BackgroundHealth policies internationally advocate ‘support for self‐management’, but it is not clear how the promise of the concept can be fulfilled.ObjectiveTo synthesize research into professional practitioners’ perspectives, practices and experiences to help inform a reconceptualization of support for self‐management.DesignCritical interpretive synthesis using systematic searches of literature published 2000–2014.FindingsWe summarized key insights from 164 relevant papers in an annotated bibliography. The literature illustrates striking variations in approaches to support for self‐management and interpretations of associated concepts. We focused particularly on the somewhat neglected question of the purpose of support. We suggest that this can illuminate and explain important differences between narrower and broader approaches. Narrower approaches support people to manage their condition(s) well in terms of disease control. This purpose can underpin more hierarchical practitioner–patient communication and more limited views of patient empowerment. It is often associated with experiences of failure and frustration. Broader approaches support people to manage well with their condition(s). They can keep work on disease control in perspective as attention focuses on what matters to people and how they can be supported to shape their own lives. Broader approaches are currently less evident in practice.Discussion and conclusionBroader approaches seem necessary to fulfil the promise of support for self‐management, especially for patient empowerment. A commitment to enable people to live well with long‐term conditions could provide a coherent basis for the forms and outcomes of support that policies aspire to. The implications of such a commitment need further attention.

BackgroundSmoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby.AimTo understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design.DesignEvidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout.SettingUK.ParticipantsThe qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking.Methods(1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test.ResultsOut of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A ‘ladder’ logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical ‘ladder’ towards smoking cessation and breastfeeding. Incentive interventions provide opportunity ‘rungs’ to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women’s capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave ‘healthily’ risk them feeling pressurised and failing. To avoid ‘losing face’, women may disengage.LimitationsIncluded studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population.ConclusionsIncentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is important.Study registrationThis study is registered as PROSPERO CRD42012001980.FundingThe National Institute for Health Research Health Technology Assessment programme.

This article draws on British newspaper reports in order to demonstrate that trolling, and the media's subsequent framing of trolling, involves "silencing strategies". It is important to examine how trolling is discussed within the media to understand how it might frame public opinion, debate and action, and implicitly victim blame. The article presents findings on: the forms of (online) abuse and behaviours related to trolling in media reports, including rape threats, death threats and body shaming. It also explores the media portrayal of victims of trolling, and the advice given concerning how to respond to trolls. To comply with the message to women, which is propagated in media and popular discourses: "do not feed the This is a pre-print version of the article published in Feminist Media Studies Vol.17, No.6 (December 2017).2 troll", means that "symbolic violence" is exercised with the complicity of the victim(s) of trolling, which has broader implications. IntroductionThis article focuses on the framing of trolling in British newspaper reports. Trolling is a form of gendered and "symbolic violence" (Pierre Bourdieu & Loic J. D. Wacquant 1992) as it is performed in relation to women and other minority groups on social media platforms such as Twitter, Instagram and Facebook (Lumsden and Morgan forthcoming). Media reports, public debate and academic research concerning the 'dark side' of the web have focused on the rise of online abuse including trolling (Whitney Phillips 2015), hate crime, Islamophobia (Imran Awan 2016), cyber-bulling, revenge porn, stalking, and sexting. However, the media's framing of trolling and online abuse has been largely overlooked in academic studies. Jane (2014a: 532) argues that "extravagant invective, the sexualized threats of violence, and the recreational nastiness that have come to constitute a dominant tenor of Internet discourse", should be a priority for academic analysis instead of being treated as a moral panic. She also points out that not reprinting examples of online abuse can undermine how academics understand the nature of trolling, as it is then deemed "unspeakable". It is important to examine how trolling is discussed within the media to understand how it might frame public opinion, debate and action, and implicitly victim blame via "silencing strategies". The tactics employed by trolls, including rape threats and death threats, can be viewed as examples of "silencing strategies". "Silencing strategies" attempt to remove the individual This is a pre-print version of the article published in Feminist Media Studies Vol.17, No.6 (December 2017).3 from participation in (online) public space (such as on social media sites), or dissuade them from engaging in further public debate (by responding to or challenging an offensive "tweet" on Twitter or photograph on Instagram). The media portrayal and framing of trolling can be said to reinforce these "silencing strategies". For example, as we will show, the advice given to those who are victims of online abuse -"do not feed the...

Digital self-tracking is rising, including tracking of menstrual cycles by women using fertility tracking apps (FTAs). However, little is known about users’ experiences of FTAs and their relationships with them. The aim of this study was to explore women’s uses of and relationships with FTAs. This exploratory study employed a mixed methods approach, involving the collection and analysis of an online survey and follow-up interviews. Qualitative analysis of survey and interview data informed hypothesis development. Online surveys yielded 241 responses and 11 follow-up interviews were conducted. Just over a third of women surveyed had experience of using FTAs (89/241) and follow-up interviews were conducted with a proportion of respondents (11/241). Four main motivations to use FTAs were identified: (a) to observe cycle (72%); (b) to conceive (34%); (c) to inform fertility treatment (12%); and (d) as contraception (4%). Analysis of the free-text survey questions and interviews using grounded theory methodology highlighted four themes underpinning women’s relationships with FTAs: (a) medical grounding; (b) health trackers versus non-trackers; (c) design; and (d) social and ethical aspects. Participants who used other health apps were more likely to use FTAs (p = 0.001). Respondents who used contraception were less likely to use FTAs compared with respondents who did not use contraception (p = 0.002). FTA usage also decreases (p = 0.001) as age increases. There was no association between FTA usage and menstrual status (p = 0.259). This research emphasises the differing motivations for FTA use. Future research should further explore the diverse relationships between different subgroups of women and FTAs.

Professional development and service improvement initiatives should recognise these tensions and uncertainties and support clinicians to navigate them well.

Plain english summaryIt is recommended that research studies are carried out with or by patients and the public through their involvement from the beginning and in as many stages as possible (known as PPI). Some studies formally invite patients and the public to participate in interviews and focused group discussions to collect views about topics (known as qualitative research). In our study on financial incentives for giving up smoking in pregnancy and breastfeeding, we combined both PPI and qualitative research to include the views of women with a range of experiences of smoking and breastfeeding.We involved two mother and baby groups in disadvantaged areas of North East Scotland and North West England as research partners on our team. First, we asked members to comment on our research plans and documents, which is standard PPI. Second, we asked members to participate in voice recorded discussions, contributing to qualitative research data. These discussions revealed different views from those that we heard through research interviews. They allowed us to develop more relevant research tools and resources. Members also helped us to identify people outside the groups who we could interview.Combining involvement and participation helped us to include the views of a wide range of women from ‘harder-to-reach’ groups who don’t usually take part in research. This was important because the research was intended for women who could benefit from incentives to stop smoking in pregnancy and breastfeed, often present in such groups. Positive continuing relationships and trust improved on involvement or participation alone.AbstractᅟBackgroundPatient and public involvement (PPI) in all research studies is recommended from the earliest point and in as many stages as possible. Qualitative research is also recommended in the early stages of designing complex intervention trials. Combining both together might enable inclusion of ‘harder-to-reach’ perspectives from the target population(s), particularly when the research is intended for their benefit. However, the interface between PPI and qualitative research has received little attention.In a multi-disciplinary, mixed methods study to inform the design of incentive trials for smoking cessation in pregnancy and breastfeeding, we combined PPI and qualitative research, with some overlap. Mother and baby groups from two geographically separate disadvantaged areas, with diverse experiences of the smoking and breastfeeding, but no training or previous involvement in research, were recruited as PPI research grant co-applicants. An iterative partnership approach facilitated involvement in research conduct and design across all project phases. Group PPI members were also invited to contribute to more formal qualitative data collection, as and when indicated by the research questions, and emerging analysis.ResultsWe engaged with ‘harder-to-reach’ women in mother and baby group settings, rather than in academic or home environments. These settings were relaxed and informal, which facilitat...

ObjectiveTo survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design.DesignCross-sectional survey.Setting and participantsBritish general public.MethodsSeven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models.ResultsAgreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%).ConclusionsWomen and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic groups are required prior to implementing incentive interventions.Trial registration numberCRD42012001980.

BackgroundEuroFIT is a gender-sensitised, health and lifestyle program targeting physical activity, sedentary time and dietary behaviours in men. The delivery of the program in football clubs, led by the clubs’ community coaches, is designed to both attract and engage men in lifestyle change through an interest in football or loyalty to the club they support. The EuroFIT program will be evaluated in a multicentre pragmatic randomised controlled trial (RCT), for which ~1000 overweight men, aged 30–65 years, will be recruited in 15 top professional football clubs in the Netherlands, Norway, Portugal and the UK. The process evaluation is designed to investigate how implementation within the RCT is achieved in the various football clubs and countries and the processes through which EuroFIT affects outcomes.MethodsThis mixed methods evaluation is guided by the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions. Data will be collected in the intervention arm of the EuroFIT trial through: participant questionnaires (n = 500); attendance sheets and coach logs (n = 360); observations of sessions (n = 30); coach questionnaires (n = 30); usage logs from a novel device for self-monitoring physical activity and non-sedentary behaviour (SitFIT); an app-based game to promote social support for physical activity outside program sessions (MatchFIT); interviews with coaches (n = 15); football club representatives (n = 15); and focus groups with participants (n = 30). Written standard operating procedures are used to ensure quality and consistency in data collection and analysis across the participating countries. Data will be analysed thematically within datasets and overall synthesis of findings will address the processes through which the program is implemented in various countries and clubs and through which it affects outcomes, with careful attention to the context of the football club.DiscussionThe process evaluation will provide a comprehensive account of what was necessary to implement the EuroFIT program in professional football clubs within a trial setting and how outcomes were affected by the program. This will allow us to re-appraise the program’s conceptual base, optimise the program for post-trial implementation and roll out, and offer suggestions for the development and implementation of future initiatives to promote health and wellbeing through professional sports clubs.Trial Registration ISRCTN81935608. Registered on 16 June 2015.