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Publications (3)
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Factors affecting the quality of life of adults living with Congenital Adrenal Hyperplasia: A qualitative study of lived experience
22 April 2026
Endocrine Connections Bioscientifica
James KL, Parkin N, Elford S, McKnight C, Phillips R, Pickles T, Ahmed SF, Krone N, Llahana S, O’Reilly M, Tomlinson JW, Rees DACongenital adrenal hyperplasia (CAH) is a genetic condition caused by enzymatic defects of adrenal steroidogenesis. The physical manifestations of CAH are well recognised but the effects on health-related quality of life (HRQoL) are unclear. We sought to explore the factors impacting the HRQoL of individuals with CAH. Phenomenological qualitative study of lived experience. In-depth, timeline-assisted, semi-structured interviews were undertaken virtually with participants recruited via the Living with CAH patient support group. Participants, purposively selected until data saturation, were adults (≥18 years) with CAH and parents/partners of adults with CAH. Interviews were audio-recorded, transcribed verbatim and analysed using Framework Analysis. Twenty-three participants were interviewed (20 classic, 1 non-classic, 2 mothers). Most participants (n=19) were female. CAH has a profound physical, psychological and psychosocial impact on individuals. The psychological wellbeing of women was compromised by trauma from childhood medical examinations and lack of agency in treatment decision. Poor self-esteem, shame and negative body image impaired female social functioning. Female sexual dysfunction from genital malformation/surgery and psychosexual issues negatively impacted intimate relationships. Fertility and reproductive choices were a concern to both sexes. Complex family dynamics with dependent relationships was evident. This study identified a breadth of factors impacting HRQoL in CAH – domains overlooked by an existing measure which predominantly focus on physical symptoms. Further work is needed to develop a sensitive, comprehensive disease-specific HRQoL measure which reflects the lived experience of individuals with CAH to facilitate delivery of patient-centred care and improved patient outcomes.Objective
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‘A completely different space’: Teachers' perspectives on disadvantage, access to nature and outdoor learning
07 January 2026
British Educational Research Journal Wiley
Parkin N, Hobson K, Poortinga W, Stead M, Newth J, Reeves J, Gattis MAbstract
This study examined teachers' perspectives on how children benefit from time in nature, how disadvantage shapes access and the role of schools in facilitating such access. Drawing on interviews conducted in 2022 with 25 UK primary school teachers who participated in Generation Wild, a nature connection programme for schools in economically disadvantaged areas, the research explored how outdoor learning might support children's wellbeing and recovery in the aftermath of the COVID‐19 pandemic. The study identified four themes using reflexive thematic analysis: (1) nature's positive impact on children's wellbeing and behaviour; (2) disadvantage as a persistent barrier to access to nature; (3) nature's role in supporting post‐pandemic recovery; and (4) systemic constraints on outdoor teaching. Teachers described natural environments as ‘a completely different space’ for children, offering calm, freedom and emotional expression, and consider this particularly valuable for those most affected by the impacts of the pandemic. However, they expressed frustration at their limited ability to incorporate outdoor learning in the curriculum, despite recognition of its benefits. Many linked the pandemic to widening inequalities in access to nature and called for more sustained, supported engagement. The results highlight a disconnect between teacher values and educational structures and call for systemic change to prioritise nature‐based teaching and learning.
Making outdoor learning accessible and inclusive for children with special educational needs and disabilities (SEND): a case study
19 December 2025
Journal of Adventure Education and Outdoor Learningahead-of-print(ahead-of-print):1-20 Informa UK Limited
Godwin E, Jarvis L, Parkin N, Poortinga W, Hobson K, Stead M, Reeves J, Marshall M, Gattis MOutdoor learning enhances children’s academic performance, social communication, and well-being. Accessible and inclusive opportunities for outdoor learning are essential for children with Special Educational Needs and Disabilities (SEND) to experience these benefits. This case study applied the Universal Design for Learning (UDL) framework to evaluate the accessibility and inclusivity of outdoor learning programmes. The study involved qualitative interviews with expert outdoor learning staff at three WWT wetland centres in the UK. Reflexive thematic analysis identified four themes: resources and adaptations, communication with schools, staff approach to inclusion, and balancing needs. The findings highlight factors that shape the accessibility and inclusivity of outdoor learning provision for children with SEND. The study demonstrates how UDL can inform inclusive and proactive approaches to outdoor education, offering a model for organisations seeking to enhance the accessibility of their outdoor learning programmes. We conclude with recommendations for practitioners to support belonging for all children.
