appraisal was reported of rigor. A total of eight studies met the inclusion criteria and four themes were extracted: (i) "Frustration over lifestyle adjustments," (ii) "Limited understanding and inadequate educational resources," (iii) "Limited training and knowledge in staff," and (iv) "Potential for effective DSM with appropriate support." Current support is inadequate to meet the needs of people with ID and their caregivers self-managing diabetes. Structured education to improve health literacy and diabetes knowledge in people with ID is required, together with training for caregivers which leads to a culture of nurturing autonomy.

Social exclusion and isolation are worldwide social and health concerns with negative effects becoming exacerbated in deprived communities. There is limited understanding related to the role of community-based centres in reducing social exclusion and isolation, so the aim of this research was to explore the role one family centre had in improving social inclusion in a deprived community in Glasgow, Scotland. Interpretative Phenomenological Analysis was utilized to analyse interviews from 10 parents to explore their lived experiences of creating and developing social networks through family centre attendance. Findings indicate that attending the family centre positively impacted on social inclusion and social support for all parents interviewed. Relationships created in the centre were proposed as being meaningful, non-judgemental and produced social capital-rooted in reciprocity and trust. Findings can inform services that aim to reduce social isolation in deprived communities.

RATIONALE:Suicide is a major public health concern and its aetiology is complex. Evidence suggests that experiences of early disrupted attachment relationships with parents and family members are associated with later experiences of suicidal thoughts and behaviours (STB). However, no study has investigated this relationship from an inductive, interpretative and idiographic perspective.OBJECTIVE:This paper explores the role of interpersonal relationships in STB among nine individuals who have attempted suicide.METHOD:Semi-structured face-to-face interviews were analysed using an interpretative phenomenological analysis approach.RESULTS AND CONCLUSION:Two inter-related master themes were identified: 1) 'challenging relationships as catalysts for STB'; and 2) 'positive relationships as buffers against STB'. Findings indicate that experiences of early disrupted parent-child attachments may contribute to vulnerability for STB by shaping participants' perceptions of intimate others and themselves (internal working models). These working models, along with other environmental factors and life events, may increase the risk of STB through perceptions of defeat, entrapment, perceived burdensomeness and thwarted belongingness. Results also suggest that being exposed to respectful, caring, unconditionally accepting, reciprocal, trusting, and non-judgemental intimate adult relationships increase resilience and is associated with recovery from past STB and a reduction of current suicide risk. The theoretical and clinical implications are discussed.

The current study aimed to explore the lived experience of patients with hepatitis C virus infection. Semi-structured interviews were conducted with seven male participants living with hepatitis C virus and were analysed using interpretative phenomenological analysis. Two master themes were identified: (1) diagnosis and the search for meaning and (2) impact of stigma on disclosure. Participants reported fears of contaminating others, feelings of stigma and concerns of disclosing the condition to others. Response to diagnosis, stigma and disclosure among the participants appeared to be interrelated and directly related to locus of blame for virus contraction. More specifically, hepatitis C virus transmission via medical routes led to an externalisation of culpability and an openness to disclosure. Transmission of hepatitis C virus as a direct result of intravenous drug use led to internalised blame and a fear of disclosure. The inter- and intra-personal consequences of hepatitis C virus explored in the current study have potential implications for tailoring future psychological therapy and psychoeducation to the specific needs of the hepatitis C virus population.

ObjectivesAcute psychiatric inpatient wards are characterized by minimal provision of therapeutic activities and high readmission rates. Implementation of a comprehensive inpatient psychological intervention service has been recommended to overcome these problems; however, whether this is feasible or effective remains unclear. MethodsThis non-randomized parallel cluster feasibility trial examined the feasibility of delivering and evaluating cross-diagnostic psychologically informed acute psychiatric care the Edinburgh-Acute Psychological Inpatient Therapy Service (EDAPTS) and gathered preliminary clinical outcome data. Patients able to consent and complete questionnaires were recruited from two adult acute wards (i.e., clusters) and received either EDAPTS plus TAU or TAU. ResultsBetween October 2015 and October 2016, 96 inpatients were recruited. Findings suggested that there were good data completion rates for several clinical outcomes, that several EDAPTS components were successfully delivered, and that some initial effects appeared to favour the intervention, depending on outcome. However, difficulties relating to the recruitment process were also identified, as well as problems relating to adequate delivery of group therapies, participant engagement in some intervention components, and data completion at follow-up. ConclusionThese issues, and the feasibility of randomization and rater-blinding, have important implications for the design of future trials. Overall, this study provides an important insight into the challenges and complexities of developing and evaluating a comprehensive psychological intervention service in an acute psychiatric setting. Practitioner points Individual therapy sessions can be delivered in the acute environment. The EDAPTS intervention showed some promise on outcomes of distress and self-efficacy. Delivery of nurse-led groups was challenging and may need to be embedded into routine clinical practice to increase intervention and outcome reach. More parameters, for example, randomization at cluster level, should be tested before progressing to an adequately powered, single-blind, definitive cluster RCT.

Background People with intellectual disabilities remain at high risk of developing type 2 diabetes (T2D) due to lifestyle-associated risk factors. Educational programmes have been adapted for people with intellectual disabilities targeting ongoing T2D self-management. However, there are no adapted programmes which aim to prevent T2D through reducing risk factors. The present study initiates addressing this gap. Methods Further education (FE) colleges in Scotland were recruited for feasibility study using the Walking Away (WA) from Diabetes programme. Process evaluation assessed recruitment, retention, baseline physical activity levels, and acceptability and accessibility using focus groups. Results Ninety six percent of invited students agreed to participate. WA was positively received, and some short-term impact was described. Suggestions for further adaptations regarding materials, delivery and content were provided, including delivery embedded within FE college curriculum. Conclusions Recruitment, retention and acceptability provide rationale for further research on T2D prevention in FE colleges.

Existing qualitative studies focussed predominantly on exploring immigrants’ stress, distress and coping aimed at reducing stress. Little attention has been paid to immigrants’ psychological growth or positive life changes. In the present study, the impact of post-migration experiences on well-being among economic immigrants has been explored. Semi-structured interviews were conducted with a sample of 17 immigrants. Transcripts were analysed by a deductive and inductive thematic analysis. All immigrants reported positive life changes as a result of migration. Experiences related to migration helped immigrants rebuild their sense of self-worth and find ‘mental peace’ after living a demanding and burdensome life in Poland. Immigrants’ accounts also suggested that their thinking and behaviour patterns may be shaped by their cultural values and socio-economic background. Overall, the study indicates that migration is not merely a stressful life event but can have a positive impact on many aspects of immigrants’ lives and may provide opportunities for personal growth.

OBJECTIVES The effectiveness of psychological therapies for those receiving acute adult mental health inpatient care remains unclear, partly because of the difficulty in conducting randomized controlled trials (RCTs) in this setting. The aim of this meta-analysis was to synthesize evidence from all controlled trials of psychological therapy carried out with this group, to estimate its effects on a number of important outcomes and examine whether the presence of randomization and rater blinding moderated these estimates. METHOD A systematic review and meta-analysis of all controlled trials of psychological therapy delivered in acute inpatient settings was conducted, with a focus on psychotic symptoms, readmissions or emotional distress (anxiety and depression). Studies were identified through ASSIA, EMBASE, CINAHL, Cochrane, MEDLINE, and PsycINFO using a combination of the key terms 'inpatient', 'psychological therapy', and 'acute'. No restriction was placed on diagnosis. The moderating effect of the use of assessor-blind RCT methodology was examined via subgroup and sensitivity analyses. RESULTS Overall, psychological therapy was associated with small-to-moderate improvements in psychotic symptoms at end of therapy but the effect was smaller and not significant at follow-up. Psychological therapy was also associated with reduced readmissions, depression, and anxiety. The use of single-blind randomized controlled trial methodology was associated with significantly reduced benefits on psychotic symptoms and was also associated with reduced benefits on readmission and depression; however, these reductions were not statistically significant. CONCLUSIONS The provision of psychological therapy to acute psychiatric inpatients is associated with improvements; however, the use of single-blind RCT methodology was associated with reduced therapy-attributable improvements. Whether this is a consequence of increased internal validity or reduced external validity is unclear. Trials with both high internal and external validity are now required to establish what type, format, and intensity of brief psychological therapy is required to achieve sustained benefits. PRACTITIONER POINTS Clinical implications: This review provides the first meta-analytical synthesis of brief psychological therapy delivered in acute psychiatric inpatient settings. This review suggests that brief psychological therapy may be associated with reduced emotional distress and readmissions. LIMITATIONS The evidence in this review is of limited quality. The type, format, and intensity of brief psychological therapy required to achieve sustained benefits are yet to be established.

The effectiveness of psychological therapies for those receiving acute adult mental health inpatient care remains unclear, partly because of the difficulty in conducting randomized controlled trials (RCTs) in this setting. The aim of this meta-analysis was to synthesize evidence from all controlled trials of psychological therapy carried out with this group, to estimate its effects on a number of important outcomes and examine whether the presence of randomization and rater blinding moderated these estimates. A systematic review and meta-analysis of all controlled trials of psychological therapy delivered in acute inpatient settings was conducted, with a focus on psychotic symptoms, readmissions or emotional distress (anxiety and depression). Studies were identified through ASSIA, EMBASE, CINAHL, Cochrane, MEDLINE, and PsycINFO using a combination of the key terms ‘inpatient’, ‘psychological therapy’, and ‘acute’. No restriction was placed on diagnosis. The moderating effect of the use of assessor-blind RCT methodology was examined via subgroup and sensitivity analyses. Overall, psychological therapy was associated with small-to-moderate improvements in psychotic symptoms at end of therapy but the effect was smaller and not significant at follow-up. Psychological therapy was also associated with reduced readmissions, depression, and anxiety. The use of single-blind randomized controlled trial methodology was associated with significantly reduced benefits on psychotic symptoms and was also associated with reduced benefits on readmission and depression; however, these reductions were not statistically significant. The provision of psychological therapy to acute psychiatric inpatients is associated with improvements; however, the use of single-blind RCT methodology was associated with reduced therapy-attributable improvements. Whether this is a consequence of increased internal validity or reduced external validity is unclear. Trials with both high internal and external validity are now required to establish what type, format, and intensity of brief psychological therapy is required to achieve sustained benefits. Clinical implications: Limitations: