English Health Research Articles

The viability and sustainability approach to support organisational resilience: Learning in a recent case study in the health sector

AbstractIn the context of ongoing global pandemics and political and economic instability, supporting public health organisations to improve their performance and develop their resilience is becoming a central issue in the organisational resilience research agenda. This paper offers a briefing on the viability and sustainability (v&s) approach and provides an example of application of the self‐transformation methodology (STM) at the breast care unit in an English Health Trust. The way of conducting the systemic application, the chosen methodology and tools and the way of interacting with the clients all exhibit the aspects of holistic flexibility. The paper demonstrates how the v&s approach and the STM enabled the collective identification of more effective policies and strategies for improving individual and organisational effectiveness for this health service unit, when interacting with a complex and changing environment. It also discusses the potential for adapting and replicating the approach across the healthcare sector.

Knowledge, attitudes, behavioral and organizational factors of health professions students for a competent smoking cessation practice: An instrument adaptation and psychometric validation study in Spanish and English samples

BackgroundTo improve smoking cessation, training of health professions students is essential. However, no specific instrument is available to assess factors that may affect students' learning about smoking cessation practice. AimTo adapt and validate the Knowledge, Attitudes, Behaviors and Organization questionnaire in the population of undergraduate health professions students. DesignMethodological research. MethodsThe researchers conducted this study with 511 Spanish and 186 English health professions students from four different universities. We used a four-step approach: 1) adaptation of the items to the target population and validation of the content by a panel of experts; 2) a pilot study to test face validity; 3) linguistic adaptation of the Spanish version to English; and 4) the psychometric assessment based on construct validity, criterion validity and internal consistency. ResultsExploratory factor analysis revealed four subscales for the Spanish version, namely ‘Individual knowledge and skills’, ‘Individual attitudes and beliefs’, ‘Organizational support’ and ‘Organizational resources’, which accounted for 85.1% of the variance. Confirmatory factor analysis in the holdout Spanish and English samples revealed adequate goodness-of-fit values, supporting the factor structure. Hypotheses testing demonstrated significant differences by capacitation in smoking cessation interventions and degree courses, providing further evidence regarding construct validity. All the subscales correlated positively with the criterion variables (5 A’s smoking cessation model), except for the ‘Organizational resources’ subscale, which was not significantly correlated with the 5 A's. The overall Cronbach’s alpha was.83 for the Spanish version and.88 for the English one. ConclusionsOur results provide empirical support for the use of the Knowledge, Attitudes, Behaviors and Organization questionnaire for Students as a reliable and valid instrument to assess knowledge, attitudes, behaviors and organization perceptions in health professions students, which is essential for competent smoking cessation practice. Interestingly, ‘Organizational resources’ subscale presented the lowest correlations among factors and did not correlate with any component of the 5 A's, suggesting the need of enhancing students' responsibility and involvement during their internships, as well as the interest of some organizations.

Rethinking local resilience for extreme heat events

ObjectiveThis study aims to provide insights into how local resilience structures in England can be leveraged to deliver a whole-of-society approach to managing a national response to extreme heat events during summer months. Study designA communication based on the literature review of currently available research on health emergency response and extreme heat events in England. MethodsThis communication draws insights from the authors’ research programmes, which examined national-level public health emergency response during the COVID-19 pandemic and literature review of the latest available English research on health and extreme heat events. ResultsPeriods of extreme heat are on the rise in England. Local resilience forums (LRFs), due to their multiagency nature, offer a shared situational awareness and understanding of the need in their local communities. Such information is critical to ensure messaging about heat risks and available resources are tailored to reach specific targeted groups within their communities. Scenario planning and adaptation efforts require a more local articulation which LRFs are well placed to manage. ConclusionsLRFs are well suited as key structures in the English emergency response to extreme heat events. We suggest that English public health and hospital organisations, working with community partners via the LRFs, must develop their thinking about pressures from adverse weather in the summer months.

Qualitative analysis of stakeholder perspectives on engaging Latinx patients in kidney-related research

BackgroundLatinx individuals are disproportionally burdened by kidney diseases compared to non-Latinx White individuals and are underrepresented in kidney-related research. We aimed to describe stakeholder perspectives on Latinx patient engagement in kidney-related research.MethodsWe conducted a thematic analysis of two online moderated discussions and an interactive online survey with open-text responses involving participants (i.e. stakeholders), with personal and/or professional experiences with Latinx patients with kidney diseases and their families/caregivers.ResultsAmong the eight stakeholders (Female:75%; Latinx ethnicity:88%), there were three physicians, one nurse, one patient with kidney disease who received a kidney transplant, one policy maker, one Doctor of Philosophy, and one executive director of a non-profit health organization. We identified five themes. The majority of themes and their respective subthemes (in parentheses) reflected barriers to engagement: Lack of personal relevance (unable to relate to research staff and marketing resources, and unclear benefit of research to self, family, and community); fear and vulnerability (immigration concerns, stigma with seeking care, skepticism of Western medicine); logistical and financial barriers (limited opportunities to enroll in clinical trials, out-of-pocket costs, transportation issues); and distrust and asymmetry of power (related to limited English proficiency or health literacy, and provider bias). The last theme centered on stimulating interest and establishing trust in the research process.ConclusionsTo overcome barriers to engagement in kidney-related research and establish trust among potential Latinx research participants, stakeholders recommended employing cultural responsiveness and community-based strategies. These strategies can help identify local health priorities, enhance research recruitment and retention strategies, and establish partnerships that continue to elevate research endeavors aiming to enhance the health of Latinx individuals with kidney diseases.

Reasons for incomplete STI vaccination among men who have sex with men in an English sexual health service.

In England, vaccination for human papillomavirus, hepatitis A, and hepatitis B is recommended for men who have sex with men (MSM). However, uptake is sub-optimal and some men do not complete all recommended vaccine doses. This service evaluation aimed to explore reasons for lack of uptake for each of these vaccines among MSM in one English sexual health service and to inform improvements in service delivery to increase full dose completion rates. MSM, ≥18 years, who had previously attended NHS Solent Sexual Health for at least one vaccination, and who had not completed the full dosing regimen for at least one of these vaccines, were invited to participate in an anonymous, online survey between 14/12/2020-11/04/2021. Among 246 MSM (M = 42.1 years), the most common reason for non-vaccination was that participants thought it was unneeded and had not been recommended by a doctor or healthcare provider. None reported vaccine hesitancy. Likewise, the most common reasons for vaccination were doctor/healthcare provider recommendation (51.7-65.6%) and self-protection (60.9-68.1%). The most common reason for not having completed the full course of vaccination was being unaware that the next dose was due (30.0-37.8%). Many participants who had not completed vaccination indicated that a doctor/healthcare provider recommendation would be a motivating factor and that reminder messages and being able to book subsequent appointments in advance would facilitate vaccination. Sexual health clinicians should be encouraged to discuss STI vaccination with MSM and services should explore possibilities to improve ease and access to vaccine appointments to increase uptake and completion rates.

Integrated care systems and equity: prospects and plans

PurposePolicies on integrated care have waxed and waned over time in the English health and care sectors, culminating in the creation of 42 integrated care systems (ICSs) which were confirmed in law in July 2022. One of the four fundamental purposes of ICSs is to tackle health inequalities. This paper reports on the content of the overarching ICS plans in order to explore how they focus on health inequalities and the strategies they intend to employ to make progress. It explores how the integrated approach of ICSs may help to facilitate progress on equity.Design/methodology/approachThe analysis is based on a sample of 23 ICS strategic plans using a framework to extract relevant information on health inequalities.FindingsThe place-based nature of ICSs and the focus on working across traditional health and care boundaries with non-health partners gives the potential for them to tackle not only the inequalities in access to healthcare services, but also to address health behaviours and the wider social determinants of health inequalities. The plans reveal a commitment to addressing all three of these issues, although there is variation in their approach to tackling the wider social determinants of health and inequalities.Originality/valueThis study adds to our knowledge of the strategic importance assigned by the new ICSs to tackling health inequalities and illustrates the ways in which features of integrated care can facilitate progress in an area of prime importance to society.

A community-based crisis intervention for people with borderline personality disorder

Structured clinical management is an evidence-based intervention for people with borderline personality disorder (BPD). There is a lack of evidence on crisis interventions for people with BPD, who are often admitted to hospital or supported in emergency care settings when they present with acute mental health needs. The home-based treatment team (HBTT) at an English NHS mental health trust undertook a pilot service improvement project in which they designed a ‘managing distress pathway’ – a crisis intervention for people with BPD adapted from the structured clinical management model. A small-scale evaluation of the project found that, after the intervention, patients spent less time in hospital and staff’s skills and confidence in supporting patients had improved. Patients reported high levels of satisfaction with their care. By using the principles of structured clinical management within an HBTT, non-specialist mental health practitioners can deliver effective community-based crisis interventions for people with BPD.

Global Health Competencies and Educational Needs for Nursing Students in South Korea

Despite the increasing demand for global health education, relatively few global health courses currently are offered in Korea. This mixed-methods study examined the need for global health competency and global health education experience for nursing students. A survey of 208 nursing students was conducted from May 2020 to August 2020, and three focus groups were conducted with 12 nursing students. The average score of global health nursing competencies was 2.8 ± 0.7 on a scale ranging from 1 to 4. Female, higher academic achievement, fluent English, and higher global health education experience had a significant effect on global health competency. The most influential factor was more experience with global health education. Nursing students' perceptions and educational needs related to global health education were classified into four subthemes. The development of global health education programs for nursing students is needed. [J Nurs Educ. 2023;62(2):75-82.].

The role of biology teachers in epistemically insightful health and wellbeing education: a case study of the English relationships, sex and health education curriculum

ABSTRACT In the period following a global pandemic, the promotion of health and wellbeing is a priority area for schools. This accompanies growing calls for health and wellbeing education to be delivered through a whole-child/whole-school approach that connects across subject areas. While it may be clear to most people that a purely scientific sexuality education is undesirable, it is also clear that biology plays a vital role in developing students’ understanding about a variety of health and wellbeing topics, including those around sex, sexuality and sexual health. In this article, we explore the contribution of the biology teacher to an integrated health and wellbeing education in schools through a case study comparison of the English Relationships, Sex and Health Education curriculum and the English biology curriculum. Biology teachers in England and many other national and regional jurisdictions operate in a compartmentalised system which can create frustration and anxiety for both students and teachers when navigating the complexities of how sensitive topics are delivered in different disciplinary siloes. Epistemically insightful approaches, conceptualised at the macro-, meso- and micro-level of school organisational structures, may provide a way for biology teachers and educational leaders to address and overcome some of these challenges.

BLOod Test Trend for cancEr Detection (BLOTTED): protocol for an observational and prediction model development study using English primary care electronic health record data

BackgroundSimple blood tests can play an important role in identifying patients for cancer investigation. The current evidence base is limited almost entirely to tests used in isolation. However, recent evidence suggests combining multiple types of blood tests and investigating trends in blood test results over time could be more useful to select patients for further cancer investigation. Such trends could increase cancer yield and reduce unnecessary referrals. We aim to explore whether trends in blood test results are more useful than symptoms or single blood test results in selecting primary care patients for cancer investigation. We aim to develop clinical prediction models that incorporate trends in blood tests to identify the risk of cancer.MethodsPrimary care electronic health record data from the English Clinical Practice Research Datalink Aurum primary care database will be accessed and linked to cancer registrations and secondary care datasets. Using a cohort study design, we will describe patterns in blood testing (aim 1) and explore associations between covariates and trends in blood tests with cancer using mixed-effects, Cox, and dynamic models (aim 2). To build the predictive models for the risk of cancer, we will use dynamic risk modelling (such as multivariate joint modelling) and machine learning, incorporating simultaneous trends in multiple blood tests, together with other covariates (aim 3). Model performance will be assessed using various performance measures, including c-statistic and calibration plots.DiscussionThese models will form decision rules to help general practitioners find patients who need a referral for further investigation of cancer. This could increase cancer yield, reduce unnecessary referrals, and give more patients the opportunity for treatment and improved outcomes.

Readability and Quality of English and Spanish Online Health Information about Cochlear Implants.

According to the American Medical Association, Internet web site health information should be written at or below a 6th grade reading level. The purpose of this study was to evaluate the readability and quality of cochlear implant web site health information. Cross-sectional web site analysis. Four Internet search engines involving the top 200 web sites (English and Spanish). "Cochlear implant" was queried in four Internet search engines, and the top 200 English and Spanish web sites were aggregated. After removing duplicates, the web sites were evaluated for readability by using the following validated online readability calculators: Flesch Reading Ease score for English web sites and the Fernandez-Huerta Formula for Spanish web sites. Information quality was assessed using the validated DISCERN quality criteria and the presence of Health on the Net Code of Conduct (HONcode) certification. A total of 80 non-industry-sponsored (43 English and 37 Spanish) and 11 industry-sponsored (4 English and 7 Spanish) cochlear implant health information web sites were included in the study. English web sites were written at a higher reading level (mean = 50.88, SD = 11.98) compared with Spanish web sites (mean = 59.79, SD = 6.04) ( p < 0.01). For both English and Spanish web sites, these scores correlate to the reading level of the average 10th to 12th grade student. Only 12% of Spanish web sites and 27% of English web sites were HONcode certified. The average DISCERN quality score was 41.67 for English web sites and 43.46 for Spanish, indicating significant concerns for quality. There was no association found between readability and quality of the web sites analyzed. Patient-directed English and Spanish web sites regarding cochlear implantation were written at reading levels that significantly exceed those recommended by the AMA. Furthermore, these web sites have significant quality shortcomings. Patients would benefit from more rigorous editing to improve readability and quality of content.

A critical overview of how English health and social care publications represent autistic adults’ intimate lives

Autistic people face more social barriers to, and experience greater anxiety around, intimate relationships than the general population in our majority neurotypical society, leading to increased loneliness and social isolation. National health and social care policies and publications should recognise these inequalities and guide service systems in reducing them. In this paper, we employ a document analysis design to analyse a cross-section of English national health and social care publications to investigate how autistic adults’ intimate lives are represented and prioritised in these publications. Most publications do not adequately and proportionally recognise or prioritise autistic people's intimate lives. They focus on the risks associated with sex and relationships and overlook autism-specific intimacy needs. They prioritise participation in the workforce while renouncing government responsibility for supporting intimate relationships which can reduce loneliness and alienation. We offer recommendations to ensure that health and social care publication processes better recognise intimate lives.

Navigating the micro-politics of major system change: The implementation of Sustainability Transformation Partnerships in the English health and care system.

To investigate how health and care leaders navigate the micro-politics of major system change (MSC) as manifest in the formulation and implementation of Sustainability and Transformation Partnerships (STPs) in the English National Health Service (NHS). A comparative qualitative case study of three STPs carried out between 2018-2021. Data collection comprised 72 semi-structured interviews with STP leaders and stakeholders; 49h of observations of STP executive meetings, management teams and thematic committees, and documentary sources. Interpretative analysis involved developing individual and cross case reports to understand the 'disagreements, 'people and interests' and the 'skills, behaviours and practice'. Three linked political fault-lines underpinned the micro-politics of formulating and implementing STPs: differences in meaning and value, perceptions of winners and losers, and structural differences in power and influence. In managing these issues, STP leaders engaged in a range of complementary strategies to understand and reconcile meanings, appraise and manage risks and benefits, and to redress longstanding power imbalances, as well as those related to their own ambiguous position. Given the lack of formal authority and breadth of system change, navigating the micro-politics of MSC requires political skills in listening and engagement, strategic appraisal of the political landscape and effective negotiation and consensus-building.

Economic evaluation of a vision-based patient monitoring and management system in an acute adult and an older adult mental health hospital in England

Background and aims Patients on acute adult and older adult inpatient mental health wards are at an increased risk of accidental injuries and deliberate harm to self and others. A vision-based patient monitoring and management (VBPMM) system was designed by Oxehealth Limited to support ward staff to provide better and more efficient care and to reduce incidents. The VBPMM system uses an infrared-sensitive camera, installed in a patient’s room, that works with cleared medical device software to deliver contact-free vital sign and activity insights to clinical teams. Data from two studies undertaken at an English National Health Service (NHS) mental health trust were used to inform an early economic assessment of VBPMM implementation into acute adult and older adult mental health wards. Methods A cost calculator was used to compare the introduction of the VBPMM system as an adjunct to standard care versus standard care alone. Observational data were collected at two English NHS mental health trusts. Both compared data pre- and post-VBPMM implementation using a 12-month baseline period. The model estimated cost per occupied bed day, cost per patient, annual cost per average-sized ward, and total cost to NHS mental health trusts across England. Costs were modeled from an NHS perspective over a 12-month time horizon. Scenario analysis was conducted to test the uncertainty of results using statistical significance of key inputs. Results and conclusions This early analysis indicated that the VBPMM system is likely to be cost saving within both settings examined, with an estimated cost saving of £272 per acute adult mental health patient and £4,591 per older adult mental health patient. This translates to £22.3 and £63.3 million, respectively, across NHS mental health trusts in England every year. VBPMM, therefore, has the potential to augment standard care, leading to positive clinical outcomes and monetary savings.

Leveraging Social Media to Increase Access to an Evidence-Based Diabetes Intervention Among Low-Income Chinese Immigrants: Protocol for a Pilot Randomized Controlled Trial.

Type 2 diabetes (T2D) in Chinese Americans is a rising public health concern for the US health care system. The majority of Chinese Americans with T2D are foreign-born older immigrants and report limited English proficiency and health literacy. Multiple social determinants of health limit access to evidence-based diabetes interventions for underserved Chinese immigrants. A social media-based diabetes intervention may be feasible to reach this community. The purpose of the Chinese American Research and Education (CARE) study was to examine the potential efficacy of a social media-based intervention on glycemic control in Chinese Americans with T2D. Additionally, the study aimed to explore the potential effects of the intervention on psychosocial and behavioral factors involved in successful T2D management. In this report, we describe the design and protocol of the CARE trial. CARE was a pilot randomized controlled trial (RCT; n=60) of a 3-month intervention. Participants were randomized to one of two arms (n=30 each): wait-list control or CARE intervention. Each week, CARE intervention participants received two culturally and linguistically tailored diabetes self-management videos for a total of 12 weeks. Video links were delivered to participants via WeChat, a free and popular social media app among Chinese immigrants. In addition, CARE intervention participants received biweekly phone calls from the study's community health workers to set goals related to T2D self-management and work on addressing goal-achievement barriers. Hemoglobin A1c (HbA1c), self-efficacy, diabetes self-management behaviors, dietary intake, and physical activity were measured at baseline, 3 months, and 6 months. Piecewise linear mixed-effects modeling will be performed to examine intergroup differences in HbA1c and psychosocial and behavioral outcomes. This pilot RCT study was approved by the Institutional Review Board at NYU Grossman School of Medicine in March 2021. The first participant was enrolled in March 2021, and the recruitment goal (n=60) was met in March 2022. All data collection is expected to conclude by November 2022, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study. This study will serve as an important first step in exploring scalable interventions to increase access to evidence-based diabetes interventions among underserved, low-income, immigrant populations. This has significant implications for chronic care in other high-risk immigrant groups, such as low-income Hispanic immigrants, who also bear a high T2D burden, face similar barriers to accessing diabetes programs, and report frequent social media use (eg, WhatsApp). ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/ct2/show/NCT03557697. DERR1-10.2196/42554.

Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales.

Background:Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear.Methods:We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history.Results:Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0–22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21–1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3–35.2) in week 1 to 1.80 (95% CI, 1.50–2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses.Conclusions:High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.

The Effect of Mental Health Intervention before English Test on College Students' English Test Scores.

It is necessary to pay attention to and study the physical and mental health development of college students. On the basis of statistical analysis of the questionnaire, this paper studies the impact of pretest mental health intervention on college students' English test scores, summarizes the problems and characteristics of college students' mental health, and explores the reasons for psychological problems. Based on the research results and related survey data of the mental health status of college students by scholars, this paper believes that these reasons mainly include students' personal reasons, school and social environment pressure, and insufficient family support factors. The data analysis shows that in the relationship between English education and mental health in colleges and universities, the amount of mental health intervention of students' extracurricular exercise has a stable and low negative correlation with the scores of each factor of SCL-90 (Symptom Checklist 90) and is negatively correlated with the scores of each subscale. The experimental results show that there are extremely significant differences in academic performance (F = 5.084, P < 0.01), and there is a certain linear relationship between students' mental health level and students' English exercise feeling. The lower the fatigue score, the higher the mental health level of the students, which effectively promotes the mental health development of college students.

Rethinking digital biopedagogies: How sociomaterial relations shape English secondary students' digital health practices

It is widely recognised that while many young people in high-income countries are active users of digital health technologies, their engagement can be short term. In this article, we draw on feminist materialism theory to analyse findings from the two qualitative phases of a mixed-methods three phase study of English secondary students' digital health practices. Bringing together work on biopedagogies alongside more-than-human thinking, we analyse our participants' accounts of their intra-actions with human and nonhuman affordances and materialities. Our findings reveal how young people's capacity for navigating the digital health landscape and translating knowledge into health practice is highly contingent on the complex engagement of different actors in digital health assemblages, including more-than-digital relational connections. Our study found that key human actors – typically in face-to-face settings – were crucial in doing the affective work necessary to guide adolescents through the tensions and conflicts they experienced when dealing with competing knowledges and expectations. The research underlines the ways in which feminist materialism perspectives can supplement scholarship on biopedagogies, specifically contributing to the theorising on young people's learning and embodiment through digital practices.

India’s date with second demographic transition

Using data from various sources, this paper discusses the recently documented below replacement level fertility in India in the context of the universality of marriage of girls, most of which are arranged by the parents, and increase in their mean age at marriage, mainly due to decrease in child marriage. There is virtually no increase in divorce rate, cohabitation, or voluntary childlessness, except for some anecdotal evidence from metro cities. The paper shows that the transition to small family in India is not due to cultural shifts towards post-modern attitudes and norms that accept and stress individuality and self-actualization. It is largely due to high aspirations among urban middle-class parents for children which can be fulfilled when they have one or at most two children in view of the rising cost of private English medium education and health care.

Barriers and enablers to implementation of the therapeutic engagement questionnaire in acute mental health inpatient wards in England: A qualitative study.

A strong association exists between the quality of nurse-service user therapeutic relationship and care outcomes on acute mental health inpatient wards. Despite evidence that service users desire improved therapeutic engagement, and registered mental health nurses recognize the benefits of therapeutic relationships, such interactions remain sub-optimal. There is a dearth of evidence on factors influencing implementation of interventions to support and encourage therapeutic engagement. This study aimed to understand the barriers and enablers to implementation of the Therapeutic Engagement Questionnaire (TEQ), across fifteen acute inpatient wards in seven English mental health organizations. Qualitative methods were used in which data were collected from ethnographic field notes and documentary review, coded, and analysed using thematic analysis. Theoretical framing supported data analysis and interpretation. Reporting adheres to the Standards for Reporting Qualitative Research. The TEQ as an evidence-based intervention co-produced with service users and nurses was valued and welcomed by many nurse directors, senior clinicians, and ward managers. However, a range of practical and perceptual factors impeded implementation. Furthermore, many existing contextual challenges for intervention implementation in acute inpatient wards were magnified by the COVID-19 pandemic. Suitable facilitation to address these barriers can help support implementation of the TEQ, with some transferability to implementation of other interventions in these settings. Our study suggests several facilitation methods, brought together in a conceptual model, including encouragement of reflective, facilitative discussion meetings among stakeholders and researchers, effort put into winning nurse 'buy-in' and identifying and supporting ward-level agents of change.