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Background Mental health services aim to provide recovery-focused care and facilitate coproduced care planning. In practice, mental health providers can find supporting individualized coproduced care with service users difficult while balancing administrative and performance demands. To help meet this aim and using principles of coproduction, an innovative mobile digital care pathway tool (CPT) was developed to be used on a tablet computer and piloted in the West of England. Objective The aim of this study was to examine mental health care providers’ views of and experiences with the CPT during the pilot implementation phase and identify factors influencing its implementation. Methods A total of 20 in-depth telephone interviews were conducted with providers participating in the pilot and managers in the host organization. Interviews were audio recorded, transcribed, anonymized, and thematically analyzed guided by the Consolidated Framework for Implementation Research. Results The tool was thought to facilitate coproduced recovery-focused care planning, a policy and organizational as well as professional priority. Internet connectivity issues, system interoperability, and access to service users’ health records affected use of the tool during mobile working. The organization’s resources, such as information technology (IT) infrastructure and staff time and IT culture, influenced implementation. Participants’ levels of use of the tool were dependent on knowledge of the tool and self-efficacy; perceived service-user needs and characteristics; and perceptions of impact on the therapeutic relationship. Training and preparation time influenced participants’ confidence in using the tool. Conclusions Findings highlight the importance of congruence between staff, organization, and external policy priorities and digital technologies in aiding intervention engagement, and the need for ongoing training and support of those intended to use the technology during and after the end of implementation interventions.

PurposeThis paper aims to discuss factors affecting temporary migrants' ability to access and make effective use of public and private healthcare services in the Republic of Cyprus (hereafter referred to as Cyprus). These factors are raised in the context of a larger study focusing on the healthcare needs of temporary migrants from non‐EU countries living and working in Cyprus.Design/methodology/approachSemi‐structured interviews with 13 domestic workers and 17 students from Sri Lanka, Pakistan, Bangladesh, India and the Philippines explored migrants' experiences with accessing and utilizing healthcare services in Cyprus. The theoretical framework utilized is grounded in the health capability approach which focuses on individuals' confidence and ability to be effective in achieving optimal health.FindingsThe study highlights issues concerning the accessibility and acceptability of healthcare services which emerge as the result of both the organisation and delivery of healthcare services and social, political and economic structures.Research limitations/implicationsThe implications of this study are relevant in the current debate taking place at the EU level about the opportunities and challenges of temporary migration. Specifically, it is argued that governments and societies should promote individual freedoms and opportunities that empower people to lead the lives they want to live.Originality/valueTemporary migrants form a group whose experiences and needs have not been as extensively investigated as those of other migrant groups, particularly in Cyprus. The capability approach allows for assessing both policy and health systems taking into consideration equity and the impact of multi‐sectoral influences on health.

Purpose – Drawing findings from a large mixed-method study on perceptions of dignity, care expectations, and support in relation to older women from Black and minority-ethnic backgrounds, the purpose of this paper is to explore the interrelationships between life course events and the multiple roles adopted by women at different points in time that have shaped their perceptions of care and their care expectations in old age. Design/methodology/approach – In total, 32 semi-structured interviews were undertaken, allowing for the collection of data on the participants’ understanding of growing old, and the meaning and attributes of care and what care with dignity “looked and felt like”. The theoretical framework is guided by a life-course approach and grounded within an intersectionality perspective. The majority of the participants were migrants. Findings – Social markers such as ethnicity and cultural identity were found to influence the participants’ understanding and expectations of care with factors such as gender identity and integration in the local community also of importance. How women felt they were perceived and “recognised” by others in their everyday lives with particular focus at the time of old age with the increased potential of loss of dignity due to declining capabilities, raised the importance of the family involvement in care provision, and perceived differences in the attributes of paid and non-paid care. The notion of “care from the heart” emerged as a key attribute of care with dignity. Care with dignity was understood as a purposeful activity, undertaken with intent to show respect and to acknowledge the participants’ sense of worth and value. Practical implications – The implications of this study are relevant in the current debate taking place at the EU level about the lived experiences of ageing migrant groups and care expectations. Originality/value – The study highlights the importance of the social nature of dignity, how wider societal structures can impact and shape how care is understood for older women of migrant and minoritised backgrounds, and the need to explore migration and care across the life course.

Health literacy has gained popularity as a useful concept to promote and protect health. Even though health literacy research has been prolific it has also been fragmented, facing challenges in achieving its empowerment and social justice-related aims. Crucial limitations make the application of its principles to the health of vulnerable and underrepresented groups problematic, even though these groups are disproportionately affected by ill health. Efforts to refine and make the concept more relevant have tended to expand health literacy models and situate health literacy ‘in context’ to reflect environmental and social factors shaping health literacy. Context-related factors however, have not been consistently embedded in operationalisation and measurement efforts. This paper argues for health literacy to be re-conceptualised through a capabilities approach lens. It proposes that the capabilities approach can uniquely address the conceptual and methodological criticisms applied to health literacy, whilst encompassing its critical conceptual understandings of health. The advantage of this approach over and above other developments in health literacy theory and practice is its focus on both people’s opportunities or freedoms to achieve desired health-related aims, and their ability to do so. It enables shifting the focus away from health literacy as individual skills and competencies and towards the enabling or inhibiting factors shaping health literacy. A participatory approach is seen as essential for realising this conceptual shift.

Introduction‘Real world’ bleeding in patients exposed to different regimens of dual antiplatelet therapy (DAPT) and triple therapy (TT, DAPT plus an anticoagulant) have a clinical and economic impact but have not been previously quantified.Methods and analysisWe will use linked Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) data to assemble populations eligible for three ‘target trials’ in patient groups: percutaneous coronary intervention (PCI); coronary artery bypass grafting (CABG); conservatively managed (medication only) acute coronary syndrome (ACS). Patients ≥18 years old will be eligible if, in CPRD records, they have: ≥1 year of data before the index event; no prescription for DAPT or anticoagulants in the preceding 3 months; a prescription for aspirin or DAPT within 2 months after discharge from the index event. The primary outcome will be any bleeding event (CPRD or HES) up to 12 months after the index event. We will estimate adjusted HR for time to first bleeding event comparing: aspirin and clopidogrel (reference) versus aspirin and prasugrel or aspirin and ticagrelor after PCI; and aspirin (reference) versus aspirin and clopidogrel after CABG and ACS. We will describe rates of bleeding in patients prescribed TT (DAPT plus an anticoagulant). Potential confounders will be identified systematically using literature review, semistructured interviews with clinicians and a short survey of clinicians. We will conduct sensitivity analyses addressing the robustness of results to the study’s main limitation—that we will not be able to identify the intervention group for patients whose bleeding event occurs before a DAPT prescription in CPRD.Ethics and disseminationThis protocol was approved by the Independent Scientific Advisory Committee for the UK Medicines and Healthcare Products Regulatory Agency Database Research (protocol 16_126R) and the South West Cornwall and Plymouth Research Ethics Committee (17/SW/0092). The findings will be presented in peer-reviewed journals, lay summaries and briefing papers to commissioners/other stakeholders.Trial registration number76607611; Pre-results.

Women from marginalized groups working in occupations such as domestic work are at increased risk for sexual violence. Scarce evidence exists about training interventions targeting such groups. The article aims to identify community and workplace-based training interventions aiming to increase capacity among marginalized at-risk women to deal with sexual violence. A systematic review was applied. Inclusion criteria were English language published between 2003 and 2013; reporting on delivery and/or evaluation; focusing on any form of sexual violence; delivered to professionals, affected or at-risk women; targeting migrant, at-risk women or domestic workers. Data were extracted on the setting, content, evaluation process and target population. Four studies which focused on prevention or responding to sexual violence were included. One study provided sexual violence training to vulnerable female and one provided a HIV prevention intervention to marginalized women. Learning objectives included increasing knowledge around issues of sexual violence and/or gender and human rights, prevention and response strategies. Two studies aimed to train trainers. All studies conducted an outcome evaluation and two a process evaluation. It seems there is a gap on participatory empowerment training for marginalized women. Community train-the-trainer interventions are imperative to protect themselves and deal with the risk of sexual violence.

Purpose – Research evidence indicates the need for studies that explore the salience of dignity from the perspective of older people from a range of ethno-linguistic and cultural backgrounds. Drawing findings from a mixed-methods study on social-care expectations of community-dwelling older women from black and minority-ethnic backgrounds, the purpose of this paper is to explore the interrelationships between life-course events (such as migration) and the roles adopted by the women throughout their lives, which shaped their understanding of dignity. Design/methodology/approach – Face-to-face, semi-structured interviews with 32 older women in Wales were conducted in the participants’ first languages. The interview schedule was developed, piloted and peer-reviewed; it covered the themes of migration, perceptions of dignity, dignity in later life, perceptions of care and care with dignity. Transcripts were analysed using thematic analysis. This paper focuses on what dignity meant to older women and how a sense of dignity was fostered in later life. Findings – For the participants, a sense of dignity in later life was shaped by migration to the UK, and their shifting, transnational understanding of growing old in the UK and of the perceived worth and value of the roles they played. Although some women also saw other platforms (such as work and their status as professionals) as being of importance, a sense of purpose fostered in their roles as wives, mothers and grandmothers, and as mentors and guardians of cultural knowledge, underpinned their understanding of dignity, and reinforced their sense of acknowledgement and worth. Fostered from an early age through interactions with the family and close community (religious, cultural or ethnic), respect for older people was revealed to remain a key element of the participants’ personal and cultural value systems, as were the ways in which respect should be both earned and manifested. The sense of heightened vulnerability, because of advancing age, and the impact of cumulative negative encounters and racialised micro-aggressions, were real and pressing. Practical implications – Given the changing demographic of the older population throughout Europe and the world, there is a need to raise awareness among policy makers and practitioners of the importance of dignity from a range of perspectives – providing first-hand accounts that bring these to life, and data that can be used to help develop effective interventions. Originality/value – This paper adds to the understanding of dignity from a transnational, multi-ethnic perspective; the potential impact of multiple social positions (being old, being a woman, being a migrant and being from a minority-ethnic group) on the perception of being treated and regarded as important and valuable; and the need to raise awareness among policy makers and practitioners of the importance of dignity from a range of perspectives, providing first-hand accounts that bring these to life and that can be used to help develop effective social-care interventions.