The recent promotion of male circumcision as a public health strategy is based on research evidence from three randomised control trials conducted in South Africa, Kisumu in Kenya, and Rakai in Uganda. The evidence suggests that male circumcision provides heterosexual men 50–60% protective benefit against HIV infection. For the Kikuyu people in Kenya, male circumcision is a cultural rite of passage from childhood to adulthood. The focus of this study was male circumcision practices in Muranga of Kenya and their implications on public health. There is a paucity of studies and reports on cultural practices of male circumcision in Kenya. This article discusses male circumcision meaning and associated changes with a central focus on women. A qualitative research design underpinned by an Interpretivist paradigm was employed. Focused ethnographic methodology captured the cultural context of the ritual and its meaning. Purposive and snowball sampling were used to select the study participants. Indepth interviews with 13 circumcision mentors, participant observations in three churches, and narratives writing with 43 male students from six schools were conducted. Data were analysed using thematic analysis. The findings suggest a changing circumcision ritual with women at the forefront of most of these changes in a male arena ritual. The church, hospital, and urbanisation emerged as the drivers of change, through which women aimed at protecting their sons from practices in the ritual, that they deemed harmful, such as harassment and sexual violence. The changes in the male circumcision ritual are significant to public health.

Engaging with older people who self-identify as lonely may help professionals in mental health and other services understand how they deal with loneliness. The evidence-base for effective interventions to address loneliness is inconclusive. This study aimed to explore how community-dwelling lonely older people in England manage their experiences of loneliness. Twenty eight community-dwelling older people identifying as lonely, based on responses to two loneliness measures (self-report and a standardised instrument), participated in in-depth interviews between 2013 and 2014. Fifteen lived alone. Thematic analysis of transcribed interviews was conducted by a multidisciplinary team including older people. Participants drew on a range of strategies to ameliorate their distress which had been developed over their lives and shaped according to individual coping styles and contexts. Strategies included physical engagement with the world beyond their home, using technologies, planning, and engagement with purpose in an 'outside world', and acceptance, endurance, revealing and hiding, positive attitude and motivation, and distraction within an 'inside world'. Strategies of interests and hobbies, comparative thinking, religion and spirituality and use of alcohol straddled both the inside and outside worlds. Participants conveyed a personal responsibility for managing feelings of loneliness rather than relying on others. This study includes the experiences of those living with loneliness whilst also living with other people. When developing policy and practice responses to loneliness it is important to listen attentively to the views of those who may not be engaging with services designed for 'the lonely' and to consider their own strategies for managing it.

Lack of access to visual cues can cause challenges and sometimes make social interaction difficult for many visually impaired persons in face-to-face situations. The loss of vision, therefore, demands adjustments-not only for the individual's adaptation with sight loss for independent living but also for communication. While recognizing that older adults with vision impairment face challenges when communicating with others due to inability to perceive visual cues, this study examines the challenges and opportunities presented to them when using a computer to communicate with others. The study employed a case study approach, conducting semi-structured interviews with 20 visually impaired older adults aged 60-87 years. Findings suggest that the lack of visual cues in text-based computer-mediated communications (CMCs) supported their daily social communication. The paper discussed how, within online communication, people with vision impairment compensate for sight loss through CMC. Implications of findings for broader issues that may steer the use of Information communication technologies among visually impaired older people are discussed. This paper adds novel understanding to the field of CMC, in highlighting the need for more attentive rehabilitation than the need for circumventing face-to-face interaction.

Background: With population ageing, research is needed into new low-cost, scalable methods of effective promotion of health and wellbeing for older people. We aimed to assess feasibility, reach and costs of implementing a new tailored computer-aided health and social risk appraisal system in primary care.Methods: Design: Feasibility study. Setting: Five General Practices in London (Ealing) and Hertfordshire, United Kingdom (UK) Participants: Random sample of patients aged 65 + years. Intervention: The Multi-dimensional Risk Appraisal for Older people (MRA-O) system includes: 1) Postal questionnaire including health, lifestyle, social and environmental domains; 2) Software system generating a personalised feedback report with advice on health and wellbeing; 3) Follow-up of people with new concerning or complex needs by GPs or practice nurses. Evaluation: Feasibility of implementation; participant wellbeing, functional ability and quality of life; social needs, health risks, potential lifestyle changes; and costs of implementation.Results: Response rates to initial postal invitations were low (526/1550, 34%). Of these, 454/526 (86%) completed MRA-O assessments. Compared to local UK Census data on older people, participants were younger, more were owner-occupiers and fewer were from ethnic minority groups than expected. A range of problems was identified by participants, including pain in last week (269/438, 61.4%), low physical activity (173/453, 38.2%), sedentary lifestyle (174/447, 38.3%), falls (117/439, 26.7%), incontinence (111/441 25.2%), impaired vision 116/451 (25.7%), impaired hearing (145/431, 33.6%), depressed mood (71/451, 15.7%), impaired memory (44/444 9.9%), social isolation (46/449, 10.2%) and loneliness (31/442, 7.0%). Self-rated health was good/excellent in 312/437 (71.4%), and quality of life and well-being were slightly above age-specific population norms. Implementation costs were low. Practices reviewed medical records of 143/454 (31.5%) of participants as a consequence of their responses, and actively followed up 110/454 (24.2%) of their patients.Conclusions: A computer-aided risk appraisal system was feasible for General Practices to implement, yields useful information about health and social problems, and identifies individual needs. Participation rates were however low, particularly for the oldest old, the poorest, and ethnic minority groups, and this type of intervention may increase inequalities in access. Widespread implementation of this approach would require work to address potential inequalities.

Little is known about self-management approaches to loneliness. We conducted in-depth interviews with 28 community-dwelling people in two diverse English areas, aged 65+, with self-declared or risk of loneliness. Experiences, self-management and support-seeking for loneliness were explored. Data were analysed thematically by a multi-disciplinary team, including lay older people. Participants articulated a breadth of loneliness experiences and their considerations in self-managing these negative emotions. Loneliness seemed complex, often inseparable from life events and circumstances, and characterised by terms of severity/frequency across the life-course. For many loneliness was a private matter for which they were reluctant to seek external support. Management strategies included getting outdoors regularly, planning/engaging in meaningful activity and cognitive coping strategies, including developing acceptance/feelings of control of one’s situation, adopting a positive attitude/focus, focussing on the present not future, and relative comparisons with others. New approaches to alleviate loneliness should consider how these coping strategies can be optimised.

Loneliness in later life is a common problem with poor health outcomes. However, interventions to prevent or ameliorate loneliness have a weak evidence base. The views of older people experiencing or at risk of loneliness in the community are important in identifying features of potential support, but have been little studied. Twenty-eight community dwelling people, aged 65 and over who reported being 'lonely much of the time' or identified as lonely from the de Jong Gierveld six-item loneliness scale in a larger study, participated in in-depth interviews, between June 2013 and May 2014. Views and experiences on seeking support from primary care and community based one-to-one and group based activities, including social and shared interest groups, were explored. Interviews were recorded and transcribed. Thematic analysis was conducted by a multidisciplinary team, including older people. Using two different measures of loneliness enabled a spectrum of loneliness experience to be explored. Two-thirds of the participants were the 'younger old' and all were able to leave their homes independently. Older people with characteristics of loneliness were generally knowledgeable about local social and community resources but, for the majority, community and primary care based services for their loneliness were not considered desirable or helpful at this point in their lives. However, group based activities with a shared interest were thought preferable to one-to-one support (befriending) or groups with a social focus. Descriptions of support as being for loneliness and specific to older people discouraged engagement. Older people experiencing or at risk of loneliness did not consider that primary care has a role in alleviating loneliness because it is not an illness. They thought primary care practitioners lack understanding of non-physical problems and that a good relationship was necessary to discuss sensitive issues like loneliness. For many, loneliness was a complex and private matter that they wished to manage without external support.

Since 2005, health trainers and other lay public health workers (LPHWs) have been increasingly active in the UK. Although elsewhere in the world LPHWs are expected to come from the communities within which they work and know that their knowledge is valued, neither is the case for LPHWs in the UK. This study sought to discover the lay knowledge of health trainers and other LPHWs, aiming to ascertain how this knowledge might more effectively be utilised within UK public health services. This paper describes a participatory and ethnographic case study research project undertaken on an anonymised urban estate in North East England. Findings were generated by a range of means including by participant observation and semi-structured interviews. Seven LPHWs took part, as did 32 other community members. This study found that the lay health knowledge of an individual UK LPHW is determined primarily by his or her position within, or in relation to, the community within which he or she works. Insider LPHWs possess an embodied knowledge and incomer LPHWs possess an experiential knowledge which, although different from one another, are essentially interpersonal in nature. Lay health knowledge can take different forms, and different LPHWs can provide different forms of lay health knowledge. Public health structures and services in the UK should make better use of all forms of LPHW knowledge, and should seek from LPHWs training on how to engage the most 'hard-to-reach' or 'difficult-to-engage' groups. Services recruiting LPHWs should decide whether they are seeking embodied insider LPHW knowledge, experiential incomer LPHW knowledge or a mixture of both.

Aims: This study examined the prevalence of loneliness among the oldest old within a 10-year period and studied the influence of various sociodemographic, social and health characteristics on loneliness. Methods: The study used population-based data from the Umeå85+/GErontological Regional DAtabase-study (GERDA) for the years 2000–2002, 2005–2007 and 2010–2012 including 85-year-old, 90-year-old and ⩾95-year-old participants. A final sample of 304 participants in 2000–2002, 329 participants in 2005–2007 and 401 participants in 2010–2012 was included in the analyses. Results: Although the level of loneliness was already high in 2000–2002 (49.3% reported frequent loneliness), the results showed limited changes in loneliness during the 10-year study period. Loneliness was closely related to living alone, depressive symptoms and living in institutional settings. Conclusions: Although societal changes such as solitary living and growing urbanization suggest a changing trend in loneliness, we found that the prevalence of loneliness was relatively stable in this study. Nevertheless, loneliness is common among the oldest old and a focus on social issues related to living arrangements and on depressive symptoms is important in understanding loneliness.

ABSTRACT The active management of the experience of living with dementia appears to improve quality of life despite the lack of disease modification. However, research to date has been largely of modest scale and explanatory factors for improvements have been under-conceptualised. Thus, although promulgated through national strategies, the evidence base is relatively weak. This paper reports on a nation-wide study of the influence of the National Dementia Strategy for England in relation to Dementia Adviser and Peer Support Network services in 40 demonstration sites. The research aimed to identify ways in which the services contribute to the wellbeing and resilience of people with dementia and care partners. A mixed-methods research design collected data through: activity and outcome monitoring; organisational surveys; in-depth case studies, including qualitative interviews with people with dementia (N = 47) and care partners (N = 54), wellbeing and quality of life measures, and interviews with staff and other stakeholders (N = 82). Three themes are explored: addressing individual and community needs; promoting independence, control and choice; and getting a life back. Services promoted independence, control and choice, and consequently enabled people to re-narrate their lives as purposeful within their communities. Ways in which these are achieved resemble the public health model of lay health advisor and this research adds to the imperative to approach dementia as a key public health concern.

In this chapter, the authors consider the meanings of the concepts of healthy ageing, ageing well, salutogenic ageing and reciprocity between the sense of coherence (SOC) and ageing processes. They discuss how the community can provide resources to strengthen older adults’ SOC, perceived well-being and quality of life. Quoting ‘It’s not how old we are; it’s how we are old’, the authors illuminate critical differences in understanding healthy ageing by professionals, researchers and older people themselves.

Peer support is well established in fields such as the disability movement and mental health and is increasingly recognised as one way of enabling support by and for people with a diagnosis of dementia and their immediate carers. It was central to the implementation of the National Dementia Strategy (NDS) for England, when 40 demonstration sites were established. This mixed-methods study included in-depth qualitative interviews with people living with dementia ( n = 101) and staff/stakeholders ( n = 82) at 8 of the 40 sites. Data analysis was a five-stage process: coding framework developed (using 25 transcripts); further development of the framework (using a further 70 transcripts); development of emerging themes; modelling of themes and verification of models based on the entire data set. Peer support had positive emotional and social impact that was rooted in identification with others, a commonality of experience and reciprocity of support. There was also a contrast between the quality of peer support and support from professionals. This emphasises the significance of lived experience and promoting a strength-based approach to interpersonal support that is enabling and challenges a deficit approach to understanding dementia.

As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two-staged research design was used. Stage 1 explored the participants' experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty-four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title 'Bridge People'. Bridge People have different backgrounds: family and friends, public sector workers and staff from community-based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.

Background: Previous studies of loneliness have largely focused on establishing risk factors in specific age groups such as in later life or in young people. Researchers have paid less attention to the link between social capital and loneliness across different age groups. The aim of this study was to examine the association between social capital and experienced loneliness in different age groups in a Finnish setting.Methods: The data originates from a population-based cross-sectional survey conducted among 4618 people aged 15-80 in Western Finland in 2011. The response rate was 46.2 %. The association between social capital, measured by frequency of social contacts, participation in organisational activities, trust and sense of belonging to the neighbourhood and loneliness was tested by logistic regression analyses stratified by four age groups.Results: Frequent loneliness (defined as experienced often or sometimes) was higher among younger people (39.5 %) compared to older people (27.3 %). Low levels of trust were linked to loneliness in all four age groups. The association between other aspects of social capital and loneliness varied across age groups.Conclusions: Frequent loneliness is common among the general adult population and could be seen as a public health issue. Our findings imply that low social capital, especially in terms of low trust, may be a risk factor for loneliness. However, further research is needed to assess the influence of poor health and reverse causality as explanations for the findings.

Introduction: In the UK, 1 in 5 people aged 75 and over live with sight loss. Visually impaired older people (VIOP) have an above average incidence of falls and 1.3-1.9 times more likely to experience hip fractures, than the general population. Older people with eye diseases are similar to 3 times more likely than those with good vision, to limit activities due to fear of falling. This feasibility study aims to adapt the group-based Falls Management Exercise (FaME) programme to the needs of VIOP and carry out an external pilot trial to inform the design of a future definitive randomised controlled trial.Methods and design: A UK based 2-centre mixed methods, randomised, feasibility study will be conducted over 28 months. Stakeholder panels, including VIOP, will make recommendations for adaptations to an existing exercise programme (FaME), to meet the needs of VIOP, promoting uptake and adherence, while retaining required effective components of the exercise programme. 80 VIOP aged 60 and over, living at home, ambulant with or without a walking aid, will be recruited in Newcastle (n=40) and Glasgow (n=40) through National Health Service (NHS) Trusts and third sector partners. Participants randomised into the intervention arm will receive the adapted FaME programme. Participants randomised into the control arm will continue with usual activity. Outcomes are, recruitment rate, adherence and validated measures including fear of falling and quality of life. Postintervention in-depth qualitative interviews will be conducted with a purposive sample of VIOP (N=10). Postural stability instructors will be interviewed, before trial-specific training and following the intervention.Ethics and dissemination: Ethics approval was secured through the National Research Ethics Service (NRES) Committee North East, Newcastle and North Tyneside 2. Glasgow Caledonian University was approved as a non-NHS site with local ethics approval. Findings will be disseminated through peer-reviewed journals, national and international conferences.

This paper recounts the process of undertaking a randomised controlled trial which was designed to examine the effectiveness of an intervention for socially isolated older people aged 75 years and over. It describes the reasons for early cessation of the study and raises the implications of this outcome for policy, practice and research. The intervention under investigation was designed to alleviate loneliness and foster companionship. It involves participants being linked with a small group of others through a teleconferencing system with each group being facilitated by trained volunteers. There was a requirement to recruit and train a minimum of 30 and a maximum of 60 volunteers over 1 year to facilitate 20 friendship groups to meet the number of older people required to be recruited to the study. Problems with recruiting and retaining the volunteer workforce by the voluntary sector organisation, who were commissioned to do so, led to the study closing even though older people were recruited in sufficient numbers. The paper draws upon analysis of various data sources from the study to identify the potential reasons. The discussion raises considerations regarding the extent of infrastructure required to deliver community services to vulnerable user groups at scale, identifies some of the issues that need to be addressed if such volunteer-initiated services are to be successful and informs future research programmes in this area.

Many older people are increasingly using the internet. This study investigated the experiences of visually impaired older people on internet use and explored how it fits into their lives. 20 visually impaired older people aged 60 years and over were recruited from a voluntary organisation for blind people. Qualitative interviews were conducted with all participants to investigate how they perceive the relevance of internet use to their daily lives. Findings suggest that the internet not only has potential to promote their ability to perform daily tasks, cope with vision impairment and feel socially included. However, the rapid pace of technological advancement is feared as a development that could further widen the digital divide if they are not carried along by addressing barriers to their internet.

BACKGROUND:The ROAdmap for MEntal health Research in Europe project aimed to create an integrated European roadmap for mental health research. Leading mental health research experts across Europe have formulated consensus-based recommendations for future research within the public mental health field. METHODS:Experts were invited to compile and discuss research priorities in a series of topic-based scientific workshops. In addition, a Delphi process was carried out to reach consensus on the list of research priorities and their rank order. Three web-based surveys were conducted. Nearly 60 experts were involved in the priority setting process. RESULTS:Twenty priorities for public mental health research were identified through the consensus process. The research priorities were divided into summary principles-encompassing overall recommendations for future public mental health research in Europe-and thematic research priorities, including area-specific top priorities on research topics and methods. The priorities represent three overarching goals mirroring societal challenges, that is, to identify causes, risk and protective factors for mental health across the lifespan; to advance the implementation of effective public mental health interventions and to reduce disparities in mental health. CONCLUSIONS:The importance of strengthening research on the implementation and dissemination of promotion, prevention and service delivery interventions in the mental health field needs to be emphasized. The complexity of mental health and its broader conceptualisation requires complementary research approaches and interdisciplinary collaboration to better serve the needs of the European population.

Loneliness in older people is associated with poor health-related quality of life (HRQoL). We undertook a parallel-group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of telephone befriending for the maintenance of HRQoL in older people. An internal pilot tested the feasibility of the trial and intervention.