‘Don't fix what ain't broke’: evaluating the effectiveness of a Men's Shed in inner‐regional Australia

Men's Sheds and similar community programmes are known to encourage help‐seeking behaviour and thus improve the health and well‐being outcomes for the men who attend. This paper investigates this issue through a community needs assessment of a Men's Shed programme in inner‐regional Australia. The immediate purpose of this research was to help direct future funding initiatives, and provide recommendations for potential changes and improvements to the programme. A community‐level needs assessment is a systematic process used to determine and address gaps or needs between current and desired conditions within a particular community. We sought to explore how particular formats and structures of Men's Sheds programmes contribute to improve social and medical well‐being, and whether there are key programme characteristics that could be emulated. In total, 22 surveys and 20 interviews were conducted with the men who participated in the programme. The report finds 95% of men are satisfied with the current running of the programme. While there were areas that have been identified for improvement, most men reported that they are content with the current format and would not like to see major changes to its implementation. The results of this research confirm the known benefits of these types of programmes. This paper provides other community programmes with some insight into the key success factors for running a Men's Shed.     

Mentoring at Men's Sheds: an international survey about a community approach to health and well‐being

Men's Sheds are named within the Australian and Irish National Male Health Policies as an exemplar of male health and well‐being and offer a range of formal and informal mentoring to counter the known consequences of social exclusion. The study aimed to report on whether Men's Sheds undertake mentoring programmes, and if so, who is being mentored; are mentors being trained, and if so by whom; and the perceived effectiveness of the mentoring programme. Furthermore, the study aimed to explore associations between sheds with a mentoring programme and factors that reflect an inclusive and a health‐focused environment. All known Men's Sheds were invited to participate in the survey; of those, 324 (42.8%) Men's Sheds in Australia and 59 (48.0%) International sheds participated in the study between April and August 2012. Overall, 39.2% (n = 127) of Australian sheds and 23.7% (n = 14) of International sheds undertook formal mentoring. Youth was the most common group being mentored in both Australia (60.6%; n = 77) and Internationally (71.4%; n = 10). Over half of Australian shed co‐ordinators rated their mentoring programme as moderately effective (52.8%; n = 67) and over a third as highly effective (36.2%; n = 46), while half of International shed co‐ordinators rated theirs as highly effective (50.0%; n = 7). The findings from this paper support the notion that a large number of Men's Sheds offer formal mentoring programmes targeting a range of disadvantaged sub‐populations, thus supporting social inclusion. Inter‐generational mentoring is the most frequently occurring type of mentoring programme. While training mentors occurs at some sheds, the efficacy of this training and programme outcomes are unknown. A typology of shed types appears to be emerging based on a divergence of sheds with a more utilitarian focus and sheds that appear to embrace a health and well‐being focus.     

Expectations of new treatment in rheumatoid arthritis: developing a patient‐generated questionnaire

Background

Service‐user partnerships in research exist in mental health, but there have been few advances in other disciplines, apart from cancer.

Objectives

To develop a patient‐generated expectancy measure for new treatments in rheumatoid arthritis (RA), using a participatory method.

Method

Stage 1: three repeated focus groups and two expert panels with patients with RA conducted by a patient researcher to generate items for the draft questionnaire. Stage 2: feasibility study of draft scale with consecutive outpatient attendees.

Results

Patients identified 21 dimensions of new treatment expectations, grouped into (i) physical, (ii) psycho‐social and (iii) expectations relating to the impact of treatment. This resulted in a draft instrument assessed in a feasibility study.

Discussion and Conclusion

The participatory research method was useful in involving patients actively in research and to produce collaboratively a feasible, valid and acceptable measure in RA. The scale will be included in a longitudinal observational study, with newly diagnosed patients, to assess (i) whether the new scale demonstrates sensitivity to change for expectations when receiving new treatment and (ii) participants' completion rate of the new scale compared with five instruments included in the future study.     

The everyday risk work of Dutch child‐healthcare professionals: inferring ‘safe’ and ‘good’ parenting through trust,as mediated by a lens of gender and class

Amidst intensifying policy concerns with children's wellbeing and development, healthcare professionals are required not only to assess risk of abuse and neglect, but to manage risk of ‘poor parenting’ more broadly. Drawing on 15 in‐depth interviews and non‐participant observations of 61 professional‐family interactions, across four preventative public health services for children in the Netherlands, we explored how professionals accomplished such risk work amid intractable uncertainties. Building inferences from brief encounters with families, professionals gauged the extent to which they trusted parents to care ‘appropriately’. This trust developed most readily with parents experienced as ‘familiar’ by the largely middle‐class female professionals. Harnessing Schutzian phenomenology, we analyse the related manifestations of social structure within the interactional‐dynamics and lifeworlds of risk assessment. We argue that social structures of gender, class and ethnicity can be seen as influential both through the differing potential for ‘we‐relationships’ to be formed and via the generalising and stereotyped knowledge applied in their absence.     

‘You're just a locum’: professional identity and temporary workers in the medical profession

Internationally, there has been substantial growth in temporary working, including in the medical profession where temporary doctors are known as locums. There is little research into the implications of temporary work in health care. In this paper, we draw upon theories concerning the sociology of the medical profession to examine the implications of locum working for the medical profession, healthcare organisations and patient safety. We focus particularly on the role of organisations in professional governance and the positioning of locums as peripheral to or outside the organisation, and the influence of intergroup relationships (in this case between permanent and locum doctors) on professional identity. Qualitative semi‐structured interviews were conducted between 2015 and 2017 in England with 79 participants including locum doctors, locum agency staff, and representatives of healthcare organisations who use locums. An abductive approach to analysis combined inductive coding with deductive, theory‐driven interpretation. Our findings suggest that locums were perceived to be inferior to permanently employed doctors in terms of quality, competency and safety and were often stigmatised, marginalised and excluded. The treatment of locums may have negative implications for collegiality, professional identity, group relations, team functioning and the way organisations deploy and treat locums may have important consequences for patient safety.     

Masculinities, ‘guy talk’ and ‘manning up’: a discourse analysis of how young men talk about sexual health

Sexually transmitted infection testing rates among young men remain low, and their disengagement from sexual health services has been linked to enactments of masculinity that prohibit or truncate discussions of sexual health. Understanding how men align with multiple masculinities is therefore important for tailoring interventions that appropriately respond to their needs. We draw on 32 in‐depth interviews with 15–24‐year‐old men to explore the discourses that facilitate or shut down sexual health communication with peers and sex partners. We employ a critical discourse analysis to explore how men’s conversations about sexual health are constituted by masculine hierarchies (such as the ways in which masculinities influence men’s ability to construct or challenge and contest dominant discourses about sexual health). Men’s conversations about sexual health focused primarily around their sexual encounters – something frequently referred to as ‘guy talk’. Also described were situations whereby participants employed a discourse of ‘manning up’ to (i) exert power over others with disregard for potential repercussions and (ii) deploy power to affirm and reify their own hyper‐masculine identities, while using their personal (masculine) power to help others (who are subordinate in the social ordering of men). By better understanding how masculine discourses are employed by men, their sexual health needs can be advanced.     

‘We’re all wounded healers’: A qualitative study to explore the well‐being and needs of helpline workers supporting survivors of domestic violence and abuse

Domestic violence and abuse (DVA) can include physical, psychological, sexual, emotional or financial abuses, and is a globally widespread problem across all age groups, cultures and socioeconomic groups. Alongside the impacts of DVA experienced by survivors, there is a growing recognition that other people, who form the support network of survivors, may also be affected by the situation. Domestic violence organisations such as helplines are important third sector services supporting survivors. However, there has been little research into the impact on those providing the support. This qualitative study of domestic violence helpline workers explored their needs and well‐being. We used qualitative methodology, conducting interviews with staff recruited from a selection of different helplines who all undertook direct client‐focused work. The interviews used a semi‐structured format and followed a topic guide covering the training received before commencing work, self‐care strategies, the impact of work on their daily life and support offered by their employer. Ten helpline staff were interviewed, all female. Following analysis of the qualitative data, a number of themes emerged. Participants disclosed numerous ways in which their work challenged their well‐being, including burnout, impact on personal relationships, and lack of training and support at work. Participants used some self‐care strategies in order to “switch off” from work, but they also wanted clinical supervision to support them with the difficulties they experienced at work. This study suggests that helpline staff should receive more education about trauma triggers, and ongoing support to reduce the impact on their home and social life, thus improving mental well‐being and job satisfaction. This work begins the debate on the well‐being needs of frontline helpline workers, and whether better meeting these needs can facilitate the provision of better support.     

Reflections from the forgotten frontline: ‘The reality for children and staff in residential care’ during COVID-19

Currently, 78,150 children are in care in England, with 11% of the most vulnerable living in 2,460 residential homes due to multitype traumas. These children require safe and secure trauma-informed therapeutic care. However, the children's residential care workforce delivering this vital care is an unrepresented, under-researched and largely unsupported professional group. The workforce undertakes physically and emotionally challenging work in difficult conditions, exacerbated by the COVID-19 pandemic. Practitioner wellbeing is directly associated with outcomes for children. Therefore, we sought to understand how experiences within the workforce could improve overall working conditions, and thus outcomes for staff and children. Thirty participants took part in a survey, providing feedback on their experiences and the situations they faced during the English lockdown April-June 2020. Two participants also opted to take part in a teleconference interview, rather than survey, although were asked the same questions. Data were analysed through thematic analysis. A stakeholder advisory board supported the project, including frontline staff, care leavers, service managers and policy researchers. The advisory board assisted in reflecting on the data from the survey and interviews to generate a complete analysis. Overall, staff require facilitated safe spaces for peer-support, reflective and emotionally supportive supervision. An organisational awareness that staff wellbeing is intrinsically connected to the wellbeing and therapeutic outcomes of the children they care for is essential. Further, staff require a sense of belongingness to feel safe and competent in their role due to a lack of external recognition and professional representation or validation. Based on the findings of the study and an iterative process with the stakeholder advisory board, we created a Wellbeing Charter for adoption within organisations to promote and protect the wellbeing of this vital workforce. The COVID-19 pandemic has exposed professional, financial and environmental inequalities that affect these frontline workers. Implementing organisational, statutory and policy-driven initiatives to prioritise their wellbeing are essential for the vulnerable children they care for.     

‘Keeping It Real’: women's Enactments of Lay Health Knowledges and Expertise on Facebook

This article presents findings from a qualitative study concerning Australian women's use of Facebook for health and medical information and support and the implications for understanding modes of lay knowledge and expertise. Thinking with feminist new materialism theory, we identify the relational connections, affective forces and agential capacities described by participants as technological affordances came together with human bodily affordances. Affective forces were a dominant feature in users’ accounts. Women were able to make relational connections with peers based on how valid or relevant they found other group members’ expertise and experiences, how supportive other members were, how strong they wanted their personal connection to be and how much privacy they wanted to preserve. We identified three modes of engagement: 1) expertise claims based on appropriation and distribution of biomedical knowledge and experience; 2) sharing experiential knowledge without claiming expertise and 3) evaluation and use of knowledge presented by others principally through observing. We conclude that an ‘expert patient’ is someone who is familiar with the rules of engagement on sites such as Facebook and is able to negotiate and understand the affects and levels of disclosure and intimacy that such engagement demands.     

‘The living death of Alzheimer's’ versus ‘Take a walk to keep dementia at bay’: representations of dementia in print media and carer discourse

Understanding dementia is a pressing social challenge. This article draws on the ‘Dementia talking: care conversation and communication’ project which aims to understand how talk about, and to people living with dementia is constructed. In this article I draw on the construction of dementia manifest in two data sets – a corpus of 350 recent UK national newspaper articles and qualitative data derived from in‐depth interviews with informal carers. These data were analysed using a thematic discursive approach. A ‘panic‐blame’ framework was evident in much of the print media coverage. Dementia was represented in catastrophic terms as a ‘tsunami’ and ‘worse than death’, juxtaposed with coverage of individualistic behavioural change and lifestyle recommendations to ‘stave off’ the condition. Contrary to this media discourse, in carers' talk there was scant use of hyperbolic metaphor or reference to individual responsibility for dementia, and any corresponding blame and accountability. I argue that the presence of individualistic dementia ‘preventative’ behaviour in media discourse is problematic, especially in comparison to other more ‘controllable’ and treatable chronic conditions. Engagement with, and critique of, the nascent panic‐blame cultural context may be fruitful in enhancing positive social change for people diagnosed with dementia and their carers.