Lived Experience Research Articles

APPTS (Accreditation Programme for Psychological Therapies Services) – A quality improvement programme for psychological therapies services, bringing benefits to service users, services and the wider system

Declaration of interests:All authors are current or former members of the APPTS Project BoardThe first author is the clinical lead for an NHS Talking Therapies service for Anxiety and Depression that is APPTS accredited and works for a Trust that has accredited all of its NHS Talking Therapies for Anxiety and Depression servicesThis paper describes an accreditation programme for psychological therapies services. It highlights the centrality of service user involvement to the programme’s design and delivery. Advantages for service users, staff, services and commissioners are outlined with feedback from different stakeholders included. Psychological therapies services need to be aware of this option to achieve accreditation from a body specifically tailored to evaluate such services. The programme is aligned to the Care Quality Commission’s five domains, utilising a supportive model of peer review, through which participating services are encouraged to share good practice and learn from one another. The process revolves around the APPTS standards, which have been developed collaboratively with key stakeholders, staff from member services, and representatives with lived experience, and provide the framework for what a high-quality psychological therapies service should look like.

Pioneering Approaches: Navigating Mind Wandering and Self-Silencing in Dissociated Adolescent Female Sexual Trauma Survivors - An Interpretative Phenomenological Analysis

BackgroundMinimal exploration exists on mind wandering and self-silencing in adolescent girls with sexual trauma and dissociation. ObjectiveTo investigate the lived experiences of female adolescent sexual trauma survivors with dissociation, focusing on overcoming mind-wandering and self-silencing through Pranayama, mindfulness meditation, music, and art therapy. Participants and settingsThis study, conducted in Sikkim, India, addresses a research gap in a culturally distinct context. Three adolescent girls diagnosed with PTSD and dissociation by a psychiatrist were selected through purposive sampling. MethodThis study uses Interpretative Phenomenological Analysis (IPA) to explore participants' individual stories and perspectives. It provides a comprehensive understanding of the lived experiences and narratives of three participants. ResultsThe IPA analysis revealed three super-ordinate themes: coping mechanisms, support and relationships, and, therapeutic approaches and the healing journey. In coping mechanisms participants reported (1) mind-wandering, self-blame, and daydreaming, (2) self-silencing, and (3) sublimation through academic achievement. The support and relationships theme included (1) lack of support from family, (2) attachment issues with mothers, (3) gender-based double standards, (4) Lack of infrastructure and health care human resources, with some participants turning to (5) faith-healing for mental health issues. The therapeutic approaches and healing journey theme demonstrated the effectiveness of Pranayama, mindfulness meditation, music, and art therapy in alleviating mind-wandering and self-silencing. ConclusionsThis study underscores the resilience of survivors of post-sexual trauma, advocating for culturally sensitive healing and evidence-based practices. Addressing mind-wandering and self-silencing through Pranayama, mindfulness meditation, music, and art therapy strengthens support systems, pioneering ways to mitigate the impact of sexual abuse.

'The Norm Is to Not Openly Collaborate': Using the Lens of Co-Production to Evaluate the Development of a COVID-19 ICU Triage Policy.

In 2020, surging cases of COVID-19 meant that health services had to plan for crisis-level triage. In the Australian Capital Territory, the Clinical Health Emergency Coordination Centre sought to develop a triage policy in collaboration with a range of consumer, carer and community groups. This study aims to map the collaborative development of the COVID-19 ICU triage policy onto the principles of co-production. Interviews were conducted with facilitators, members of advocacy or consumer groups and clinicians who were involved in the development of the triage policy. Interviews were thematically analysed using both theory- and data-driven approaches to, respectively, draw on the theoretical framework of co-production, and to explore participants' perspectives relevant to but beyond the scope of this theoretical framework. The findings suggest that at each stage of the initiative, there were ways in which the principles of co-production were met, and ways in which they were not met. One of the fundamental concerns that arose was about whether trying to solve a problem based on resources was compatible with a solution based on human rights. Literature about co-production has been critiqued for being limited to aspirational concerns, or implying co-production is easily achievable. The current study contributes to existing research through the application of the theoretical framework of co-production and exploring ways its aims were met and not met within a system-level collaboration developing a high-stakes health policy. This study has been conducted and written by researchers working from lived experience perspectives, and other researchers working from traditionally mainstream health disciplines, including psychology and medicine. Further, the study is about patient and public involvement in the development of a health policy. Thus it both embodies and is about non-tokenistic collaboration between people with lived experience and other health professionals.

Ethnicity and suicide in England and Wales: a national linked cohort study

Understanding of ethnic disparities in suicide in England and Wales is poor as ethnicity is not recorded on death certificates. Using linked data, we examined variations, by sex, in suicide rates in England and Wales by ethnicity and migrant and descendant status. Using the Office for National Statistics 2012-19 mortality data linked to the 2011 census from the Public Health Research Database, we calculated the age-standardised suicide rates by sex for each of the 18 self-identified ethnicity groups in England and Wales. We present rates by age, sex, and methods used for suicide by ethnic group. We estimated age-adjusted and sex-adjusted incidence rate ratios (IRRs) using Poisson regression models for each minority ethnic group compared with the majority population. We involved people with lived experience in the research. Overall, 31 644 suicide deaths occurred over the study period, including 3602 (11%) in people from minority ethnic backgrounds, with a mean age of death of 43·3 years (SD 17·0, range 13-96). Almost all minority ethnic groups had a lower rate of suicide than the White British majority, apart from individuals who identified as being from a Mixed heritage background or White Gypsy or Irish Travellers. In females who identified as Mixed White and Caribbean, the suicide IRR was 1·79 (95% CI 1·45-2·21) compared with the White British majority; in those who identified as White Gypsy or Irish Travellers, the IRR was 2·26 (1·42-3·58). Rates in males identifying as from these two groups and those identifying as White Irish were similar to the White British majority. Compared with the non-migrant population, migrants had a lower rate of suicide regardless of ethnicity, but in the descendant population, people from a Mixed ethnicity background had a higher risk of suicide than the White British majority. There are ethnic disparities in suicide mortality in England and Wales, but the reasons for this are unclear. The higher rate in previously overlooked minority ethnic groups warrants further attention. Wellcome Trust.

Athlete identity in para-sport: A comparative study of athletes with congenital and acquired disabilities

BackgroundIdentity development explores how individuals perceive themselves based on their life experiences, including their current self and aspirations. Athlete Identity has been studied using a 4-factor framework across various sports and ability groups. However, there is limited research on how individuals with physical disabilities perceive themselves as athletes and how an acquired disability impacts identity compared to a congenital disability. ObjectiveTo test the validity of the 4-Factor Model of Athlete Identity and to determine if athletic identity differs between para-athletes who have congenital versus acquired disabilities. MethodsSecondary analysis of cross-sectional data from the National Wheelchair Basketball Association. Participants consisted of 408 individuals (8 years and older) who play wheelchair basketball (n = 315 male; 29.13 ± 13.89 yrs; M ± SD) who responded to a brief online questionnaire including basic demographics and the 10-item Athlete Identity Measurement Scale (AIMS). ResultsNo significant differences in total AIMS scores were found between participants with congenital disabilities and participants with acquired disabilities. Age was a significant covariate. Eigenvalue analysis of the AIMS scores shows that 2 factors describe this population of athletes. ConclusionsDisability acquisition is not associated with total AIMS scores. Athletic identity is weaker in older participants suggesting a more inclusive self-schema as one ages. The 4-factor model of Athletic Identity is not applicable in this population. Continued research into the intersection of athlete and disability identity is warranted. Abstract presentedNorth American Society for the Psychology of Sport and Physical Activity, 2019.

Suicide in individuals with eating disorders who had sought mental health treatment in England: a national retrospective cohort study

Although studies have suggested a high risk of suicide in people with eating disorders, most studies have focused on suicidal ideation and attempts. There is little research on the characteristics of people with eating disorders who died by suicide, nor investigation of trends over time. We aimed to compare the characteristics of patients with eating disorders who died by suicide versus patients with other mental health diagnoses who died by suicide in England and to examine the trends in rates. In this national retrospective cohort study, data on all people (aged ≥10 years) who died by suicide in England, UK, between Jan 1, 1997, and Dec 31, 2021, while under the care (within the previous 12 months) of mental health services were obtained from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), in which clinical information is collected via a questionnaire completed by the mental health professional responsible for the patient's care. Incidence of suicide in, and demographic, clinical, and treatment characteristics of, patients with a diagnosis of eating disorder (as recorded by the treating clinician) who died by suicide were compared with patients with other mental health diagnoses who died by suicide within the same timeframe using univariable logistic regression analysis. People with related lived experience were involved in the study design, implementation, interpretation, and writing of the manuscript. Of 119 446 people for whom NCISH were notified of dying by suicide in England, 30 795 were under the recent care of mental health services, of whom 30 246 had known diagnoses and were included in analyses. Of these individuals, 10 373 (34%) were female and 19 873 (66%) were male; 2236 (8%) were of minority ethnicity; 382 (1%) had a diagnosis of eating disorder and 29 864 (99%) had another mental health diagnosis. Compared with patients with other mental health diagnoses who died by suicide, patients with eating disorders were younger (median age 33 years [range 15-90] vs 45 years [10-100]), more often female (343 [90%] female and 39 [10%] male in the eating disorders group; 10 030 [34%] female and 19 834 [66%] male in the other diagnoses group), and less likely to have evidence of conventional risk factors for suicide such as living alone (odds ratio [OR] 0·68, 95% CI 0·55-0·84). 22 (6%) of 382 were from a minority ethnic group. Patients with an eating disorder were characterised by a greater clinical complexity (eg, self-harm [OR 2·31, 95% CI 1·78-3·00], comorbidity [9·79, 6·81-14·1], and longer duration of illness [1·95, 1·56-2·43]), and were more likely to have died following overdoses (2·00, 1·62-2·45) than patients with other diagnoses. Childhood abuse (52 [37%] of 140) and domestic violence (18 [20%] of 91) were common in patients with eating disorders. Similar to patients with other diagnoses, most (244 [75%] of 326) of those with eating disorders who died by suicide were rated as low risk by clinicians at last contact. The number of suicide deaths in patients with eating disorders rose between 1997 and 2021 (incidence rate ratio [IRR] 1·03, 95% CI 1·02-1·05; p<0·0001), but rates fell when accounting for the greater number of patients entering mental health services (IRR 0·97, 0·95-1·00; p=0·033). This study was focused on people who sought help from mental health services. It did not consider subtypes of eating disorders or include a control group, but it does highlight possible areas for intervention. The comprehensive provision of evidence-based treatment for eating disorders and underlying conditions to address the clinical complexity in these patients might help to reduce suicide. Recognising limitations in clinical risk assessment, addressing early life experiences and current adversities, and appropriate prescribing might also be of benefit. Suicide prevention must remain a priority for eating disorder services and mental health care more widely. The Healthcare Quality Improvement Partnership.

“It is something you live with, like an organ in your body” a qualitative study on the lived experiences of people suffering from chronic low back pain in Lebanon

Purpose This paper aims to understand the distinctive biopsychosocial aspects and patient perspectives on chronic low back pain in Lebanon, an Arab country with a unique and rich cultural heritage. Method Qualitative, semi-structured interviews with 12 Lebanese patients purposefully sampled from various governorates. The interviews included participants from different geographic areas and religions. The data underwent analysis through an inductive thematic approach guided by a bounded relativist ontology, a subjectivist epistemology, and a descriptive phenomenological framework. The coding process was managed by computer-assisted qualitative data analysis software (QSR NVivo version 12.0). Results The researchers identified and constructed two themes: (1) Chronic low back pain: understanding the impact, coping strategies, and communication patterns in lived experiences within the Lebanese context. This theme sheds light on the complexities of pain management and societal influences in Lebanon. (2) Explanatory model of patients living with chronic low back pain in Lebanon. This theme allowed an exploration of the multifaceted narratives of chronic low back pain. Conclusion This study found that Lebanese individuals attribute chronic low back pain to biomedical factors despite some recognizing psychosocial elements. It emphasizes the need to educate patients on the biopsychosocial model, facilitate better care, and dispel misconceptions.

'It's Just Not Working', a Qualitative Exploration of the Weight-Related Healthcare Experiences of Individuals of Arab Heritage With Higher Weight in Australia.

Culturally and linguistically diverse population groups disproportionately experience higher weight and other non-weight-related discrimination in healthcare settings outside of their ancestral country. Little is known about the experiences of individuals with Arab heritage. This study aimed to qualitatively explore the intersectional weight-related healthcare experiences of individuals of Arab heritage with higher weight in Australia. A general inductive enquiry approach was used. Purposive, convenience and snowball sampling was used to recruit individuals of Arab heritage residing in Australia. Individuals were invited to participate in an online semistructured interview. Interviews were recorded, transcribedand thematically analysed. Fifteen participants took part in the study. Of these participants, 93% were female (n = 14), 80% were aged between 18 and 44 years (n = 12), 73% were university educated (n = 11), 53% were born outside of Australia (n = 8)and all were Muslim (n = 15). Four main themes were identified: (1) appearance-based judgement, (2) generalised advice and assumptions, (3) cultural responsivenessand (4) healthcare system constraints. Individuals of Arab heritage with higher weight in Australia, namely, females, often perceive their healthcare experiences as dismissive of their cultural and religious needs and driven by causality assumptions around weight. It is crucial that care delivered encompasses cultural humility, is weight-inclusiveand acknowledges systemic constraints. Cultural safety training benchmarks, healthcare management reformand weight-inclusive healthcare approaches are recommended to assist healthcare providers in delivering effective, holisticand culturally safe care. Insights gained from conversations with Arab heritage community members with lived experiences regarding weight-related healthcare encounters informed the study design and approach.

How do BPoC design professionals pursue environmental justice considerations when planning and designing recreational spaces?

ABSTRACT Recreational spaces like parks and playgrounds play a vital role in community development. They serve as avenues for important experiences like physical activity, social interaction, and shared cultural expressions. However, BPoC (Black Person, and Person of Color) communities face disparate unjust environmental barriers to utilizing such spaces. Yet not much is known about how BPoC professionals in dedicated professional associations, could address such barriers through the pursuit of environmental justice when planning and designing recreational spaces. This study aims to address this lacuna in research. Findings from in-depth interviews demonstrate that in the design and planning of spaces for recreation, BPoC design professionals drew on their lived experiences from community history and personal encounters to: (1) foster opportunities for participation in design and planning processes (procedural justice), (2) address location-related concerns pertaining to systemic strains in resource allocation (distributive justice), and (3) integrate features that support socio-cultural relationships (interactional justice).

Developing a Consensus Statement to Target Oral Health Inequalities in People With Severe Mental Illness.

Oral diseases are more prevalent in people with severe mental illness (SMI) compared to those without mental illnees. A greater focus on oral health is needed to reverse unacceptable but often neglected oral health inequality in people with SMI. This provided the impetus for developing 'The Right to Smile' consensus statement. We aimed to develop and disseminate a consensus statement to address oral health inequality, highlighting the main areas for concern and recommending an evidence-based 5-year action plan to improve oral health in people with SMI. The Right to Smile consensus statement was developed by experts from several professional disciplines and practice settings (mental, dentaland public health) and people with lived experience, including carers. Stakeholders participated in a series of online workshops to develop a rights-based consensus statement. Subsequent dissemination activities were conducted to maximise its reach and impact. The consensus statement was developed to focus on how oral health inequalities could be addressed through a set of 5-year improvement targets for practice, policyand training. The consensus was reached on three 5-year action plans: 'Any assessment of physical health in people experiencing SMI must include consideration of oral health', 'Access to dental services for people with SMI needs to improve' and 'The importance of oral health for people experiencing SMI should be recognised in healthcare training, systems, and structures'. This consensus statement urges researchers, servicesand policymakers to embrace a 5-year action plan to improve oral health for people with SMI. The team included people with lived experience of SMI, their carers/family membersand mental and dental health service providers. They were involved in every stage of developing the consensus statement, from conception to development and dissemination.

Socially Embedded Nature of Sensory Experiences in Daily Life for Autistic Young Adults

Abstract Date Presented 03/22/24 This qualitative study explored autistic young adults’ sensory experiences. Findings suggest that sensory experiences are notably intertwined with social contexts and have important implications for OT practice with this population. Primary Author and Speaker: Sharada Krishnan Contributing Authors: Tessa Madar, Ellen Cohn, Gael Orsmond

How many Trainee Clinical Psychologists (TCPs) in the UK self-report lived mental health experience (LMHE)?

Lived mental health experience’ (LMHE) describes direct impact of a mental health problem and/or being a mental health carer. LMHE among Trainee Clinical Psychologists (TCP) is rarely investigated despite encountering challenges throughout training. The current study aimed to estimate point, period, and lifetime prevalence of LMHE among TCPs. UK-based TCPs (N=301) completed an online survey. Results found 39.9% identified as a mental health carer at some point in life (current for 21.2%; historical for 32.8%) with 38.5% acquiring mental health carer responsibilities before training, and 6.6% since training commenced. Additionally, 44.9% and 45.2% respectively reported experiencing a diagnosed or undiagnosed mental health problem at some point in life (current for 55.8%; historical for 63.6%). Moreover, 86.4% reported a mental health problem prior to training, and 11.2% since training started. TCPs are likely to experience a mental health problem or identify as a mental health carer at some point in their life either before or during their doctoral training. This is the first study to estimate point, period and lifetime prevalence of self-reported lived mental health experience among UK based TCPs. Although just an estimate, dissemination of prevalence rates to DClinPsy course staff and employing trusts may be useful to prompt development of supportive resources and adaptations for TCPS with LMHE. This may also facilitate normalisation of LMHE within this population and combat stigma.

Perceptions, Barriers, and Facilitators of Cannabis Screening During Pregnancy and Labor: A Qualitative Study

BackgroundCannabis is the most commonly used federally illicit substance during pregnancy. Yet, little is known about women’s lived experiences of being screened for cannabis use during pregnancy. ObjectiveTo explore perceptions of cannabis use during pregnancy and childbirth, including experiences of being screened for cannabis use during the intrapartum period. MethodsWe conducted a phenomenological qualitative study using semi-structured, online interviews with 16 English-speaking women who gave birth at a U.S. hospital within the past three months. After transcription of interview recordings, two coders analyzed data using inductive thematic analysis. We also generated descriptive statistics for sociodemographic characteristics and cannabis use behaviors. FindingsMost participants were 25-34 years of age (75%, n=12), Black (75.00%. n=12), and had less than a bachelor’s degree (68.75%, n=14). Participants reported low-risk perceptions of cannabis use during pregnancy and often used cannabis to alleviate mental health conditions and pain during pregnancy and childbirth. Women reported mixed perceptions of harm, using cannabis as a medicine and because they were addicted, being fearful of disclosing cannabis use due to potential involvement of child welfare and protective services, and perceiving negative provider communication a barrier to disclosing cannabis use. ConclusionsFindings underscore the importance of patient education about adverse maternal and neonatal health outcomes of prenatal cannabis use, regardless of whether disclosure occurs. To facilitate disclosure of use, close attention should be paid to verbal and non-verbal communication when screening and counseling women during pregnancy and childbirth. Additional studies are needed to further examine patient-provider cannabis-related communication, with a focus on identifying discriminatory behaviors and practices resulting in health inequities.

Lived Experiences of Family Caregivers of Persons Living With Dementia in Acceptance &amp; Commitment Therapy

Abstract Date Presented 03/21/24 This session will present findings of the first study to explore lived experiences of family caregivers of people with dementia in acceptance and commitment therapy (ACT). Perceived benefits in ACT warrant more studies for diverse caregivers. Primary Author and Speaker: Areum Han Contributing Authors: Hon Yuen, Jeremy Jenkins

Building Back Better: Exploring the Resilience of Schools in Disaster Recovery

As natural and human-made disasters escalate globally, the urgency to rebuild resilient communities is increasingly evident. With this study, Building Back Better: Exploring the Resilience of Schools in Disaster Recovery explores the experiences, disaster recovery, challenges, coping mechanisms, and insights of three school administrators and four teachers designated as school Disaster Risk Reduction coordinators in the Monkayo East District of Davao de Oro. This study utilized qualitative phenomenological study to delve into the lived experiences of educational professionals during post-disaster recovery. This research aims to gain a deep understanding of the challenges, coping mechanisms, and insights from a purposive sample of four teachers designated as school Disaster Risk Reduction coordinators and three school administrators who have directly engaged with the recovery processes following natural disasters. The data were gathered through an in-depth face-to-face interview and used an audio recorder to record the discussion. The significant finding from the study is the multifaceted and long-lasting impact of disasters on students' learning environments. This finding highlights how disasters not only cause physical damage to school infrastructure but also disrupt the educational process, widen achievement gaps, and affect the emotional well-being of students. The disruption of normal routines and the psychological stress experienced by students underscore the critical need for comprehensive recovery strategies, including academic support and mental health resources, to help students regain stability and continue their education effectively. This emphasizes the importance of preparedness and resilience in educational institutions to mitigate the impact of such crises. This study highlights the need for timely assessments, repairs, and coordination with local authorities to ensure the structural integrity of school facilities. It underscores the importance of disaster preparedness and the implementation of robust recovery strategies to mitigate the impact on the educational environment and maintain a safe and conducive learning space. This focus on infrastructure is foundational, as it directly influences the ability of schools to function effectively post-disaster. Teachers and school heads are pivotal in disaster risk reduction within educational institutions. They create safety plans, organize drills, and educate students on emergency procedures, fostering a culture of preparedness. School heads provide leadership, while teachers act as first responders, guiding students to safety and offering necessary care. Collaboration between teachers, school heads, and stakeholders is crucial for a resilient school environment. By involving the entire school community in planning and implementing safety measures, schools can effectively respond to disasters, ensuring the safety and well-being of everyone involved. This partnership promotes a proactive approach to disaster preparedness, making safety a priority in all school activities.

Listening to the Voices of Aboriginaland Torres Strait Islander Women in Regional and Remote Australia About Traumatic Brain Injury From Family Violence: A Qualitative Study.

Indigenous women experience high rates of family violence-related head injuries. At present, lived experience accounts from Indigenous women are absent, which results in incomplete understandings and inadequate responses that have detrimental impacts onthem and their families. The aim of this study was to gain insight into Indigenous women's personal and family perspectives regarding violence-related traumatic brain injury (TBI), including impacts on life, as well as decision-making processes about healthcare access and engagement. Purposeful sampling was used to complete semi-structured interviews with 18 Indigenous women living in regional and remote Australia who had experienced TBI from family violence. The data from these interviews were augmented by data from interviews and focus groups with 28 community members, including family members or carers of Indigenous women living with TBI from family violence. Three themes were conceptualised based on the data and research aims: interweaving of the past and the present-ways women experience brain injury; factors that inform decision-making to access healthcare; and managing everyday changes that result from TBI from family violence. Indigenous women described living with a range of symptoms following repeated head injuries including problems with memory, cognition and concentration. A range of strategies to manage long-term symptoms of TBI were used by Indigenous women and when they did seek healthcare, Indigenous women were required to navigate a range of barriers. The findings identify a range of gaps in healthcare and housing supports for Indigenous women with TBI from violence, highlighting the significant investment needed to develop responsive and appropriate pathways of care in regional and remote areas. A range of suggestions are discussed including development of a specialised workforce who can provide apppropriate follow-up support, co-designed concussion clinics and educational resources. TBI must also be a key aspect of policy and practice for services working with Indigenous women who have experienced violence to ensure appropriate responses are provided. Indigenouswomen shared their views and experiences of TBI from family violence as well as decision-making about accessing healthcare and managing TBI symptoms. As such, study participants provided public contributions to the research.

Experiences of and treatment preferences for insomnia in autistic adults: An Interpretative Phenomenological Analysis

Insomnia and insomnia symptoms are frequent experiences of autistic people resulting in pronounced daytime effects and poor quality of life. This study employed an Interpretive Phenomenological Analysis approach to explore lived experiences of autistic adults with insomnia, perspectives on current available interventions and future treatment preferences. Twelve participants (aged 21–48 years old) were interviewed following screening for insomnia, using the Sleep Condition Indicator (scores ranged from 1 to 12; cut off >16). Each interview was analysed individually developing Personal Experiential Themes for each case, which were then mapped across cases based on identified patterns and connections. Results yielded rich personal accounts and identified two Group Experiential Themes: “The Night is Friendlier” and “It Doesn't Really Work for Me”. Participants described experiences with sleeplessness throughout their adult lives and often since childhood. They discussed how the night time offers them a more relaxed and safe space to freely behave as they wish. Advice and interventions were viewed by participants via the prism of underlying social issues, such as autism acceptance and trust, and how these structures can affect participants' experiences with insomnia, help seeking and effectiveness of current interventions. Our results highlight the need for inclusion of autistic people in insomnia research through co-production and co-creation as well as clinical practice and delivery. This is the first study to integrate perspectives and experiences of autistic people towards insomnia and sleep-related advice by health care professionals. Findings are discussed in relation to theoretical and practical implications, as well as directions for future research.

Yoga for Health and Wellness: A Review

Yoga- The Sanskrit word for a bodily posture is asana. In a broad sense, asana refers to a particular position that can be kept for an extended amount of time while being calm and pleasant. Mind-Body Harmony-The yogic lifestyle emphasizes the integration of physical well-being and mental serenity. Benefits of the yogic lifestyle-A yogic lifestyle is highly beneficial for our physical, mental, emotional, and spiritual well being. It expands your spiritual energy, brings balance, creates positivity, improves health, and increases your overall happiness. Health and Wellness-Health is one of the basic human needs and the good health is an important contribution for the quality of human life experience. Disciplined Life-When one examines the lives of all outstanding individuals, one thing becomes clear: they are all disciplined. Stress Reduction-Moving tension out the body, de-stressing, meditating and breath control reduces stress considerably. Self-Acceptance and Self Control-Focusing inward and realizing, through yoga that perfection is not the goal, self-acceptance takes over. Concentration and Memory-As little as 8 weeks of yoga can result in better concentration and more motivation. Conclusion-Yoga can help with mental and emotional well-being, including reducing stress, anxiety, and depression, and improving Concentration.

Using the Knowledge to Action framework to improve housing and support for people with Multiple Sclerosis.

Background People with Multiple Sclerosis (MS) have unique housing and support needs that are essential for maintaining independence at home; however, there is limited research to guide the design of community living options for this population. The aim of this study was to examine housing and support needs and preferences of people with MS with the intention to inform the planning of a co-designed intervention based on the study's findings. Methods Using the Knowledge to Action (KTA) framework, quantitative (n =79) and qualitative (n =6) data from people with MS were extracted and integrated from projects completed by the research team that explored the housing and support needs and preferences of people with disability. Results were synthesised and presented to a reference group for validation, contextualisation, and adaptation to the Australian context. Results High physical support needs were common across participants. People most commonly required home modifications to improve accessibility, such as ramps, equipment such as heating and cooling, and assistive technology. Many people required more than 8 hours per day of paid support. Moving into individualised housing facilitated independence and community reintegration. People reported gaps between what they wanted from support workers and what they received, citing individual and systemic barriers. Conclusion People with MS have support needs that require proactive and responsive funding arrangements, housing design and support provision. In line with KTA principles, findings will inform the planning of a co-designed intervention that involves people with lived experience of MS and other stakeholders to influence policy and improve home and living outcomes for this population.

Because I See You: Pharmacist Social Determinants of Health as Predictor of Structural Awareness.

The contribution of Social Determinants of Health to health disparities and patient outcomes is widely acknowledged. Much less has been done to characterize provider SDOH, and in particular their effect on delivery of structurally competent care. Differing lived experiences create blind spots to the critical upstream factors contributing to health. The primary objective of this study was to examine the association between Structural Awareness (SA) and Social Determinants of Health (SDOH) when controlling for year of first licensure, primary setting of pharmacy practice, race, and gender. The secondary objective was to examine the difference in mean SA scores with four stand-alone predictor variables: reliance on public transportation, insurance coverage gaps, food insecurity, and housing insecurity. This study is a cross-sectional web-based survey of 606 Minnesota pharmacists. SDOH risk and SA scores were assessed using modified versions of the PRAPARE and CCSAQ tools, respectively. The association of these scores was assessed using a multiple linear regression model and the association with stand-alone variables was done using t-tests. SDOH risk was significantly associated with SA at the 95% confidence level with a p-value of 0.0016. Food and housing insecurity were also significantly associated with SA score while reliance on public transportation and insurance coverage gaps were not. Pharmacy and other healthcare professional training programs should create opportunities for exposure to the SDOH experienced by their patients through immersive learning and/or experiential education.