Explore the vast range of titles available.

Background The UK Fire and Rescue Service (FRS) routinely deliver Home Fire Safety Visits (HFSVs) in people’s homes. HFSVs offer support with fire safety and a range of health-related issues. This study aimed to explore the perspectives of those delivering and designing the HFSV service. Methods Twenty eight members of the FRS who deliver HFSVs and service leaders involved in HFSV service-design were interviewed. Data were analysed thematically. Results Participants described a cultural shift within the FRS from response to prevention and public health work. Most felt positively about this change, though some reported difficulty adjusting to their new role. Working with other services was seen as integral to the HFSV service due to the links between fire risk and other facets of health. However, participants felt the FRS were expected to plug gaps in other services, despite not always feeling equipped to do so. Challenges were identified in reaching and supporting underserved groups (e.g. mental health issues and dementia). Conclusions HFSVs could address a range of health-related needs. However, whether the FRS should be expected to fill gaps in other services needs further exploration. Supporting underserved groups via HFSVs is important and warrants further investigation.

Background The global nursing workforce crisis has worsened since the Covid-19 pandemic. In England 10% of nursing posts are unfilled, with the general practice nursing workforce being particularly vulnerable across England and Wales. Similar challenges are reflected internationally and pose a risk to patient care and the long-term future of general practice. However, primary care nursing is under-researched and factors which support or challenge retention of nurses in general practice are poorly understood. In this paper we aim to explore the influence of the intersection of cultural and structural factors underpinning retention of nurses in general practice. Methods An exploratory qualitative interview study was conducted. Professional and social media networks and snowballing techniques were used to recruit. Forty-one participants were interviewed who were either working in, or who had worked in, nursing teams in general practice across England and Wales, as well as nurse leaders. Data were collected between October 2023-June 2024. Framework Analysis was used with Bourdieu’s concept of Capital used as a sensitising concept. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained and the study was funded by the General Nursing Council Trust. Results Professional and societal level constructs influenced and impacted on cultural and structural issues associated with retention of nurses working in general practice in our study. Gender, social class, race, ethnicity and age intersected with each other, alongside medical hegemony and professional identity to shape nursing in general practice. Analysis indicates nurses in general practice lack, or - just as importantly - are perceived to lack, social, economic and cultural capital and this impacts on their position within general practice, results in perpetuation of social disadvantage, reproduces inequality and contributes to the devaluing of nursing, ultimately contributing to attrition. Conclusions The intersection of the underpinning cultural and structural factors identified indicate why retention of nurses in general practice is difficult to resolve. We suggest that the first steps are to raise these factors to a conscious level and argue that unless they are acknowledged, and work to address them is undertaken, strategies to support retention of nurses working in general practice may be unsuccessful. Trial registration Registered at Open Science Framework: https://osf.io/2byxc/ .

In this paper, we outline our qualitative protocol for the largest, independent, mixed-method, evaluation of the High Volume-Low Complexity Surgical Hubs programme in England – The MEASURE study. In addition to serving as a protocol paper, we outline the key methodological considerations and adaptations that are needed when designing big qualitative studies – complex (multi-site, multi-stakeholder), multi-method (e.g. interviews, observations, documents) qualitative research involving a large number of participations (n = 100+). This paper expands on our previous methodological work, where we used our experience of undertaking a big qualitative study as part of a mixed-method evaluation of a national emergency care-based initiative, to outline the methodological considerations and uncertainties for designing and analysing “big” qualitative studies. In this paper, we put these considerations into practice by providing a transparent account of our qualitative study design. The methodological reflections which we present are centred around the areas where we feel there is the most uncertainty for big qualitative research: study design, sampling (of case sites and stakeholders) and analysis. Underpinning this uncertainty are broader challenges which utilising this approach incite. Namely, that striving for both breadth (national-level insights) and depth (local variation and context), challenges paradigmatic norms and expectations and forces either methodological innovation, or the adaption of existing qualitative methods. We hope this paper provides transparency and insight into an area of qualitative research which has, potentially due to a perception of “safety in numbers” been inherently trusted and rarely scrutinised. Ultimately, we hope that by providing a transparent account of our study design and the challenges we have faced that we continue to encourage discussion and innovation in this evolving area of qualitative research.

People are living longer internationally, with a growing number experiencing very old age (≥95 years). Physical, psychological and social changes can challenge one’s sense of self and disrupt existing identities. However, experiences of the very old in society are seldom researched and how they construct identity and negotiate a sense of self is little understood. Our study focuses on participants aged >95 years to understand how identity is conceptualised to negotiate a continued place in society. Qualitative interviews with 23 people were thematically analysed, underpinned by Positioning Theory. Five themes were generated: A contented life; reframing independence; familial positioning; appearance and physical wellbeing; reframing ill health. Participants saw themselves as largely content and, despite their world becoming smaller, found pleasure in small routines. Perceptions of self were reframed to maintain autonomy within narrow parameters. Past relationships and experiences/events were drawn on to make sense of ongoing ways of living. There were tensions around feelings of loss of autonomy and independence, with some valuing these over issues such as safety. This sometimes conflicted with views of others and small acts of resistance and subversion were acted out to maintain some sense of control. However, participants minimised progressive ill health. Findings provide insight into how the very old may utilise identity to negotiate, acquiesce, resist and challenge the world around them.

Acceptability, in the context of healthcare interventions is a frequently used term, including in evaluations of surgical interventions. This reflects the importance of the concept to all stakeholders and significance to designing, implementing and evaluating interventions. Despite this, definitions and measurement of acceptability are not standardised, and acceptability is often poorly conceptualised. The aim of this scoping review was to identify how studies define, measure and report the acceptability of a surgical intervention. A scoping review was conducted adhering to the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A comprehensive search of MEDLINE; Embase:APA PsycInfo; EBHealth-KSR Evidence; Cochrane Central Register of Controlled Trials; International HTA database; ClinicalTrials.gov and WHO International Clinical Trials Registry Platform was conducted for the period January 2000 to November 2023. No language limits were applied. Sixty-seven studies from 25 countries were included. The majority of studies (n = 60; 90%) did not provide a definition of acceptability. Various methods were used to collect data on acceptability, most frequently a questionnaire (n = 36; 54%), followed by qualitative interviews (n = 16; 24%). Thirty-three studies (49%) reported acceptability of the surgical intervention received to patients, nine (13%) reported hypothetical acceptability of the surgical intervention to patients, four (6%) reported acceptability to both patients and surgeons, and four studies (6%) the acceptability to surgeons alone. Studies assessing acceptability of a surgical intervention tended not to provide a definition of acceptability and demonstrated a lack of clarity in the use of acceptability in the context of surgical interventions. There was substantial variability in how and when acceptability was measured and from which perspective. Further research is required to explore the most appropriate approaches to address variability and promote a more consistent conceptualisation and accurate measurement of acceptability in evaluations of surgical interventions.

Over the past decade, there has been a growing trend towards the use of ‘big qualitative data’ in applied health research, particularly when used as part of mixed methods evaluations of health policy in England. These ‘big qualitative’ studies tend to be longitudinal, complex (multi-site and multi-stakeholder) and involve the use of multiple methods (interviews, observations, documents) and large numbers of participants (n = 100+). Despite their growing popularity, there is no methodological guidance or methodological reflection on how to undertake such studies. Qualitative researchers are therefore faced with a series of unknowns when designing large qualitative studies, particularly in terms of knowing whether existing qualitative sampling and analysis methods are appropriate in this context. In this paper, we use our experience of undertaking a big qualitative study, as part of a national mixed methods evaluation of a health policy in England to reflect on some of the key challenges that we faced in our qualitative study, which broadly related to: sample size, data analysis and the role of patient and public engagement. Underpinning these difficulties was the challenge of being flexible and innovative within the largely positivist research climate of applied health research and being comfortable with uncertainty relating to the three issues outlined. The reflections we present are not to be viewed as a method ‘how to’ guide, but rather as a platform to raise key issues relating to the qualitative methods that we found challenging, in order to stimulate discussion and debate amongst the qualitative community. Through this paper, we therefore hope to demystify what it is like to undertake such a study and hope to spark much needed discussion and innovation to support the future design and conduct of qualitative research at scale.

Background The perception and use of scientific evidence in orthopaedic surgical decision-making is variable, and there is considerable variation in practice. A previous conceptual framework described eight different drivers of orthopaedic surgical decision-making: formal codified and managerial knowledge, medical socialisation, cultural, normative and political influence, training and formal education, experiential factors, and individual patient and surgeon factors. This Qualitative Evidence Synthesis (QES) aims to refine the conceptual framework to understand how these drivers of decision-making are applied to orthopaedic surgical work in a dynamic and fluid way. Methods A QES explored how different types of knowledge and evidence inform decision-making to explore why there is so much variation in orthopaedic surgical work. Nine databases were systematically searched from 2014 to 2023. Screening was undertaken independently by two researchers. Data extraction and quality assessment were undertaken by one researcher and accuracy checked by another. Findings were mapped to the conceptual framework and expanded through thematic synthesis. Results Twenty-five studies were included. Our re-conceptualised framework of evidence-based orthopaedics portrays how surgeons undergo a constant process of medical brokering to make decisions. Routinely standardising, implementing and regulating surgical decision making presents a challenge when the decision-making process is in a constant state of flux. We found that surgeons constantly prioritise drivers of decision-making in a flexible and context-specific manner. We introduce the concept of socialisation in decision making, which describes “the socialisation of factors affecting decision-making. Socialisation is additive to surgeon identity and organisational capacity, which as explanatory linchpins act to mediate our understanding of how and why surgical decision-making varies. Our conceptual framework allows us to rationalise why formal codified knowledge, typically endorsed through clinical guidelines, consistently plays a limited role in orthopaedic decision-making. Conclusions We present a re-conceptualised framework for understanding what drives real world decision-making in orthopaedics. This framework highlights the dynamic and fluid way these drivers of decision-making are applied in orthopaedic surgical work. A shift in orthopaedics is required away from prioritising informal, experiential knowledge first to incorporating evidence-based sources of evidence as essential for decision-making. This paradigm shift, views decision-making as a complex intervention, that requires alternative approaches underpinned by multi-faceted, evidence-based implementation strategies to encourage evidence-based practice. Registration PROSPERO CRD42022311442 Clinical Trial Number Not applicable.

Background Increasing shortfalls in nursing workforces are detrimental to safety critical patient care. In general practice in England up to one-in-two nursing posts are predicted to be unfilled by 2030/31, with Wales similarly threatened. This is reflected internationally. Limited attention has been paid to how cultural and structural issues affect retention of nurses in general practice. The aim of our study is to understand factors that challenge retention and support nurses to stay in general practice. Methods We conducted an exploratory qualitative interview study with n  = 41 members of nursing teams working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment was through professional and social media networks and snowballing techniques. Data were analysed following framework analysis and were collected between October 2023-June 2024. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained. The study was funded by the General Nursing Council Trust. Results Recognition of the value of nurses working in general practice was central to the retention of nurses at all levels of practice and was affected by structural and cultural issues and reflected in several themes: The essence of nursing in general practice; The commodification and deprofessionalisation of nursing in general practice; Opportunities for development; Employment of nurses outside of the National Health Service; Lack of voice, precarity of position and lack of recourse; Tipping points. Conclusion Cultural and structural issues impacted on retention of nurses in general practice. While some supported retention, others revealed deep-seated, complex issues which require addressing at practice, local and national organisational levels. Nurses in general practice experience factors which leave them vulnerable and underserved. Policy makers, employers and professional organisations need to work to support retention and enable nurses in general practice, not only to survive, but thrive. Protocol registration Open Science Framework ( https://osf.io/ ) Identifier: DOI https://doi.org/10.17605/OSF.IO/2BYXC   https://osf.io/2byxc/ . Protocol published: https://onlinelibrary.wiley.com/doi/ https://doi.org/10.1111/jan.16313

Background Evidence is needed to support local action to reduce the adverse health impacts of climate change and maximise the health co-benefits of climate action. Focused on England, the study identifies priority areas for research to inform local decision making. Methods Firstly, potential priority areas for research were identified from a brief review of UK policy documents, and feedback invited from public and policy stakeholders. This included a survey of Directors of Public Health (DsPH) in England, the local government officers responsible for public health. Secondly, rapid reviews of research evidence examined whether there was UK evidence relating to the priorities identified in the survey. Results The brief policy review pointed to the importance of evidence in two broad areas: (i) community engagement in local level action on the health impacts of climate change and (ii) the economic (cost) implications of such action. The DsPH survey ( n  = 57) confirmed these priorities. With respect to community engagement, public understanding of climate change’s health impacts and the public acceptability of local climate actions were identified as key evidence gaps. With respect to economic implications, the gaps related to evidence on the health and non-health-related costs and benefits of climate action and the short, medium and longer-term budgetary implications of such action, particularly with respect to investments in the built environment. Across both areas, the need for evidence relating to impacts across income groups was highlighted, a point also emphasised by the public involvement panel. The rapid reviews confirmed these evidence gaps (relating to public understanding, public acceptability, economic evaluation and social inequalities). In addition, public and policy stakeholders pointed to other barriers to action, including financial pressures, noting that better evidence is insufficient to enable effective local action. Conclusions There is limited evidence to inform health-centred local action on climate change. More evidence is required on public perspectives on, and the economic dimensions of, local climate action. Investment in locally focused research is urgently needed if local governments are to develop and implement evidence-based policies to protect public health from climate change and maximise the health co-benefits of local action.

Background Children with symptomatic flat feet (pes planus) frequently present for care but there remains uncertainty about how best to manage their condition. There is considerable variation in practice between and within professions. We intend to conduct a three-arm trial to evaluate three frequently used interventions for pes planus (exercise and advice, exercise and advice plus prefabricated orthoses, and exercise and advice plus custom made orthoses). Each of these interventions are complex and required developing prior to starting the trial. This paper focusses on the development process undertaken to develop the interventions. Methods We used a modified Nominal Group Technique combining an electronic survey with two face-to-face meetings to achieve consensus on the final logic model and menu of options for each intervention. Using the Nominal Group Technique across consecutive meetings in combination with a questionnaire is novel, and enabled us to develop complex interventions that reflect contemporary clinical practice. Results In total 16 healthcare professionals took part in the consensus. These consisted of 11 podiatrists, two orthotists, two physiotherapists, and one orthopaedic surgeon. Both meetings endorsed the logic model with amendments to reflect the wider psychosocial impact of pes planus and its treatment, as well as the increasing use of shared decision making in practice. Short lists of options were agreed for prefabricated and custom made orthoses, structures to target in stretching and strengthening exercises, and elements of health education and advice. Conclusions Our novel modification of the nominal group technique produced a coherent logic model and shortlist of options for each of the interventions that explicitly enable adaptability. We formed a consensus on the range of what is permissible within each intervention so that their integrity is kept intact and they can be adapted and pragmatically applied. The process of combining survey data with face-to-face meetings has ensured the interventions mirror contemporary practice and may provide a template for other trials.