In Denmark, as in other countries, policymakers and municipalities seek to promote leisure-time physical activity among children and adolescents. However, many initiatives focus on the individual child, overlooking the role of parents in children's leisure practices. In contrast, a system-oriented family coaching approach was developed as part of an intervention aimed at involving parents in supporting their children's leisure-time physical activity. Drawing on qualitative methods, reflexive thematic analysis and utilising a symbolic interactionist perspective, this paper examines how participating children, parents, and family coaches interact in ascribing meaning to physical activity and identify actions to support the child's participation. The results showed that the issue of finding a meaningful leisure activity for the child often turned out to be a negotiation between the parents and the child that was mediated by the coach. Furthermore, when parents were not in a position to support their child's leisure-time physical activity dilemmas arose for both the coaches and the parents. By illuminating these interactional dynamics, the paper offers new insights into both the opportunities and challenges of utilising systemic family coaching as a strategy for engaging parents in their children's leisure-time physical activity.

This article explores the implementation of a supportive intervention in Danish municipal senior centres targeting social isolation among older people. The intervention, implemented between April 2022 and April 2023, comprised three key components: a start conversation for all new users; an assigned "buddy" among existing users; and monthly follow-up conversations. Skills development workshops for staff members were held prior to implementation of the intervention. The feasibility evaluation revealed concerns about the intervention implementation. This study describes the low level of implementation and explanatory factors contributing to the failure. We conducted a process evaluation as part of a feasibility evaluation of the intervention. The intervention was implemented in three municipal senior centres, ten senior centre staff members and 18 senior centre users participated. Data collection involved 23 semi-structured interviews with users and staff. Thematic analysis was conducted. Results are presented in two parts: 1) Overview of implemented components showing a low degree of fidelity in implementation, 2) Explanatory factors influencing implementation. The three factors identified were: A "too" systematic approach; Navigating frailty; and Lack of integration. These factors resulted in challenges recruiting participants and issues with performing some of the intervention elements. This evaluation provides insights into delivering interventions in municipal senior centres, emphasising explanatory factors to avoid implementation failures. The findings can support future development of contextually responsive interventions that can function as intended when delivered in real-world settings.

OBJECTIVE:To explore healthcare professionals' (HCPs) experiences of providing gestational diabetes mellitus (GDM) care, education, and support, and their perceptions of how well women's and families' needs are addressed. METHOD:A qualitative exploratory study was conducted using semi-structured interviews with 10 HCPs from obstetric and diabetes outpatient clinics in Southern Denmark. Data were analysed using reflexive thematic analysis. RESULTS:Four themes were identified: (1) benefits and limitations of a fixed GDM care system; (2) the influence of risk information, motivation, and partner support; (3) challenges related to culture, language, and health literacy; and (4) psychological and social aspects of GDM, including shock and stigma. DISCUSSION:HCPs valued the universal multidisciplinary care model but described challenges in addressing individual and complex psychosocial needs. CONCLUSIONS:While current GDM care supports high-quality treatment and prevention of complications, greater flexibility and patient-centred approaches are needed, particularly for vulnerable groups within universal healthcare settings.

Community capacity building is widely regarded as a valuable approach in health promotion and applied across diverse contexts. However, there is a lack of research in applying community capacity building to promote leisure-time physical activity among children and adolescents.This study aimed to build community capacity to develop leisure-time physical activities for children and adolescents in public housing areas. In this article we examine how participating community stakeholders (municipal employees, social workers, representatives from sports clubs and a sports organization) attribute meaning to a co-production process as part of building community capacity. To explore this, we conducted four focus groups and one individual interview with participating stakeholders and observed 27 co-production workshops. We followed a strategy of reflective thematic analysis and orientated the coding process in Robert Chaskin's (2001) conceptualization of community capacity.Our analysis shows that the participating stakeholders were more focused on developing activities for children in the area than in building community capacity. The stakeholders’ level of commitment to reach their shared vision was challenged by ambiguities in their roles and responsibilities, competition for resources, and frustrations about the research-based design of the project. As many stakeholders measured success by the number of children participating in the developed activities, they perceived the project as less successful when implementation of activities failed, even if initial community capacities were developed.This article highlights the importance of future initiatives recognising and addressing the tensions involved in prioritizing community capacity building equally alongside the achievement of specific programme outcomes.

Social isolation is a significant challenge among the aging population. A newly developed intervention was implemented in municipal senior centres to support new users to become part of the social community, with the intention of reducing social isolation. The intervention consisted of a starting conversation with staff members, a 'buddy' from existing users and monthly follow-up conversations. This study aims to explore the acceptability of the intervention among senior centre staff members as part of a process evaluation, drawing upon the Theoretical Framework of Acceptability by Sekhon et al. Data were collected through observation and interviews with senior centre staff members (N = 10) involved in the implementation and delivery of the intervention. Data analysis was inspired by thematic analysis. The results indicated a decline in acceptability during the intervention period. Underlying reasons were organized in three main themes: 'Why do it this way, when I can do it my way'; 'I don't like to place these demands on the user'; and 'We just had to prioritise'. Overall, participants suggested a preference for a noninstitutional approach to welcoming new users and felt the intervention misaligned with the organizational goals to improve health. High staff turnover and workload further negatively affected intervention acceptability. This study highlights the complexities of implementing interventions in senior centres, where staff hesitance and a misalignment with values can affect intervention acceptability.

Denne artikel beskriver hvordan en intervention til fremme af mental sundhed hos unge i 7-9 klasse i en dansk kommune blev udviklet igennem en samskabende proces samt undersøger forskellige kommunale ledernes perspektiv på deres involvering i denne proces. Interventionsudviklingen var del af et forsknings-praksissamarbejde mellem kommunen og forskere på Aalborg Universitet og tog afsæt i det britiske medicinske forskningsråds (the Medical Research Council) anbefalinger, som bla. har fokus på involvering af interessenter. Forskernes rolle var at bidrage til at interventionen blev baseret på relevante teorier og den seneste forskning samt at bidrage til udarbejdelse af en programteori, mens de kommunale ledere og forskellige fagprofessionelle indenfor skoleområdet, sundhedsplejen, fritidstilbud og tandpleje bidrog med indsigt i organisatoriske forhold og politiske prioriteringer samt fagindsigt. Der blev udviklet to relaterede interventioner, en stilet mod forældre til børn i 7. klassetrin og en stilet mod at styrke medarbejderes viden og mentale sundhedskompetencer ift. at fremme mental sundhed i skolen. Den efterfølgende evaluering vil vise hvorvidt indsatsen skal revideres før videre implementering.

Prevalence of dysphagia is high in hospitalised geriatric patients, posing risks of complications including malnutrition, dehydration, aspiration, and pneumonia. These complications may lead to reduced daily functioning, frailty, prolonged hospital stays, readmissions, and mortality. Diagnosing dysphagia in geriatric patients is often challenging due to the complex health conditions of this patient group, and overall these patients are at risk of lack of continuity in patient pathways and unnecessary hospitalisations. Recognising the critical importance of prompt diagnosis and treatment of dysphagia, we developed a dysphagia screening intervention aligned with clinical guidelines and the political focus to improve patient pathways and reduce preventable hospitalisations. This article outlines the development process of a dysphagia screening intervention to geriatric patients (≥ 65 years) admitted to medical inpatient wards. We applied a theory-, evidence- and implementation-based approach combined with stakeholder involvement in adherence to the IdentifyiNg and assessing different approaches to DEveloping compleX intervention (INDEX) guidance, encompassing eleven actions. We developed a dysphagia screening intervention comprising a screening procedure (the 4 Questionnaire Test (4QT), the 30 ml water swallowing test, and an action algorithm) targeting the patient level. Moreover, we developed an implementation strategy (activities necessary for adequate delivery of the dysphagia screening procedure and activities supporting the delivery of the screening procedure) targeting health professionals and the organisational level. The dysphagia screening intervention is now ready for feasibility testing, promising improved health and healthcare services for hospitalised geriatric patients.

Background: Adolescent knee pain was historically viewed as a self-limiting condition. Still, it may severely impact health-related quality of life and physical activity, and almost half of adolescents may continue to experience pain into adulthood. Currently, no tool is available to support the consultation and shared decisionmaking process when an adolescent suffering from non-traumatic knee pain presents at clinical practice. By supporting shared decision-making and tailoring management strategies, such a tool could optimize treatment delivery and improve the prognosis of this common condition. Objectives: This study aimed to develop a clinical decision-support tool (The MAP-Knee Tool) to improve the management of adolescents with non-traumatic knee pain. Design: Development study with end-user testing. Method: This multi-step study consisted of five steps ((1-4) initial development and (5) end-user testing with adolescents with or without non-traumatic knee pain and medical doctors). It ended with the first version of the MAP-Knee Tool for the six most common non-traumatic knee pain conditions. The tool includes four components: 1) tool for diagnosing, 2) credible explanations of the diagnoses based on two systematic literature searches and an Argumentative Delphi process with international experts, 3) prognostic factors based on an individual participant data meta-analysis, and 4) option grid including an unbiased presentation of management options based on the available evidence. Results: We included seven children/adolescents (8-15 years old) and seven medical doctors for the end-user testing. All four components were revised accordingly, and the text was condensed as the initial draft was too comprehensive. Conclusions: We developed a clinical decision-support tool for clinicians and adolescents with non-traumatic knee pain based on a multi-step process, including end-user testing to support the consultation in clinical practice.

PROBLEM:Despite solid evidence and national recommendations supporting midwife-led continuity-of-care models, Danish women's access to such programs remains limited. BACKGROUND:A public birth facility introduced a midwife-led continuity-of-care model, targeting a subset of women receiving antenatal and intrapartum care. AIM:To compare care satisfaction during pregnancy and birth and birth experience between women receiving midwife-led continuity of care and those receiving standard midwifery care. METHODS:This cross-sectional study used convenience sampling, with data collected via an online questionnaire distributed 4-6 weeks postpartum. Participants were recruited during antenatal visits. Birth experience and care satisfaction were assessed using the WOCCA and Pregnancy and Childbirth Questionnaires (PCQ). Domain scores of the PCQ were compared using linear regression to compare adjusted mean differences (aMD). Single items were compared with Mann-Whitney U-tests for non-normally distributed variables. FINDINGS:Between October 2022 and September 2023, 563 women were enrolled, with 368 responding. The midwife-led continuity of care group reported significantly higher satisfaction in both pregnancy domains than standard midwifery care (Personal Treatment: aMD 3.0 points; CI 1.7-4.3 and Education and Information: aMD 2.1 points; CI 0.9-3.3). Additionally, they reported a significantly more positive birth experience (p = 0.010), with 88.5 % (vs. 74.4 %) rating it very positive or outstanding. Also, overall care satisfaction during birth was higher, with 96.2 % (vs. 84.8 %) reporting being very or extremely satisfied (p = 0.021). CONCLUSION:Women receiving midwife-led continuity of care reported more positive birth experiences and higher care satisfaction levels than women receiving standard midwifery care. The findings add to the evidence of the benefits of midwife-led continuity of care models. More comprehensive access to this model of care could enhance the pregnancy and birth experiences of more women, also in settings already offering midwifery-led care.

BackgroundEarly identification of psychosocial vulnerability among expectant parents through psychosocial assessment is increasingly recommended within maternity care. For routine antenatal assessment, a strong recognition exists regarding conversational assessment tools. However, the knowledge base of conversational tools is limited, inhibiting their clinical use.ObjectiveSynthesising existing knowledge pertaining to antenatal conversational psychosocial assessment tools, including identifying characteristics, acceptability, performance, effectiveness and unintended consequences.DesignMixed-method systematic review based on searches in CINAHL, PubMed, Embase, PsycINFO, Cochrane and Scopus. 20 out of 5394 studies were included and synthesised with a convergent integrated approach using a thematic analysis strategy.FindingsWe identified seven antenatal psychosocial assessment tools that partially or completely utilised a conversational approach. Women's acceptability was high, and tools were generally found to support person-centred communication and the parent-health care professional relationship. Evidence regarding effectiveness and performance of conversational tools was limited. Unintended consequences were found, including some women having negative experiences related to assessment of intimate partner violence, lack of preparation and lack of relevance. High acceptability was reported by health care professionals who considered the tools as valuable and enhancing of identification of vulnerability. Unintended consequences, including lack of time and competencies as well as discomfort when assessment is very sensitive, were reported.ConclusionsEvidence regarding conversational tools effectiveness and performance is limited. More is known about the acceptability of conversational tools, which is generally highly acceptable among women and health care professionals. Some unintended consequences of the use of included conversational tools were identified.

In low-income communities, there is often a lack of resources and facilities for adolescents to engage in organized sports and leisure time physical activity. Therefore, different intervention strategies have been applied to promote physical activity. Yet, a systematic overview of the experiences of those involved in the interventions is lacking. Thus, the purpose of this qualitative systematic review was to synthesize participating adolescents', their parents' and other stakeholders' perspectives on family and/or community interventions that seek to support adolescents' leisure time physical activity in low-income areas. Five databases were searched using PIICo (P [population], I [intervention], I [phenomena of interest], and Co [context]) to operationalize the review question. Sixteen studies met the inclusion criteria. Through a thematic synthesis inspired by Thomas and Harden, six themes were constructed: (1) developing relationships with a trustworthy adult coach, (2) meeting an inclusive approach: 'A place for everyone', (3) forming new friendships through fun sports activities, (4) receiving support through free services, (5) experiencing the neighbourhood as unsafe and (6) challenging life circumstances for adolescents' participation. The findings showed that coaches and other programme staff are significant for adolescents' positive experiences of the intervention and continuous participation. Furthermore, mutual trust, respect and coaches utilizing inclusive approaches were significant to the development of social bonds between peers and their coaches. However, life circumstances and the experience of an unsafe neighbourhood impacted the adolescents' attendance negatively. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Background Knee pain affects one in three adolescents, which makes it one of the most common pain sites. Guideline recommendations about the clinical selection of patients likely to benefit from interventions are unclear, which leads to treatment heterogeneity and the potential of wasted resources among adolescents with a good prognosis. In contrast, adolescents with a poorer prognosis may not receive sufficient care. A newly developed clinical decision-support tool (The MAP-Knee Tool) intends to support clinicians in engaging with patients and adjusting the clinicians’ evidence-based practices to accommodate patient preferences and treatment needs via a shared decision-making process. The aims of this trial are 1) to investigate the effectiveness of using a clinical decision-support tool (The MAP-Knee Tool) compared with usual care in adolescents with non-traumatic knee pain in reducing pain measured by KOOS-Child Pain after 12 weeks and 2) to investigate how the intervention worked, for whom, why and under which circumstances applying realist evaluation methodology.Methods This trial is a cluster-randomised superiority trial with a delayed intervention and a realist evaluation. Six hospital departments start with a usual care period of 4 months before randomly crossing over to using the intervention (The MAP-Knee Tool) after 4, 6, or 8 months, respectively. We will recruit 290 adolescents suffering from non-traumatic knee pain diagnoses who are followed for one year, with the change in KOOS-Child Pain after 12 weeks considered the primary endpoint. Secondary outcomes include 1) Global Rating of Change, 2) EQ-5D-Youth, 3) Anterior Knee Pain Youth, 4) the International Physical Activity Questionnaire short version, and 5) sports participation. The realist evaluation will utilise a prospective, qualitative approach for collecting data needed to develop and test a program theory and identify context-mechanism-outcome configurations essential for understanding how outcomes are achieved within specific contexts.Discussion This trial focuses on how the initial clinical encounter can be improved to meet the support and management needs of adolescents with chronic knee pain seeking treatment for knee pain in secondary care and investigates how the intervention worked, for whom, why and under which circumstances.Trial registration [Clinicaltrials.gov][1] ([NCT05791513][2]). Prospectively registered on March 30th, 2023.### Competing Interest StatementThe authors have declared no competing interest.### Clinical TrialNCT05791513### Funding StatementThis study was funded by TrygFonden and The Independent Research Fund Denmark### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The trial was approved by the Ethics Committee of the North Denmark Region (N-20220043).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present study are available upon reasonable request to the authors [1]: http://Clinicaltrials.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05791513&atom=%2Fmedrxiv%2Fearly%2F2024%2F05%2F02%2F2024.04.29.24306576.atom

Abstract Background Inpatient mortality of patients with cardiogenic (CS) has been reported as high as 50%. Those who present in CS are at high risk of having recurrent admissions to hospital or requiring advanced heart failure (HF) therapies. The Toronto General Hospital (TGH) is a quaternary cardiac center, providing mechanical circulatory support (MCS) and heart transplantation (HT), serving as a regional CS transfer hub for a population of over 8 million people. While inpatient management of CS patients has been studied extensively, there is little data on where or how these patients are followed after their discharge. We aimed to determine the long-term clinical outcomes and nature of follow up after a CS admission. Methods This was a retrospective cohort study of CS patients admitted to TGH between 2014 and 2023. We collected data regarding survival to discharge and the type of follow up patients received after their index CS admission. Survival was compared using Kaplan-Meier methods. Results 1582 patients were admitted during the study. The mean age was 59.9 + 16.1 years, including 474 (30.0%) females and 335 (21.2%) patients with acute myocardial infarction CS. In-hospital mortality was 32.4%, with a further 17 (1.8%) patients transferred to palliative care during their index CS admission. After excluding patients who underwent heart transplantation (HT) or durable MCS implant, 679 patients were discharged alive, with median follow-up of the 307 (range 0 – 3436) days. Overall mortality was 57.0%. Among discharged patients, 396 (56.8%) were followed at the regional hub hospital. A further 54 (8.0%) patients were followed by a cardiology provider at a referring community center. A total of 202 (29.7%) patients did not have outpatient follow up arranged at the time of their discharge and no details of further care were available. Median survival during follow-up was higher among patients with confirmed follow-up at the time of their discharge, but not statistically significant (1798 vs 1775 days, p=0.067). There was a significant survival benefit among CS patients followed at a heart function clinic compared with those who were not, (1821 vs. 1775 days, p= 0.020). In terms of candidacy for advanced therapies, having outpatient follow up was associated with receiving durable MCS or HT (6.3% vs. 0.5%, p=0.003). Conclusion Despite advances in the management of CS, overall mortality remains high at 57.0%. Follow-up after CS admission is of essential importance- both in improvement of long-term outcomes, and access to advanced heart failure therapies. There was a survival benefit among patients who were followed in a specialized heart function clinic. Additionally, having outpatient follow up was significantly associated with receiving advanced therapies. Further research is needed to identify the barriers to accessing post discharge follow-up care.

Purpose: Cardiac allograft vasculopathy (CAV) portends a risk of graft failure and poor prognosis following heart transplant (HT). Intravascular imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) allows early detection of CAV intimal hyperplasia, however these modalities have differences in lateral resolution and are differentially affected by plaque components which may impact intima visualization. Their efficacy in assessing CAV has not been compared at scale. This study examined the relationship between IVUS and OCT-based volumetric analysis of CAV early post HT.

IntroductionPatient decision aids can support patient-clinician shared decision-making, yet little is known about the underlying change-mechanisms which facilitates patient-clinician collaboration in clinical settings. The MAP-Knee Tool was developed with GPs and adolescents with non-traumatic knee pain. It incorporated different components (diagnosis tool, credible explanations, prognostic factors, and an option grid) to support the consultation process and enhance patient-clinician collaboration. Our study was a Realist Evaluation of the effectiveness of the MAP-Knee Tool tested in a stepped-wedge randomised cluster trial in hospital settings.Methods and MaterialsThe Realist Evaluation investigates how, why, for whom and under which circumstances adolescents with knee pain and clinicians (GPs, physiotherapists, surgeons) benefitted from the MAP-Knee Tool though a theory-gleaning process. Data comprised intervention documents, survey data and qualitative realist interviews with researchers, adolescents, and clinicians. Thematic Realist Analysis of the qualitative data was applied, and findings were integrated with quantitative findings to establish an initial program theory and identify context-mechanism-outcome configurations.ResultsData indicated that absence of observable symptoms in adolescents increased the complexity of treatment situations, heightened diagnostic uncertainty, and complicated shared decision-making. However, clinicians employed various strategies to mitigate this complexity. Five context-mechanism-outcome configurations were identified, relating to clinicians’ confidence, recognizing patients pain experience, diagnostic uncertainty, credible explanations, defensive actions, and systemic barriers.ConclusionTheory-gleaning indicated that the MAP-Knee tool likely facilitates shared decision-making by reducing the complexity within the treatment situation. However, additional data is needed to refine and expand the identified change-mechanisms, providing a more comprehensive understanding of their impact.

This article draws on two surveys of international students in Sydney and Melbourne, undertaken in 2019 and during the 2020 COVID-19 lockdowns. Using the concept of bounded agency, we identify how the challenges of living in one of the world's most expensive rental housing markets impact students' perceptions of their academic attainment. We find housing insecurity, unaffordability and condition, amplified by financial stress, contribute significantly to student anxiety about their studies. These relationships differ by student background and education. We argue students' agency to meet their educational ambitions in Australia is constrained by the cost of housing and the housing choices they consequently make to mitigate financial stress. Our findings suggest the importance of 'town' or non-institutional aspects of the international student experience on their satisfaction and academic outcomes. We call for further research to explore these relationships in other global contexts.

Abstract Background The World Health Organization (WHO) has recognised social determinants of health (SDH) as non-medical factors that affect health outcomes. These SDH have a significant effect on health inequities, whereby more marginalised populations often have worse outcomes due to unfair and avoidable differences in health status. The Ontario Marginalization index (ON-Marg) is an area-level index derived from 42 census variables identifying differences in marginalisation, allowing identification of inequities between population groups and geographical areas. The ‘racialised and newcomer populations’ dimension of the ON-Marg characterises the proportions of recent immigrants and/or people belonging to ‘visible minority’ groups in geographical locales. These data can be used as a surrogate for individual patient data to investigate health outcomes related to this dimension. This study investigated the prevalence and mortality associated with racial marginalisation in patients admitted with cardiogenic shock at a quaternary cardiac referral centre. Methods A single-centre registry of CS admissions from 2014-2023 at a quaternary referral centre cardiac intensive care unit (CICU) in Ontario, Canada was studied. Patient postal codes were identified and mapped to ON-Marg ‘racialised and newcomer populations’ data using the Postal Code Conversion File. The ON-Marg data are categorised into equal quintiles, which was used to determine differences in distribution of CS cases and inpatient survival using the Chi-squared test and Kaplan-Meier methods. Only the index CS hospitalisation was included in the analysis. Results We identified 1513 patients, including 456 (30.1%) females, aged 60.2±16.1 years, with 333 (24.8%) due to acute myocardial infarction CS. The majority of patients were SCAI stage D (69.2%) with 488 (32.3%) dying and 186 (12.3%) receiving a heart transplant or durable ventricular assist device (VAD) before discharge. CS patients were more likely to be in the higher quintiles for marginalisation racialised and newcomer populations and these individuals had higher mortality (p=0.005, figure 1). In a survival analysis, with right-censoring for transplant or VAD, there were significant differences between marginalisation quintiles (figure 2). Conclusions Patients admitted with CS to a large cardiac centre were more likely to be from populations with higher levels of racialised and newcomer individuals. Increasing marginalisation was associated with higher mortality. This identifies a need for delineating whether these differences are aetiological or whether there are barriers in accessing high-quality care in a timely fashion. This could allow an improvement in outcomes for these patient groups. While census-based area-level marginalisation indices can be helpful for identifying possible barriers to equitable care, individualised patient-level data are needed to confirm these findings.

Adults often experience a loss of social relations and sense of belonging in later life, leading to the risk of social isolation. Municipal senior centres offer a potential site for intervention, as they provide social communities targeting older people. However, not all older people find it easy to access these social communities due to experiencing physical and/or psychosocial frailties and could therefore continue to experience a decline in social relations and sense of belonging, which potentiates poor physical and psychosocial health and well-being. To date, there are limited evidence-based interventions in Denmark. The present article describes the development of an intervention to increase belongingness and decrease social isolation among older people with frailties who attend Danish municipal senior centres. The development process was conducted with reference to the INDEX (IdentifyiNg and assessing different approaches to DEveloping compleX intervention) guidance. The development process resulted in a 6-month supportive intervention, consisting of four elements: skills development workshops for all staff members; a start conversation including frailty screening; allocation of a 'buddy' among existing service users; and monthly follow-up conversations with staff members. This theory-informed approach can progress to feasibility testing and outcome evaluation in order to generate an evidence base. Concurrently, the article reflects on current guidance for intervention development and how it may be used and optimized to strengthen developmental processes in the future.

Background: While continuity of care is a core element of high-quality maternity care, it is potentially even more important for pregnant women and their partners who are at risk of adverse health outcomes because of psychosocial vulnerability. However, little is known about how a coherent care journey can be ensured for women and families who may require interdisciplinary and inter-sectoral services during pregnancy and the postnatal period.Aim: To explore the role of continuity of care in creating a coherent care journey for vulnerable parents during pregnancy and the postnatal period.Methods: An ethnographic study conducted in Denmark based on interviews with, and field observations, of 26 mothers and 13 fathers receiving services due to mental health problems, young age, past substance abuse and/or adverse childhood experiences. Findings: Three key findings emerged: 1). Developing relationships allowed parents to know and feel known by care providers, which helped them feel secure and reach out for support. 2). Handover of information allowed parents to feel secure as their need for support was recognised by care providers; some parents, however, felt exposed when information was shared 3). Receiving relevant services allowed parents to have their needs for support addressed, which requires easy referral pathways and coordination of services. Conclusion: All forms of continuity of care should be prioritised in the organisation of maternity care services for women and families in vulnerable positions. While relational continuity is important, continuity of care must also reach across providers, sectors and services to ensure coherent care journeys.