This study seeks to extend the variety of written methods used in sport and exercise research by outlining the use of a novel written technique for data collection: 'a letter to my younger self'. The use of solicited letter writing has long been endorsed as a valuable technique as part of the therapeutic process, but has yet to be considered as a method of collecting qualitative data. In this study, 21 participants who had experienced chronic pain while playing sport were invited to write a letter back to their younger self. A dialogical narrative analysis was used to analyse the written letters and our results are presented in two forms. First, a 'collective letter', written using amalgamated participant quotations. Second, an accompanying commentary which illustrates the characterisations, structure, and narrative themes that were evident in the data collected. Our findings extend existing knowledge of chronic pain in sport, contrasting previous literature that has presented degenerative stories. Further, we also illuminate the danger of the performance narrative in privileging personal agency and the risks this poses to receiving support during chronic pain. We conclude by challenging researchers to consider the importance that should be attributed to hindsight and the value of re-describing experiences with wisdom and knowledge of the significance of the past.

ObjectivesThe objectives of this systematic review are to identify studies that assess the effectiveness of patient-directed financial incentive interventions to improve asthma management behaviours, determine overall effectiveness of financial incentives, identify design characteristics of effective interventions and assess the impact on longer-term outcomes in the context of asthma.DesignSystematic review with narrative synthesis.Data sourcesElectronic databases (MEDLINE, Embase, Global Health, PsycINFO, CINAHL, PubMed and Web of Science) and grey literature sources (NHS Digital, CORE, ProQuest, Clinical Trials Register and EU Clinical Trials Register) were searched in November 2021 and updated March 2023.Eligiblity criteriaEligible articles assessed financial incentives to improve asthma management behaviours (attendance at appointments, medication adherence, tobacco smoke/allergen exposure, inhaler technique and asthma education) for patients with asthma or parents/guardians of children with asthma. Eligible study design included randomised controlled, controlled or quasi-randomised trials and retrospective/prospective cohort, case-controlled or pilot/feasibility studies.SynthesisA narrative synthesis was conducted; eligible studies were grouped by asthma management behaviours and financial incentive framework domains.ResultsWe identified 4268 articles; 8 met the inclusion criteria. The studies were from the USA (n=7) and the UK (n=1). Asthma management behaviours included attendance at appointments (n=4), reduction in smoke exposure (n=1) and medication adherence (n=3). Five studies demonstrated positive behaviour change, four of which were significant (attendance at appointments (n=3) showed significant differences between intervention and control: 73% and 49% in one study, 46.3% and 28.9% in another, and 35.7% and 18.9%, respectively; medication adherence (n=1) showed significant change from 80% during intervention to 33% post intervention). These four significant studies used ‘positive gain’, ‘certain’, ‘fixed’ financial incentives of smaller magnitude, given for ‘all’ instances of behaviour.ConclusionThere is some evidence that patient-directed financial incentives improve asthma management behaviours. However, in view of the wide heterogeneity in study design and measured outcomes, determining overall effectiveness was challenging.PROSPERO registration numberCRD42021266679.

Objective Explore perspectives from healthcare workers in a large public hospital (11,000 staff) on employers supporting their health and well-being. Methods Heads of departments/services were invited to convene focus groups, facilitated by a moderator using a semi-structured discussion guide.  Results Over 450 members of staff participated in 28 focus groups. Themes identified were: 1)unique nature of working in a large hospital, 2)hospital management agenda and relationship with staff, 3)working environment, and 4)staff health and well-being initiatives. Conclusions Optimal uptake of health-promoting initiatives was hindered in part due to lack of staff awareness and a range of barriers. Key requirements for improving staff health were perceived to be sufficient staffing, time and space to work safely and comfortably. Engaging with staff to hear their views, build trust and identify their needs is an essential first step.

Background: The health and wellbeing of healthcare workers influences absenteeism, presenteeism and ultimately patient care and outcomes. In 2016 NHS England funded six pilot sites to launch the ‘NHS Healthy Workforce Project’, a programme of services and support for NHS staff to support their health and wellbeing. This paper explores the perspectives of healthcare workers in a large public hospital (11,000 staff) on employers supporting their health and wellbeing, and the initiatives being trialled. Methods: Heads of departments/services were invited to convene focus groups, which were facilitated by a moderator using a semi-structured discussion guide. An observer took notes and circulated sign-in sheets to capture approximate numbers of attendees. The discussions were audio-recorded, transcribed verbatim and analysed thematically.Results: Approximately 450 members of staff participated in 28 focus groups. Themes identified were: 1) unique nature of working in a large hospital, 2) hospital management agenda and relationship with staff, 3) working environment, and 4) staff health and wellbeing initiatives. Optimal uptake of health-promoting initiatives was hindered in part due to lack of staff awareness and a range of barriers, such as lack of time, limited breaks, putting patients first, not trusting employers’ motivations, issues of confidentiality, and inadequate facilities. Key requirements for improving staff health were perceived to be sufficient staffing, time and space to work safely and comfortably. Conclusions: Rather than investing in a range of initiatives devised by the organisation (a top down approach), an essential first step might be to engage with staff to hear their views, build trust and identify their needs (a bottom up approach). Looking after NHS staff health has become even more of a priority during the COVID-19 pandemic. As staff needs change, as they have done during the pandemic, it is important to continue engaging with them to understand how best to support them to look after their health and stay safe. Increased pressure on NHS staff is likely to have decreased the time they have to look after their own health and wellbeing, making it even more important that managers engage with and listen to their staff’s views.