Background: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual's health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. Notions of the support they might wish to receive from them. Methods: Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed. Results: Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in) visibility of participants' economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system. Conclusions: This study, the first of its kind in the UK, indicated that participants' health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

Background Postnatal care continually attracts less attention than other parts of the childbirth year. Many regions consistently report poor maternal satisfaction with care in the post-birth period. Despite policy recommending post-birth planning be part of maternity services there remains a paucity of empirical evidence and reported experience using post-birth care plans. There is a need to report on post-birth care plans, identify policy and guideline recommendations and gaps in the current empirical research, as well as experiences creating and using post-birth care plans. Methods This scoping review accessed empirical literature and government and professional documents from 2005 to present day to build a picture of current understanding of policy imperatives and existent published empirical evidence. The review was informed by the Arksey and O’Malley approach employing five stages. Results The review revealed that post-birth care planning is promoted extensively in health policy and there is emergent evidence for its implementation. Yet there is a paucity of practice examples and only one evaluation in the UK. The review identified four overarching themes: ‘Positioning of post-birth care planning in policy; ‘Content and approach’; ‘Personalised care and relational continuity’; Feasibility and acceptability in practice’. Conclusions Empirical evidence supports post-birth care planning, but evidence is limited leaving many unanswered questions. Health care policy reflects evidence and recommends implementation of post-birth care plans, however, there remains a paucity of information in relation to post-birth care planning experience and implementation in practice. Women need consistent information and advice and value personalised care. Models of care that facilitate these needs are focused on relational continuity and lead to greater satisfaction. It remains unclear if a combination of post-birth care planning and continuity of carer interventions would improve post-birth outcomes and satisfaction. Gaps in research knowledge and practice experience are identified and implications for practice and further research suggested.

A journey of self-discovery and transformation: a theoretical and comprehensive evaluation of the Queen's Nursing Institute Scotland community development programme.

Background As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them. Methods Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.Results Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.Conclusions This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

cognitive scores (coefficient, 12 months vs never breastfed: 0.34; 95%CI: 0.25 to 0.44). Adjustment for SEP approximately halved the effect sizes and further adjustment for maternal cognitive scores removed the remaining association (coefficient: 0.06; 95%CI: -0.03 to 0.14). Findings were similar for ages 7 and 11 but not for age 14, in which the score of those who breastfed for 12 months remained 0.20 s.d. (95%CI: 0.08 to 0.31) higher than the score of those never breastfed, after full adjustment. The crude results for spatial scores at age 5 showed that participants breastfed for 12 months scored 0.21 s.d. (95%CI: 0.12 to 0.31) higher than those never breastfed. After full adjustment, the differences vanished (coefficient: -0.03; 95%CI: -0.12 to 0.07). However, those participants breastfed for 4 and <6 months scored 0.10 s. d. (95%CI: 0.02 to 0.18) higher than those never breastfed, after full adjustment. Results were similar for ages 7 and 11. Exclusive breastfeeding showed similar patterns. However, even after full adjustment, a duration of 4 months was associated with improved verbal scores at age 14 (coefficient: 0.11; 95%CI: 0.02 to 0.20) and spatial scores at age 7 (coefficient: 0.09; 95%CI: 0.01 to 0.17) and 11 (coefficient: 0.09; 95%CI: 0.01 to 0.18). ConclusionThe positive associations between any breastfeeding duration and cognitive development were explained in full after adjusting for SEP and maternal cognitive scores, except at age 14 (verbal). Exclusive breastfeeding duration seemed to be associated with improved cognitive verbal scores at age 14 and spatial scores at ages 7 and 11 after full adjustment, although with modest effect sizes.