This paper reports on a study exploring the experiences of working carers in the South of England-part of a larger research project exploring carers' needs, experiences and ideas about improving carer involvement in research. The purpose of this element of the project was to understand the experience of being in paid employment whilst providing unpaid care to someone, including adjustments made to employment, support provided by employers and support agencies, the impact on the carers perceived well-being and ideas for improving their involvement in carers research. An online survey was distributed across a range of employers in four counties located in the South of England, and n = 51 participants responded to share their experiences. The survey was coproduced with n = 6 unpaid carers who attended a one and a half hour facilitated workshop where they contributed to the design and development of the questionnaire. Amendments to the questionnaire were then reviewed by n = 2 of the workshop participants chosen at random who provided additional comments and revisions before it was distributed. Several themes emerged concerning the carers experience at work, the support mechanisms in place which were helpful to them, issues and challenges experienced and ranked suggestions for future research to develop further understanding of the world of the working carer. We discuss areas where changes in policy and practice might address working carer concerns in relation to their retention in the workforce and ability to juggle all aspects of their working life with their caring responsibilities. This research highlights the importance of developing more humanised ways of understanding working carer needs-including further training to support wider organisational culture-to meaningfully support them in meeting their full potential within the workforce.

Recent literature in social work/care continues to highlight limited levels of research involvement by practitioners coupled with low confidence and knowledge of research skills. This article reports on findings from a study to develop a better understanding of the challenges of building capacity to undertake social care research in the South of England and opportunities for building research engagement and capacity. It focuses on research skill gaps identified in current training pathways and qualification routes from the perspective of practitioners working in social care. A qualitative approach was undertaken. Participants were practitioners working in local authority social service departments. Participants completed an online questionnaire (n = 22), with a subsample (n = 6) being interviewed. A semi-structured interview schedule collected positive and negative views of research experiences and of using research evidence. Logistical and research skill enablers and research skill barriers were extracted as themes from the data and are described. The authors then discuss possible initiatives that might assist in helping to improve social work practitioner research skills and embedding research into practice.

Challenges with the retention of social workers have increased over the past ten years with links made to higher caseloads, increased stress, shrinking office space and hybridisation of work roles driven by both austerity and changes resulting from the coronavirus disease 2019 (COVID-19) pandemic. This article reports on findings from a study developed with two local authorities exploring retention in adult social care from the perspective of practitioners working in the South of England. A mixed methods approach was taken. A group of (n = 57) social workers at two local authorities completed an online survey and (n = 13) were interviewed in depth. A semi-structured interview schedule was constructed to collect expanded reflections on issues affecting retention. Several themes emerged concerning the differential impacts of the changing workplace post-COVID-19. These include increased stress and high caseloads and the potential negative impact of hotdesking and hybrid working on supervision and well-being. We discuss areas where changes might address some of the current concerns highlighted by participants, which may in turn exert a positive impact on retention. This article reports on findings from a study exploring retention issues in adult social care from the perspective of social work practitioners in the South of England. It focuses on themes emerging around the differential impacts of the changing workplace post-coronavirus disease 2019 (COVID-19). These include increased stress and high caseloads and the potential negative impact of hotdesking and hybrid working on supervision and well-being. It discusses areas where changes could address some of the current concerns highlighted by participants, which may in turn exert a positive impact on retention.

Incidences of catfish impersonating (the act of luring others into online relationships using false identities) and Munchausen by Internet (feigning illness on social media) are frequently discussed in the popular media but rarely researched. This chapter will review recent research and discuss psychological theories applied to explain online identity deception. Our research collected incidences of and attitudes toward these two types of online deception and participants' views regarding legislation. A pilot study collected qualitative data to help develop questions for the subsequent quantitative study; it is this latter study that is the main focus of this chapter. 198 participants completed a 19-item online survey. Data were analyzed within five categories relating to identity deception: (1) vigilance; (2) personal experiences; (3) awareness; (4) perceived motivations for deception; and (5) legal views. High levels of exposure to and knowledge of both types of deception were shown. Participants felt that the duty of care regarding legislation rested more with social media providers than at a national level; interestingly, few participants felt the onus was on individuals to realize that this was a risk of using social media. In conclusion, incidences of impersonation and feigning illness online will continue to increase and are probably being underreported globally. Further research is planned, which will use an observational method to analyze the discussions and user perceptions held on Twitter regarding these types of online deception.

The UK has been experiencing an extended cost-of-living crisis since 2021 and students attending universities have struggled with the impacts of rising prices. This article reports on findings from a study to explore local recruitment and retention issues in adult social care from the perspective of different populations of interest in the South of England. A mixed methods approach was undertaken. One group of participants were students enrolled in social work undergraduate and postgraduate programmes. They completed an online questionnaire (n = 20), with a subsample (n = 11) being interviewed. Comments relating to the wide-ranging effects of cost-of-living issues discussed by the participants were themed together and are described. The findings offer suggestions to evaluate student support mechanisms and reduce the potential impacts of ongoing financial difficulties caused by the need to juggle course, placement and financial demands across this and other applicable undergraduate sectors and their programmes. They also reflect risks to future workforce recruitment alongside the potential of 'earn and learn' programmes, such as apprenticeship routes - which may offer a viable alternative to qualification for those at particular risk of financial hardship whilst studying.

Background When considering the policing environment of 2022, many roles previously in the domain of warranted officers (police officer) are now performed by nonwarranted police staff equivalents. These police staff roles have expanded rapidly into other areas such as investigations, custody, and contact management, which were traditionally seen as police officer functions and put staff under some of the same stresses as police officers. A UK police force requested help in investigating technologies that could be used to improve health and well-being for both officers and staff. Objective The aim of this study was to create a health and well-being app for police officers and staff, which considered the unique requirements of the users throughout the designing, building, prototyping, and testing stages. Methods This study involved quantitative approaches (demographic web-based survey questions and the System Usability Scale) and qualitative approaches (open web-based survey questions and semistructured interviews). Unsupervised usability testing of a prototype app was undertaken by members (N=48) of the commissioning client using their smartphones. After completing a preregistration application for screening purposes, participants downloaded a trial version of the app. Then, they completed a web-based questionnaire after testing the app for 10 days. A subsample of participants (9/48, 19%) was interviewed. Deductive thematic analysis was undertaken to identify key themes and subthemes. Results Data collected during usability testing concerned the 6 domains of the app—food and diet, activity, fluid intake, sleep, good mental health, and financial well-being—and informed the creation of improved design during prototyping. Some usability and design issues and suggestions for improvements were also addressed and implemented—including shift management and catch-up cards—during this cycle of development. Conclusions This study highlights the importance of coparticipation with officers and staff across the entire development cycle, to coproduce a human-centered design methodology to enable the development of a considered and user-centered solution. It demonstrates the need for producing a multifunctional tool rather than focusing purely on an individual element for this user group. It also highlights how linking and being able to track optional, personalized elements of health data against one another, cross-referenced to individual shift patterns, might help to inform and provide users with a chance for reflection and therefore influence behavior change.

To achieve a growth in practice-focused research, social care requires a solid infrastructure including a skilled research workforce, funding and a framework of national, strategic priorities. This article concerns practitioner researchers and developing the skills and support to enable practitioners to become active researchers within social care practice. It reports on findings from a study to develop a better understanding of the challenges of building capacity to undertake social care research in the South of England and the opportunities for building research engagement and capacity within local authorities (LAs) to include practitioner-led research. A qualitative approach was undertaken. Participants were practitioners working in LA social service departments. Participants completed an online questionnaire (n = 22), with a subsample (n = 6) interviewed. A semi-structured interview schedule collected positive and negative views of research experiences and of using research evidence. Individual-level and organisational research barriers were extracted as themes from the data and are described. The authors then discuss areas where practical ground level initiatives could be focused that might assist in developing a more positive research environment within social care organisations employing social workers and other practitioners.

Background Police officers often work long, unsocial hours in a highly pressurized environment and may experience difficulties in managing their health and well-being. Their jobs can be highly stressful and feature unusual working hours and multiple shift patterns. When considering the policing environment of 2021, many roles that were previously the domain of warranted officers are now being carried out by nonwarranted police staff equivalents. These police staff roles are relatively new to policing but put staff under some of the same stresses as police officers. A UK police force requested help to investigate technologies that could be used to improve health and well-being and research how these technologies could be used to measure and track health behavior change. Objective Historical research studies need to be appraised in light of this new policing environment, and new research also needs to include this shift in dynamics when considering aspects of policing, including their health and well-being. This study explores police officer and staff attitudes toward and their use of existing health-related technology, highlights existing practices, and gathers views about how technology could be used more effectively. Methods A web-based survey was completed by police officers and staff (N=213) during the initial period of the UK lockdown in 2020. The survey was designed to find the solutions that participants used outside of those supplied by their employer, identify issues or problems, and find what they would like a hypothetical app to focus on. Additional requirements data were captured through client meetings, including discussions concerning previously attempted solutions and those currently in place. Thematic analysis was undertaken to identify the key themes. Results Attitudes toward and uses of existing health-related technology were captured, and existing practices were highlighted. Participants identified a need for an app to consider that a user was on shift—an important point, as many issues and problems with elements of their health and well-being involved shift work. Data also highlighted that a multifunctional tool would be more beneficial to participants than focusing on just 1 element. The key features and four domains were identified for app coverage. The prioritized order of importance of the four domains was activity, food and diet, sleep, and fluid intake. Conclusions For police officers and staff, research data suggest that there is a previously unidentified requirement for a mobile app that could provide an easily accessible platform for them to use, regardless of the current location; one that could provide guidelines on diet, lifestyle habits, and health behavior to help the user make informed decisions to assist in personalized behavior change. Notably, one which is multifunctional and which also aligns effectively with the irregular shift patterns of its users.

BACKGROUND Police officers often work long, unsocial hours in a highly pressurised environment and may experience difficulties when managing their health and wellbeing. Those working in the police face different health issues in comparison to the general public; their job can be highly stressful and feature unusual working hours and multiple shift patterns. A UK police force requested help investigating technologies which could be used to improve health and wellbeing; researching how these technologies could be used to measure and track health behaviour change. OBJECTIVE Research aims were focused on exploring current police officer attitudes to health and wellbeing technology and their use of existing health-related technology, conducted via an online survey for police officers and client meetings. Highlighting existing practice, gathering views about how technology could be used and opinions on what specific areas of health officers would like to see covered in a tailored mobile technological solution. This information would be used as a starting point for future prototyping of a targeted application that aimed to help solve issues that existing technology did not effectively cover. METHODS An online survey was completed by (n=213) police officers during the first period of UK lockdown. The survey was designed to find out what solutions the participants used outside of those supplied by their employer, as well as identifying issues or problems and what they would like a hypothetical application to focus on. Due to challenges arising from COVID-19 restrictions - in terms of logistics and operational pressures on the commissioning force – additional requirements data was captured through client meetings; including discussions concerning previous attempted solutions and those currently in place. A thematic analysis was undertaken to identify key themes. RESULTS Key challenges and opportunities of designing and delivering an integrated digital solution and maintaining user engagement were highlighted. Four key themes were identified for application coverage. These were the four areas of health and wellbeing that participants felt they would benefit from the most. In order of importance these were Activity, Food and Diet, Sleep, and Fluid Intake. CONCLUSIONS Research data suggests there is a requirement for a mobile application which would provide an easily accessible platform for police officers to utilise regardless of current location. One which could provide guidelines on diet, lifestyle habits and behaviour to help the user make informed decisions to assist in personalised behaviour change. Notably one which also aligns effectively with the irregular shift patterns of its users.

Background Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS), experienced by more than 80% of people with MS. FACETS (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle) is an evidence-based, face-to-face, 6-session group fatigue management program for people with MS. Homework tasks are an integral part of FACETS and are currently undertaken in a paper-based form. Feedback from a consultation undertaken with FACETS attendees and health care professionals with experience in delivering the FACETS program suggested that being able to complete the homework tasks digitally would be desirable, potentially enhancing engagement and adherence and enabling on-the-go access to fit into busy lifestyles. Relative to other long-term conditions, there are few apps specifically for MS and, of those available, many have been developed with little or no input from people with MS. Objective The purpose of this mixed methods study was to create a digital toolkit comprising the homework tasks (eg, activity diary, goal planner, thought diary) of the FACETS program for people with MS, considering end users’ unique requirements throughout the design, build, prototyping, and testing stages. Methods Phase 1 involved the elicitation of detailed user requirements for the toolkit via 2 focus groups with previous attendees of FACETS (n=3 and n=6) and wireframing. Phase 2 involved supervised usability testing with people with MS (n=11) with iterative prototyping. The usability sessions involved going through test scenarios using the FACETS toolkit on an Android test phone with video capture and concurrent think-aloud followed by completion of the System Usability Scale (SUS) and a semistructured interview collecting feedback about design, content, and functionality. Results The mean SUS score for the digital toolkit was 74.3 (SD 16.8, 95% CI 63.2-85.6; range 37.5-95), which equates to an adjective rating of good and a B grade (70th-79th percentile range) on the Sauro-Lewis curved grading scale. A number of usability and design issues (such as simplifying overall screen flow to better meet users’ needs) and suggestions for improvements (such as using location-based services and displaying personalized information and progress via a central dashboard) were addressed and implemented during the usability testing cycle. Conclusions This work highlights the importance of the participation of people with MS across the entire development cycle, working to a human-centered design methodology to enable a considered and MS-centered solution to be developed. Continued horizon scanning for emergent technological enhancements will enable us to identify opportunities for further improvements to the FACETS toolkit prior to launch. The toolkit supports self-monitoring and management of fatigue and has potential applicability to other long-term conditions where fatigue is a significant issue.

Background Global demand for capacity building has increased interest for eLearning. As eLearning resources become more common, effective implementation is required to scale up utilization in Low- and Middle-Income Countries (LMICs). Objective This paper describes the process of implementing a malnutrition eLearning course, effectiveness of course delivery models devised, factors affecting course completion, and cost comparison between the models and face-to-face training at healthcare and academic institutions in Ghana. Methods Four delivery models: Mobile Training Centre (MTC), Online Delivery (OD), Institutional Computer Workstation (ICW) and Mixed Delivery (MD) – a combination of OD and ICW – were determined. Participants were enabled to access the course using one of the four models where contextually appropriate. Pre and post-assessments and questionnaires were administered to compare participants’ course completion status and knowledge gain between delivery models. The effect of access to computer and Internet at home and relevance of course to job and academic progression on course completion were further investigated. Comparison of delivery model costs against face-to-face training was also undertaken. Results Of 7 academic and 9 healthcare institutions involving 915 people, 9 used MTC (34.8%), 3 OD (18.8%), 3 ICW (34.2%) and 1 MD (12.2%). Course completion was higher among institutions where the course was relevant to job or implemented as part of required curriculum activities. Knowledge gain was significant among most participants, but higher among those who found the course relevant to job or academic progression. The implementation costs per participant for training with MTC were £51.0, OD £2.2, ICW £1.2 and MD £1.1, compared with a face-to-face training estimate of £105.0 (1 GHS = 0.14 GBP). Conclusion The malnutrition eLearning course makes global capacity building in malnutrition management achievable. Adopting contextually appropriate delivery models and ensuring training is relevant to job/academic progression can enhance eLearning effectiveness in LMICs.

This chapter defines and gives a brief history of exergaming and considers the evidence base, focusing particularly on multiple sclerosis (MS). It describes two case studies based on MS research studies. The first, a laboratory-based clinical trial comparing active video gaming (AVG) to traditional balance training, illustrates the concept of 'flow', arguably a key characteristic of AVG. The second, a pilot study, demonstrates the use of behaviour change techniques in a physiotherapist-supported home-based AVG programme. When designing an exergaming intervention, a person-centred, interdisciplinary and collaborative approach that involves end users and carers along with other stakeholders such as clinicians, service providers and commissioners will help to ensure it is fit-for-purpose and will increase the likelihood of enjoyment and flow experiences. It is also important to consider issues related to implementation and scalability early on, the likely lifespan of the technology and whether principles and learning can be generalised to other emerging technologies.

BackgroundScaling up improved management of severe acute malnutrition (SAM) has been identified as the nutrition intervention with the greatest potential to reduce child mortality but it requires improved operational capacity.ObjectiveTo investigate whether an eLearning course, which can be used at scale in resource-poor countries, leads to improved diagnosis, clinical management and survival of children with SAM.DesignA 2-year preintervention and postintervention study between January 2015 and February 2017.SettingEleven healthcare facilities: nine in Ghana, one in Guatemala, and one in El Salvador.InterventionScenario-based eLearning course ‘Caring for infants and young children with severe malnutrition’.Main outcome measuresIdentification of children with SAM, quality of care, case-fatality rate.MethodsMedical record reviews of children aged 0–60 months attending eleven hospitals between August 2014 and July 2016, observations in paediatric wards, and interviews with senior hospital personnel.ResultsPostintervention there was a significant improvement in the identification of SAM: more children had the requisite anthropometric data (34.9% (1300/3723) vs 15.9% (629/3953)) and more were correctly diagnosed (58.5% (460/786) vs 47.1% (209/444)). Improvements were observed in almost all aspects of the WHO ‘Ten Steps’ of case-management, and case-fatality fell from 5.8% (26/449) to 1.9% (14/745) (Post-pre difference=−3.9%, 95% CI −6.6 to −1.7, p<0.001).ConclusionsHigh quality, interactive eLearning can be an effective intervention in scaling up capacity building of health professionals to manage SAM effectively, leading to a reduction in mortality.

Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) and is the main reason why people with MS stop working early. The MS Society in the United Kingdom funded a randomized controlled trial of FACETS-a face-to-face group-based fatigue management program for people with multiple sclerosis (pwMS)-developed by members of the research team. Given the favorable trial results and to help with implementation, the MS Society supported the design and printing of the FACETS manual and materials and the national delivery of FACETS training courses (designed by the research team) for health care professionals (HCPs). By 2015 more than 1500 pwMS had received the FACETS program, but it is not available in all areas and a face-to-face format may not be suitable for, or appeal to, everyone. For these reasons, the MS Society funded a consultation to explore an alternative Web-based model of service delivery.The aim of this study was to gather views about a Web-based model of service delivery from HCPs who had delivered FACETS and from pwMS who had attended FACETS.Telephone consultations were undertaken with FACETS-trained HCPs who had experience of delivering FACETS (n=8). Three face-to-face consultation groups were held with pwMS who had attended the FACETS program: London (n=4), Liverpool (n=4), and Bristol (n=7). The interviews and consultation groups were digitally recorded and transcribed. A thematic analysis was undertaken to identify key themes. Toward the end of the study, a roundtable meeting was held to discuss outcomes from the consultation with representatives from the MS Society, HCPs, and pwMS.Key challenges and opportunities of designing and delivering an integrated Web-based version of FACETS and maintaining user engagement were identified across 7 themes (delivery, online delivery, design, group, engagement, interactivity, and HCP relationships). Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS' weekly homework tasks and symptom monitoring and management.A minimum viable Web-based version of FACETS was suggested as the best starting point for a phased implementation, enabling a solution that could then be added to over time. It was also proposed that a separate study should look to create a free stand-alone digital toolkit focusing on the homework elements of FACETS. This study has commenced with a first version of the toolkit in development involving pwMS throughout the design and build stages to ensure a user-centered solution.

Fatigue is a highly debilitating symptom experienced by the majority of people with MS and third in the James Lind Alliance ‘Top 10’ research priorities. Over 1500 people with MS in the UK have received FACETS, a group-based fatigue management programme, shown to be effective in a national multi-centre randomised controlled trial. Homework tasks are integral to FACETS, enabling strategies learned to be translated into everyday life. A recommendation from a consultation we undertook with people with MS and healthcare professionals about online delivery models was for the homework elements to be made available as a suite of mobile apps, enabling on-the-go use, real-time symptom monitoring and reminders. We are currently developing this toolkit – for use alone or in combination with FACETS – for Android, with ongoing input from people with MS. We describe progress to date (including scoping, card sorting, wire-framing and usability testing phases), challenges encountered and what’s next.

In this paper, we report on the first stages of creating a stand-alone digital toolkit focusing on the homework elements of FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle). FACETS is an evidence-based face-to-face fatigue management group programme for people with multiple sclerosis. This paper details the participatory design process from requirements elicitation to initial prototyping and how offline activities linked to each session have been mapped in the digitised solution (mobile app).