‘Tell me a story’: Understanding African-Australian concepts of health, wellbeing and community

Objective: analyze the differences in the perception of health and well-being between university students with high and low Cardiovascular Health Index (CHI) to identify those modulators that determine their adherence to healthy habits. Methods: We conducted a qualitative study with twenty-four students at the Medical School of the Faculty of Medicine of the UNAM, selected through purposive sampling and using the in-depth interview technique as a methodological tool. We structured the information in such a way as to facilitate addressing the differences in the perception of health and well-being based on the CHI to generate a model that would allow visualization of the interdependence between modulators of adherence to healthy behaviors. Results: We determined differential patterns in the perception of well-being and health between both groups, identifying the dimensions that influence the cardiovascular health status of the participants, with family support being the principal modulator of cardiovascular health in the analyzed sample. Conclusion: The analysis of narratives on the perception of health and well-being among students with high and low chi revealed that individual habits influenced by family, emotional, and academic modulators determined cardiovascular health.

Report of themes from community consultations on a pilot Race Equality Framework for health and care research organisations

Background: Reflexive thematic analysis is widely used in qualitative research published in Palliative Medicine, and in the broader field of health research. However, this approach is often not used well. Common problems in published reflexive thematic analysis in general include assuming thematic analysis is a singular approach, rather than a family of methods, confusing themes and topics, and treating and reporting reflexive thematic analysis as if it is atheoretical. Purpose: We reviewed 20 papers published in Palliative Medicine between 2014 and 2022 that cited Braun and Clarke, identified using the search term ‘thematic analysis’ and the default ‘relevance’ setting on the journal webpage. The aim of the review was to identify common problems and instances of good practice. Problems centred around a lack of methodological coherence, and a lack of reflexive openness, clarity and detail in reporting. We considered contributors to these common problems, including the use of reporting checklists that are not coherent with the values of reflexive thematic analysis. To support qualitative researchers in producing coherent and reflexively open reports of reflexive thematic analysis we have developed the Reflexive Thematic Analysis Reporting Guidelines (the RTARG; in Supplemental Materials) informed by this review, other reviews we have done and our values and experience as qualitative researchers. The RTARG is also intended for use by peer reviewers to encourage methodologically coherent reviewing. Key learning points: Methodological incoherence and a lack of transparency are common problems in reflexive thematic analysis research published in Palliative Medicine. Coherence can be facilitated by researchers and reviewers striving to be knowing – thoughtful, deliberative, reflexive and theoretically aware – practitioners and appraisers of reflexive thematic analysis and developing an understanding of the diversity within the thematic analysis family of methods.

The purpose of this study was to establish the role played by subjective perceptions of physical health in the relationship between psychological well-being and two social contexts that are stratified by socio-economic differentials pertaining to race, socio-economic indices and infrastructural resources. An availability sample of 514 participants from Potchefstroom ( n = 384) and Mafikeng ( n = 130), North West Province, completed questionnaires on the perceptions of health and psychological well-being. Regression equations were computed to explore the viability of relationships between context and subjective perceptions of physical health, context and psychological well-being, and psychological well-being and subjective perceptions of physical health. Structural equation models showed that subjective perceptions of physical health mediate the relationship between context and psychological well-being. The implications of the findings are indicated.

The contribution of women to the achievement of global public health targets cannot be underestimated. It is well evidenced that within families, women are a key influence on the health and well-being of their children and partners. However, geographical differences in women's health inequalities persist and research focusing specifically on women's perceptions of locality factors influencing their own health and well-being is scarce. This paper presents an interpretive, qualitative research study undertaken in 2011 with a group of women living in one locality in the North East of England in the United Kingdom which aimed to better understand their health and well-being perceptions and locality influences on it. Fifteen women participated in two focus groups and six individual, semi-structured interviews. Thematic analysis yielded four key themes: health and well-being perceptions; mental resilience; low income and choice; and influence of place. The influence of women's geographical location in relation to amenities and services and loneliness were recurring factors in the discussion, each influencing lifestyle. It was evident that women in their local context were themselves assets through which their own physical and mental health could be improved. However, women's perceptions of protective factors and their influences on health and well-being varied. Connecting with women in the context of their immediate living circumstances and understanding their perceptions as individuals are important first steps in the process of gaining consensus and mobilising their assets to collectively build healthy local communities.

The aim of this study was to examine sheltered housing tenants' views of health and well-being, the strategies they adopted to support their well-being, and their use of health and social care services through a Health Needs Assessment. Sheltered housing in the UK is a form of service-integrated housing for people, predominantly over 60. The study used a parallel, three-strand mixed method approach to encompass the tenants' perceptions of health and well-being (n=96 participants), analysis of the service's health and well-being database, and analysis of emergency and elective hospital admissions (n=978 tenant data sets for the period January to December 2012). Tenants' perceptions of well-being were seen to reinforce much of the previous work on the subject with strategies required to sustain social, community, physical, economic, environmental, leisure, emotional and spiritual dimensions. Of the tenants' self-reported chronic conditions, arthritis, heart conditions and breathing problems were identified as their most common health concerns. Hospital admission data indicated that 43% of the tenant population was admitted to hospital (886 admissions) with 53% emergency and 47% elective admissions. The potential cost of emergency as opposed to elective admissions was substantial. The mean length of stay for emergency admissions was 8.2days (median 3.0days). While elective hospital admission had a mean length of stay of 1.0day (median 0.0days). These results suggest the need for multi-professional health, social care and housing services interventions to facilitate sheltered housing tenants' aspirations and support their strategies to live well and independently in their own homes. Equally there is a need to increase tenants' awareness of health conditions and their management, the importance of services which offer facilitation, resources and support, and the key role played by prevention and reablement.

This study analyzes the relationship between the territorial concentration of the Chinese immigrant population and their perception of health and well-being in Seville, a city in southern Europe, where this ethnic community has seen one of the fastest growth rates in recent times. An ethnographic design and a merging strategy by data transformation were adopted. The results show that there is a greater perception of good health and well-being among the Chinese population, who live mainly in neighborhoods with a high concentration of Chinese immigrants with a high socioeconomic status. However, this territorial concentration does not result in a lower perception of integration, affection or support from the host society. This apparent contradiction could be explained by the importance of relations with their fellow nationals at work as a key element in the socialization of the Chinese population.

678 Background: Bladder cancer is the sixth most common malignancy in the United States. Social determinants of health (SDOH) have been increasingly recognized as drivers of disparities in cancer care. Improved understanding of the role of social vulnerabilities could better inform the cancer care delivery interventions towards equitable cancer care for bladder cancer patients. We aimed to study the impact of key SDOH measures (everyday discrimination, supportive relationships, neighborhood characteristics, and food and housing security) on the perception of overall health in bladder cancer patients using a publicly available database. Methods: A cross-sectional study was conducted using overall health and SDOH survey data collected by the National Institutes of Health All of Us Research Program from June 2017 to June 2022. Ordinal logistic regression was utilized to assess associations between overall perception of health and each specific SDOH survey domain. All statistical tests were two-sided, and a p-value less than 0.05 was statistically significant; multiplicity adjustments were not made. The Statistical package (0.13.5) of Python (Version 3.1) was used for all statistical analyses. Results: 1,796 participants with bladder cancer met the inclusion criteria. 640 (38.58%) had completed the SDOH surveys and were considered for analysis. Of the total population, there was a significant male preponderance (66.1% vs 31%). 559 (87.3%) were White, 3.4% Black or African American, and 3.6% with Hispanic ethnicity. In the ordinal logistic regression models. for every unit increase in the score of the supportive relationships SDOH domain (more supportive relationships), participants were 4% (OR = 1.04, 95% CI = [1.018, 1.053], p<0.0001) more likely to have a higher perception of general health. Similarly for every unit increase in the food and housing security domain (more secure food and housing status), participants are 19% ((OR =1.19, 95%CI= [1.06,1.34], p 0.004) more likely to have a higher perception of general well-being. Controlling for all other variables, Black race, Hispanic ethnicity, smokers, and age less than 65 years were independently significant for poor perception of overall health (p < 0.05). Conclusions: This is one of the first studies evaluating the role of each component of SDOH on the perception of overall health in bladder cancer patients. Our study demonstrates a clear predictive link between social determinants of health and the perceived overall health of bladder cancer patients. Specifically, stronger social support networks and secure access to food and housing were significantly associated with a more positive perception of health. These findings suggest that future directions in bladder cancer care should prioritize the development and implementation of comprehensive care models that address these social needs.

BackgroundThis study evaluated a research project that provided employment in an Aboriginal and Torres Strait Islander community-based setting and supported participants to identify and achieve their goals and aspirations. The evaluation examined changes in personal, relationship, community and cultural strengths and resources and explored empowerment and resilience, in terms of promoting wellbeing.MethodsTen Aboriginal people employed as life coaches and peer researchers participated in semi-structured interviews and also completed the Aboriginal Resilience and Recovery Questionnaire at the beginning of their employment and 6-months after employment. Interviews with the 10 participants explored changes in their wellbeing, relationships, resilience, opportunity to lead, aspirations, goal setting skills, connection to culture and community, and empowerment.ResultsParticipants personal strengths, and cultural and community strengths, sub-scale scores showed improvements across the 6-month period, however these changes were not statistically significant. Using reflexive thematic analysis, we generated five themes including Aspirations; Personal capabilities; Constraints to wellbeing; Community engagement and cultural connection; and Employment facilitators. Overall, participants identified that despite the challenges of their work and the additional challenges posed by the COVID-19 lockdowns, they were able to develop their skills to set and achieve goals. They reported feeling empowered and proud of their work, and engaged more frequently with their communities and culture.ConclusionsThe study outcomes evidence the role of employment in an Aboriginal and Torres Strait Islander community-based project in strengthening wellbeing, enhancing resilience, and supporting participants to advance their personal goals and aspirations. These findings reinforce the importance of supporting the aspirations and employment of Aboriginal and Torres Strait Islander Peoples through employment.

The COVID-19 pandemic was a disruptive event that forced employees worldwide to quickly shift to telework. This qualitative study explored employees' experiences of telework during and after the COVID-19 pandemic in Sweden, where a more liberal approach to restrictions and telework was taken, focusing on changes in perceptions of work, work-nonwork interplay, relationships, wellbeing, health, and work-life balance. Semi-structured interviews, which were transcribed verbatim using Amberscript, were conducted with 16 participants from the SLOSH-Corona survey, who teleworked during the COVID-19 pandemic and continued to telework to varying extent after the removal of restrictions. Reflexive thematic analysis, based on Braun and Clarkes six step, identified five main themes: (1) having what it takes: the hoffice; (2) all work and no play: efficacy and loneliness; (3) faces of flexibility: freedom and balancing boundaries; (4) leadership challenges: bridging the gap between employee- and organizational needs; (5) survive or thrive? Telework and quality of life. Overall, telework was associated with high work efficacy. Additionally, increased work flexibility combined with effective management of work-nonwork boundary and strong supervisor support improved work-life balance, wellbeing, and quality of leisure time. However, work intensification was also high, as well as work-related isolation, ergonomic health problems, and sickness presence. For future telework to be sustainable, organizations would benefit from providing employees with home-based work supplies, and in particular, implementing leadership based on trust, enhanced work-related social connection, and organizational norms supporting clear work-nonwork boundaries.

Objective: The aim of this study was to analyse the views of different members of the school community regarding the health and well-being of young people and health promotion in schools. Design: Case study design was used, in which the Personal Wellbeing Index–School Children’s Questionnaire was administered to young people, and focus groups were held with other members of the school community (students, teachers, families, tutors and stakeholders). Setting: Five secondary schools in Catalonia (Spain). Method: Sequential triangulation between methods. Quantitative methods evaluated the students’ perception of health and well-being, while qualitative methods described school community perceptions of health promotion in school. Results: The results revealed a generally good perception of health among young people. Reported perceptions of health were lower among students in the later years of secondary education. Findings suggest that health promotion actions do not always translate into healthy behaviours among young people. Lack of resources and school overcrowding are key contextual factors influencing the promotion of health. Conclusion: Findings advance knowledge related to health education during the secondary years of schooling. In addition, they provide professionals with relevant data for developing and implementing health and well-being actions to include as part of a holistic curriculum.

Background Physical education (PE) aims to promote health and strengthen students’ health resources, and the concept of health is a central part of PE. curricula. However, little is known about how students understand health and experience teaching related to the concept of health in PE. Purpose This study aims to provide insight into how students understand the concept of health and how they experience and perceive teaching about health dimensions in PE. Participants A sample of 10th graders was recruited from two primary schools in Norway. Data collection and analysis Three focus group interviews were conducted with 12 students (5 boys) in 10th grade (15-16 years old). The first focus group consisted of five girls, the second of four boys, and the third of two girls and one boy. The students were asked to reflect on and discuss what health is, how it can be promoted, and their experiences of learning and teaching health in PE. The interviews were recorded using a voice recorder and lasted for between 40 and 55 min. The transcripts were analysed using reflexive thematic analysis. Analysis Through the analysis, we interpreted that students mainly focused on the physical dimension of health but became aware of the mental dimension when they discussed and reflected during interviews. Overall, students found the term health to be complex and somewhat difficult to understand. The students experienced little or no development of their health competence through PE. Although they considered that it was important to learn about health, they were concerned that, if more learning about health was implemented in PE, this would make the subject more theoretical and result in less movement and practical activities. Further, the strong activity discourse in PE is discussed in relation to students’ health perceptions. Final reflections Although curricula in PE seem to be developing towards a holistic perspective on health, students do not seem to understand health from this perspective. It seems that they encounter a biomedical approach to health and that PE teachers emphasize the physical dimension of health in teaching. The students' understanding of the concept of learning as theoretical and the teachers' instrumental teaching about health in PE could substantiate a narrow view of health in PE. To promote learning about health from a more holistic perspective, the learning focus of the subject should be highlighted. Furthermore, pedagogical approaches that aim to increase students' reflections and experiences of various dimensions of health through practical learning processes should be emphasized.

Perceptions of Nonsugar Sweeteners and Nonsugar Sweetener Front-of-Package Labels Among Parents in the United States: A Qualitative Study.

Introduction Appetite loss in older people is common and associated with malnutrition, sarcopenia and frailty. Management of appetite loss may prevent these health burdens but currently no effective clinical interventions exist. This is partly due to lack of knowledge about influences on appetite perceived by older individuals. These views may provide novel avenues for intervention on appetite loss. Aim: To understand older individual’s perceptions of influences on appetite loss. Method Semi-structured qualitative interviews with men and women aged ≥65 years, living in their own home, were audio-recorded and transcribed. Reflexive thematic analysis, with inductive coding, generated themes with data examples. Results 13 individuals (8/13 female, 4/13 living alone) were recruited. Accounts of influences on appetite were grouped into three themes: physical, psychological and external factors. The physical theme related to a physical state of ageing, using energy and being active, and physical symptoms, illness and treatment. The psychological theme explained the influence of mood or wellbeing, the appeal of food, and reward in the activity of cooking. External factors related to influences of other people, coping with life experiences and transitions, and perceptions of health. Influences were perceived to impact on appetite loss in distinct ways, via a physical feeling of fullness (physical theme), or creating a negative experience with food and eating (psychological and external themes). Individuals tended to have either a physical or psychological focus. Importantly, illness and its treatment impacted on both appetite loss narratives. Conclusions A number of influences on appetite are described by older individuals, relating to their physical and psychological self, and social and environmental factors. These seem to impact on appetite loss in distinct ways, by precipitating either a physical feeling of fullness, or a negative experience with food and eating. Identifying factors affecting an individual’s appetite could facilitate person-centred approaches to management.

Background/Aims Periodontitis is a chronic inflammatory disease affecting almost half of adults in the UK and is a leading cause of tooth loss. Current evidence suggests that periodontitis could be a causal risk factor for rheumatoid arthritis (RA) onset and progression, and periodontal treatment may improve disease activity in patients with established RA. Earlier periodontal intervention in individuals at-risk of RA could provide a unique opportunity to delay progression or prevent it entirely. This study aimed to explore the perceptions of oral health among individuals at-risk of developing RA and the perceived acceptability of preventive periodontal treatment. Methods This was a qualitative interview study employing a phenomenological approach. Anti-CCP positive at-risk individuals with musculoskeletal symptoms but no synovitis were recruited from the Leeds CCP cohort. Periodontal assessments and treatment were delivered by a dentist and/or oral hygiene therapist. Individual semi-structured interviews were conducted via video or telephone between March-June 2022. Interviews were audio-recorded and transcribed verbatim. Data were analysed using reflexive thematic analysis. Results Nineteen participants (ten women; age range 35-70) were interviewed. All had been offered periodontal assessment and treatment; four declined and nine had periodontal treatment. Three themes were identified: i) understanding risk; ii) oral health perceptions and experiences; iii) oral health treatment and maintenance. The majority of participants lacked awareness of the association between oral health and the risk of developing RA, and perceived lack of knowledge of this link among dentists. Preference for information provision relating to oral health as a risk factor varied extensively between participants. Negative perceptions towards dental appointments were common. Many participants identified the cost of dental treatment as an issue and expressed difficulty in accessing NHS dentists. Participants discussed oral health issues such as bleeding and sore gums, chipped and weak teeth, infections, and missing teeth. However, oral health was less of a priority when compared to comorbidities that had a bigger impact on daily life. Participation in a clinical trial involving preventive periodontal treatment was perceived to be acceptable for most participants. Facilitators included the personal benefits of being able to reduce risk, access a dentist, and not having to pay for treatment. Participants with dental phobia highlighted that seeing the same dentist at every visit was important. Perceived barriers included the location and time of appointments. Conclusion The impact of poor oral health may not be well understood by individuals at-risk of RA. Information relating to this risk factor should be tailored to the individual. Whilst periodontal disease is common in individuals at-risk of RA, seeking dental treatment can be hindered by dental phobia, treatment cost, or shortage of NHS dentists. A clinical trial involving preventive periodontal treatment is potentially acceptable for individuals at-risk of RA. Disclosure L.S. Chapman: None. K.A. Vinall-Collier: None. H.J. Siddle: None. Z. Mustufvi: None. K. Mankia: None. S. Serban: None.