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Understanding and addressing mental health needs and non-communicable disease in situations of fragility: RUHF research programme synopsis
No full textAlastair Ager - ORCID: https://orcid.org/0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563Sophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Karin Diaconu - ORCID: 0000-0002-5810-9725 https://orcid.org/0000-0002-5810-9725Item restricted until publication.Background: Fragile settings – marked by conflict and political, environmental, social, or economic crisis – present severe challenges to population health and the delivery of services. This is particularly the case for health conditions that require continuity of care such as non-communicable disease and mental ill-health. Objectives: To understand existing patterns of health seeking in relation to noncommunicable disease and mental health and the barriers to equitable access to quality provision. To then evaluate the feasibility, effectiveness and quality of interventions designed to address these conditions in contexts of fragility. Design and methods: Building on a foundation of focused scoping reviews, we used participatory methods – including group model building – to map pathways of access to community and health system resources in relation to non-communicable diseases and mental health. We then used a range of surveys and key informant interviews to evaluate implemented interventions. In addition, we undertook a series of global reviews of relevant topics, such as conceptualisation of fragility, the role of trust in health-seeking for noncommunicable disease care in fragile settings, analysis of policy and funding priorities of global actors regarding non-communicable diseases in low- and middle-income countries, and the political economy of NCD policy adoption and implementation at national level. Setting and participants: Field studies were focused at the district or governorate level in a range of fragile settings, including Lebanon, Sierra Leone, El Salvador and, latterly, Nigeria and Gaza. Participants included service users, (formal and informal) health providers and policy makers. Interventions: Interventions addressing NCDs included treatment protocols for hypertension and diabetes (with report cards and desk guides supporting primary care-based disease management) and a local co-created salt reduction programme (featuring community drama, school outreach and radio messaging). Mental health needs were primarily addressed in relation to the provision of community-based psychosocial support either through specific interventions (including a lay-woman-led problem solving intervention for perinatal women) or the development of assessment tools (such as a Participatory Assessment Tool for Mapping Social Connections) and contextually valid screening measures (including the Sierra Leone Psychological Distress Scale and the Sierra Leone Perinatal Psychological Distress Scale) to inform interventions. The programme also developed relevant training interventions. Main outcome measures: Measures focused on access to, and utilisation and quality of, services, including user perceptions of provision. Results: We identified a range of barriers to effective health provision in fragile settings. These reflected the cultural, political, social, economic particularities of the setting and its health system. However, trust (in specific health providers, within social and community networks, and in government) was consistently found to be a key factor in securing targeted outcomes. The skills, methods and confidence of providers was also found to be an important influence on such outcomes. Providing contextually relevant training, mentorship and tools equipped health providers in primary care settings to maintain effective, evidencebased management of diabetes and hypertension despite the ongoing challenges of their fragile context. Mobilisation of community-level resources to address non-communicable disease and mental health needs was demonstrated as relevant, feasible and potentially effective in all settings. Limitations: There was great diversity across the particular settings studied, as well as ongoing gaps in knowledge in relation to these conditions in particular. Caution should be shown in generalisation of specific findings to other situations that may not share important features. The COVID 19 pandemic disrupted data collection in both Sierra Leone and Lebanon, although the targeted power of studies was generally secured. More generally, the pandemic significantly impacted health systems operations in all settings studied, an influence that is discussed in all relevant papers. Conclusions: The research programme contributed to addressing gaps in the literature regarding effective tools and strategies to strengthen provision regarding mental health and non-communicable disease in fragile settings. Assessment of needs and barriers to accessing services is an important foundation for effective working in such contexts. This is achievable with research methods (such as group model building and remote data capture) that can accommodate the diverse challenges and uncertainty associated with these settings. Incorporating such information in service design – at the level of the community, health facility or policymaker – can secure improvement in access to, and quality of, important services. Donors and policy makers need to attend not just to the drivers of fragility but also to coherent investment in public health systems and in processes of community engagement if health needs are to be meaningfully addressed. Future work: The conceptualisation of fragility (and resilience) developed through this programme is informing the design of community, health system and wider cross-sectoral interventions in fragile contexts through the ReBuild for Resilience programme in settings including Sierra Leone, Lebanon, Myanmar and Nepal. Further work across diverse contexts of fragility is required to both identify common features and principles required for health response in these settings and refine strategies and tools that can readily be adapted to the unique characteristics of any particular context.This research was funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme (16/136/100) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government.inpressinpres
Beyond Diagnosis: Setting Research Priorities with the Neurodivergent Community
Full text linkRachael Davis - ORCID: 0000-0002-3887-6003
https://orcid.org/0000-0002-3887-6003Neurodiversity research remains heavily shaped by diagnostic categories, which increasingly appear inadequate for capturing the complex, lived realities of neurodivergent people. These categorical labels often obscure the social and structural barriers that shape daily experiences and limit the utility of research for designing inclusive services. Responding to this gap, our study sought to establish community-led research priorities that transcend diagnostic boundaries. Employing a rigorous, three-stage process—comprising participatory research, a large-scale survey, and a stakeholder workshop—we engaged neurodivergent individuals with diverse diagnostic and self-identified experiences throughout. The resulting top ten priorities expose embedded systemic barriers across mental health, education, social care, welfare, and neurodevelopmental services. Crucially, they also highlight forms of marginalisation that cut across diagnostic lines, including intersectional stigma, institutional discrimination, and exclusionary service models. Our study makes two key contributions: first, it foregrounds research priorities generated by neurodivergent communities themselves; second, it proposes an urgently needed shift in research practice—towards models that centre lived experience, challenge categorical norms, and attend to the structural dimensions of exclusion. By disrupting the diagnostic status quo, this project offers a more inclusive and socially grounded agenda for neurodiversity research.inpressinpres
LIVING AND COPING WITH HIV-RELATED UNCERTAINTIES: A CRITICAL REALIST APPROACH
Full text linkBackground: This research explores the lived experiences of individuals with HIV, focusing on uncertainty and coping through the lens of Critical Realism (CR). While uncertainty and coping have been studied in the HIV field, they have not been examined using a CR approach. Approach and methods: Seventeen participants were interviewed using a semi-structured approach. Field notes and analytic memos supported the data, which were transcribed verbatim and coded using NVivo 12 software. Data analysis followed three CR-consistent stages: identification of demi-regularities (stage 1), abduction or theoretical redescription (stage 2), and retroduction (stage 3). Findings: Four demi-regularities emerged in the first data analysis stage, reflecting the empirical and actual levels of CR reality: social networks, personal identity, understanding uncertainty and coping, and HIV infection-related demiregularity. These were analysed and conceptualised using pertinent theories, setting the stage for retroduction. Retroduction identified two dual generative mechanisms: self-acceptance or self-rejection and societal acceptance or societal rejection. Conclusions and implications: This research demonstrates how selfacceptance or self-rejection and societal acceptance or societal rejection influence uncertainty and coping in the context of HIV. From a CR perspective, social structures shape human agency. Health and social care practitioners, as part of these structures, play a crucial role in influencing uncertainty and coping. Encouraging individuals with HIV to embrace change can facilitate selfacceptance, thereby enhancing coping and reducing uncertainty
The Careful Turn: The problem with care within socially engaged art
No full textItem is restricted in this repository.Anthony Schrag - ORCID: 0000-0001-8660-7572 https://orcid.org/0000-0001-8660-7572The concept of an ‘ethics of care’ is a gaining in attention within the cultural sector, both in regard to how participants and communities are approached, but also in how organisations might ‘care’ for their artists. Drawing from Belfiore's seminal 2022 article “Who cares? At what price? The hidden costs of socially engaged arts labour and the moral failure of cultural policy,” this text reflects on this question of ‘care’ as an infrastructural concern, relating to the formalisation of management structures, and the ethical considerations this would engender. The text follows the development of this ‘ethics of care’ through its nascent phases within the domain of nursing, and delineates the authors understanding of ethics and morals. He then moves on to complicate notions of care by invoking Ranciere's text The Ethical Turn and Bishop and Mouffe's notions of dissensus, and how this complicates both the role and function of ‘art’ but also the pragmatic concerns of management (of both artists and socially engaged art projects). This chapter ends with an example from the author's own artistic practice and calls for reflection on how relational and human processes such as ‘care’ can structurally fit within bureaucratic infrastructures of management.pubpu
Contextualizing Theory Use and Development in Occupational Therapy
No full textItem is not available in this repository.Sarah Kantartzis - ORCID: 0000-0001-5191-015X https://orcid.org/0000-0001-5191-015Xn 2025, occupational therapy sits at a crossroads, an era of reckoning and reframing that the profession must face to survive and thrive. While we further ponder the future of theory in the profession in Chapter 57, it is clear we must revisit the critical role of theories, models, and frameworks in the possibility of occupational therapy addressing the contemporary occupational needs of people and populations across the globe. New paradigms are needed, informed by common values and human rights but responsive to local needs. The next revolution in occupational therapy is around the corner, and theories will need to provide the roadmap for the disruption and reconstitution of the profession as we know it today. Our hope is that this book offers readers both contemporary perspectives of established theories, but more importantly, introduces them to some of the theories, models, and concepts likely informing the next occupational therapy paradigm.https://doi.org/10.4324/9781003526766pubpu
Out of Reach: Social Connections and Their Role in Influencing Engagement Between Forcibly Displaced People and Police Scotland
No full textThe data that support the findings of this study are not publicly available. This was not agreed upon with participants at the outset of the study, and given that the research took place in 2 small cities in Scotland—a relatively small context—and was conducted in collaboration with a partner organisation, there is a risk that individuals could be recognisable even in pseudonymised form.Nicole Vidal - ORCID: 0000-0001-6159-2757 https://orcid.org/0000-0001-6159-2757Forcibly displaced people in Scotland face multiple barriers in accessing health, social care, and policing services. This paper explores how social connections shape engagement with these services, particularly the role of police in community safety and wellbeing. Drawing on qualitative interviews and social connections mapping workshops, this study examines how third-sector organisations act as key intermediaries, shaping how people access statutory services. The findings show that while community policing and partnerships with trusted organisations can improve accessibility, concerns about racial discrimination, the underreporting of hate crime, and the lack of language support continue to undermine confidence in policing. Additionally, the growing reliance on police officers to respond to mental health crises reflects wider gaps in specialist service provision. This paper argues for a shift towards a cross-sector approach that strengthens community-led safety strategies, reduces police involvement in non-criminal matters, and improves language and cultural competency within public services. Strengthening institutional accessibility and trust-building initiatives is key to improving engagement with policing and health and social care services for forcibly displaced communities.This research was funded by the Scottish Institute for Policing Research, grant number [SHC21-14].https://doi.org/10.3390/socsci1405030614pubpub
Palliative Care and Pain Management in a Resource-Limited Setting
No full textItem is not available in this repository.Palliative care is a vital component of healthcare that aims to alleviate the suffering of patients with life-threatening conditions. This specialized medical care focuses on managing symptoms, addressing social, emotional, and physical needs, and enhancing the quality of life for patients and their families. Palliative care addresses the patient’s medical, psychological, and spiritual requirements, and can be used as the primary focus of care or in conjunction with curative therapies. Pain management is a crucial aspect of palliative care, involving the control or reduction of pain through medication, therapy, and other treatments. However, pain is a subjective sensation, making quantification and effective relief challenging. This review highlights the complex issues associated with pain management in palliative care, emphasizing the need for improved training and accessible pain management techniques, such as the widely recognized “Wong-Baker Face Pain Scale”, particularly in resource-constrained environments like Nepal. The complex nature of pain management in palliative care compromises patients’ quality of life, influenced by factors like chemotherapy and terminal illness. Addressing this issue is imperative, especially in areas like Nepal where there is a shortage of appropriate training among medical personnel. Encouragingly, initiatives like mobile health teams, smartphone apps, and the establishment of a Palliative Care Training Center demonstrate progress in improving end-of-life care.http://www.kumj.com.np/issue/89/113-118.pdf23pubpub
Postdigital Practice Research: Dance Plague with Flanker Origami
Full text linkBianca Mastrominico - ORCID: 0000-0002-6827-7247
https://orcid.org/0000-0002-6827-7247John Dean - ORCID: 0009-0007-8129-4010
https://orcid.org/0009-0007-8129-4010Dance Plague with Flanker Origami by Organic Theatre is based on the digitally born characters of Flanker and Origami who are trapped in a world of digital performance. According to Phil Smith they are ‘an ontological performance of characters in the face of existential threat, attempting to exist in fiction, emerging from a crisis of liveness in the backwash of a global epidemic’. (Phil Smith 2023)
• Performed by myself as Flanker and by John Dean as Origami, the characters originally appeared at the first hybrid edition of the Edinburgh Festival Fringe in 2021, then toured festivals in Europe and Asia digitally, performing in hybrid modality in a pop-up shop in Edinburgh, and in the iterations of Dance Plague in the backstages of UK theatres and cultural organisations.
• Structurally, Dance Plague with Flanker Origami is a relentless, ritualistic, dopamine-dressed promenade, reminiscent of European carnival processions, and of the Cornish Helston Dance. It is a social event but not ‘in the usual modern sense, more like the Obby Oss or the Mari Llwd, the social meaning or purpose of which have been forgotten – or were never relevant – and yet which retain a tremendous drive to be done.’ (Phil Smith 2024).Queen Margaret Universityhttps://upstage.org.nz/?event=and-no
GPs’ experience of embedded Musculoskeletal Advanced Practice Physiotherapists in Primary Care: A cross-sectional survey with content analysis
No full textItem is not available in this repository.Background:
General Practices across Scotland have expanded their multi-disciplinary teams (MDTs) to include non-medical allied health professionals (NMAHPs) as part of the 2018 General Medical Services Contract (GMS), including musculoskeletal (MSK) Advanced Practice Physiotherapists (APPs). MDT expansion was hoped to reduce General Practitioner (GP) workloads and release their time to care for patients with complex needs. Published research concerning GPs’ experiences of these roles is conflicting on whether they perceive this to be the case.
Aim:
To understand GPs’ experience of MSK APPs since their integration within MDTs.
Design and setting:
Observational study of N = 22 GPs’ from a single health and social care partnership (HSCP) within an NHS Scotland Health Board.
Method:
Cross-sectional survey study with conceptual analysis of open free-text responses.
Results:
The majority of GPs’ agreed that MSK APPs: impacted positively on their management of clinical caseloads and diagnostic uncertainty; improved quality of care and system flow for patients with MSK conditions; had been embedded successfully with adequate implementation support, and their role was clear.
Conclusion:
Findings support the argument that APPs are contributing to the achievement of GMS contract aims. Further research is required to increase the pool of available studies from which evidence-based recommendations can be made to health boards. Consistency in the design and wording of future surveys would improve the level of inference that can be drawn on GPs’ experiences of MSK APP services.https://doi.org/10.1016/j.msksp.2025.10328576pubpu
Addressing the needs of women and girls on the move: Toward an inclusive, intersectional and culturally sensitive approach
Full text linkThis briefing outlines the intersecting and complex needs of women and girls (hereafter referred to as women) on the move, aiming to support humanitarian efforts in developing inclusive, intersectional and culturally sensitive approaches to help improve their health and well-being. The document is based on a synthesis of evidence from various displacement settings and is intended for humanitarian and development practitioners, advocates and policymakers from a range of international and local organisations. The objectives of this briefing are: • To inform diverse humanitarian actors about displaced women’s intersecting and complex needs at different stages of forced migration • To inform the development of more inclusive humanitarian policy and programmes, encouraging more support for women on the move Displaced women’s needs vary based on their socio-economic and cultural backgrounds, but some specific gendered dimensions of needs relate to displaced populations in general across forced migrant routes. Vulnerability to harm and exclusion is based on factors such as gender, age, disability and other diversity factors. An intersectional lens recognises the diversity of experiences and identities which shape women’s needs and their vulnerability to discrimination in displacement that is determined by various social identity markers and power structures.1,2 To make aid work for women, it is essential to adequately adapt interventions across different stages of forced migration, based on the needs of diverse groups of women, in a culturally sensitive and inclusive manner. It is also important to provide specialist support to survivors of torture and sexual and gender-based violence, unaccompanied minors and other groups requiring assistance (for example, older women, women with disabilities and women from minority backgrounds).https://makingaidwork.org/maw-news/addressing-the-needs-of-women-and-girls-on-the-move-toward-an-inclusive-intersectional-and-culturally-sensitive-approach/pubpu
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