Dr Suzie Wang

older people aged 80 and over are increasingly providing end-of-life care to spouses at home and often do so for long periods of time, while also trying to manage their own illnesses and disabilities. Little of the research on older spousal carers has focussed on the oldest carers; hence, the needs of this particular population are not fully known.to explore the experiences of the 'oldest carers' in caring for a dying spouse at home.secondary analysis was undertaken on a subset of data from a larger qualitative interview study; this dataset comprised 17 interviews from participants aged 80 or over. Framework analysis methods were used, with items derived from the thematic analysis of the main study.the oldest carers in this subset demonstrated high levels of resilience and the ability to adapt to their caring role. Caring until death was accepted as an integral part of the commitment made to their partner as part of the 'wedding contract'. Carers felt they benefitted from the support provided by family, friends and care services; however, their own care needs were not always recognised by health and social care services.these findings underscore the complexity of the oldest carers' experiences and challenges in times of illness and end of life. Healthcare professionals should be alerted to the myriad ways caregiving is enacted in serious illness and seek opportunities for developing supportive interventions specifically for older carers.

Abstract

Public Health England (2013) survey data indicates that while the place of death is geographically uneven across England, given a choice, many older people nearing end of life would prefer to die at home. There is, however, a growing critique that policies designed to support home death fail to understand the needs and preferences of older people and the impact on family carers. Such policies also make assumption about within whose home the home death takes place. Hence, there are major gaps in our understanding of firstly, where and how care work undertaken by family members within domestic settings takes place; and secondly, how it can create tensions between home and care that fundamentally disrupt the physical and socio-emotional meaning of home for family carers, impacting on their sense of home post-death. This can have consequences for their own well-being. In this paper we draw on interview data from our 'Unpacking the Home' study to elicit an in-depth understanding of how facilitating a home death can create an ambiguity of place for family carers, where the issues faced by them in caring for a dying older person at home, and the home death itself, can fundamentally reshape the meaning and sense of home.

Background: A variety of individual therapeutic interventions have been shown to reduce hospital admissions and improve quality of life in patients with chronic obstructive pulmonary disease (COPD). However, there is a paucity of data of looking at the effect of case management in primary care (i.e. using an integrated care approach) of people at higher risk of mortality from COPD. Objective: To examine the effect of case management in primary care of patients with COPD at high risk of hospital admission, identified using a novel multidimensional index of disease severity (DOSE index). Methods: Observational pilot study in a single general practice. High-risk patients were identified using the DOSE index and case managed using an IT system according to British National Guidelines over a 6-month period. Results: Eleven patients entered and completed the study. There was no improvement in health status, but there was a non-significant reduction in total hospital admissions (three versus zero) and total bed days (16 versus 0) compared to the same reference period in the previous year. There was an increase in self-management knowledge. Conclusions: Case management of high-risk patients in primary care may reduce hospital admissions. This needs to be tested in a randomized controlled trial.

More research is needed to further our understanding of posttraumatic stress disorder symptoms (PTSD) and psychiatric co-morbidity following stroke, especially the trajectories of such symptoms over time. Previous studies suggest that exposure to a traumatic experience such as stroke is not sufficient to explain the etiology of PTSD. Alexithymia may be involved, but its relationships with PTSD and psychiatric co-morbidity following stroke remains unclear. This study aims to address these knowledge gaps. While in hospital, stroke patients (n = 90) completed questionnaires assessing PTSD symptoms, psychiatric co-morbidity, alexithymia and physical disability. PTSD symptoms and psychiatric co-morbidity were re-assessed approximately 3 months post-stroke (n = 78). The severity of post-stroke PTSD did not change significantly over time, while psychiatric co-morbidity reduced significantly. Alexithymia, in particular difficulty in identifying feelings, was associated with severity of post-stroke PTSD and psychiatric co-morbidity at baseline, but after adjusting for these, there was no significance 3 months post-stroke. We suggest that patients' difficulty in identifying feelings had a role to play in influencing relatively short-term rather than long-term PTSD and co-morbid psychiatric symptoms. Alternatively, PTSD could be interpreted as driving the alexithymic characteristics

Introduction: The Lung Information Needs Questionnaire (LINQ) assesses, from the patient's perspective, their need for education. This questionnaire yields a total score and scores in six domains: disease knowledge, medicine, self-management, smoking, exercise and diet. The aim of this study was to assess the sensitivity of the LINQ to change before and after pulmonary rehabilitation (PR). Method: PR programmes across the UK recruited 158 patients (male = 94; 59%). The participants completed the LINQ and other measures as used by the individual sites pre- and post-PR, including the Shuttle Walking Test, Chronic Respiratory Disease Questionnaire, the Hospital Anxiety and Depression Scale. Results: Data were analysed on 115 patients who completed data collection pre- and post-PR. The LINQ total scores, and subscales scores across all sites improved significantly with large effect sizes, except for the smoking domain as information needs about smoking were well met prior to PR. There were similar patterns of information needs at baseline and after PR in all sites. Discussion: This study shows that the LINQ is a practical tool for detecting areas where patients need education and is sensitive to change after PR. The quality of the education component of PR can be assessed using the LINQ, which could be considered as a routinely collected outcome measure in PR. The LINQ may also be a useful tool for general practitioners to assess their patients' educational needs.

The Stroke Action Plan for Europe (2018–2030) calls for national-level secondary prevention plans that address lifestyle, in addition to prevention medications and surgical interventions. This scoping review examines national stroke care guideline and audit documents across WHO regions to identify non-pharmacological, non-surgical stroke secondary prevention recommendations and associated performance indicators. Using a snowballing methodology, 27 guideline documents met the inclusion criteria. Sixteen (59%) detailed, non-pharmacological, non-surgical stroke secondary prevention-addressing known, modifiable population attributable risk factors, of physical inactivity (N = 11), smoking (N = 11), unsafe alcohol consumption (N = 10), diet (N = 8), weight (N = 5), stress (N = 4) and depression (N = 2). Strategies recommended to address these risk factors were: assessment of stroke risk/risk factors (N = 4); provision of advice and information on reducing lifestyle related risk (N = 16); education and counselling for lifestyle behaviour change (N = 8) and onward referral for specialist management of risk (N = 4). Of the nine stroke audits/registries identified, only three (33%) included non-pharmacological, non-surgical quality indicators of documented provision of advice or information on the following: general lifestyle (N = 2); smoking cessation for current smokers (N = 2); reduction in alcohol consumption, where relevant (N = 1), exercise participation (N = 1) and diet (N = 1). Preventive quality indicators addressing the management of weight, stress or depression were absent. This review highlights current gaps in optimal stroke secondary prevention recommendations and their implementation.

BACKGROUND: Dying at home is the preference of many patients with life-limiting illness. This is often not achieved and a key factor is the availability of willing and able family carers. AIM: To elicit family carers' views about the community support that made death at home possible. DESIGN AND SETTING: Qualitative study in East Devon, North Lancashire, and Cumbria. METHOD: Participants were bereaved family carers who had provided care at the end of life for patients dying at home. Semi-structured interviews were conducted 6-24 months after the death. RESULTS: Fifty-nine bereaved family carers were interviewed (54% response rate; 69% female). Two-thirds of the patients died from cancer with median time of home care being 5 months and for non-cancer patients the median time for home care was 30 months. An overarching theme was of continuity of care that divided into personal, organisational, and informational continuity. Large numbers and changes in care staff diluted personal continuity and failure of the GPs to visit was viewed negatively. Family carers had low expectations of informational continuity, finding information often did not transfer between secondary and primary care and other care agencies. Organisational continuity when present provided comfort and reassurance, and a sense of control. CONCLUSION: The requirement for continuity in delivering complex end-of-life care has long been acknowledged. Family carers in this study suggested that minimising the number of carers involved in care, increasing or ensuring personal continuity, and maximising the informational and organisational aspects of care could lead to a more positive experience.

© 2018, The Author(s) 2018. Background: Internationally, evidence on the support needs of family carers who look after a terminally ill adult in home settings is incomplete. Aim: To illustrate the relevance of ‘relevant background worries’ in family carers’ accounts of caring at home for a dying adult. Design: A qualitative cross-sectional observational study was conducted in England, United Kingdom, in 2011–2013 on the experiences of adult family carers (n = 59) of older dying adults (aged 50+ years) with malignant and/or non-malignant conditions. Interviews occurred post-bereavement. This article reports on a subset of participants’ interview transcripts (n = 30) where narrative analysis was undertaken. Setting/participants: Carers were interviewed in their home setting, having been purposively recruited via general practitioner practices in two study sites in England. The subset of participants (n = 30) was purposively selected from the parent sample with reference to carers’ age, relationship to the patient, family circumstances and study sites. Results: Evidence is provided on the importance of what we conceptualise as carers’ ‘relevant background worries’; these varied in nature, significance and impact. Four case studies are presented where these worries constituted psychosocial factors that impacted on caregivers’ actions and emotional well-being. Two themes are discussed: (1) whether relevant background worries are important enough to be identified and responded to and (2) how such worries could be picked up and managed by professionals. Conclusion: It is argued that the quality of clinical practice could be improved if specialist palliative care teams in community contexts both identified and responded to significant support needs associated with family carers’ relevant background worries.

The validation of McGill quality-of-life questionnaire (MQOLQ) in mainland China, which had already been used in multicultural palliative care background including Hong Kong and Taiwan, remained unknown. Eligible patients completed the translated Chinese version of McGill questionnaires (MQOL-C), which had been examined before the study. Construct validity was preliminarily assessed through exploratory factor analysis extracting 4 factors that construct a new hypothesis model and then the original model was proved to be better confirmed by confirmatory factor analysis. Internal consistency of all the subscales was within 0.582 to 0.917. Furthermore, test–retest reliability ranged from 0.509 to 0.859, which was determined by Spearman rank correlation coefficient. Face validation and feasibility also confirm the good validity of MQOL-C. The MQOL-C has satisfied validation in mainland Chinese patients with cancer, although cultural difference should be considered while using it.

Background: To manage their disease, patients with chronic obstructive pulmonary disease (COPD) may need to modify their behaviour as smoking, exercise, medication and self management can all impact on outcomes. We examined the information needs of patients in Devon recruited in primary care using the Lung Information Needs Questionnaire (LINQ). There are six domains (disease knowledge, medicines knowledge, self-management, smoking, exercise, and diet). Methods: An electronic assessment and management package was devised for use by visiting nurses in 16 practices in Devon, UK. In a comprehensive assessment, data collected included spirometry, clinical data and questionnaires: LINQ, Clinical COPD questionnaire, MRC dyspnoea scale. Results: Data were obtained from 375 patients with confirmed COPD and LINQ was completed by 340. The domain score disease knowledge was correlated with disease severity—those with more severe disease had been given more information: Pearson coefficients with FEV1% expected were 0.22, p<0.001; MRC dyspnoea scale −0.20, p = 0.001; total CCQ score −0.26, p<0.001. In some areas information needs were well met—in current smokers 93% had been advised to stop smoking and 80% had been given practical help such as nicotine therapy. Only 7% were confused about their medication and 93% tried to take their medication exactly as prescribed. However, written action plans were given to 56/335 (17%), and were provided less often to those most at need, only 2/25 (8%) with A&E attendances and 4/25 (16%) of those admitted in the last year. Only 5/24 (21%) with hospital admissions knew when to call an ambulance. For exercise, 29% had information needs adequately met, but for the most breathless (MRC grade 4 and 5) the figure was only 20%. For diet, those with low BMI (<20) are at greatest risk, of these 55% had been told nothing about diet. Conclusions: Education for patients with COPD is important to the patients and may affect outcomes. In this study, it appears that smoking and medicines information needs are well met, but self-management and exercise are poorly focused on those with greatest need.

UNLABELLED: BACKGROUND: Recent end of life care policy prioritises patient choice over place of care and in particular promotes dying at home. This policy is predicated on the assumption that there are family carers able and willing to provide care for the dying person. Through the accounts of bereaved family members, the 'Unpacking the home' study aims to gain an in-depth understanding of 'home' and the issues faced by family members caring for a dying older person at home; it also aims to examine the way the home is transformed in the process of providing end of life care, and offer a critical analysis of policies that aim to increase home deaths. This paper presents the protocol for this study. METHODS/DESIGN: A cross-sectional qualitative study has been designed to achieve the study aims. In-depth interviews will be conducted in the north and south of England with 50 bereaved family carers to elicit their accounts of witnessing the dying in the home of an older person (50+ years). All interviews will be subjected to thematic analysis, and narrative analysis will be undertaken on a subset of 30 interview transcripts. A final phase of integration and policy analysis will be conducted towards the end of the study. User involvement is integral to this study, with service users actively engaged at every stage. DISCUSSION: This study will seek to take a qualitative approach by explicitly recognising that family carers are central to the experience of dying at home for older people, and they have needs that may be amenable to support and anticipatory planning. The strengths of this study, which include its interdisciplinary and participatory approach, and in-depth data collection and analysis methods, will be explored. The limitations and challenges of this research will also be considered. This study seeks to make recommendations that will ensure that family carers receive appropriate and adequate support in caring for their loved ones at the end of life.

This qualitative study explored Chinese patients' subjective experience of posttraumatic stress following stroke (i.e. post-stroke PTSD). Two focus groups were conducted to explore post-stroke PTSD symptoms, patient self-image and future hope and beliefs about the occurrence of stroke. Content analyses revealed that most patients manifested intrusion and avoidance symptoms, and felt distressed and guilty due to loss of physical functioning and independent living. Most patients had low self-esteem and felt life was meaningless, while some struggled to maintain a glimmer of hope for recovery. Most patients believed in a physical cause for their stroke, while some believed in predetermined fate.

Objectives The purpose of this study was to assess feasibility and acceptability of a stroke-specific mindfulness-based intervention called Helping Ease Anxiety and Depression after Stroke (HEADS: UP). Method This study was a mixed-methods pilot randomized controlled trial comparing HEADS: UP to treatment as usual (TAU). HEADS: UP is a 9-week mindfulness intervention for stroke survivors. UK (United Kingdon)-based stroke survivors were recruited and attended HEADS: UP Online. Psychological functioning outcomes measures and other data were collected online at pre-intervention (Week 0), post-intervention (Week 9), and follow-up (months 3 and 6). Participants were randomized 1:1 to either HEADS: UP or TAU. Results Sixty-two participants completed baseline questionnaires and were randomized to HEADS: UP (n = 30) or TAU (n = 32). Retention rates were as follows: HEADS: UP (n = 25, 83.30%) versus TAU (n = 25, 78.10%) at post-intervention, HEADS: UP (n = 24, 80%) versus TAU (n = 26, 81.30%) at 3-month follow-up, and HEADS: UP (n = 20, 66.70%) versus TAU (n = 25, 78.10%) at 6-month follow-up. The mean age for HEADS: UP was 56.0 years versus 56.80 for TAU. The HEADS: UP group was 30% male, while the TAU group was 56% male. Depression Anxiety Stress Scales (DASS)-21 total mean score for HEADS: UP improved in the direction of expected effect (baseline 46.20, SD (standard deviation) = 24.00; post-intervention 24.00, SD = 16.10) indicating recovery versus no reliable change for TAU (baseline 36.10, SD = 18.70; post-intervention 31.60, SD = 20.40). HEADS: UP and TAU scores continued to improve over time. Between-group effect sizes (Cohen’s d) at post-intervention were large for BAI (Beck Anxiety Inventory) (d = 0.91), DASS-21 total (d = 0.89), and BDI (Beck Depression Inventory)-II (d = 0.86), highlighting the potential of HEADS: UP for improving depression and anxiety symptoms. At the six-month follow-up, the attrition rate was higher in the HEADS: UP group (33.30%) compared with TAU (21.90%). Conclusions HEADS: UP is feasible and acceptable and has potential to improve depression and anxiety symptoms for stroke survivors. Preregistration ClinicalTrials.gov: NCT04985838.

This qualitative study investigated the secondary traumatic stress (STS) of Chinese primary caregivers who cared for patients with stroke by means of two focus group discussions. The latter focused on understanding STS symptoms and how the stroke affected caregivers' future plans, life-style, financial status, emotional/physical well-being and relationships with patients. Content analyses revealed primary caregivers displayed STS symptoms of intrusion and avoidance, and that caring for their beloved ones changed their life-style, future plans and increased financial burden. Surprisingly, caregivers' relationship with patients had been strengthened as a result of the continuous care, which, however, negatively affected caregivers' emotional/physical well-being.

OBJECTIVE: To explore how bereaved family members recall managing end of life medications when delivering care to a patient dying at home in England. DESIGN: Qualitative study. SETTING: Domestic homes in two contrasting areas in England. PARTICIPANTS: 59 bereaved family carers who have delivered care to a patient who spent a minimum of 2 weeks at home prior to their death from cancer or other non-malignant condition. Cases were excluded if the place of death was: a hospice, nursing home or National Health Service (NHS) hospital. RESULTS: Participants identified a number of important concerns about managing end of life medication for the dying person at home. Although some support with medications is provided by general practitioners and nurses in the community, family carers take primary responsibility for drug administration and storage. They reported anxiety about giving correct and timely dosages, and concerns about keeping the patient comfortable without overdosing them or risking shortening their lives. In particular, they reported that certain analgesic medications, especially opioids, were considered to have a symbolic significance increasing analgesia requirements, and the use of a syringe driver was associated with deterioration and approaching death. Key barriers to managing end of life medications at home included: complex regimes; unwanted responsibility in deciding when to use 'as needed' medication; disagreements with professional staff, and anxiety about medication errors, especially if perceived to have implications for survival. CONCLUSIONS: Family carers require more information about end of life drugs and their effects, support and training in managing medication for a dying person.

Background Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial. Methods We recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could ‘enrol’ a family member/ ‘other’ to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement. Results Study 1 Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention. Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2 Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention. Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward.

BACKGROUND AND PURPOSE: Post-stroke anxiety and depression symptoms are common after stroke and can persist long-term. Despite this, there is a lack of long-term psychological support for post-stroke anxiety and depression. Mindfulness-based interventions are emerging as feasible, acceptable and potentially effective interventions for post-stroke anxiety and depression. Sustained use of mindfulness practice can help stroke survivors to self-manage their anxiety and depression in the long-term. However, stroke survivors' experiences of continued practice following a mindfulness-based intervention have yet to be explored. This study aims to identify mechanisms underpinning sustained mindfulness practice by stroke survivors following completion of an adapted, stroke-specific mindfulness-based intervention called HEADS: UP (Helping Ease Anxiety and Depression After Stroke). MATERIALS AND METHODS: A secondary analysis of 6-month follow-up qualitative data from course participants (n = 12) in the HEADS: UP randomised controlled trial was analysed using critical realist thematic analysis. RESULTS: Seven mechanisms were identified as determining sustained mindfulness practice: 1) Believing continued practice brings benefits, 2) Personal preferences and accessibility, 3) Continued learning, 4) Attitudes of others and society, 5) Togetherness and connection, 6) Structuring and scaffolding practice, and 7) Competing priorities. CONCLUSION: The mechanisms provide explanations behind stroke survivors' experiences of sustained mindfulness practice following HEADS: UP. The findings highlighted the potential benefit of providing support following a mindfulness-based intervention to facilitate sustained practice. Awareness of the mechanisms could aid future intervention design and help clinical practitioners and stroke support professionals support continued mindfulness practice.

The Care Certificate was developed to support healthcare assistants (HCAs) in providing care with compassion following the Francis report (2013) which found instances of poor care in one National Health Service (NHS) Trust. The Report recommended that HCAs develop the skills of reflection for learning. Previously, the practice of reflection was the preserve of the professional. This study is the first to explore the effects of facilitated reflective learning (the process of learning from one’s experiences through the facilitation of a more experienced professional) for hospital based (non-professional) HCAs.  A constructivist case study approach was undertaken involving semi-structured interviews with twenty-five HCAs who attended facilitated reflective groups as part of their Care Certificate course. Their data were supplemented with documentary analysis and interviews with seven nurse-educators. Findings indicate that the work environment in the case Trust focused on physical labour and was more suited to the non-reflective learning of standards and tasks, which Francis (2013) warned could contribute to non-compassionate care. The groups provided a supportive environment which facilitated the development of softer skills associated with emotional labour thereby emancipating the HCAs. The facilitated reflective group sessions for HCAs helped transform their approach to practice from task-focused to care-focused. These findings are especially pertinent with the national HCA workforce currently providing around 60% of direct patient care. It is recommended that Trusts, educationalists and policymakers consider utilising facilitated reflective learning groups for their HCA workforce, especially in Trusts where staff are resorting to task based care due to nursing shortages and high dependency/turnover of patients. The case Trust mirrored such circumstances. This study confirms that the provision of facilitated reflective learning groups for HCAs provides a more supportive, empowering learning environment in which HCAs are enabled to be more caring and compassionate.

Background: The present research examined the perceived feasibility, acceptability and effectiveness of using a set of multi-component tailored relaxation techniques administered on a relaxation DVD for stroke survivors, including those with aphasia.  Method: A mixed-methods design was utilised during a two-phase study. During T1 38 stroke survivors completed baseline questionnaire measures and were presented with the relaxation techniques delivered on a relaxation DVD within their support group setting. Participants received a copy of the DVD to practice twice a day, five times a week at home over the 4 weeks. They then returned to T2 to complete the follow-up measures (n=24 at T2). Focus group discussions/interviews were also conducted at the end of T2.  Results: Qualitative findings portray stroke survivors perceived the set of tailored relaxation techniques as feasible to practice and appropriate for those who have experienced stroke. They demonstrate a perceived effectiveness of the techniques in relation to their confidence and in feeling less anxious/stressed. However, only their situation-specific confidence scores showed an improvement after using the relaxation techniques. All of the techniques are deemed useful, however certain techniques are perceived as more effective in inducing relaxation. Generally, survivors appeared to prefer practicing at home as opposed to the group setting, yet they outline potential benefits of group activities.  Conclusion: This feasibility study provides a basis for a larger, future research study to test the effectiveness of multi-component, tailored relaxation techniques on stroke survivors’ confidence, anxiety and distress levels. The evidence regards the tailored relaxation techniques as a promising, feasible and appropriate intervention for stroke survivors, although a lower frequency of practice would be helpful.

Following publication of the original article [https://doi.org/10.1186/s40359-022-00954-x], some formatting and data entry errors were identified in Table 10, ‘Correlations between creativity and wellbeing variables’: The p-value for the correlation between overall originality and negative affect should not have been formatted in bold; The p-value for the correlation between OKC raw score and life satisfaction should not have been in bold either; The correlation between OKC raw score and mental health should be − 0.024; The correlation between negative affect and mental health should be − 0.490.

BACKGROUND: The relationship between wellbeing and personality has been studied extensively, but few studies have examined these in the period of adolescence and emerging adulthood. Moreover, the influence of contextual factors such as engagement in leisure activities are rarely considered. METHODS: The present study employs a combination of frequentist and Bayesian analyses to evaluate the concurrent impact of personality traits and leisure activities on five conceptions of wellbeing (life satisfaction; positive affect; negative affect; mental health; flourishing) in three cohorts of young people (aged 14-15; 16-17; 18-20 years). RESULTS: Personality traits were the only significant predictors of life satisfaction and negative affect, but leisure activities in the form of socialising or physical activity, in addition to personality traits, predicted positive affect, mental health and flourishing. Neuroticism was the largest predictor of wellbeing overall, whereas conscientiousness was the most consistent. Lower levels of wellbeing were also associated with higher levels of creative potential. CONCLUSIONS: The study not only confirms the importance of personality traits as predictors of wellbeing in adolescents and young adults, but also indicates the necessity to consider the impact of leisure activities in different conceptions of wellbeing. The negative relationship between creative potential and wellbeing is in line with the literature which shows a link between mental illness, particularly at subclinical levels, and creativity.

Objective: Studies on psychological techniques to reduce stroke-related anxiety and/or distress are limited. More scarce is research on tailoring such techniques to suit stroke survivors’ needs, including the needs of those with aphasia. To address this gap, we report two sequential studies. Study 1 explored preferred psychological techniques (i.e., mindfulness and relaxation) and ways to modify them for stroke survivors, including those with communication difficulties. Study 2 examined the feasibility and acceptability of these modified techniques with a new sample of survivors. Design: Mixed-methods using qualitative and quantitative approach in both studies.

Previous research has examined how creative potential develops during childhood and has identified peaks, slumps, and bumps during maturation. However, little is known about the causes of such changes. This study employed a longitudinal approach to assess predictors of change in creative ideation over 2 years in young people (N = 76) aged 14–20 years old at the first time point. The analysis employed frequentist and Bayesian methods to evaluate the effect of individual factors, such as openness to experience (assessed using the BFI‐10 short form), and contextual factors, such as pursuing creative hobbies (measured with a leisure questionnaire). Openness at the first time point and change in openness over time predicted change in peak originality. Engagement in creative hobbies at the first time point predicted change in fluency. The findings support the contribution of individual factors, in the form of openness to experience, and contextual factors, in the form of engagement in creative hobbies, in the development of divergent thinking abilities in mid‐adolescence and young adulthood. Altogether, this study suggests that interventions aimed at increasing time spent on creative activities and promoting openness to experience may enhance divergent thinking abilities, which are essential components of creative potential.

Abstract

Stroke survivors with aphasia (SsWA) tend to experience high levels of anxiety and stress, leading to an increased risk of recurrent strokes. Mindfulness and/or relaxation that does not require language outputs could reduce psychosocial stress; however, these approaches work best if they consist of a range of techniques and are modified to suit the needs of SsWA. Using a mixed-methods approach, we examined the feasibility and acceptability of a set of tailored mindfulness and relaxation techniques for SsWA. Nine SsWA were recruited (six men and three women, median age = 51 years). Four relaxation and mindfulness techniques which had been tailored for SsWA were filmed into a DVD/YouTube video and were given to participants together with a practice diary for home practice once daily for 5 weeks. The participants joined focus group discussions and completed a feasibility scale 5 weeks later. The participants perceived these techniques as easy, user-friendly and acceptable for SsWA in general. Although practised less often than instructed, many participants reported benefits of regular practice. The perceived relevance of these techniques to the participants' own situations and the intention to continue varied. Future research could encourage the regular practice of self-help interventions by incorporating behavioural change techniques such as using prompts and cues.

Stroke survivors and informal caregivers experience high levels of stress and anxiety, linked to heightened risk of secondary stroke in survivors. Relaxation and mindfulness could reduce stress and anxiety; being most effective when tailored to the target populations. Aims of the PPI include to: (1) consult on possible alterations to an existing relaxation and mindfulness intervention, delivered via YouTube/DVD and (2) discuss relevance and preference of prompts and cues designed to facilitate the daily practice of the intervention. Eleven UK PPI contributors were consulted during 2020: four stroke survivors (F = 2, M = 2), three caregivers (F = 1, M = 2), and four HCPs (F = 4) (range = 23–63 years). Contributors watched the existing intervention and provided feedback via online discussions. Transcripts were analysed using thematic analysis. Five themes were identified, highlighting several necessary alterations to the intervention: “Who represents the stroke population?”; “The paradox of age”; “Specifically selected language”; “Visual presentation of the intervention”; and the “Audio qualities”. Contributors ranked the prompts and cues in order of preference with setting alarms and email alerts as the most popular. The PPI consultations resulted in several alterations enabling a revised version of the intervention. Including a PPI consultation at an early stage of the research improves the relevance and appropriateness of the research. The revised intervention is more representative of the stroke population thus more likely to be practised by survivors and caregivers, which will enhance the extent of effectiveness, reducing the risk of a secondary stroke.

The development of creativity in young children has been studied extensively, but relatively few studies have examined the period of adolescence and emerging adulthood in relation to creative potential. The present study employs a combination of frequentist and Bayesian analyses to evaluate the impact of individual factors (e.g., IQ) and contextual factors (e.g., pursuit of creative hobbies) on creative ideation in three cohorts of young people aged 14-20 years. Measures of divergent thinking, specifically the Alternate Uses Task (AUT) and the Overcoming Knowledge Constraints Task, were used to this end. Openness to aesthetic and imaginative experience was the strongest predictor of creative potential for the three AUT measures. Moreover, Bayesian hypothesis testing revealed that the best predictive model for AUT ideational fluency and AUT overall originality was one that included only Openness, whereas the best predictive model for AUT peak originality, or the propensity to generate highly original responses, included Openness, as well as IQ and Engagement in Creative Hobbies. No group differences in creative potential were found between the three age cohorts (aged 14-15, 16-17, and 18-20). The study not only confirms the importance of openness to aesthetic and imaginative experience as a predictor of creative potential in adolescents and young adults, but also indicates the necessity to consider the combined and differentiated impact of individual and contextual factors in different facets of creative ideation.

The literature has focused on women’s use of online support for perinatal mental health. However, research exploring the scope of available well-being services and the views of healthcare professionals (HCPs) who deliver this provision is extremely limited. This study focused on HCPs’ experiences providing online perinatal mental health and well-being support. Based on interviews with eight UK-based HCPs providing various forms of online perinatal mental health and well-being support, reflexive thematic analysis distilled four themes that captured experiences and perceptions of online provision: 1) New ways of working bring new opportunities; 2) Obstacles and areas for development; 3) Bridging the gap— formal and informal peer support; and 4) Too little too late: lack of mental health education in antenatal services. HCPs indicated that blended ways of working (online and face-to-face) were valuable within their services. Findings emphasize the need for online support services to be available to new and expectant mothers who may not require an HCP referral. The versatility, convenience, and accessibility of online resources bridge the gap between face-to-face services and a viable economic and effective form of mental health provision. Keywords: postpartum, mental health, health professionals, online support

© 2020 American Psychological Association. The development of creativity in young children has been studied extensively, but relatively few studies have examined the period of adolescence and emerging adulthood in relation to creative potential. The present study uses a combination of frequentist and Bayesian analyses to evaluate the impact of individual factors (e.g., IQ) and contextual factors (e.g., pursuit of creative hobbies) on creative ideation in three cohorts of young people aged 14-20 years. Measures of divergent thinking, specifically the Alternate Uses Task (AUT) and the Overcoming Knowledge Constraints Task, were used to this end. Openness to aesthetic and imaginative experience was the strongest predictor of creative potential for the 3 AUT measures. Moreover, Bayesian hypothesis testing revealed that the best predictive model for AUT ideational fluency and AUT overall originality was one that included only Openness, whereas the best predictive model for AUT peak originality, or the propensity to generate highly original responses, included Openness, as well as IQ and Engagement in Creative Hobbies. No group differences in creative potential were found between the three age cohorts (aged 14-15, 16-17, and 18-20). The study not only confirms the importance of openness to aesthetic and imaginative experience as a predictor of creative potential in adolescents and young adults, but also indicates the necessity to consider the combined and differentiated impact of individual and contextual factors in different facets of creative ideation.

The perinatal period can be challenging and yet reluctance to disclose wellbeing concerns to health professionals is well documented. The current study sought to explore how women use online parenting forums to seek advice and support for maternal mental health concerns. Forum threads (n = 153) from a popular UK parenting website were analysed to explore postpartum mothers’ discussions about their maternal mental health. Through reflexive thematic analysis, four themes were generated: (1) Navigating the motherhood role: unprepared and overwhelmed; (2) ‘I’m struggling, but looking on here I know I’m no way alone!’; (3) Challenging feelings of failure: ‘it doesn’t make you a bad mother’; and (4) Forums facilitate help seeking. There were two main findings; first, forums may act as a potential solution to providing a supportive, reassuring community and safe space for disclosure around maternal mental health concerns. Furthermore, forums are beneficial in providing women with an honest, realistic view and expectation of motherhood, thus supporting their transition to parenthood. Consequently, forums could be utilised to inform training for healthcare professionals to understand disclosure barriers.