Health Expectations

Remote consultations, including telephone, video, text or web-based consultations, are now common in sexual and reproductive health services (SRHS) in England and Wales, offering convenience and efficiency but raising concerns about safeguarding service users compared to in-person care. Ensuring protection and support for individuals remain central to SRHS. While guidance exists, evidence on how safeguarding is enacted remotely is limited. This study explores how safeguarding is managed in remote SRHS, examining associated challenges, benefits, and perceptions of acceptability. This qualitative study, part of the CONNECT study (NIHR153151), explored safeguarding in remote delivery of SRHS across three diverse case study areas in England and Wales. Semi-structured interviews were conducted with service users and providers (March 2024-January 2025). Data were thematically analysed using inductive and deductive approaches. Eighty-nine interviews were conducted with 54 service users/potential service users and 35 professional stakeholders across three study sites. Four key themes were identified: (1) challenges of delivering remote safeguarding in practice, (2) importance of a safe space for the patient, (3) one size approach does not fit all, and (4) strategies to support remote safeguarding. Participants described difficulties identifying risks without visual cues, variable comfort with disclosure, and privacy concerns. Providers used adaptive, collaborative approaches to build trust, ensure safety, and tailor safeguarding to individual circumstances. Both service users and providers recognised the effectiveness of remote safeguarding largely depended on clinician judgement, structured questioning, and sensitive communication. While remote consultations offered flexibility, remote safeguarding relied on service users having access to safe, private space. People with language barriers or those less able to create a safe space at home, such as those experiencing housing instability or coercive control may also have greater safeguarding needs. Ensuring access to in-person options, clear safeguarding protocols, and appropriate clinician training is essential to mitigate these challenges. Author summaryDuring the COVID-19 pandemic, sexual and reproductive health services used more remote appointments, such as phone, video, or online consultations. These appointments can make it easier for some people to get care. But there are concerns about whether staff can spot safeguarding issues, such as people who may be at risk of harm, without seeing them in person. In this study, we spoke with people who use sexual and reproductive health services, people who had never used these services before, and staff who work in these settings. People described challenges with remote appointments, including not being able to see body language, feeling unsure about talking about sensitive issues, and worries about privacy at home. Staff described changing how they worked by asking careful questions, building trust, and making safeguarding fit each persons situation. Both service users and staff felt that keeping people safe during remote appointments depends on clear communication and professional judgement. It is harder when people do not have a private space, face language difficulties, or live in unsafe housing or controlling relationships. Our findings show the importance of keeping in-person appointments available and making sure staff have the right training and guidance.

BackgroundRemote consultations (via telephone or video) were critical during COVID-19 restrictions for Sexual and Reproductive Health Services (SRHS) in England and Wales and continue to be implemented widely. However, there remains limited evidence on their impact on outcomes and health inequalities. This study, guided by the Framework for Digital Health Equity, explores the equity implications of remote sexual health consultations in England and Wales, examining their acceptability and appropriateness. MethodsWe conducted semi-structured interviews with 54 service users and potential service users and 35 professional stakeholders across three diverse case study areas. Participants were purposively sampled to ensure diversity in socio-demographic profile and service experience. All participants provided informed consent, and ethical approval for the study was granted by NHS Research Ethics Committee (REC: 23/NS/0128). Data were thematically analysed into narrative themes, with findings interpreted collaboratively with public and patient involvement groups. ResultsThe study found that remote consultations have reshaped care delivery, improving efficiency but also generating additional clinical workload and, for some clinicians, reduced job satisfaction. While generally acceptable, remote models were perceived to affect rapport, extend care pathways for some service users, and impact privacy and safeguarding. We found the benefits of remote consultation are unevenly distributed, with those experiencing digital exclusion, who lack access to suitable private spaces, or who experience language barriers, being less able to take advantage of their convenience. ConclusionsRemote consultations transform SRHS delivery, improving efficiency for some but introducing challenges by impacting interaction, equity, and confidentiality. Benefits and burdens are unevenly distributed, reflecting structural, social, and individual factors influencing access. SRHS must ensure equitable access to appropriate care for all populations when implementing remote consultations. The findings show that a one-size-fits-all approach is not appropriate, and that giving service users choice in how they consult, including in-person, is important.

PurposeTo explore mens assisted reproductive technology (ART) experiences, awareness and concerns about fertility-associated health outcomes, and perceptions of using administrative health records in the United Kingdom (UK) without consent to investigate these outcomes. MethodsOver a two-year period, all adult men were eligible to complete an anonymous online survey distributed via a UK-based fertility charitys social media. Free-text responses underwent thematic analysis, and categorical responses were analysed with descriptive statistics and Fishers exact test. ResultsAmong 80 participants, most were aged [≥]40 (66.7%), completed university (70.2%), White (77.2%) and UK residents (83.0%). Older (p=0.004) and White (p=0.001) men more likely underwent ART. Most ART users received treatment privately (60%) within the past three years (71.4%). Only one-fifth of the 15 men with identified fertility problems received discussion on fertility-associated health outcomes in clinic. Regarding perceptions, most were unaware of but concerned about these outcomes across biopsychosocial aspects, with participant quotes reflecting uncertainty and vulnerability. Recency of ART was associated with awareness (p=0.015) and concerns (p=0.001). Overall, 90.3% supported using administrative health records to investigate long-term health of fertility-challenged men, and 84.2% had no concerns about doing so without individual consent under established legal frameworks. Others raised concerns about the reliability of data anonymisation. Quotes suggested participants desire to understand the wider health implications of male fertility amidst a perceived gender imbalance in fertility research. ConclusionsGaps in participant knowledge, clinician communication and research in male fertility-associated outcomes support the need for universal education and further investigations in these outcomes. Capsule SummaryMost men showed limited awareness of but notable concern about fertility-related long-term health outcomes, and most supported using administrative health records without individual consent for investigating these outcomes.

BackgroundWomen with limited or no English proficiency experience persistent barriers to accessing maternity care in the UK, contributing to well-documented inequalities in maternal and perinatal outcomes. NHS parent education classes are predominantly delivered in English, and provision of multilingual classes within individual maternity units is often limited and duplicative. Evidence to inform collaborative, cross-trust service models remains scarce. ObjectiveTo assess womens access to, preferences for, and perceived relevance of NHS parent education classes, with particular focus on willingness to travel across London to attend classes delivered in a preferred language, in order to inform equitable and efficient service design. MethodsA cross-sectional, multilingual survey was conducted as a quality improvement initiative across multiple London maternity networks. The survey was translated into 18 languages and captured sociodemographic characteristics, access to parent education, preferences for delivery format, timing, location, and language, and perceived relevance of content. Quantitative data were analysed descriptively and thematically. ResultsA total of 97 women participated in the survey (n=97), the majority of whom reported speaking at least one non-English language at home (79.4%, n=77). Regarding mode of delivery, 51.6% of women preferred in-person parent education classes (n=50), 15.5% preferred online delivery (n=15), and 32.9% reported no preference (n=32). Most participants reported access to a suitable device and reliable internet (85.6%, n=83) and confidence using online platforms (77.3%, n=75). In relation to timing and format, weekends were the most commonly preferred time for classes (40.2%, n=39), followed by weekdays during school hours (35.1%, n=34) and weekday evenings (24.7%, n=24). Nearly half of women preferred delivery across two 2-hour sessions (48.5%, n=47), while 30.9% reported no preference regarding session length or number (n=30); fewer preferred two 3-hour sessions (11.3%, n=11) or a single 4-hour session (8.3%, n=8). Regarding willingness to travel, 67.0% of participants reported they would attend parent education classes delivered outside their booking maternity unit (n=65). Overall, 68.0% were willing to travel up to 45 minutes for in-person classes (n=66), while 29.9% preferred not to travel (n=29). With respect to language of delivery, 40.2% of women preferred classes delivered in their native language (n=39), and a further 40.2% reported English with an interpreter as acceptable (n=39); fewer were comfortable relying on a partner or friend to translate (19.6%, n=19). Most participants perceived that delivery by a native-speaking health professional would improve trust and learning (75.3%, n=73), and an equal proportion expressed a preference for a female interpreter (75.3%, n=73). ConclusionsWomen with limited English proficiency demonstrate clear willingness to travel across maternity networks to access antenatal education in their preferred language. These findings support the development of collaborative, cross-trust models that standardise core antenatal content while centralising multilingual provision, reducing duplication and improving equity of access across London maternity services.

BackgroundBetween May and December 2022, the UK Health Security Agency reported 3,585 cases of mpox. The 2022 global outbreak was characterised by transmission predominantly within sexual networks of gay and bisexual men (GBMSM). UK public health responses included information and vaccination campaigns, supported by behaviour change among GBMSM. We describe community reflections on the UK mpox outbreak and the responses to it. MethodsBetween August 2023 and April 2024, we conducted five focus groups with participants (n=27) recruited through community organisations in London and Manchester. Participants were predominantly gay men from ethnically diverse backgrounds. Data were analysed thematically. ResultsComing soon after COVID-19, the mpox outbreak intensified fears of returning to lockdown. Reports of GBMSM being most affected, and its framing in the media as a gay disease, coupled with warnings within GBMSM networks echoed earlier experiences of HIV. Those who had acquired mpox reported that media coverage had intensified their experiences of stigma and discrimination. Participants perceived vaccine roll out as inequitable; Furthermore, the perceived sudden cessation of public health messaging and advice left participants uncertain about ongoing risk and the need for prevention. ConclusionsParticipant reflections two years after the 2022 mpox outbreak demonstrate how previous pandemics shape emotional responses to new outbreaks. Key challenges included stigmatising media coverage, inequitable vaccine rollout, and sudden discontinuation of public health messaging. These findings highlight the importance of targeted, non-stigmatising and unambiguous communication from trusted sources during and after an outbreak. What is already known on this topicThe media response to the 2022 UK mpox outbreak led to stigma among GBMSM and public health measures were not equitably accessible What this study addsPeople from communities affected by the outbreak sought timely information from trusted sources. Communication needs do not end with outbreaks How this study might affect research, practice or policyThere is a need for ongoing public health work to build trusted networks who can maintain inter-outbreak communications and respond rapidly to outbreaks

Background/ObjectivesIn England, gay, bisexual and other men-who-have-sex-with-men (GBMSM) are eligible for vaccinations at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV). However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. MethodsA qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. ResultsTwenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories and limited system-level follow-up processes (e.g. automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. ConclusionsTo improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake and implementing enhanced approaches to support vaccination completion (e.g. prompts or reminders).

ObjectiveTo evaluate experiences of labor and delivery (L&D) staff with a Values Clarification and Attitude Transformation (VCAT) workshop on abortion perspectives and professional responsibilities prior to expanding abortion services to L&D. MethodsWe conducted VCAT workshops about abortion with 192 perinatal healthcare personnel at a single urban, community-based, tertiary care center in California. The workshops used a virtual adaptation of the Four Corners exercise, a previously published VCAT method that prompts participants to reflect on and represent diverse abortion viewpoints. Post-workshop, 25 participants, including nurses, physicians and midwives completed semi-structured interviews about their experience with the workshop. Transcripts were coded and thematically analyzed using a framework approach. ResultsFour major themes emerged: (1) VCAT promoted personal reflection and perspective taking, where participants described how representing others views deepened their understanding of their own beliefs, fostered empathy, and challenged assumptions about colleagues. 2) VCAT prompted reconsideration of professional roles and the role of L&D in abortion care with some viewing L&D as a space incompatible with abortion care and others seeing opportunity to expand inclusive, compassionate care. (3) Professional and personal contexts shaped participants engagement with the workshop with factors like compassion fatigue from many years of service in a hospital with many social needs and personal abortion experiences influencing how participants processed the workshop. (4) Respect for autonomy and commitment to patient care emerged as core, shared values, even among those with differing personal beliefs. ConclusionsVCAT workshops provided a structured opportunity for L&D staff to reflect on the complex personal and professional dimensions of abortion care. The process helped participants explore value tensions, clarify their professional roles, and identify shared ethical commitments to patient care. These findings suggest VCAT may be a valuable tool for preparing multidisciplinary perinatal teams to navigate institutional abortion care expansion with empathy, professionalism and cohesion.

ObjectivesChemsex is the use of select psychoactive drugs to enhance sexual experiences and has been described among gay, bisexual, and other men who have sex with men (GBMSM). We aimed to characterise sexual risk, wellbeing and health-seeking behaviours among GBMSM and gender-diverse people reporting chemsex-associated drug use. MethodsWe analysed data from Reducing inequalities in Sexual Health (RiiSH), an online community survey of 2,758 UK-resident men and gender-diverse people having sex with men. We compared those reporting chemsex-associated drug use with those who did not, assessing sociodemographic characteristics, well-being, sexual risk behaviours and sexual health service (SHS) engagement. ResultsOverall, 8% (218/2,758) reported chemsex-associated drug use in the last year. Participants reporting chemsex-associated drug use in the last year were more likely to report [&ge;]1 marker(s) of sexual risk (such as prior bacterial STI diagnosis, [&ge;]5 male condomless anal sex partners in the last 3-4 months) (85% vs 61%, p<0.001) and were more likely to have attended a SHS in the last year (81% vs 57%, p<0.001) compared to those who did not. Those reporting chemsex-associated drug use more frequently reported a long-term limiting mental health condition (36% vs 24%, p<0.001) and poorer personal wellbeing (e.g. reporting low life satisfaction 36% vs 20%, p<0.001). ConclusionWhile a minority of participants in this national, community-based sample reported chemsex-associated drug use, this group had higher sexual risk and poorer indicators of wellbeing. Many participants also attended SHS, reinforcing the key supporting role of SHS for referral pathways to harm reduction support for those experiencing problematic drug use.

BackgroundFemoral periprosthetic fractures (PPFs) are a significant complication following hip and knee arthroplasty, with an incidence of approximately 5.5-18%. These injuries require complex surgical management and are associated with persistent pain, impaired mobility, prolonged hospital stays, and poorer functional outcomes. Socio-economic factors are known to influence recovery, yet patient perspectives following PPFs remain underexplored. AimTo explore patients experiences of recovery following femoral periprosthetic fracture during hospital admission, with particular attention to the influence of socio-economic factors. MethodsA qualitative study design was employed using semi-structured interviews with patients recovering from femoral PPFs during inpatient admission. Participants (n=9) were recruited from a major trauma hospital in the North West of England and categorised into socio-economic groups using the English Indices of Deprivation. Data were analysed using Braun and Clarkes thematic analysis framework, supported by NVivo(R) software, with both inductive and deductive coding approaches. ResultsSeven core themes were identified across two overarching categories: Recovery Experience and Socio-economic Influences. Recovery experience included themes of persistent pain, restricted mobility, emotional distress, and a strong desire to regain independence characterised recovery experiences. Whereas, socio-economic factors influenced access to resources, communication with healthcare professionals, and reliance on family and social support networks. Participants from more socio-economically deprived backgrounds reported greater frustration related to delays, perceived resource limitations, and unmet recovery needs. ConclusionsRecovery following femoral PPF is shaped by an interaction of physical, psychological, and socio-economic factors during hospitalisation. These findings highlight the need for integrated and individualised care pathways that explicitly address socio-economic inequalities. Improved communication, tailored rehabilitation planning, and enhanced support mechanisms may contribute to more equitable and meaningful recovery outcomes for this vulnerable patient population. Lay SummaryO_ST_ABSStudy TitleC_ST_ABSRecovery following femoral periprosthetic fracture: a qualitative study of patient experience and socio-economic influences during acute hospitalisation Who carried out the research?This study was conducted by a researcher based at a major trauma hospital in the North West of England. The study was part of a postgraduate academic project. There were no commercial sponsors or competing interests. Thank you to study participantsWe would like to sincerely thank the patients who took part in this study. Their time, honesty, and openness helped us better understand what recovery really feels like after a major injury. Why was the research needed?A femoral periprosthetic fracture is a serious complication that can happen after hip or knee replacement surgery. It often leads to a long recovery, pain, and difficulty returning back to everyday activities such as walking. We know that people from different backgrounds dont always have the same access to care or support, which can affect how well they recover. However, very little is known about patients personal experiences, especially those from more deprived areas. This study aimed to fill that gap. What were the main questions studied?O_LIWhat is it like for patients recovering from a femoral periprosthetic fracture while in hospital? C_LIO_LIDo patients from different socio-economic backgrounds experience recovery in different ways? C_LI Where and when did the study take place?The study took place in 2024 at a major NHS trauma hospital in the North West of England. Interviews were conducted with patients while they were still in hospital. Who participated in the study?Nine adult patients recovering in hospital after a femoral periprosthetic fracture took part. They were grouped according to where they lived, based on national measures of deprivation. This allowed the researcher to explore the effects of social and economic background. What happened during the study?Participants took part in a one-on-one interview with the researcher. They were asked open questions about their recovery, how they felt physically and emotionally, what support they had, and how they were being treated during their hospital stay. The responses were analysed to find common themes and differences. What were the results of the study?The study found four key themes grouped under two main areas: the general recovery experience and the impact of socio-economic background. O_LIMost patients reported ongoing pain, problems with mobility, and emotional distress, such as anxiety or feeling a loss of independence. C_LIO_LIMany said that regaining independence -- being able to move freely or go outside on their own -- was their top recovery goal. C_LIO_LIFamily support was essential. Those without strong social support, particularly from more deprived backgrounds, often struggled more. C_LIO_LIPatients from lower-income regions reported more delays, worse communication, and fewer resources available to help them recover. C_LI How has this study helped patients and researchers?This study gives a voice to patients recovering from a complex injury and highlights how social and economic inequality can influence health outcomes. It shows the need for: O_LIBetter emotional and psychological access and support during recovery following injury. C_LIO_LIRecovery goals that are personalised and focused on independence. C_LIO_LIMore support systems (e.g., community care) for people without family or friend help. C_LIO_LIClearer, more compassionate communication from healthcare staff particularly when awaiting surgery. C_LI Details of any further research planned.Future studies should involve a larger and more diverse group of patients, follow their recovery over a longer period (including after discharge), and test specific solutions such as improved communication or social support programs whilst in hospital. Where can I learn more about this study?You can find more information by contacting the research team at Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Core Therapies Department or by accessing future published versions of this study in academic journals or NHS research summaries.

BackgroundMaking Every Contact Count (MECC) is a person-centred approach to health behaviour change, utilising behavioural science to promote healthy lifestyle choices. Weight-related conversations in mental health settings are particularly important, with users noting gaps in information on medication-related weight gain and support needs. MECC training can address these gaps by improving staff confidence and service delivery, enhancing weight management for individuals with serious mental illness. This study explores staff experiences of weight-related MECC conversations in a mental health setting. MethodsThis mixed-methods study involved healthcare staff from a National Health Service (NHS) mental health inpatient setting in Northeast England. A quantitative online survey administered pre- MECC training, post-MECC training, and 8-10 weeks later captured staff perspectives. Qualitative interviews were conducted with trained and non-trained staff to explore MECC implementation. Quantitative data were analysed using independent and paired-samples t-tests, while qualitative data underwent thematic analysis, using the COM-B framework that examines Capability, Opportunity, and Motivation as key drivers of behaviour. ResultsThirty-six staff completed the pre-training survey, 20 completed the post-training survey, and 25 participated in interviews (15 trained, 10 non-trained staff). Quantitative analysis showed that training improved staff perceptions of confidence and motivation to deliver MECC, though most changes were not statistically significant. Perceptions around opportunity (time, resources, social support) declined at follow-up. Perceived importance and usefulness of MECC also declined over time (p < .05). Qualitative analysis identified barriers and facilitators, mapped to the COM-B model. Trained staff highlighted organisational resources, training structure, and wider determinants of health in supporting MECC delivery, alongside skills in rapport-building. Non-trained staff noted gaps in MECC awareness, recording systems, and training but recognised MECC importance and impact. Both groups identified time constraints, confidence, and the integration of MECC within their professional roles as key factors influencing delivery of weight-related conversations. ConclusionMECC training positively impacted healthcare professionals perceptions and confidence in delivering weight-related MECC conversations in mental health settings. While only confidence changes were evident in surveys, qualitative findings showed multifaceted influences on MECC implementation, emphasising the need for sustained support and system-level changes to overcome structural barriers and ensure long-term MECC delivery.

BackgroundShort-term funding initiatives are often used to stimulate innovation and improve service delivery. They are a main source of funding for voluntary, community and social enterprise (VCSE) organisations. However, reliance on these short-term grants can limit their funded activities and sustainability. In 2023, the Department of Health and Social Care (DHSC) set up the Suicide Prevention Grant Fund (SPGF). This was awarded to VCSEs for a single year to deliver diverse, innovative interventions aimed at preventing suicide. This study aimed to explore service managers perceptions of the SPGFs impact. Specifically, we sought to identify key factors that contributed to a successful delivery of the projects, any challenges in the implementation process and the services capacity to carry on beyond the funding period. MethodsWe conducted semi-structured online interviews with managers from 20 SPGF-funded services across England. Representatives from an additional 31 services completed a short survey to complement the interview data. Data were analysed using a framework analysis, with a combination of inductive and deductive coding. The analytic framework was developed and refined in collaboration with our expert working group, including our team of Lived Experience Researchers. ResultsData were categorised into three overarching themes, shaped by our objectives (impact, implementation, and sustainability), with 16 sub-themes identified across these themes. Funding had a clear impact in expanding service provision. Managers identified the importance of the funded projects, which often filled gaps in service provision, targeting underserved groups. Many reported improved well-being, coping, and a reduction in distress. Implementation facilitators included co-designed interventions, skilled staffing, and productive partnerships with external agencies. However, short timescales, administrative burden, and a retrospective payment model particularly strained smaller charities. Sustainability outlooks were mixed. A minority (notably digital or embedded services) expected full continuation; most anticipated partial continuation or closure without further funding. ConclusionsShort-term grants can catalyse impactful, targeted suicide prevention, but sustainability is jeopardised by brief funding windows, reimbursement models, and administrative load, especially for smaller VCSEs. Many services indicated perceived benefits of their interventions, but further evaluation of the impact of novel initiatives in reducing suicide rates is desirable, where possible.

Purpose: Human anatomy remains foundational to clinical practice, yet reduced instructional hours raise concerns about graduate competence and preparedness for patient care. Although trainees often report confidence, supervisors may perceive deficiencies, creating a gap between self-assessment and external evaluation. This study examined stakeholder perspectives on anatomical competence within physical therapy education to identify areas of discordance in perceived capability. Methods: A cross-sectional web-based survey collected responses from 165 stakeholders associated with an entry-level Doctor of Physical Therapy program featuring a 16-week dissection curriculum. Participants rated four domains of anatomical competence using a 5-point ordinal scale. Group differences were analyzed with the Kruskal-Wallis test appropriate for ordinal data. This methodology ensured robust assessment of stakeholder perceptions and comparative analysis. Results: Median ratings of preparedness and capability were 4 of 5 (quite prepared). Significant discordance emerged in three domains: recent graduates rated their foundational knowledge and ability to explain complex concepts to lay audiences higher than faculty or clinical instructors, whereas faculty expressed lower confidence in graduates' ability to explain patient symptoms using anatomical principles. No significant differences were observed in the ability to describe structures by location, suggesting shared perceptions of basic anatomical understanding despite variation in applied reasoning. Conclusions: Stakeholders generally viewed graduates as well prepared, yet disagreement persisted regarding clinical application of anatomical knowledge. Faculty skepticism about symptom explanation indicates that mastery of anatomy alone does not guarantee clinical reasoning. Curricular strategies emphasizing vertical integration and explicit connections between anatomical science and patient-centered reasoning may help bridge perception gaps and enhance professional competence.

BackgroundClinical placements are a vital element of physiotherapy education, where students must demonstrate competence across a range of professional attributes. Although core competencies such as clinical knowledge, ethical conduct, and communication are universally valued, clinical educators (CEs) from different cultural contexts may emphasize these attributes in different ways. Gaining insight into how Hong Kong CEs evaluate students is important for aligning academic expectations with clinical practice. ObjectiveThis study identifies the key student attributes prioritized by Hong Kong CEs and summarizes the behavioral examples they use to distinguish performance levels on the Assessment of Physiotherapy Practice (APP) Global Rating Scale. MethodsA secondary qualitative analysis was conducted on 456 qualitative feedback comments from APP forms completed by 45 CEs assessing physiotherapy students across two cohorts. The data were analyzed using AI-assisted thematic analysis combined with human expert interpretation, followed by deductive validation across performance levels (Excellent, Good, Adequate, Not Adequate). ResultsSix core attributes emerged from the analysis: (1) communication and interpersonal skills, (2) clinical reasoning and decision-making, (3) practical knowledge and technical competence, (4) learning attitudes and reflective practice, (5) professionalism and work ethics, and (6) safety and risk management, and patient-centered care. Behavioral examples were mapped across performance levels, revealing clear distinctions between competent and underperforming behaviors. Among these attributes, learning attitudes and reflective practice were consistently emphasized, reflecting cultural values within the Hong Kong clinical education context. ConclusionHong Kong CEs prioritize not only technical and cognitive competence, but also reflective and affective attributes rooted in professional and cultural values. The identified attributes and behavioral descriptors may provide actionable guidance for curriculum design, educator training, and student preparation, fostering coherent, transparent, and culturally informed clinical assessment practices.

BackgroundCommunication issues across the primary-secondary care interface are considered one of the most important challenges in improving patient safety in primary care in the UK. Teleconferencing offers a potential means of improving communication during referrals but is largely unevaluated. AimTo explore teleconferencing as an alternative to written Advice and Guidance (A&G) referrals for neurology cases, by assessing its impact on GP-specialist communication and relationships, and exploring implications for patient care. Design and SettingA qualitative case study of a primary care network (PCN) and a secondary care centre in East Anglia. Methods18 clinicians and 10 other stakeholders were interviewed. Observations of teleconferences and a focus group with five PCN staff provided additional data. Data collection and analysis were guided by the Consolidated Framework for Implementation Research and Reflexive Thematic Analysis. ResultsAdvantages of teleconferencing identified by participants included greater clinician satisfaction, mutual educational value, streamlined patient journeys and continuity of care. Teleconferences were also seen to build GP-specialist relationships and reduce unnecessary outpatient referrals. Perceived issues included time constraints, clinical governance and funding sustainability; teleconferences were not seen as appropriate for all referrals. Overall, participants welcomed the teleconference approach but stressed the need to robustly assess its cost-effectiveness and replicability in other settings. ConclusionTeleconferencing is a potentially promising alternative to written A&G referrals and was perceived by participants to help build GP-specialist relationships. However, further studies are needed to assess clinical effectiveness and costs, and to guide future development and implementation. How this fits inO_ST_ABSWhat is known?C_ST_ABSReferral interventions involving direct GP-specialist dialogue can enhance referral quality, reduce outpatient referrals and improve GP-specialist relationships, with some demonstrating improved clinical outcomes. However, they often face sustainability challenges, and their cost-effectiveness and mechanisms of impact require further assessment. What does this study add?This qualitative study identifies key mechanisms through which virtual GP-specialist dialogue may lead to downstream benefits: enabling shared decision-making and delivering consultant-level care closer to home; empowering GPs to manage complex cases; and reducing overall workload across primary and secondary care systems. The programme theory developed can be used to guide future intervention design, implementation and evaluation.

Women with HIV(WLHIV) have diverse and complex reproductive health needs that require patient-centered, informed decision making. Digital tools to support reproductive life planning may improve reproductive health counseling and outcomes for these women. We evaluated user-experiences with a self-administered, tablet-based family planning(FP) counseling tool as part of a packaged digital health intervention evaluated in a cluster randomized trial in Kenya. We conducted focus group discussions with WLWH who received the counseling tool(n=10) and in-depth interviews with providers(n=10). Data were collected using semi-structured guides, transcribed, translated, and thematically analyzed. Among 95 women, median age was 26 years and 52% were married. Providers had median 7 years experience. WLWH and providers found the counseling tool acceptable, and felt it improved decision-making, FP knowledge, and patient-provider interactions. Women reported the counseling tool supported informed FP decisions, educated on less familiar options, and dispelled myths and misconceptions. Providers said the counseling tool helped tailor counseling though it was challenging to use with women with more FP experience or with a selected method, but helpful among FP-initiators and adolescents. The counseling tool was useful and acceptable, but too lengthy. Tailoring the counseling tool and making it optional for specific groups of WLWH may improve feasibility.

Electronic Health Records (EHRs) have not been widely implemented in mental health settings, representing a significant gap in digital health care transformation. A reason for underutilisation includes concerns from healthcare professionals regarding the collection and storage of patients sensitive information. Language use can positively influence clinician-patient relationships, and stigmatising language in EHRs viewed by patients could undermine trust. This is concerning as using EHRs have benefits which allow patients to feel safe and empowered regarding their care. Moreover, minority ethnic groups have been found to disengage with EHRs and are more likely to access mental health services through crisis pathways. This qualitative study in collaboration with Bradford District Care NHS Foundation Trust comprises two stages to explore minority ethnic perspectives on mental health EHRs and develop recommendations for their implementation. Stage one investigates minority ethnic service users perceptions on EHRs and explores mental health professionals understanding regarding the sharing of EHRs with service users from minority ethnic groups. The workshops in stage two will use an Experience-Based Co-Design approach to produce practical recommendations for EHR implementation in mental health settings. Participants include minority ethnic service users, mental health professionals, stakeholders, and relevant bodies such as mental health organisations and Information Technology experts utilising EHRs. Data will be gathered through semi-structured interviews, focus groups and workshops, and analysed using reflexive thematic analysis. The study was approved under the Integrated Research Application System (IRAS ID: 348764) and Health Research Authority and Health and Care Research Wales. Findings will be disseminated via social media, blogs, conferences, journals, academic articles, and community and staff meetings held by the Trust. An executive summary will be shared with participants who consented to receive the results.

BackgroundCommunity safety is a key determinant of mental well-being, yet racially and ethnically minoritised communities in the UK often face higher exposure to violence alongside barriers to formal protection and support. In these contexts, informal support networks may play a critical role in shaping how safety is experienced and how distress is managed. Although such networks are widely recognised as protective for mental well-being, there is limited qualitative research examining how they operate in relation to community safety in settings shaped by structural inequality. This study explores how informal support networks influence experiences of community safety and mental well-being among racially and ethnically minoritised groups in South East London. MethodsThis qualitative study draws on semi-structured interviews (n = 31) with racially and ethnically minoritised participants aged 16+ living or working in Lambeth and Southwark [South East London]. Using a co-produced qualitative design, community consultations informed the development of interview topics. Interviews explored informal support networks, experiences of community safety and their intersections with mental well-being. Audio-recorded interviews were transcribed verbatim and analysed using inductive thematic analysis. ResultsFour themes were identified: (1) experiences of community safety and their mental health impacts; (2) gendered experiences of safety and responsibility; (3) formal support and its barriers; and (4) community and peer-led initiatives as a response to institutional distrust. ConclusionInformal support networks are central to everyday safety and emotional well-being, yet they cannot substitute for adequately resourced, culturally informed public provisions. Strengthening public infrastructure must involve meaningful collaboration with trusted community networks and address the intersectional needs of racially and ethnically minoritised groups.

BackgroundThe University of Limericks Allied Health Community Engaged Placement (CEP) model promotes interprofessional teamwork, enabling allied health students to learn with, from, and about each other through shared community placements. CEPs complement traditional clinical placements by offering socially responsive experiences, fostering community partnerships, and preparing students for diverse practice settings. MethodologyThis mixed method study used a qualitative dominant design, underpinned by social constructivism. Data was collected via focus groups and an online survey. Five focus groups were conducted with students (n=9), practice educators (n=6), and community partners (n=5). Reflexive thematic analysis underpinned qualitative analysis. The survey included an 8-item, 6-point Likert scale to assess perceived skill development, distributed to all three groups. FindingsSix themes were generated: (i) lifting the veil of the social determinants of health, (ii) not your traditional placement, (iii) developing skills to serve communities, (iv) rolling with resistance, sense of growth, and (vi) beyond placement beyond academia. Students valued interprofessional and collaborative skills developed, though some noted clinical skills gaps. Educators observed improved communication and teamwork, while community partners highlighted students leadership, professionalism, and meaningful contributions to the community. DiscussionCommunity engaged placements support development of teamwork, adaptability, and cultural responsiveness skills essential for addressing health inequities. These competencies are achieved through transformative experiences with community members, which cultivate shared learning and growth for students, practice educators, and partners. To maximise impact for all three groups guidelines are needed to support understanding, preparation, and sustainability of placements.

ObjectivesUnderstanding fertility desires is one of the key components for understanding total fertility rates. The study aims to explore how attitudes towards fertility and childbearing are associated with fertility desires. MethodsA cross-sectional online survey was conducted among 822 childfree, heterosexual women aged between 18 and 35 who were involved in a romantic relationship and were not diagnosed with infertility. The relationship between attitudes to fertility and childbearing and both (1) the desire to have children and (2) the preferred timing of childbearing was analyzed. ResultsWomen who had a higher score in the Fertility and the child as an important value subscale and Personal awareness and responsibility concerning having a child subscale were more likely to (1) want to have a child and (2) want to have a child sooner (within the next 5 years). Conversely, higher scores on the A child as a barrier subscale were associated with a decreased likelihood of desiring a child and an increased likelihood of planning to have a child later than in the next five years. ConclusionThe findings highlight the role of fertility-related attitudes in shaping reproductive intentions among women of reproductive age.

BackgroundApproximately 1 in 5 Canadians experience a mental health illness in any given year. While most individuals can be successfully treated within a primary care setting, a subset of individuals present with a severity and complexity requiring specialist care. Unfortunately, a shortage of psychiatrists (especially in rural regions) can result in wait times of months to years. MethodsWe designed the Alberta Network for Community Health Outreach and Rural Mental Health. ANCHOR-MH is a 12-week program that includes a unique educational intervention, collaborative case conferencing, and a community of practice between family medicine (FM) physicians and psychiatrists. We enrolled two pilot cohorts of n=20 FM physicians each and measured participants confidence and comfort in diagnosing, managing, and treating psychiatric conditions. We also conducted qualitative analyses of their experience. ResultsData from participants that completed both the pre- and post-program survey (n=34) showed increased confidence in screening for, diagnosing, and managing psychiatric issues, as well as increased comfort discussing mental health concerns with patients and families and reduced stigma towards certain psychiatric conditions. Qualitative thematic analysis (n=39) reflected this increased confidence, revealed an increased sense of connectedness to the mental healthcare landscape, and highlighted specific examples of practice changes. Participants broadly agreed that the program improved their ability to provide mental healthcare and would improve psychiatric outcomes within their practice. InterpretationANCHOR-MH improved FM physicians confidence and ability to deliver mental healthcare in their primary care settings. Increasing the reach of this program may improve mental healthcare in underserved communities.