ObjectivesThe objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.DesignWe searched MEDLINE, all evidence-based medicine, CINAHL, Embase and PsychINFO covering the period 2009 to 2018 for electronic, mobile or telehealth interventions. Quality was assessed according to rigour and relevance. Those studies providing a richer description (‘thick’) were synthesised using a realist matrix.Setting and participantsStudies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.ResultsEighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.ConclusionsResearch incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.

The prevalence of faecal incontinence in adults living in the community is 1-10%, depending on the definition used. 1 2 Faecal incontinence is a neglected problem that receives limited medical attention, and despite its profound negative impact most patients do not tell their doctor about it. 3 4 Simple, low cost interventions will often improve or even cure symptoms. More sophisticated second line investigations and treatments are available, but referral for these is not common. This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on managing faecal incontinence in adults. 5 Recommendations NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*). General approach All staff working with people with faecal incontinence should be aware of the physical and emotional impact this condition can have on patients and their carers. Consider patients' needs and preferences when planning treatment and ensure they have the opportunity to make informed decisions in partnership.

IntroductionAdults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese.Methods and analysisA two-arm pragmatic practice-level cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40–70 years with a body mass index ≥28 kg/m2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patient-facing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme.Ethics and disseminationThe study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval.Trial Registration numberACTRN12617001508369; Pre-results.

THIS PAPER REPORTS ON an analysis of teachers' talk of play-based learning and intentional teaching of mathematics. The participants in the study were two early childhood teachers in a pre-Prep program (the year before school). Teachers' talk of how they engaged in the interplay between children's play and the use of intentional teaching practices to introduce mathematics concepts formed the data set to be analysed. Conversational interviews and stimulated recall were used to gather data. A poststructural analysis of the teachers' talk suggests that socially and culturally constructed ways of being an early childhood teacher are both enabled and constrained by discourses of play and intentional teaching.

THE EARLY CHILDHOOD SECTOR HAS in recent times engaged in processes of professionalisation. The expectations associated with engagement in professional relationships is one element of such processes. Another element is an expectation of ethical practice. The paper considers how particular representations of relationships and representations of ethics contribute to the construction of the professional identities of early childhood teachers. Discussion is presented of the ways early childhood teachers experience relationships with parents and colleagues. Possibilities of ‘new’ constructions of professionalism are explored through disruptions to taken-for-granted discursive practices which shape relationships between teachers and parents and between teachers and colleagues. To engage in such disruptions, a theoretical framework of poststructuralism is used to analyse early childhood literature, which works to construct particular identities for early childhood teachers. This analysis identifies possible challenges to a binary response of either acceptance of, or resistance to, dominant discourses at work in identity constructions. One outcome of this challenge is to argue the possibility of holding opposites together in the work of identity construction. Holding opposites together makes possible new, socially and contextually informed ways to think, speak and do constructions of these identities. Representation of ethics as a relational construct is located within these new possibilities of professional identity constructions.