BackgroundProfessionalism is expected of health professionals and advocated by professional regulators in the United Kingdom (UK). Concepts of professionalism have evolved in sociological discourse and its meaning for dentistry is unclear. It is, none-the-less, considered a core domain of dental education and professional practice by the United Kingdom regulator, the General Dental Council. This paper reports the sense-making process, or social process, of professionalism in practice within England.AimTo explore the research question ‘What does dental professionalism mean in practice?MethodsTaking a constructivist grounded theory approach, involving purposive and theoretical sampling, 24 dental professionals were recruited to participate in this qualitative study. In-depth, semi-structured interviews were conducted by one interviewer (AT). Interviews were recorded, transcribed verbatim, and analysed leading to the development of a theory grounded in the data.ResultsA focus on the social-professional constructs used by participants to make sense of their experiences, resulted in a grounded theory where Reconciling Duty emerged as the core category. This represents a process of meeting professional duties to different parties that are often mutually exclusive. It is comprised of three supporting categories: Applying order to the system, where individuals attempt to identify what constitutes professional attitudes and behaviours, Rationalising what is fair, where individuals make judgements on how the conflict between duties should be resolved, and finally Responding to the System, where individuals attempt to actualise these desired resolutions in the context of the complex social system in which they practice. Three dentist archetypes (typologies) emerged, which involved a personal (Type 1), patient (Type 2), or a societal (Type 3) compromise.ConclusionProfessionalism can be conceptualised as process of reconciling multiple, competing, legitimate duties to different parties, in seeking a fair solution. Once this has been identified, individuals need to work within the complex system of dentistry to make their identified outcome a reality. The findings suggest that using the theory of Reconciling Duty helps us to engage with the meaning that the participants drew from the term ‘professionalism’, and anchors it in the lived, everyday professional experiences and challenges faced. A novel typology is proposed, commensurate with calls for a systems approach to the topic.

Disparities in the uptake of routine and COVID-19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, accessand low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. This study used a theory-informed, community-based participatory research approach to co-design a culturally tailored behaviour change intervention aimed at increasing COVID-19 vaccine uptake among Congolese migrants in London, United Kingdom (2021-2022). It was designed and led by a community-academic partnership in response to unmet needs in the Congolese community as the COVID-19 pandemic started. Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviourmodel to identify target behaviours and strategies to include in interventions. Interventions were co-designed and tailored in workshops involving Congolese migrants. Thirty-two Congolese adult migrants (24 (75%) women, mean 14.3 (SD:7.5)years in theUnited Kingdom, mean age 52.6 (SD: 11.0) years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. Fourteen barriers and 10 facilitators to COVID-19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivationsand social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablementand environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. Our study demonstrates how behavioural theory can be applied to co-designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co-producing all stages of the study and co-authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study.

Area-based index of multiple deprivation (IMD) indicators of financial hardship lack individual specificity and sensitivity. This study compared self-reports of hardship with area measures in relation to health status. Interviews in one London Borough, reported financial hardship and health status. Associations of health status with most and least deprived quintiles of the IMD 2015 were compared with self-reported hardship; always or sometimes 'having difficulty making ends meet at the end of the month' in relation to never. 1024 interviews reported hardship status in 1001 (98%). 392 people (39%) reported they 'always' or 'sometimes' had hardship. In multivariate analysis, self-reported hardship was more strongly associated with smoking; odds ratio = 5.4 (95% CI: 2.8-10.4) compared with IMD, odds ratio = 1.9 (95% CI: 1.2-3.2). Health impairment was also more likely with self-reported hardship, odds ratio = 11.1 (95% CI: 4.9-25.4) compared with IMD; odds ratio = 2.7 (95% CI: 1.4-5.3). Depression was similarly related; odds ratio = 2.4 (95% CI: 1.0-5.6) and 2.7 (95% CI: 1.2-6.6), respectively. Self-reported hardship was more strongly related to health status than area-based indicators. Validity and implementation in routine health care settings remains to be established.

Objectives: Social distancing and self-isolation were key parts of the UK's strategy for reducing the spread of COVID-19. This study explored young people's attitudes, perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic. Methods: Qualitative individual, family and paired-friendship interviews were conducted. All 26 participants lived or worked in East London and were aged between 20 and 39years. Results: Qualitative analysis revealed three main themes: 1) trust and breaking of the social distancing and self-isolation rules-trust in their friends to be careful and say if they are unwell; 2) own rule making-making their own household rules which made them less guilty about breaking national rules as they were adhering to rules (albeit their own); and 3) lack of clarity around self isolation and the need for practical support-confusion around length of time needed to self isolate and what self-isolation really meant. Conclusion: Developing more effective and targeted communications and practical support mechanisms to encourage better adherence to social distancing and self-isolation rules among young people will be essential to prevent the spread of COVID-19.

AimsChildren and young people may have health needs which are unmet or have long term health conditions or disabilities which require ongoing monitoring. The role of the School Age Clinic at Hackney Ark is to address and review the health needs of children in school age where their health needs might impact on their progress in educational settings.We sought to review the caseload and report the underlying diagnosis and co-morbidities of the children seen in School Age Clinic at Hackney Ark, highlighting the importance of an evidence-based approach in planning and monitoring of services.MethodsThe School Age Clinic at Hackney Ark is run by the Community Paediatricians and their services are primarily for children above 5 years old who live in the City and Hackney areas of London and are registered with a local GP.We evaluated the caseload open to the School Age Clinic until 2022. All the medical records of the children seen in the clinic were reviewed to ascertain their demographic details, diagnosis, co-morbidities, motor, sensory, communication disabilities, learning difficulties and educational needs.ResultsOf the 282 children that met the assessment criteria, 56% (n=169) were male and the mean age of the children seen in clinic was 10 years old. 28% of the of the children had an underlying known chromosomal or genetic condition. The conditions most commonly seen in the School Age Clinic were Autism Spectrum Disorder (15%), Social communication concerns (15%), Speech and Language difficulties (14%) and Trisomy 21 (11%).The majority of children seen in the clinic had an Education, Health and Care Plan (EHCP) in place (n=171, 61%), while 32% had documented learning difficulties at school, without an EHCP. The majority of the children with an EHCP had a formal diagnosis (78%) and their mean age was 10.7 years old. The mean age of the children with documented learning difficulties and without an EHCP was 8.7 years old and 64% did not have a formal diagnosis.Behavioural, sleep difficulties and overweight were co-morbidities commonly present in the children seen in the clinic (58%, 32% and 20%, respectively).ConclusionThis is the first evaluation of diagnosis and co-morbidities of children seen in School Age Clinic at Hackney Ark. This work supports the need for a comprehensive epidemiological database to inform the aetiology as well as consider effective preventative and intervention strategies for the children being seen in School Age Clinic.

ABSTRACTIntroductionInequitable uptake of routine and COVID-19 vaccinations has been documented among intersectionally marginalised populations, including migrants, and attributed to issues of mistrust, access, and low vaccine confidence. Novel approaches which seek to share power, build trust and co-design tailored interventions with marginalised or underserved communities must be explored, to promote equitable engagement with vaccination and other health interventions.MethodsA theory-informed, qualitative, community-based participatory research study, designed and led by a community-academic partnership, which aimed to understand decision-making related to COVID-19 vaccination among Congolese migrants in the UK and co-design a tailored intervention to strengthen their vaccine uptake (2021-2022). Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model to identify target behaviours and strategies to include in interventions. Workshops were done in partnership with Congolese migrants to co-design and tailor interventions.Results32 Congolese adult migrants (foreign-born and living in UK; 24 (75%) women, mean 14.3 [SD 7.5] years in UK, mean age 52.6 [SD 11.0] years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. We identified 14 barriers and 10 facilitators to COVID-19 vaccination; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences; environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations, and social opportunities. Strategies included behaviour change techniques based on education, persuasion, modelling, enablement, and environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, COVID-19 vaccination plays and posters. Findings and interventions were disseminated through a community celebration event.ConclusionsOur study demonstrates how behavioural theory can be applied to co-designing tailored interventions with marginalised migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities’ unique cultural needs and realities.Patient or public contributionPatient and public involvement (PPI) were embedded in the participatory study design and approach. An independent PPI board comprising five adult migrants with lived experience of accessing healthcare in the UK were also consulted at significant points over the course of the study.Practitioner pointsResearch has shown that migrants experience a range of health and vaccination inequalities but are not well included in health research nor the design of interventions to address these. Using community-based participatory methods, we demonstrated that underserved communities, such as migrants, are resilient, resourceful, and use community assets to find real-world solutions to their health needs.Our approach shows how practitioners can adapt and use behavioural theory and design thinking within a participatory research paradigm to meaningfully involve underserved populations in co-designing acceptable and culturally relevant health interventions to address a range of health issues and inequalities.

ContextThis work was carried out alongside the Association of Directors of Public Health (ADPHL) Steering Group on Supporting Black, Asian and minority ethnic communities during and beyond Covid – working with public health leaders in London, particularly local authority directors of public health and their teams.Issue/ChallengeDuring the first wave of the Covid pandemic, in 2020, there was renewed public and professional interest in ethnic inequalities in health, following the release of the Public Health England (PHE) reports, which highlighted the disproportionate impacts of COVID-19, particularly amongst Black, Asian and minority ethnic communities.At the same time, there was an increased social awareness of the impacts of racism and the Black Lives Matter movement, following the murder of George Floyd.There was a moment in time to speak out on the situation and that emboldened us to be heard in a way we haven’t been heard before. Reflecting on our experience as black female public health leaders in the London public health landscape, the challenge was how we capture this and respond to this matter in a way that brings real change and maintains momentum.A particular piece of work was supporting the development of the ADPHL policy statement ‘Racism is a public health issue’ and its related action plans.Traditionally, the medical/healthcare professions have been challenged in understanding and taking into account the impact of racism in health. There is an identified need for a different kind of health leadership during these uncertain times.-Although there is increased interest and discussion of racism and its impacts currently, we anticipate challenges with maintaining momentum, particularly at senior level, to embed lasting changeThere is limited research on the experiences of black leaders working in this context and how they are heard, involved or valuedAssessment of issue and analysis of its causesWe looked at examples of leadership on this subject matter at local, regional and national level, including an understanding, lived experiences and perception of discrimination, support at work and in health outcomes, health literacy and access, behaviour and attitudes, black and ethnic minority workforce experiences and morale.ImpactOur work has been recognised across London local authorities, wider health and care partners and national public health forums.We were awarded the Faculty of Public Health Sam Ramaiah Award.Our work has influenced partner organisations to develop actions plans or strategies around tackling structural racism (e.g. Greater London Authority).Our work has motivated fellow Directors and Consultants to have conversations on this uncomfortable subject matter, in a way they’ve never done before and consider how we maintain this momentum.It has also led to creating a safe space through a network of ‘Black’ leaders, where we can reflect on our professional development in uncertain times.InterventionAs above, we wanted our voices to be heard in response to the challenges that were faced. During the process of developing the position statement and action plan, we considered our own positions as effective leaders in this space, how we continue to maintain momentum of this agenda, and influence other system leaders in tackling racism in public health.We invited speakers from other organisations to our working group to challenge us on these concepts as system leaders, and considered how we could bring the service users’ voice to hold us to account, as well as provide their perspectives.We also organised and facilitated workshops with London local authority public health Directors and Consultants on this subject matter.Involvement of stakeholders, such as patients, carers or family members:There was no direct patient involvement, however we shared our lived experiences.Key MessagesReflecting on our experience as senior black healthcare leaders leading effective multicultural teams and addressing health inequalities we found that:There is change and changing language around racism and healthCultural competency and cultural humility in leadership plays a crucial role and there are different views so we need to look at the different perspectives and actually understand what it meansAlthough leading whilst holding discomfort is universal there appears to be disproportionate burdenThe impact on perception, behaviour and morale from a workforce and patient/community perspectiveSupport and peer engagement does not always happenThe narrative can be deemed to be repetitive and nuances get missedLessons learntThere is interest in leading this wayHolding the ambiguity and discomfort is universal to leadership in this context and so as leaders of this agenda we need to ensure we do not respond to the pressure to react with immediacyWe learnt that we still need allies and we need timeMeasurement of improvementThis is ongoing and will be measured using qualitative approaches such as through the various dialogues across the public system, training and organisational development.Strategy for improvementWe will look at this as part of the workforce development, share at conferences and through the work with ADPH.

IntroductionMigrants positively contribute to host societies yet experience barriers to health and vaccination services and systems and are considered to be an underimmunised group in many European countries. The COVID-19 pandemic has highlighted stark inequities in vaccine uptake, with migrants facing access and informational barriers and lower vaccine confidence. A key challenge, therefore, is developing tailored vaccination interventions, services and systems which account for and respond to the unique drivers of vaccine uptake in different migrant populations. Participatory research approaches, which meaningfully involve communities in co-constructing knowledge and solutions, have generated considerable interest in recent years for those tasked with designing and delivering public health interventions. How such approaches can be used to strengthen initiatives for COVID-19 and routine vaccination merits greater consideration.Methods and analysisLISOLO MALAMU (‘Good Talk’) is a community-based participatory research study which uses qualitative and coproduction methodologies to involve adult Congolese migrants in developing a tailored intervention to increase COVID-19 vaccine uptake. Led by a community–academic coalition, the study will involve (1) semistructured in-depth interviews with adult Congolese migrants (born in Democratic Republic of Congo, >18 years), (2) interviews with professional stakeholders and (3) codesign workshops with adult Congolese migrants. Qualitative data will be analysed collaboratively using reflexive thematic analysis, and behaviour change theory will be used in parallel to support the coproduction of interventions and make recommendations across socioecological levels. The study will run from approximately November 2021 to November 2022.Ethics and disseminationEthics approval was granted by the St George’s University Research Ethics Committee (REC reference: 2021.0128). Study findings will be disseminated to a range of local, national and international audiences, and a community celebration event will be held to show impact and recognise contributions. Recommendations for implementation and evaluation of prototyped interventions will be made.

ObjectivesTo assess primary impact of selective Licensing (SL), an area-based intervention in the private rented housing market, on individual self-reported anxiety and neighbourhood mental health (MHI—Mental Healthcare Index) and secondary impacts on antisocial behaviour (ASB), population turnover and self-reported well-being.DesignDifference-in-difference (DiD) was used to evaluate effects of SL schemes initiated 2012–2018. 921 intervention areas (lower super output areas) were matched 3:1 using propensity scores derived from sociodemographic and housing variables (N=3.684 including controls). Average treatment effect on treated (ATT) was calculated for multiple time period DiD in area-level analyses. Canonical DiD was used for individual-level analysis by year of treatment initiation while adjusting for age, sex, native birth and occupational class.SettingIntervention neighbourhoods and control areas in Greater London, UK, 2011–2019.ParticipantsWe sampled 4474 respondents renting privately in intervention areas (N=17 347 including controls) in Annual Population Survey and obtained area-level MHI population data.InterventionsPrivate landlords in SL areas must obtain a licence from the local authority, allow inspection and maintain minimum housing standards.ResultsATT after 5 years was significantly lower for MHI (−7.5%, 95% CI −5.6% to −8.8%) than controls. Antidepressant treatment days per population reduced by −5.4% (95% CI −3.7% to −7.3), mental health benefit receipt by −9.6% (95% CI −14% to −5.5%) and proportion with depression by −12% (95% CI −7.7% to −16.3%). ASB reduced by −15% (95% CI −21% to −8.2%). Population turnover increased by 26.5% (95% CI 22.1% to 30.8%). Sensitivity analysis suggests overlap with effects of London 2012 Olympic regeneration. No clear patterns were observed for self-reported anxiety.ConclusionsWe found associations between SL and reductions in area-based mental healthcare outcomes and ASB, while population turnover increased. A national evaluation of SL is feasible and necessary.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.