Health Expectations

Background Effective communication during consultations is facilitated by clinical empathy and realistic optimism, and can enhance patient satisfaction with care, alleviate symptoms, and improve quality of life. However, primary care systems are under significant strain and changing rapidly, which may affect practitioners' ability to communicate empathically and convey realistic optimism, with implications for the patient-practitioner relationship and patient outcomes. Understanding patients' perspectives of healthcare communication in the current clinical context is therefore important. We aimed to explore patients' experiences and perceptions of communication in UK primary care consultations, focussing on the communication of clinical empathy and realistic optimism. Methods A qualitative interview study was conducted as part of a multi-centre cluster-randomised trial of EMPathicO, a brief e-learning package for Primary Care Practitioners (PCPs) on communicating clinical empathy and realistic optimism. Participants were not aware whether their general practice had access to EMPathicO or not. Interviews were conducted within 7-14 days of participants' consultations, explored their views and experiences of clinical empathy and realistic optimism, and were transcribed verbatim. Interviews were analysed using Ritchie and Spencer's Framework Method. Results We conducted semi-structured audio-recorded qualitative telephone interviews with 71 participants from 29 primary care practices taking part in the EMPathicO trial. Following comprehensive mapping of data to the framework derived following initial analysis, four themes were agreed. Overall, most participants described positive empathic consultations with their PCPs, however, participants' experiences were shaped by wider systemic and contextual factors. They described a stretched and inefficient primary care system impacting empathy and optimism; the impact of PCP 'preparedness' as a marker for empathy; how consultation modality (i.e. in-person or telephone) shaped perceptions of empathy, and how PCPs sharing next steps in participants' treatment and management could foster realistic optimism. Conclusions While clinical empathy and realistic optimism may be experienced by patients during consultations with practitioners, the wider contextual challenges of accessing and navigating primary care systems can threaten overall perceptions of feeling cared for. Future primary care policy and workforce training must consider these system pressures to preserve effective communication in consultations and positive patient-practitioner encounters.

Background: Patient satisfaction is a key measure of healthcare quality among people experiencing homelessness. Student-run free clinics (SRFCs) provide care to underserved populations, but the role of student involvement in patient satisfaction remains unclear. Methods: We conducted a cross-sectional study of patients receiving care at an SRFC. From February 2024 to February 2025, patients completed post-visit surveys assessing satisfaction that were evaluated using regression analyses. Results: Eighty-eight patients completed surveys, reporting high overall satisfaction (mean 9.26/10). In separate linear regression models adjusted for age, gender, and race, greater perceived benefit of student involvement was associated with higher satisfaction ({beta} = .298, p = .037), whereas perceiving the visit as too long was associated with lower satisfaction ({beta} = -.285, p = .019). Conclusion: Greater perceived benefit of student involvement was associated with higher patient satisfaction, whereas longer perceived visit duration was associated with lower satisfaction. These findings highlight the importance of balancing educational opportunities with efficient workflows in SRFCs.

Reddit has emerged as an accessible, anonymous platform for public discourse surrounding mental illness, yet little research has examined how users perceive and evaluate existing anti-stigma initiatives. This study addresses this gap by analyzing public discourse around destigmatization efforts, including both corporate-led campaigns (i.e., Bell Lets Talk) and broader community-based discussions. We conducted an interpretive content analysis of Reddit posts and comments identified through an a priori search protocol registered on the Only Science Framework. We drew a criterion-based purposive sample from r/mentalhealth and general Reddit using keywords related to anti-stigma discourse (e.g., anti-stigma, destigmatizing, and #BellLetsTalk). Fifty posts met inclusion criteria, yielding 581 coded references. Posts predominantly addressed mental health in general terms rather than specific diagnoses, with public stigma (n=28 posts) and structural stigma (n=16 posts) most discussed; internalized stigma was rarely a primary focus. #BellLetsTalk posts located outside the mental health community generated substantially greater engagement than posts within r/mentalhealth, with several threads exceeding 300 comments. Four themes emerged during the qualitative analysis: (1) anti-stigma efforts are unhelpful (n=381), (2) hopeful sentiments about anti-stigma efforts, (3) the mixed role of media, and (4) future directions for anti-stigma efforts.

Background: Pregnancy is a uniquely complex ethical and clinical context in which precision medicine approaches, including genomics-driven risk prediction tools, biomarker-based stratification, and data-intensive analytics, are rapidly evolving. There is a need for community consultation on the ethical, social, and practical implications of precision medicine in pregnancy research and healthcare. Aim: The primary aim of this study was to engage healthcare consumers to build consensus on the acceptability of precision medicine approaches in pregnancy research and healthcare. We also sought to identify consumer priorities for future research. Methods: A two-round modified Delphi study was conducted to determine consumer opinions on the use of precision medicine approaches in pregnancy research and healthcare. Seven in-person workshops (round one) were held, with purposeful recruitment to ensure a representative group of healthcare consumers who engage with the healthcare system during pregnancy. These included first-time parents, culturally and linguistically diverse women, Aboriginal and Torres Strait Islander women, and women and their partners who had experienced previous pregnancy complications. Recruitment was conducted through established advocacy networks, and each workshop was facilitated by representatives from each organization. A second-round online survey, based on workshop content, was completed to assess the acceptability of precision medicine and to determine consumer priorities for future precision medicine research on pregnancy health. Results: Precision medicine research and the implementation of new technologies in clinical care were acceptable to participants; however, the need for transparency and trust between participants and researchers regarding the use and storage of genetic material was highlighted, particularly among Aboriginal and culturally and linguistically diverse participants. Outcomes related to survival and perinatal complications (stillbirth, preterm birth, and labor complications) were the highest-rated consumer research priorities, along with maternal mental health and breastfeeding. When asked whether participants would like to see PM available as part of routine pregnancy care for conditions with available treatments, complete consensus (100%) was reached. Conclusion: Healthcare consumers strongly support the use of precision medicine in pregnancy research and its translation into routine clinical care, particularly when effective interventions are available. However, implementation must be underpinned by transparency, trust, culturally appropriate governance, and clear communication about the collection, storage, and use of genetic material. These findings provide a consumer-informed framework for prioritizing future precision medicine research and guiding its responsible translation into pregnancy care.

Background: Diabetes poses a major global health and economic burden, and effective self management is essential for preventing complications. The National Health Service in England has recently announced plans to shift from analogue to digital services in their 10-year plan. However, digital health technology may also risk widening existing inequalities. MyWay Diabetes is a digital self-management intervention implemented in three regions across England. Understanding the acceptability of online and digital tools to support diabetes self-management, particularly among non users and underserved groups, is essential to ensure equitable engagement and implementation. Objectives: To (1) explore barriers to using online and digital support across diverse demographic groups with type 1 and type 2 diabetes who had not used the MyWay Diabetes platform, and (2) identify factors that could improve uptake and continued engagement. Design: Cross-sectional qualitative study. Methods: We conducted six focus groups with n=35 people living with diabetes (27F, 8M; 40% Asian British Pakistani) across three regions in England. The Theoretical Framework of Acceptability (TFA) informed data collection and analysis. Data were transcribed and analysed thematically using template analysis, mapped onto constructs of the TFA. Results: Digital engagement in diabetes self management was shaped by intersecting personal, social, and healthcare system factors. Participants' confidence with navigating digital environments was constrained by the emotional and practical burden of living with diabetes. Social and structural barriers, including cultural mismatch, accessibility challenges, financial constraints, and reliance on family further limited meaningful use of digital tools. Engagement was strongly influenced by trust in healthcare professionals and services; digital tools were considered acceptable when they complemented person-centred care, but resisted when perceived as replacing personalised, face to face support. Conclusions: Digital support for diabetes self management is more likely to be acceptable when it aligns with people's capabilities, social circumstances, and trusted healthcare relationships. Therefore, to prevent widening inequalities, digital tools should be accessible, culturally relevant, and embedded within supportive, person centred models of care. Lived Experience or Public Contribution: Public contributors with lived experience of diabetes (3F, 3M) reviewed participant materials and pseudonymised focus group transcripts, providing feedback on recruitment, data collection, and interpretation. Their insights informed analysis and theme development, ensuring a lived-experience perspective. Our public co-applicant is a co-author on this manuscript.

Background: This study focused on adults with complex care needs due to problems on multiple life domains and consequent high acute care use. The Hotspotters Project was undertaken to assess the effects of proactive integrated care on health outcomes and healthcare costs in this group. We evaluated the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of the Hotspotters Project in order to identify factors that influenced implementation and outcomes. Method: This mixed method study followed the RE-AIM-framework, using validated questionnaires, routine care data and semi-structured interviews. Qualitative data from patients and care providers offered insight in the quantitative outcomes. Quantitative data were analyzed descriptively (SPSS), and interview transcripts were analyzed using inductive thematic content analysis (Atlas.ti). Results: As acute care use was lower than expected, few patients were eligible (153/1403) and subsequent low enrollment (n=30) limited conclusions regarding effectiveness. Nevertheless, the intervention improved collaboration with social work, and the structured intake was valued for the overview of patients complex needs. Many practices adopted the intervention into regular care, despite the complex inclusion process. Care providers proposed revising the target population and recruitment to better reflect the Dutch context. Conclusion: Although cost-effectiveness could not be assessed, this study nonetheless provides insights that can help future interventions and trials to better match patients needs, adapt to local context and reduce patients study burden. Adapting the definition of patients with complex needs to a local context can strengthen the rationale for implementation and enhance patient motivation.

Background: Post-abortion care (PAC) encompasses emergency treatment, counselling, contraceptive services, and referral linkages. Emergency post-abortion care (EPAC), the life-saving component of PAC, addresses acute abortion-related complications, including haemorrhage, sepsis, retained products of conception, and severe pain. In Uganda, where abortion is legally restricted and socially stigmatised, womens care experiences are shaped by clinical urgency, fear, moral vulnerability, provider interactions, and structural health system constraints. Despite EPACs centrality to maternal survival, qualitative evidence on how women interpret and evaluate their care experiences in referral hospital settings in Uganda remains limited. This study explored womens experiences of EPAC at Kawempe National Referral Hospital (KNRH) and identified the factors that shaped those experiences. Methods: A qualitative phenomenological design was employed. Sixteen in-depth interview transcripts from women who received EPAC at KNRH in March-April 2026 were analysed using inductive thematic analysis. The Socio-Ecological Model (SEM) was applied as an interpretive framework. Results: Six themes were identified: (1) survival and physical relief as the immediate measure of good care; (2) pain, fear, and emotional distress during treatment; (3) reassurance and support as buffers against vulnerability; (4) dignity under pressure: communication and privacy in EPAC; (5) structural barriers across the pathway of care; and (6) experiences beyond discharge: incomplete recovery and uncertainty. Care was frequently evaluated through the lens of survival, yet these accounts co-existed with intense procedural pain, compromised privacy, delays, financial burden, and inadequate post-discharge support. EPAC at KNRH was experienced as a complex encounter shaped by bodily vulnerability, interpersonal dynamics, and system-level constraints. Conclusions: Strengthening EPAC requires patient-centred approaches that integrate clinical effectiveness with respectful communication, pain management, improved triage, and structured post-discharge support.

Background: Chronic intestinal failure is a devastating rare disease in which patients require complex and life-saving parenteral nutrition or intravenous fluids delivered through a central venous catheter. There is a shortage of clinical expertise to manage chronic intestinal failure and patients in the United States lack access to the limited number of expert care centers. We developed a patient intestinal failure (PIF) ECHO intervention with patient advocates who have lived experience with the goal of connecting patients and family caregivers virtually to multidisciplinary intestinal failure experts for best practice learning. Objective: We pilot-tested the acceptability and feasibility of a direct-to-patient telelearning program based on the well-established ECHO Model focused on best practices in chronic intestinal failure care. Setting and Participants: 19 adults with chronic intestinal failure attended the pilot PIF-ECHO program for 12 consecutive weeks via Zoom between April and July 2026. All participants completed the post intervention questionnaire and 16 individuals participated in 3 focus groups. Design: A mixed methods evaluation was conducted. Questionnaires were assessed according to seven domains of the Theoretical Framework of Acceptability and qualitative data from the virtual focus groups were coded and analyzed using iterative thematic analysis. A data-derived PIF-ECHO logic model was developed to illustrate pathways between the program content and anticipated outcomes. Results: There was strong or very strong agreement that sessions were accessible, enjoyable, worth the time spent, and improved understanding of intestinal failure and its management. Information learned increased confidence for self-advocacy in navigating healthcare needs, disease and therapy self-management, and improved well-being. Interaction with facilitators, expert presenters, and peers was positive, judgement free, validating, and respectful. Participants felt empowered and reported lower levels of emotional strain due to the supportive resources and knowledge gained. Conclusions: A patient-facing tele-learning program in chronic intestinal failure is feasible, accessible, and acceptable to patients and appears to result in important short-term and medium-term benefits. The program was perceived as valuable and notably different from patient and peer-led support groups. The model could be applied more widely to other rare diseases. Lived Experience and Patient Contributions: Four patient advocates with lived experience in chronic intestinal failure were involved throughout the study including pre-study interviews and focus groups to inform PIF-ECHO design and content, recruitment, as presenters on topics of self-advocacy and role of patient support groups, and in the analysis and refinement of the program logic model. Their input shaped the relevance and acceptability of the PIF-ECHO pilot program. All four patient advocates fulfil uniform requirements for authorship and are co-authors on this paper. This work documents a meaningful partnership in the creation of a patient-facing virtual tele-learning adaptation of the ECHO model and establishes a valuable collaboration for future study of PIF-ECHO on a larger scale.

Primary ciliary dyskinesia (PCD) is a rare, genetic, multiorgan disease requiring lifelong management. Although PCD affects everyday life, little is known about how people with PCD experience social functioning (SF). We conducted a study within the international participatory Living with PCD study to comprehensively explore SF. First, we conducted a focus group and two semi-structured interviews with adults and parents of people with PCD. We analysed qualitative data thematically and used the findings to develop a multilingual online questionnaire on SF. The questionnaire was completed by 277 participants: 225 adults and adolescents with PCD (81%) and 52 parents of children with PCD (19%). Participants reported active social lives and strong close relationships. PCD had a positive impact on family relationships for 39% of adult/adolescent participants and 41% of parents reporting for children. Among adult/adolescent participants, 49% reported positive or no impact on romantic/intimate relationships, while 17% had avoided or ended a relationship because of PCD. PCD affected the ability to meet responsibilities for 54% of participants, free time for 58%, and planning effort for 53%. Participants were more comfortable discussing PCD with family, friends, and partners than in work or educational settings, where only 29% reported receiving support. Financial support, flexible work, or educational policies and better-trained healthcare professionals were the most frequently identified unmet needs. This study suggests that maintaining SF with PCD requires substantial individual and relational work. Improving SF for people with PCD requires systemic responses in healthcare, education, and employment, alongside support from close networks.

Background: Mobile outreach initiatives have emerged to address persistent barriers to care for people experiencing homelessness, substance use, and mental illness. Although these models show promise, less is known about how and under what conditions they enable engagement and coordinated care. This study explains how, why, and under what circumstances a mobile, cross sector outreach model enables access to care for marginalized populations. Methods: We conducted a realist evaluation of Supportive Outreach Services (S.O.S.), a mobile, cross sector outreach program in Grey County, Ontario. Data included 31 semi structured interviews with outreach providers, partner organizations, system leaders, and clients, supplemented by document review and stakeholder feedback. Using retroductive reasoning and constant comparison, we developed and refined context mechanism outcome configurations to construct an explanatory program theory. Results: Five interconnected realist explanations account for how the model enables access to care. Trust built through repeated, non judgmental encounters supports engagement; proximity reduces barriers to participation; accessible support enables timely help seeking; cross sector relationships enable adaptive coordination; and visible results build legitimacy that sustains participation and resources. Together, these explanations provide a linked explanatory account of how mobile outreach reduces friction between marginalized populations and fragmented services while identifying the structural conditions that constrain its effectiveness. Conclusions: The effectiveness of mobile outreach depends less on the services delivered than on its capacity to reduce friction, sustain relationships, and adapt care across organizational boundaries. The resulting program theory offers transferable explanations for designing coordinated community based services while highlighting the structural conditions required for durable change.

In increasingly strained socio-political-economic contexts, reliance on community supports deepens, particularly for those failed by or unable to access appropriate care through statutory services. However, little is known about the scope, equity-oriented provision or the conditions that enable and constrain community care. This mapping addressed these gaps, exploring community services in London and Greater Manchester, supporting children's mental health and wellbeing. Co-produced with co-researchers and community stakeholders from conceptualisation to dissemination, we conducted a systematic scoping of community-based services, not government-provided or commissioned, offering free mental health or wellbeing support for children (0-18 years), carers, or families. We extracted service characteristics and equity-oriented provision, and provider and stakeholder insights informed a collaborative narrative synthesis. We identified 297 eligible services (261 London, 41 Greater Manchester), with 48.9% of initially identified services excluded due to government commissioning/contracts. The majority (84%) advertised at least one equity-oriented practice, most commonly cultural safety/specific care (38%), though few explicitly intersectional (11%). Among those with a primary specialisation, support for violence and abuse was highest (12%). Services predominantly supported older children, with gaps in early intervention and prevention. The synthesis revealed trade-offs and tensions: responsiveness competes with planning, capacity-building and communications; navigation barriers alongside selective information sharing; and the ripple effects of funding precarity undermining provision and choice. Community supports are relied on yet structurally vulnerable. As policy increasingly emphasises community partnerships, this requires sustainable funding models, collaboration guidance and resourcing to embed equity-oriented practices.

Background Access to exercise facilities is particularly important for the health, wellbeing, and social participation of people with disability. However, many facilities remain difficult for them to access. Methods This research used a mixed-method case study of twenty-three gyms in New Zealand. Quantitative accessibility audits based on the requirements of NZS4121:2001 were used to assess the compliance of accessible parking, entrances, interiors and bathrooms. Interviews with staff or managers at each gym provided qualitative data on operational practice and awareness of inclusivity. Results The most accessible aspects include parking spaces, footpaths, entrance doors and bathrooms with features such as clear signage, well-designed ramps, and evacuation protocols demonstrating best practice inclusivity. Improvements in service counters, lifts, tactile and auditory communication are needed. Community gyms and university gyms are the most inclusive and their staff have the most comprehensive experience in interacting with people with different disabilities. Small private gym owners know little about accessibility barriers and financial constraints limit their ability to improve access features. Conclusion The main recommendations for improving gym accessibility for people of all abilities include strategies to facilitate their joining gyms and strategies to support them as long-term gym members. The involvement of healthcare professionals in prescribing regular exercise and monitoring the health effects, coupled with subsidised gym membership will make it easier for people with disability to join gyms. More extensive staff training, targeted exercise programs, inclusive signage and communication and regular maintenance of the facility will improve the ongoing experience. Participating in regular exercise and social environments will help improve the physical and psychological health of people with disability.

Background: Trauma-informed approaches (TIAs) are increasingly implemented across public-sector settings to improve support for young people affected by adverse childhood experiences (ACEs). However, practitioners often report difficulties translating broad trauma-informed principles into everyday practice, and young people are rarely involved in developing resources intended to support implementation. Aim: To co-design, implement and undertake a preliminary evaluation of a youth-led trauma-informed resource for professionals working with young people in public-sector settings in England. Methods: The study formed part of the UKRI-funded Attune programme and employed Accelerated Experience-Based Co-Design (AEBCD). Eighteen adolescents with lived experience of ACEs and 16 professionals from nine public-sector settings participated in three regional co-design workshops. Findings from a prior arts-based lived experience study informed the workshops. Participants collaboratively developed Validating Voices, a low-cost resource designed to increase validating interactions between professionals and young people. The resource was subsequently introduced into nine organisations and evaluated using staff surveys and semi-structured interviews. Results: Co-design participants identified professional invalidation of young peoples experiences, identities, needs and emotions as an under-recognised contributor to mental health. The resulting resource combined discussion cards, creative activities, role-play and organisational reflection exercises to promote validating practices. Five organisations implemented the resource and reported it to be feasible. Flexible local adaptation was common, while more participatory role-play elements proved harder to implement consistently. Staff observed increased opportunities for disclosure, reflection, peer connection and professional curiosity about young peoples experiences. Staff reported listening differently to young people and, in some settings, implementing changes in response to young people's recommendations. Conclusions: Youth-led co-design identified validation as a practical and meaningful mechanism for operationalising trauma-informed principles in everyday professional practice. With refinements, Validating Voices shows promise as a resource to support more relational, collaborative and trauma-informed responses to young people in public sector settings.

Background. The Crew Resource Management teamwork training model widely used in healthcare improves teamwork behaviours, but evidence of improved patient outcomes is weak. Other professions with teams displaying high performance under pressure, such as military units and sporting teams may have lessons for teamworking in healthcare. We conducted a qualitative study with trainers from these environments, to explore aspects of their approaches and beliefs which might inform an alternative model for healthcare team strengthening. Methods. We conducted and thematically analysed semi-structured interviews with 14 coaches or leaders of military and sporting teams. The findings were used to define principles for team strengthening programmes. Experienced healthcare staff and Human Factors experts reviewed these principles and identified challenges in translating them into healthcare environments. Results: We identified 6 themes and 18 sub-themes. The principles identified encompassed A. Deliberate self-development of team values by the group, their promotion by leaders and maintenance by experienced team members B. Frequent intensive realistic whole team training, and full integration of sub-teams, C. Celebration of success and encouragement of an attitude of embracing pressure D. Use of Buddying and mentoring, symbols of belonging and team social events. Important contextual issues requiring attention when adapting these principles for healthcare environments were identified. Conclusion: The approaches to creating cultures of mutual supportiveness associated with high performance under pressure in military and sports teams were very similar. Adoption of these in healthcare may be feasible, but would require significant contextual adaptation. Pilot studies would allow refinement and evaluation of potential benefits.

Preventive health is a crucial health systems component for managing disease burden and achieving health promotion policy goals. However, effective prevention relies on the modification of relevant risks, often requiring systemic health behaviour change. Australia's National Preventive Health Strategy (NPHS) prioritises seven focus areas: tobacco and nicotine, healthy diet, physical activity, cancer screening, immunisation, alcohol and other drugs, and mental health. The readiness of community members in Australia to address health behaviours relating to these areas has not been fully examined. In response, six focus groups were conducted with 27 adults from the Australian general population to explore their perspectives and experiences of preventive health information and behaviours relating to the seven NPHS focus areas. Themes and sub-themes were identified using an applied descriptive framework. Participants described motivations, barriers and experiences surrounding preventive health through the themes of 'Making informed health choices', 'Facilitating behaviour change and the role of support systems' and 'Spreading the preventive health word'. Sub-themes detailed processes of prioritisation, risk-benefit assessment, critical appraisal, sociocultural influence and support-seeking to understand and personalise preventive health information, implement behavioural change, and share information with others. The focus areas participants engaged with most strongly were healthy eating and physical activity, while cancer screening was discussed less often. These findings indicate high preventive health engagement in the Australian community, alongside challenges navigating and adapting relevant information to personal needs. These insights can support policymakers, healthcare providers and others to effectively enact the NPHS through more targeted preventive health information and care delivery.

Background: Patient safety learning systems operate primarily at the national level, yet the potential for international sharing of safety intelligence remains largely unrealised. Other safety-critical industries, including civil aviation, nuclear power, and rail, have developed international incident reporting and learning systems whose design principles may offer transferable insights for healthcare. Objective: To explore the views and experiences of safety-critical industry experts regarding the purpose, key functions and features, transferability, barriers, enablers, and incident priorities of a potential international patient safety learning system. Design: Qualitative phenomenological study using semi-structured key informant interviews analysed with the five-stage framework analysis method. Participants: Eleven international experts purposively sampled from safety-critical industries (healthcare, civil aviation, maritime, and railway) across six countries. Interviews were conducted by telephone or internet-based audio call between May and September 2019. Results: Seven themes were identified: (1) purpose of an international patient safety learning system; (2) key functions; (3) key features; (4) transferability of learning; (5) enablers; (6) barriers; and (7) patient safety incident types appropriate for international sharing. Rare and emerging event detection emerged as the most distinctive value of an international system, a capability that cannot be replicated at national level. Critical functions included robust feedback loops, multidisciplinary analytical capability, and actionable recommendations. Key barriers, including blame culture, inter-organisational mistrust, and cross-border privacy legislation, were each amplified at the international level relative to their national-level equivalents. Conclusions: This study provides the first cross-industry qualitative account of design requirements for an international healthcare patient safety learning system, highlighting transferable lessons from established industries alongside healthcare-specific challenges that require bespoke solutions.

Background Anxiety, depression and menstrual problems are conditions that significantly impact an individual's health and wellbeing yet, barriers to healthcare can prevent access to appropriate medical care. Trust in doctors is a notable factor as previous studies have shown that it affects engagement with healthcare services and has declined in recent years. Methods Using the Avon Longitudinal Study of Parents and Children, we investigated associations between trust in doctors and healthcare access at two timepoints, for anxiety, depression (mothers and partners) and menstrual problems (mothers only). Results Mothers reporting greater trust in doctors were more likely to access care for anxiety (n=1849, adjusted odds ratio (AOR) 1.11, 95% confidence interval (95% CI) 1.08-1.14), depression (n=2411, AOR 1.10, 95% CI 1.07-1.12), and menstrual problems (n=1723, AOR 1.04 95% CI 1.01-1.06). If mothers and partners endorsed 'the doctor is always helpful', they were more likely to access care for depression (mothers: n=2005, AOR 1.30, 95% CI 1.16-1.46; partners: n=580, AOR 1.46, 95% CI 1.05-2.03) and for anxiety (mothers: n=1892, AOR 1.35, 95% CI 1.19 to 1.54; partners: n=734, AOR 1.40, 95% CI 1.02-1.91). Implications This study supports association between trust in doctors and healthcare access for anxiety, depression and menstrual problems, particularly amongst mothers. This contributes to previous literature that suggests that trust remains an important factor in understanding treatment gaps, and that researchers and clinicians must work to improve public trust in healthcare systems.

Background: Immigrant patients with limited dominant-language proficiency may face intersecting challenges when navigating cancer care and long-term oral anticancer treatment. Although studies have reported lower medication adherence among migrant and ethnic minority populations, less is known about how migration-related, linguistic, experiential and contextual factors shape treatment engagement from patients own perspectives. This study explored how immigrant patients experience illness, navigate treatment and engage with oral anticancer medication within the broader context of cancer care. Methods: Thirteen immigrant patients with limited dominant-language proficiency receiving oral anticancer medication for haematological malignancies were recruited from the haematology outpatient clinic of a Belgian university hospital. Semi-structured interviews were conducted in participants native languages using an adapted version of the McGill Illness Narrative Interview, with professional interpreters or intercultural mediators. Interviews were analysed using inductive reflexive thematic analysis within an interpretivist framework. Results: Analysis of patients illness narratives generated five experiential dimensions: 1) bodily, biographical and identity rupture; 2) temporal disruption and uncertainty; 3) linguistic vulnerability shaping the illness experience; 4) meaning-making and explanatory frameworks; and 5) resources sustaining treatment engagement. Linguistic vulnerability shaped access to biomedical knowledge, participation in healthcare encounters and patient autonomy, while patients mobilised personal, relational, existential, linguistic and institutional resources to sustain treatment continuity. Treatment engagement emerged as a dynamic and relational process embedded within broader migration-related, linguistic and healthcare contexts. Rather than representing fixed determinants or sequential stages, the five dimensions formed an evolving configuration whose relative salience varied throughout the illness trajectory. Conclusion: This study proposes a multidimensional interpretive model of engagement with oral anticancer medication among immigrant patients with limited dominant-language proficiency. Rather than conceptualising adherence as an isolated individual behaviour, the findings show how migration-related contexts shape the conditions under which treatment engagement becomes possible, difficult or fragile. By foregrounding immigrant patients lived experiences, the study identifies experiential, linguistic, relational and structural dimensions of cancer care that are difficult to capture through behavioural adherence measures alone and offers insights for more equitable, context-sensitive and patient-centred oncology care.

People with intellectual disabilities and their communities are rarely involved in setting priorities for research. Our study addressed this gap through consultations with the UK communities of three genetic syndromes in which intellectual disabilities are common: Down syndrome (DS), Fragile X syndrome (FXS) and Williams syndrome (WS). The study aimed to provide an understanding of (1) the views of the DS, FXS and WS communities on current UK research; (2) their priorities for future research; and (3) participants views of engaging with UK research. We conducted focus group discussions with 39 community members including: children and adults with DS, FXS and WS; parent/carers of people with DS, FXS and WS; practitioners and researchers who work with these communities. Our study was carried out in collaboration with a Steering Group and two Advisory Groups of DS, FXS and WS community members. We identified three themes. First, participants shared their dissatisfaction with the current research landscape and wanted a more balanced landscape, with more research with direct application to the daily lives of people with DS, FXS and WS. Second, community members emphasised the importance of translating research into practice, advocating for better access to research and more meaningful participation to research of individuals with lived experience. Third, our study not only identified what should be the focus of future research on DS, FXS and WS, but also how researchers should conduct their research. Whilst including children in our sample was a strength, there were some limitations to the diversity of our sample; children with FXS were not represented and gender, ethnic and geographic diversity could have been broader. Nevertheless, we hope that our findings will change the future of research in this field so that research carried out in the name of individuals with intellectual disabilities such as DS, FXS and WS, is of direct use to these communities.

Background: As musculoskeletal physiotherapy evolves toward advanced practice and direct access, evaluating high levels of clinical competence has become pressing. Quality indicators underpin large-scale audit systems, but indicators discriminating advanced competence remain insufficiently defined. Objective: To identify and characterize indicators capable of discriminating high levels of clinical competence in musculoskeletal physiotherapy. Methods: A modified Delphi comprised an exploratory pre-round and two consensus rounds. Experienced French-speaking musculoskeletal physiotherapists were recruited using an expertise scoring grid. Candidate indicators, generated from open-ended responses and existing quality indicators, were rated on 6-point Likert scales for relevance, formulation, and tool adequacy. Consensus was predefined as [≥]75% of ratings [≥]5. Results: Thirty-two experts completed the pre-round, 29 the first round, and 27 the second (84% retention), generating 49 candidate indicators. Thirteen reached consensus for relevance, and 10 also for formulation. Retained indicators primarily reflected advanced clinical reasoning: real-time adaptation, hypothesis prioritization, decision-making under uncertainty, and error management. Only one outcome indicator reached consensus: clinical performance weighted by case complexity. Conclusion: High levels of clinical competence in musculoskeletal physiotherapy appear characterized less by standardized outcome attainment than by managing complexity, uncertainty, and error through advanced clinical reasoning. These findings may inform competence-oriented audit and feedback systems. Trials registration: Not applicable.