Social housing landlords face mounting pressure to decarbonise their housing stock, yet tenant refusals can hinder delivery. Drawing on longitudinal interviews with 15 households before, during, and after a large-scale retrofit programme, this study examines how tenants' experiences of the installation process and outcomes (i.e. the retrofit journey) shape their willingness to recommend the work to others. Eleven households were willing to recommend the work despite mixed or negative installation process experiences, as long as tangible benefits, particularly improved warmth or, to a lesser extent, reduced bills, outweighed the disruption they faced. Conversely, ambiguous or negative outcomes combined with unresolved issues reduced advocacy. Trust emerged as a key mediator, shaped by perceptions of organisational ability, benevolence, and integrity, and undermined by inconsistent contractor communication and limited landlord visibility during installation.To explain these dynamics, we identify five willingness-to-recommend profiles that reflect the diverse retrofit journeys tenants experienced. We use these profiles to conceptualise the disruption-to-benefit ratio, a conceptual framework describing how tenants weigh the short-term disruption of the retrofit installation process against realised benefits within the context of their household characteristics. The findings suggest willingness to recommend may offer a more actionable indicator of tenant advocacy than satisfaction alone and could support word-of-mouth strategies for social housing landlords to build trust, reduce refusals and accelerate retrofit adoption. The study highlights the importance of trust-building measures, including clear communication, visible accountability, and structured aftercare alongside technical delivery.

To assess the mental health and well-being of optometrists in the UK and explore associated factors. A cross-sectional online survey of UK-based optometrists was conducted over a 3-month period during 2024. The survey included validated, well-established measures to assess psychological distress (Kessler Psychological Distress Scale), depression (Patient Health Questionnaire-2) and anxiety (General Anxiety Disorder-2). Well-being was evaluated in relation to optimal healthy living behaviours. The study includes results from 1303 qualified optometrists, of whom 37

SIGNIFICANCE:Work-related stress is common in the optometry profession, yet there is limited research on how optometrists and organizations manage and mitigate these issues. This study explores strategies to reduce work-related stress and provides recommendations for individuals, employers, and the profession, to inform future support and guidance. PURPOSE:To explore how optometrists self-manage work-related stress and to identify potential strategies that employers can implement to minimize stress and foster a supportive and positive work environment. METHODS:This study was a qualitative analysis of 1284 responses from an online cross-sectional survey of optometrists registered with the General Optical Council in the United Kingdom during 2024. Content analysis was applied to responses to three different open questions covering work-related stress: what participants do to minimize stress in the workplace; what employers could do; and which aspects of their role participants find most enjoyable. RESULTS:We identified four themes that describe personal strategies for managing work-related stress: (1) in-work approaches; (2) work-life balance strategies; (3) leisure and social support activities; and (4) personal and professional interventions. Three themes described actions employers could take: (1) clinical efficiency and workload management; (2) clinical-commercial business strategy; and (3) workplace culture and emotional well-being. In terms of their role, clinical and patient-related work was the most enjoyable. Many expressed a strong interest in professional development, with higher clinical qualifications, particularly in independent therapeutic prescribing, being the most aspirational form of self-development. CONCLUSIONS:Addressing work-related stress requires a collaborative approach where individuals adopt personal coping strategies, and employers and the profession implement tailored, multifactorial interventions to mitigate systemic stressors. Such combined efforts are essential to foster supportive work environments, reduce stress across the workforce, and drive the systemic changes necessary to enhance professional well-being and patient care in optometry.

Introduction: As emerging therapies enter clinical trials, functional vision assessments are required by regulatory bodies to show real-world effectiveness. Development of new outcome measures should begin with a thorough understanding of the goals of people with low vision. The study aims to explore the rehabilitation goals of people with low vision by analyzing data collected with the Canadian Occupational Performance Measure (COPM) in an Australian cohort. Methods: We applied thematic analysis to a retrospective dataset of reported goals of people with low vision, obtained using the COPM. The dataset was obtained from a low vision service provider, Vision Australia. We analyzed de-identified COPM data from 190 clients (122 female, 64%). Three main themes were identified (safety and confidence, life skills, and leisure). Results: "Safety and confidence" is about participants being able to access their home, community, and workplace safely and confidently. Most (87%) of the goals related to effective navigation and mobility. The "life skills" theme included goals related to personal care (25%), kitchen skills (25%), and interpersonal skills (5%), and for parents, their child's development (43%). The "leisure" theme is about engaging in leisure activities and socializing with others. More than half (53%) of the participants reported access to media as a rehabilitation goal, and many wanted to improve their information technology skills. Discussion: In conclusion, we identified three main goals: safety and confidence, especially in accessing the wider community and safety around the home environment; life skills, including kitchen work; and leisure activity, such as accessing print and electronic material. Most mobility goals focused on enhancing feelings of safety, confidence, and independence. These findings underscore the crucial role of emotional support in enhancing functional mobility. Implications for Practitioners: The results identify important goals that could be incorporated into vision restoration clinical trials, in order to emphasize clients' desired visual functioning.

Internal wall insulation (IWI) is one of the few retrofit approaches to reduce heat loss through solid brick walls. Discontinuities in the insulation layer can result in thermal bridges, leading to reduced surface temperatures and the potential for condensation to form. Party wall junctions retrofitted with IWI act as discontinuities when neighbouring homes do not have IWI, leading to reduced surface temperatures on the neighbouring side. The condensation risk imposed on the uninsulated neighbour by a range of notional IWI systems are simulated, the resulting temperature factors indicate whether each system imposes a risk upon the uninsulated neighbour. Thicker, higher performing IWI systems were found to result in greater risk in the neighbouring property.

Night-time pedestrians, including recreational walkers and runners, remain at significant risk of being killed or seriously injured, because drivers often fail to see them in time to avoid a collision. Clothing incorporating retro-reflective markers on the moveable joints creates a visual perception of biological motion or "biomotion" which has been shown to improve night-time pedestrian conspicuity. This study investigated whether clothing with markings in the biomotion configuration retains its conspicuity if adapted to include thinner or patterned retro-reflective strips making it more acceptable to wear for recreational pedestrians. In a night-time closed road study, the relative conspicuity of pedestrians to 14 young drivers with normal vision (mean age 24.3 +/- 3.1 years) was assessed for pedestrians wearing different thicknesses and patterns of biomotion strips and compared with typical clothing worn by night-time pedestrians, including commercially available sports clothing with retro-reflective elements, a fluorescent yellow top, and black clothing. Results showed that all the biomotion configurations resulted in significantly longer recognition distances: around 2 times longer than the sports clothing, 2.5 times longer than the fluorescent top and 4 times longer than the black clothing. Similar trends were found for the distance at which drivers correctly identified pedestrian orientation (towards or sideways to the vehicle), with significantly longer distances for all the biomotion configurations, when compared to the sports, fluorescent top and black clothing. These findings highlight the effectiveness of biomotion clothing, even when using retro-reflective strips as thin as 0.75 cm and have implications for clothing designs for recreational walkers and runners to enhance their night-time safety.

Background: If health and social care delivery systems are to achieve net zero targets, fundamental changes are required to how organizations deliver care, how individuals practice clinically, how people access care, and how systems reduce the demand for healthcare. This paper explores how professionals, patients and citizens respond to this need for change. Methods: We conducted a mixed methods study, comprising 12 deliberative workshops (n = 35) and a survey (n = 413) with health and social care staff, patients and citizens in the North of England. Results: We found that while few people were aware of the net zero target, they supported it. Some, however, questioned organizational commitment, highlighting potential conflicts between cost and sustainability. Staff described a lack of agency to make changes to their practice, despite identifying many opportunities to do so. Some believed that healthcare should be exempt from carbon reduction targets. The strongest messages we found to interest, empower, and motivate people to make changes are: that individual actions matter; that we have a responsibility to set a good example of tackling climate change; and that making changes saves lives and should be a priority. We also found that people need to be reassured that the changes will not adversely affect clinical outcomes. Finally, progress towards targets needs to be tracked and publicly available. Conclusion: Our results indicate a need for clear leadership which gives sustainability a higher priority, a need for staff training to enable conversations about the environmental effects of treatment, and support for shifting the focus from treating illness to promoting health. (c) 2023 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

PURPOSE:To determine whether UK optometrists and ophthalmologists provide target refraction advice to patients prior to cataract surgery, and when this should first be discussed.METHODS:Optometrists and ophthalmologists were asked to complete a survey of two clinical vignettes (both older patients with cataract; a pre-operative myope who routinely read without glasses and a patient using a monovision approach), plus multiple choice and short answer questions either using hard copy or online.RESULTS:Responses were obtained from 437 optometrists and 50 ophthalmologists. Optometrists who reported they would provide target refraction advice were more experienced (median 22 years) than those who would leave this to the Hospital Eye Service (median 10 years). The former group reported it was in the patients' best interest to make an informed decision as they had seen many myopic patients who read uncorrected pre-operatively, and were unhappy that they could no longer do so after surgery. Inexperienced optometrists reported that they did not want to overstep their authority and left the decision to the ophthalmologist. The ophthalmologists estimated their percentage of emmetropic target refractions over the last year to have been 90%.CONCLUSION:Currently, some long-term myopes become dissatisfied after cataract surgery due to an emmetropic target refraction that leaves them unable to read without glasses as they did prior to surgery. Although experienced optometrists are aware of this and attempt to discuss this issue with patients, less experienced optometrists tend not to. This suggests that target refraction needs greater exposure in university training and continuing professional development. To provide patients with the knowledge to make informed decisions regarding their surgery, we suggest an agreed protocol within funded direct referral schemes of initial target refraction discussions by optometrists to introduce the idea of refractive outcomes and outline options, with further discussion with the ophthalmologist to clarify understanding.

Thermal retrofits of homes are central to the UK's fuel poverty and net zero carbon policies but there are concerns about poor quality installation and so new standards are to be introduced (PAS2035). We have explored retrofit installers' perceptions of the barriers to installing internal wall insulation (IWI) and of current regulations and standards for retrofits. We conducted four focus groups with retrofit installers. Thematic analysis identified three themes. (1) IWI is viewed as impractical in situations other than new builds, extensions and conversions as it is too time-consuming and expensive. (2) Installing IWI is perceived as an unskilled job with no need for training or referring to standards during installation. (3) Because standards lack credibility, installers can be sceptical of potential problems caused by on-site installation adaptations, for example thermal bridging. Our results show that retrofit standards have not improved retrofit quality. Awareness and credibility of standards is low, and new standards (PAS2035) will introduce additional costs which may reduce the pool of installers willing to engage in the retrofit market. Policies need to address installer training, professional identity and social practices, and reduce barriers to change in order to increase success.

PURPOSE:To investigate the prevalence of mental health conditions and burnout among practising optometrists in Australia.METHODS:A cross-sectional survey of registered practising Australian optometrists was undertaken over a three-week period from mid-November 2019. The survey comprised three well-established mental health scales (Kessler Psychological Distress Scale [K10], Depression Anxiety Stress Scales [DASS-21] and Maslach Burnout Inventory [MBI]) and an open-ended question inviting comments.RESULTS:Five hundred and five respondents completed the K10, representing 8.8% of registered optometrists in Australia; 466 completed all three scales. Prevalence of moderate to severe psychological distress (K10 ≥ 25) was 30.7% (95% CI 26.7%-34.7%), with similar findings for depression and anxiety (DASS-21). Prevalence of high burnout, as indicated by MBI-GS exhaustion was 56.1% (95% CI 51.7%-60.4%), cynicism 57.1% (95% CI 52.7%-61.5%) and professional efficacy 23.1% (95% CI 19.4%-26.8%). Optometrists aged ≤ 30 years were 3.5 times more likely to report moderate to severe psychological distress compared to optometrists aged >30 years (OR = 3.54, P < 0.001, 95% CI 2.38-5.25). The most frequently mentioned work-related issues concerned retail pressures, workload and career dissatisfaction.CONCLUSIONS:The rates of mental health conditions and burnout reported by practising Australian optometrists were high compared with the general population and other health professionals. Younger age and burnout were significant risk factors for psychological distress. Interventions are required to address these issues, particularly for younger optometrists, and could include workplace modifications and building resilience to improve personal mental wellbeing and ensure patient safety.

The benefits and risks associated with installing internal wall insulation (IWI) and thin internal wall insulation (TIWI) retrofits into solid wall homes are researched and evaluated for BEIS. In order to deliver this, a holistic approach was adopted and the project was split into four main sections, each of which has an accompanying Annex to this summary report: Annex A: Review of existing literature as well as primary investigations using house surveys, householder questionnaires and installer focus groups into the sociotechnical barriers to IWI and TIWI. Annex B: Technical evaluation of the performance of IWI and six novel TIWI retrofits installed in field trial solid wall Test Houses using before and after building performance evaluations. Annex C: Modelling of the impact on annual energy consumption, EPC rating, overheating risk, condensation risk and moisture accumulation made by IWI and TIWI retrofits in a range of UK house archetypes. Annex D: Laboratory testing of test walls using hygrothermal chambers to quantify the change in moisture and thermal performance of solid brick walls when they are insulated with IWI and TIWI to determine how weather

BACKGROUND:Optimising the use of patient data has the potential to produce a transformational change in healthcare planning, treatment, condition prevention and understanding disease progression. Establishing how people's trust could be secured and a social licence to share data could be achieved is of paramount importance.METHODS:The study took place across Yorkshire and the Humber, in the North of the England, using a sequential mixed methods approach comprising focus groups, surveys and co-design groups. Twelve focus groups explored people's response to how their health and social care data is, could, and should be used. A survey examined who should be able to see health and care records, acceptable uses of anonymous health and care records, and trust in different organisations. Case study cards addressed willingness for data to be used for different purposes. Co-creation workshops produced a set of guidelines for how data should be used.RESULTS:Focus group participants (n = 80) supported sharing health and care data for direct care and were surprised that this is not already happening. They discussed concerns about the currency and accuracy of their records and possible stigma associated with certain diagnoses, such as mental health conditions. They were less supportive of social care access to their records. They discussed three main concerns about their data being used for research or service planning: being identified; security limitations; and the potential rationing of care on the basis of information in their record such as their lifestyle choices. Survey respondents (n = 1031) agreed that their GP (98 %) and hospital doctors and nurses (93 %) should be able to see their health and care records. There was more limited support for pharmacists (37 %), care staff (36 %), social workers (24 %) and researchers (24 %). Respondents thought their health and social care records should be used to help plan services (88 %), to help people stay healthy (67 %), to help find cures for diseases (67 %), for research for the public good (58 %), but only 16 % for commercial research. Co-creation groups developed a set of principles for a social licence for data sharing based around good governance, effective processes, the type of organisation, and the ability to opt in and out.CONCLUSION:People support their data being shared for a range of purposes and co-designed a set of principles that would secure their trust and consent to data sharing.

Poor conspicuity increases the risk of cyclists and pedestrians being involved in collisions with vehicles under low light conditions. Retroreflective strips in biomotion configuration significantly increases conspicuity. This study explored how to design biomotion garments that will appeal to cyclists and pedestrians. Nine focus groups involving 50 participants who ran/cycled under low light conditions. Participants discussed their experiences of choosing and wearing garments for cycling/running, and barriers to wearing biomotion garments. Using thematic analysis, we identified three themes. Design describes how biomotion garments should be attractive and practical. Function describes how they should be comfortable and convenient. Promotion describes participant's beliefs regarding cost and how to best explain the safety benefits of biomotion garments. Our user-centre research identified how to make biomotion garments appealing. Safety should not compromise design and function: users are unlikely to wear poorly designed and uncomfortable biomotion garments regardless of how much they increase conspicuity.

It is well known that some patients experience difficulties adapting to new glasses. However, little is known about what patients themselves understand of the adaptation process, and how this influences their attitudes and the decisions they make when adapting to a new pair of glasses. Nor is it understood whether these factors affect their wearing habits. We conducted four focus groups. Participants were 22 glasses wearers (mean ± SD age 43 ± 14 years, range 21–71 years) who reported they: (1) wore spectacle correction for distance vision (single vision, bifocal or progressive lenses); (2) had struggled to get used to a new pair of glasses and (3) sometimes chose not to wear their distance correction. Focus groups were audio recorded, transcribed verbatim and analysed thematically. We identified three themes. Trust is about how participants' trust in their optometrist and themselves influences the likelihood of them adapting successfully to new glasses. Conflict describes how the advice patients have received about adapting to glasses can conflict with what they have experienced and how this conflict influences their expectations. Part of Me explores how participants' experiences and feelings about their glasses are important to adaptation and this includes physical, visual, emotional and behavioural aspects. The traditional optometric perspective of adaptation to glasses is much narrower than that held by patients, and significantly underestimates the physical, behavioural and emotional adaptation that patients must go through in order to feel fully comfortable wearing their glasses. Patients should receive significantly more information about adaptation, including symptoms that may be experienced and why these happen, practical tips to aid adaptation, and when and how to raise concerns. Patients should also receive information about the day-to-day effects of blur adaptation to avoid them not wearing their glasses, including for vision-critical tasks such as driving.

Pedestrians and cyclists are at significant risk of being killed as a result of a collision with a vehicle at night-time because of their poor conspicuity. Retroreflective strips positioned on the moveable joints, in a biological motion configuration (biomotion), greatly enhance the night-time conspicuity of pedestrians and cyclists, but it is not clear how widely this strategy is adopted among those running and cycling under low light levels (dawn and dusk or at night). This study explored runners' and cyclists' beliefs about their own conspicuity, and the strategies they use to increase their conspicuity and safety under low light levels. Nine focus groups involving 50 participants (mean age = 39.5 +/- 13.9 years) were held with individuals who ran and/or cycled under low light conditions or at night-time. The strategies that participants used to increase their conspicuity and enhance their personal safety, and the importance they placed on increased conspicuity to other road users at night was explored. Data were analysed thematically, with two main themes identified. Strategies describes the different approaches used to increase conspicuity when running or cycling in low light, some of which are ineffective. Importance describes how conspicuity relates to other considerations that influence cyclists and runners. While they may believe that conspicuity is essential for their safety, they may compromise their own conspicuity by prioritising style or comfort, or because they believe that being more conspicuous is of limited value because it cannot compensate for the behaviour of other road users. In summary, cyclists and runners are largely unaware of effective strategies to increase their night-time conspicuity, particularly the use of biomotion reflective strips. Garment manufacturers should ensure that conspicuity features (with supporting educative product information on labels) are incorporated into cyclists' and runners' clothing or accessories to improve wearer conspicuity and hence safety in low light conditions. (C) 2019 Elsevier Ltd. All rights reserved.

PURPOSE:Most patients report being highly satisfied with the outcome of cataract surgery but there are variable reports regarding the impact of cataract surgery on some real-world activities, such as fall rates. We hypothesised that adaptations to changed refractive correction and visual function may cause difficulties in undertaking everyday activities for some patients and used a series of focus groups to explore this issue. METHOD:Qualitative methods were used to explore patients' experiences of their vision following cataract surgery, including adaptation to vision changes and their post-surgical spectacle prescription. Twenty-six participants took part in five focus groups (Mean age = 68.2 ± 11.4 years), and the data were analysed using thematic analysis. RESULTS:We identified three themes. 'Changes to Vision' explores participants' adaptation following cataract surgery. While several had problems with tasks relying on binocular vision, few found them bothersome and they resolved following second eye surgery. Participants described a trial and error approach to solving these problems rather than applying solutions suggested by their eyecare professionals. 'Prescription Restrictions' describes the long-term vision problems that pre-surgery myopic patients experienced as a consequence of becoming emmetropic following surgery and thus needing spectacles for reading and other close work activities, which they did not need before surgery. Very few reported that they had the information or time to make a decision regarding their post-operative correction. 'Information Needs' describes participant's responses to the post-surgical information they were given, and the unmet information need regarding when they can drive following surgery. CONCLUSION:The findings highlight the need for clinicians to provide information on adaptation effects, assist patients to select the refractive outcome that best suits their lifestyle, and provide clear advice about when patients can start driving again. Patients need to be provided with better guidance from clinicians and prescribing guidelines for clinicians would be beneficial, particularly for the period between first- and second-eye surgery.

Purpose: Refractive blur is associated with decreased hazard perception and impairments in driving performance, but little is known about why people who have spectacles to correct their distance vision drive with uncorrected vision. Methods: We conducted six focus groups. Participants were 30 drivers (mean age 45) who reported having driven uncorrected at least twice in the past six months despite having spectacles to correct their distance vision. Focus groups were audio recorded, transcribed verbatim and analysed thematically. Results: We identified three themes. 1. Responsibility: participants did not feel obliged to drive with optimal vision and believed that others have a responsibility to ensure drivers maintain clear vision. 2. Safe Enough: participants felt safe to drive uncorrected, did not believe they need to wear spectacles to see sufficiently clearly and that they would know if their uncorrected eyesight fails to meet minimum standards. 3. Situations: participants discussed how they would drive uncorrected for short and familiar joumeys, when they feel alert, in daylight and in good weather. Conclusions: Beliefs about the importance of driving with clear vision compete with the benefits of not wearing spectacles. Eyecare professionals should provide more direct advice to patients regarding the need to wear their visual correction for driving. (C) 2018 Elsevier Ltd. All rights reserved.

Objective: Men's engagement in family planning has become part of the global health agenda; however, little is known about the training manuals health practitioners' use and how these manuals describe and explain men's roles within a family planning context. Design: To further understand engagement, this paper examines how training manuals written for health practitioners describe and define men's participation within family planning. Setting: The training manuals were written for UK health practitioners and covered men's contributions to family planning. Method: Discourse analysis was used to examine the three training manuals focused upon. Results: Three main discourses were identified: contraception is a woman's responsibility', men disengage with health practitioners' and men are biologically predisposed to avoid sexual responsibility'. Conclusion: Together, these three discourses function to marginalise men in family planning, constructing them as detached accessories that lack the ability to engage.

A Personal Health Record (PHR) is an electronic record that individuals use to manage and share their health information, e.g. data from their medical records and data collected by apps. However, engagement with their record can be low if people do not find it beneficial to their health, wellbeing or interactions with health and other services. We have explored the beliefs potential users have about a PHR, how it could be made personally relevant, and barriers to its use.