What works in advocating for food advertising policy change across an english region - a realist evaluation.

BACKGROUND: With increasing recognition of the role of commercial determinants of health, local areas in England have sought to restrict the advertising of products high in fat, salt and sugar (HFSS) on council-owned spaces, as part of wider strategies to reduce obesity. While there is some evidence of the impact of such policy change on behaviour, little is known about what works in the process of implementing this policy change. METHODS: Guided by a realist evaluation framework that explores the interaction between context, mechanism and outcomes, this study aims to investigate the factors that influence the restriction of outdoor advertising of HFSS products in one region in England. It refines a programme theory co-produced with stakeholders from 14 local authorities within a region and uses multiple data sources from each area with an in-depth examination of four case study sites. Data sources include longitudinal realist interviews, focus groups and surveys with policy advocates and policy stakeholders. Data were analysed retroductively to understand the causal link between context, mechanism and outcomes. RESULTS: Outcomes were driven by five dominant mechanisms: a strategic and staggered approach to stakeholder engagement, gathering intelligence, identifying policy champions, building relationships, reframing the issue; and two secondary mechanisms of amplifying the issue and increasing public will. These led to varied outcomes with no changes in formal policy position within the evaluation period but draft policy guidance in place and changes in political will demonstrated. Dominant context factors influencing change included having a named and resourced policy advocate in place supported by an external Community of Improvement and having existing aligned local objectives. Organisational complexity and change, financial concerns, lack of local examples, ideological positions and the pandemic were also influencing contextual factors. CONCLUSION: Effecting policy change in this area requires the commitment of an extended period and the valuing of short-term policy outcomes, such as increasing political will. The importance of a resourced and well-supported policy advocate to lead this work is fundamental and the commercially sensitive nature of this policy change means that a complex interplay of mechanisms is required which may be dominated by a strategically staggered approach to stakeholder engagement.

Public health practitioners as policy advocates: skills, attributes and development needs.

Effecting policy change is a key strategy in tackling wider determinants of health. In England, public health sits within Local Authorities (LAs) and responsibility for ensuring health is considered across directorates increasingly falls to public health practitioners. While international professional standards expect competence in understanding policy processes, the advocacy role has been under-explored. This paper explores the professional skills, role characteristics and learning needs of practitioners advocating for the restriction of advertising high-fat, salt and sugar products in a region of England. A series of three interviews were conducted at three time points over 10 months with policy advocates leading this policy change from four LAs. Three focus groups were also held with 12 public health advocates from 10 LAs at the end of the 10-month period of data collection. Data were transcribed and analysed retroductively. Data showed that practitioners felt inexperienced as policy advocates and saw this work as different from other public health approaches. Successful advocates required interpersonal skills, knowledge of policy-making and local governance, determination, resilience, confidence, belief in their work's value and leadership. These skills were difficult to acquire through formal education, but advocacy training, mentorship and role modelling were seen as important for professional development. To successfully implement a Health in all Policies approach and address wider determinants of health, public health practitioners need to be equipped and supported as policy advocates. The advocacy role and the complex skills required need to be more fully understood by the public health profession and prioritized within workforce development at both local and national levels.

Doing public health differently: How can public health departments engage with local communities through social media interventions?

Objectives: This paper evaluates a collaborative intervention between public health professionals and local social media administrators, in which the social media site Facebook was used with a view to strengthening engagement with and, dissemination of, core messages and building trust and resilience within local communities during the COVID-19 pandemic. Study design: A qualitative design was used, exploring the research question: how does collaboration between public health professionals and local social network group administrators create community engagement during a global crisis? Methods: Fourteen semi-structured interviews were conducted with public health staff and online group administrators. Data was analysed using framework analysis. Results: Collaboration between public health professionals and local group administrators created both opportunities and challenges. Local group administrators had wide reach and trust within the local community, but message credibility was enhanced through local authority involvement. Such collaborations contain inherent tensions due to perceived risks to social capital and independence but can be successful if receiving strong risk-tolerant support from the local authority. Findings are discussed in the context of Bourdieu's theory of social capital to examine how public health information can be delivered by trusted social media actors in communication tailored to the local community. Conclusions: Social media provides new channels of communication for delivery of public health messages, enabling new ways of working which create long-term engagement and community building. Although the intervention was developed quickly in response to the COVID-19 pandemic, participants felt it could be mobilised to address a wider range of issues.

Public health messages during a global emergency through an online community: a discourse and sentiment analysis.

The growing popularity of social media and its ubiquitous presence in our lives brings associated risks such as the spread of mis- and disinformation, particularly when these may be unregulated in times of global crises. Online communities are able to provide support by enabling connection with others and also provide great potential for dynamic interaction and timely dissemination of information compared with more traditional methods. This study evaluates interactions within the Essex Coronavirus Action/Support Facebook private group, which set out to prevent the spread of COVID-19 infection by informing Essex residents of guidance and helping vulnerable individuals. At the outset, 18 community administrators oversaw the group, which attracted approximately 37,900 members. Longitudinal Facebook group interactions across five periods spanning the UK lockdowns 2020-2021 were analysed using psychological discourse analysis and supplementary computed-mediated analysis to further explore sentiment and linguistic features. The findings endorsed that the group provided a protected space for residents to express their feelings in times of crises and an opportunity to address confusion and concern. The effective communication of public health messages was facilitated by promoting desired interaction and the construction of group identities. Administrators worked with group members to achieve a shared understanding of others' perspectives and the COVID-19 evidence base, which led to a mobilisation of the provision of support in the community. This was accomplished through the application of rhetorical and interactional devices. This study demonstrates how online groups can employ discursive strategies to engage audiences, build cohesion, provide support, and encourage health protective behaviours. This has implications for public health teams in terms of designing, implementing, or evaluating such interventions.

Designing an Effective Organizational Culture to Guard Against the Cyber Risks of Emerging Technologies.

The Internet of Medical Things (IoMT) and interoperable technologies have transformed how patient data affect medical care; such technological innovations revolutionize how healthcare organizations (HCOs) improve cost, quality, and access. New cyber risks, however, accompany developing cyber ecosystems. Although immediate data exchange is beneficial, risk arises from the IoMT's increased susceptibility to human influence. The success of quality care relies on protecting health information technology (HIT) against newly developing cyber vulnerabilities. Therefore, managers must be just as invested in their HCO's cybersecurity protocols as cybercriminals are in bypassing those protocols. This essay proposes a healthcare cyber resiliency model that leverages human and technical factors through a cycle of feedback and process improvement. It intends to equip healthcare administrators with the foundational philosophy necessary to secure their emerging technologies.

Beyond the sentence: Shared reading within a high secure hospital.

Ashworth Hospital provides care for inpatients detained under the Mental Health Acts who present a danger to themselves or others. Rehabilitative interventions can help support the best outcomes for patients, their families, care providers, and society. The efficacy of weekly Shared Reading sessions for four patients with experience of psychosis and a history of self-harm was investigated using a 12-month longitudinal case series design. Session data were subjected to psychological discourse analysis to identify discursive strategies employed to accomplish social action and change over the duration of the intervention. Archetypes of interactional achievement across sessions emerged. Broadening of capacity to consider was demonstrated through increased hedging and less declarative language. Increased assertiveness was achieved through reduced generalisation marked by a transition from second-person plural pronouns to more first-person singular pronouns. Avoidance of expression and disagreement strategies diminished over time. In addition, heightened engagement was accomplished through the increased tendency to employ functionally related and preferred responses within adjacency pairs, which mirrored non-verbal communicative strategies. Shared Reading shows promise for promoting the interactional accomplishment for individuals within high secure settings, who are ready to undertake a recovery-related activity. Pathways of interaction should continue to be explored, with consideration to the current study's strengths and limitations. This study contributes to the understanding of efficacious reading study design and the interactional outcomes of therapeutic reading.

Back to live: Returning to in-person engagement with arts and culture in the Liverpool City Region.

On July 19th 2021, the UK government lifted the COVID-19 restrictions that had been in place since March 2020, including wearing masks, social distancing, and all other legal requirements. The return to in-person events has been slow and gradual, showing that audiences are still cautious when (and if) they resume engaging in arts and culture. Patterns of audience behavior have also changed, shifting toward local attendance, greater digital and hybrid engagement, and openness to event format changes. As the arts and cultural industry recovers from the pandemic, it is important to adopt an audience-oriented approach and look at the changing patterns of engaging in arts and culture. This study aims to better understand the impact of the pandemic on the patterns of cultural and arts engagement. Eight qualitative interviews were conducted to explore the changes in arts and cultural engagement since the restrictions were lifted, focusing particularly on the audience's experiences of returning to in-person arts and cultural events in the Liverpool City Region (LCR). Using framework analysis, three themes were identified from the data: The new normal: reframing pre-pandemic and pandemic experiences of arts and culture, Re-adjusting to in-person provision, and Moving forward: online and blended provision. The findings show that the pandemic altered the ways that people engage in arts and culture. The "new normal," a blend of pandemic and pre-pandemic experiences, illustrates how the pandemic has highlighted and reconfigured the importance of arts and culture, in terms of personal and cultural identity. Resuming in-person engagement after a long break, participants noted that they were able to feel more like themselves again. Arts and culture were perceived to be beneficial in rebuilding personal resilience and confidence. Engaging in arts and culture, following the isolating experience of the pandemic, has also helped participants feel reconnected to others through their shared experiences. Finally, the findings suggest that online provision remains vital for many, ensuring wider inclusivity, particularly for vulnerable audiences. At the same time, it is important to acknowledge the barriers to online inclusion and the possibility of this resulting in a growing digital divide.

Regional Innovation in Arts Provision Spawned by COVID-19: "It Became a Lifeline for a Lot of People Who Are Stuck at Home".

Although the impact of the global COVID-19 pandemic on the arts and cultural sector due to the closure of galleries, museums, arts venues, and other cultural assets represents a significant health risk, new opportunities for arts and cultural engagement have arisen. Interviews with 24 representatives including service providers and creative practitioners from 15 arts and cultural organizations within the Liverpool City Region were conducted. The aim was to examine the impact of COVID-19 on arts and cultural provision and on organizations and people providing these services, as well as to understand the perceptions of service providers and practitioners of the effects on those whom arts and cultural organizations serve, including those who would usually access arts through formal healthcare routes (e.g., through collaboration with health partners). Interview data were analyzed using framework analysis. Four overarching themes were identified: Response: Closures, adaptations, and new directions; Challenges of online provision; Value of online provision; and the future of the arts. The arts and cultural sector has innovated rapidly, notably with accelerated digitalisation. Alternative provision has been "a lifeline" for vulnerable groups, such as those with mental health difficulties. Arts organizations have been most effective in reaching vulnerable, isolated and disadvantaged populations when they have worked in close collaboration with health and social care providers. The implementation of hybrid provision is an important move forward for the sector in light of our findings that alternative modes of provision are advantageous additions to service as usual. Given the increasing concerns about the mental health sequelae of the pandemic in the UK, arts and cultural engagement could play a pivotal role in the future recovery period.

Come together: The importance of arts and cultural engagement within the Liverpool City Region throughout the COVID-19 lockdown periods.

Introduction: Arts and cultural engagement activities have long been found to support wellbeing within the general population. In particular, community arts and cultural involvement during the COVID-19 pandemic have been an invaluable source of mental health and wellbeing support for many individuals across the globe. The initial move to remote engagement following the first United Kingdom lockdown demonstrated the importance of hybrid provisions, with isolated and vulnerable individuals finding online provisions important for wellbeing. With restrictions on movement and service access in the United Kingdom having gradually eased from March 2021, it is now important to explore how individuals navigated the ability to engage with either remote or in-person provisions. The current study aimed to explore the impact of the COVID-19 pandemic on arts and cultural engagement during periods of restrictions and initial easings on movement within the Liverpool City Region. Method: The study consisted of two waves of qualitative interviews within a broader longitudinal study. Twelve interviews were conducted during wave 1, which aimed to capture data during the initial COVID-19 lockdown period and the initial easing of restrictions. Eight of these participants were interviewed again for wave 2, which aimed to capture data during the winter 2020 lockdown period. Results: Framework analysis revealed three overarching themes: (1) The Importance of Arts and Culture for Personal Enrichment, (2) Belongingness through Socialization, and (3) Transitioning and Adjusting Throughout the COVID-19 Pandemic. Discussion: Findings presented in the current study provide further evidence of the value of arts and cultural activities in supporting wellbeing. Specifically, the current data emphasize the value of arts and cultural engagement throughout the COVID-19 pandemic and particularly during times of national restriction. Furthermore, the current study demonstrated that remote engagement provided important wellbeing support throughout the pandemic in a way that protected against mental health consequences, but with limitations on feelings of social connectedness within online environments. Amidst continuing risks from the COVID-19 virus and feelings of uncertainty, this study highlights the importance of hybrid provisions.

Strategies to enhance recruitment and consent to intensive care studies: a qualitative study with researchers and patient-public involvement contributors.

OBJECTIVE: Clinical trials and studies in intensive care units (ICUs) have complex consent processes and often encounter problems in recruiting patients. By interviewing research team members about the challenges in critical care research, we aimed to identify strategies to enhance recruitment and consent to ICU studies. METHODS: Semistructured interviews with UK-based researchers (N=17) and patient-public involvement (PPI) contributors (N=8) with experience of ICU studies. Analysis of transcripts of audio-recorded interviews drew on thematic approaches. RESULTS: Seven themes were identified. Participants emphasised the need for substitute decision-making processes in critical care studies, yet some researchers reported that research ethics committees (RECs) were reluctant to approve such processes. Researchers spoke about the potential benefits of research without prior consent (RWPC) for studies with narrow recruitment windows but believed RECs would not approve them. Participants indicated that the activity of PPI contributors was limited in critical care studies, though researchers who had involved PPI contributors more extensively were clear that their input when designing consent processes was important. Researchers and PPI contributors pointed to resource and staffing limitations as barriers to patient recruitment. Researchers varied in whether and how they used professional consultees as substitute decision-makers, in whether they approached families by telephone to discuss research and in whether they disclosed details of research participation to bereaved relatives. CONCLUSION: Critical care research could benefit from RECs having expertise in consent processes that are suited to this setting, better staffing at research sites, more extensive PPI and an evidence base on stakeholder perspectives on critical care research processes. Guidance on professional consultee processes, telephoning relatives to discuss research, RWPC and disclosure of research participation to bereaved relatives could help to harmonise practice in these areas and enhance recruitment and consent to critical care studies.

Shame and the psychosis continuum: A systematic review of the literature.

OBJECTIVES: Shame is increasingly implicated in the development and maintenance of several psychological problems including psychosis. The aim of the current paper was to review the research literature concerning the relationship between shame and the psychosis continuum, examining the nature and direction of this relationship. METHOD: Systematic searches of databases PsycINFO, Medline, Scopus, and Web of Science (from the earliest available database date until November 2016) were undertaken to identify papers that examined the relationship between shame and psychosis or psychotic experiences. RESULTS: A total of 20 eligible papers were identified. Risk of bias assessment identified methodological shortcomings across the research in relation to small, unrepresentative samples and failure to control for confounding variables. Narrative synthesis suggested positive associations between shame and paranoia (n = 10, r = .29-.62), shame and psychosis (n = 1, r = .40), and shame and affiliation with voices (n = 1, ß = .26), and suggested that shame was greater in those with psychosis compared to controls (n = 4, d = 0.76-1.16). CONCLUSIONS: Overall, several studies provide partial support for the theory that shame is an important factor in relation to psychotic experiences in both clinical and non-clinical populations, particularly paranoia. However, the predominance of cross-sectional designs prevents any conclusions being drawn concerning the temporal nature of associations. Additional research is necessary to further delineate the role of shame in relation to specific psychotic experiences such as voice-hearing. Longitudinal research is particularly needed to help establish the directionality and temporal aspects of effects. PRACTITIONER POINTS: Research indicates moderate-to-strong positive associations between shame and psychotic experiences in the existing literature. The results provide preliminary evidence that shame may play a role in relation to psychosis and, more specifically, paranoia. Findings should be interpreted with caution due to many disparities across the studies reviewed and methodological shortcomings (e.g., small sample sizes). It is not currently possible to determine causality or direction of effect due to the cross-sectional design of all existing studies.