Consistent uptake and implementation of evidence-based CBT (EB-CBT) in clinical practice remains challenging. Understanding key barriers and facilitators experienced by CBT therapists is essential for developing effective implementation strategies to enhance adoption of EB-CBT practices. This study applies the Capability, Opportunity, Motivation-Behaviour (COM-B) and Theoretical Domains Framework (TDF) to provide a theoretically driven exploration of perceived barriers and facilitators to implementing EB-CBT reported by CBT therapists. A cross-sectional survey design incorporating qualitative open-ended questions was used to gather in-depth insights from 228 UK-based CBT therapists. Data were analysed using reflexive thematic analysis. Inductive analysis identified ten barriers and eight facilitators, which were deductively mapped onto the COM-B and TDF to identify key determinants affecting practice at the individual therapist or broader organisational level. At the therapist level, barriers identified were understanding of evidence-based decision making, scepticism about EB-CBT as being rigid, based on flawed evidence, and lacking client centredness, and a preference for intuitive eclecticism. Therapist facilitators included skills in research literacy and formulation, guided self-reflection as a behaviour regulation strategy, and reinforcement through positive outcomes. Organisational barriers were limited or complex research/guidelines, difficulty accessing knowledge, lack of training/supervision, and service constraints. Organisational facilitators consisted of external monitoring as a behavioural regulation strategy, fostering communities of practice, gaining knowledge through resources, and access to training/supervision. Key perceptions as well as misconceptions around using EB-CBT in practice were identified, highlighting the need for multi-level strategies addressing both individual and organisational factors to enhance therapists’ capability, motivation, and opportunity to adopt EB-CBT practices.

As a result of reading this paper, readers should:

1. (1) Understand the key barriers UK therapists perceive as hindering the implementation of evidence-based CBT practices.

2. (2) Understand the key factors UK therapists perceive as facilitating and enhancing the implementation evidence-based CBT practices.

3. (3) Be able to use the COM-B and TDF model to map key determinants affecting adoption of evidence-based CBT practice at both the individual therapist and broader organisational level.

4. (4) Consider theoretically driven implementation interventions which could be used to target identified individual and organisational factors to improve sustained adoption of EB-CBT.

Trauma plays a critical role in psychosis, but the nature of the relationship between specific symptoms and trauma history remains unclear.

The aim of the study was to explore the experience of positive symptoms and their association with trauma and life events from the perspective of patients with first-episode psychosis (FEP).

Seventeen participants who were enrolled in an FEP programme participated in a qualitative interview examining their life and trauma events, the onset of their symptoms, their experience of positive symptoms and their perceived associations between symptoms and life and trauma events. The interview was based on a semi-structured interview of six main questions and follow-up questions. Participants also completed the Trauma and Life Experiences Checklist (TALE), and were asked about the relevance of the whole interview. Thematic content analysis, exploratory cluster analysis and matrix queries coding were performed.

Fifteen participants described the experience of psychotic symptoms as distressing or traumatic. Eleven participants attributed the onset of positive psychotic symptoms to trauma and life events. Ten participants described explicit thematic associations between their symptoms and trauma and life events. Twelve participants evaluated the interview as relevant and helpful.

Our findings give insight into the lived experience of positive symptoms and potential psychological interventions valuing causal theories of participants and the association with life and trauma events.

Nut consumption is low, with concern regarding weight gain as a barrier to intake. However, evidence indicates no association between nut consumption and body weight. The metabolisable energy of nuts may partly explain this phenomenon. This study aims to qualitatively explore perceptions of presenting nut metabolisable energy on nutrition labels, and the potential influence this may have on consumption.

Semi-structured focus groups and interviews, with an inductive, reflexive approach to thematic analysis.

Online (Australia).

18 years or older, with either no formal nutrition education (consumer group) or formal training and working in nutrition/dietetics, public health, food industry, food regulation or nut growing (stakeholder group).

Four focus groups and nine interviews consisting of twenty participants (n 8 consumers, n 12 stakeholders) in total were conducted. Five major themes were generated: (i) knowledge of nuts varies, and the healthfulness of nuts is conditional on use and preparation, (ii) nuts are versatile in the diet; the intake is low, (iii) consumers perceive over-eating nuts leads to weight gain, while stakeholders consider the whole dietary pattern, (iv) nutrition labelling is confusing for consumers and needs to be transparent and positively framed, if used and (v) knowing nut metabolisable energy will have limited perceived impact on nut consumption and advice and is dependent on the individual and product.

The findings suggest that perceptions of presenting nut metabolisable energy on labels are multi-layered, indicating this strategy may not be straightforward in resolving concerns about weight. Other strategies should be considered to promote nut consumption.

This study aims to explore the everyday experiences of people living with Lewy body dementia and their families, to deepen understanding of their care needs. Lewy body dementia is a neurodegenerative condition associated with shorter life-expectancy and poorer quality of life than other forms of dementia. Cognitive fluctuations, visual hallucinations, falls, and motor features of Parkinsonism gives rise to complex and debilitating symptoms. Other prominent features include behavioral and emotional problems, rapid eye movement sleep disorder, and autonomic dysfunction. Improving palliative care for people with dementia continues to be an international priority; however, little is known as to how a palliative care approach could support people living with Lewy body dementia and their families.

Drawing on narrative theory of self and personhood, a qualitative, longitudinal narrative approach provided unique insights into 5 couples’ experiences of living with Lewy body dementia. Analysis was conducted using Murray’s levels of narrative analysis in health psychology to explore stories at the personal, interpersonal, positional, and societal level.

Participants with Lewy body dementia described losses associated with communication, continence, and energy leading to a progressive loss of independence. For their family caregivers a loss of companionship was particularly salient. These losses, compounded by a perceived lack of clinical support, resulted in suffering both for the person with Lewy body dementia, and for those close to them.

There has been a societal and political shift to move beyond loss in dementia, to a focus on abilities and living well. However, acknowledging loss, while supporting symptom management is an important aspect of Lewy body dementia care. Providing person-centered, palliative supportive care throughout the disease trajectory could reduce suffering and enhance well-being.

A diagnostic label can have harms and benefits, particularly when provided following routine health screening tests. Whether these are discussed in clinical encounters is unknown.

To investigate whether potential impacts of diagnostic labelling are discussed before routine screening for non-cancer health conditions and explore the perceived value of such discussions by general practitioners (GPs) and healthcare consumers.

Eleven semi-structured interviews with GPs and two focus groups with eight consumers were conducted. Interviews and focus groups were audio-recorded, transcribed and analysed using thematic analysis methods based on framework analysis.

Prior to routine screening, most GPs did not discuss the potential consequences of diagnostic labelling, and no consumer recalled discussions of this nature. In contrast, many GPs provided information regarding the screening procedure and possible test limitations. Both GPs and consumers identified that it would be valuable to discuss the potential impacts of a diagnostic label; however, preferences varied as to the content and timing (i.e. before or after screening) of this discussion. Six themes that examine the utility of discussing the consequences of diagnostic labelling were identified: patient empowerment, patient variability, condition-specific information, GP and patient interactions and relationship, GP role and responsibilities, and characteristics of screening.

The practice and perceived value of discussing diagnostic labelling consequences were recognised as important by both GPs and consumers. However, preferences regarding the content of discussions and whether these occurred in clinical encounters before or after screening varied.

1. (1) Following reading this paper, readers will better understand the diagnostic and practice-based complexities involved in assessing traumatic events as a Psychological Wellbeing Practitioner (PWP) in an NHS Talking Therapies service.

2. (2) Readers will also be aware of the emotional challenges PWPs in this service have reported experiencing as a result of assessing service users that report having experienced traumatic events.

3. (3) The reader will also learn about PWPs’ perspectives on what could improve this NHS Talking Therapies service’s processes involved in assessing traumatic events and reflect on whether this might be generalisable across other, similar services.

The purpose of this research was to understand perceptions and experiences of inclusion among underrepresented early-career biomedical researchers (postdoctoral fellows and early-career faculty) enrolled in the Building Up study. Because inclusion is vital to job satisfaction and engagement, our goal was to shed light on aspects of and barriers to inclusion within the academic workforce.

We used qualitative interviews to assess workplace experiences of 25 underrepresented postdoctoral fellows and early-career faculty including: their daily work experiences; sense of the workplace culture within the institutions; experiences with microaggressions, racism, and discrimination; and whether the diversity, equity, and inclusion (DEI) policies and practices at their institution enhanced their experiences. Using qualitative methods, we identified themes that highlighted high-level characteristics of inclusion.

Four distinct themes were identified: (1) participants appreciated the flexibility, versatility, and sense of fulfillment of their positions which enhanced feelings of inclusion; (2) greater psychological safety led to a greater sense of belonging to a research community; (3) participants had varied experiences of inclusion in the presence of microaggressions, racism, and discrimination; and (4) access to opportunities and resources increased feelings of value within the workplace.

Our findings provide new insight into how inclusion is experienced within the institution among underrepresented early-career biomedical researchers. This research points to specific approaches that could be used to enhance experiences of inclusion and to address barriers. More research is needed to understand how to accomplish a balance between the two, so that perceptions of inclusion outweigh negative experiences.

This study aimed to describe medical students’ perceptions and experiences with health policy and advocacy training and practice and define motivations and barriers for engagement.

This was a mixed-methods study of medical students from May to October 2022. Students were invited to participate in a web-based survey and optional follow-up phone interview. Surveys were analyzed using descriptive statistics. Phone interviews were audio-recorded, transcribed, and de-identified. Interviews were coded inductively using a coding dictionary. Themes were identified using thematic analysis.

35/580 survey responses (6% response rate) and 15 interviews were completed. 100% rated social factors as related to overall health. 65.7% of participants felt “very confident” or “extremely confident” in identifying social needs but only 11.4% felt “very confident” in addressing these needs. From interviews, six themes were identified: (1) participants recognized that involvement in health policy and/or advocacy is a duty of physicians; (2) participants acknowledged physicians’ voices as well respected; (3) participants were comfortable identifying social determinants of health but felt unprepared to address needs; (4) barriers to future involvement included intimidation, self-doubt, and skepticism of impact; (5) past exposures and awareness of advocacy topics motivated participants to engage in health policy and/or advocacy during medical school; and (6) participants identified areas where the training on these topics excelled and offered recommendations for improvement, including simulation, earlier integration, and teaching on health-related laws and policies.

This study highlights the importance of involvement in health policy and advocacy among medical students and the need for enhanced education and exposure.

Dignity is perceived as being valued and respected. Maintaining dignity throughout illness is a fundamental principle of palliative care. Dignity can be influenced through family caregiver’s communication, support, and acts of empathy or indifference among other factors. The perception of dignity and the practices adopted by family caregivers to preserve the dignity of their ill relative with serious illness in Lebanon are explored in this paper.

This is a part of a larger study that explored the understanding of dignity from patients’ and family caregivers’ perspectives in a palliative care context. Data collection involved in-depth interviews with 15 family caregivers. Interviews were analyzed using reflective thematic analysis.

Four main themes, that explained how family caregivers understand, and uphold their relative’s dignity during illness, were developed:

(a) Familial duty expressed through presence and compassion;

(b) Holistic care and financial stability;

(c) Social connection and family roles;

(d) Compassionate services and communication.

Family caregivers maintained the dignity of their ill relatives through being there, compassionate communication, supporting the personal and medical needs of the patient, and helping them preserve their family role. Family caregiving was often underpinned by religious values and a sense of duty. Compassionate services and effective communication were essential to preserve dignity of the ill relative during hospitalizations.

Family caregivers assume multiple roles in fostering the dignity of relatives with serious illnesses. It is crucial that family caregivers are supported by policies, healthcare systems, and community initiatives as patients cannot thrive nor sustain dignity without their support.

The recent wave of clinical trials of psychedelic substances among patients with life-limiting illness has largely focused on individual healing. This most often translates to a single patient receiving an intervention with researchers guiding them. As social isolation and lack of connection are major drivers of current mental health crises and group work is expected to be an important aspect of psychedelic assisted psychotherapy, it is essential that we understand the role of community in psychedelic healing.

To explore how psychedelic guides in the United States discuss the role of “community” in naturalistic psychedelic groups.

This is a secondary qualitative data study of data from a larger modified ethnographic study of psychedelic plant medicine use in the US. Fifteen facilitators of naturalistic psychedelic groups were recruited via snowball sampling. Content analysis was used to identify themes.

Participants viewed the concept of community as essential to every aspect of psychedelic work, from the motivation to use psychedelics, to the psychedelic dosing experience and the integration of lessons learned during psychedelic experiences into everyday life. Themes and subthemes were identified. Theme 1: The arc of healing through community (Subthemes: Community as intention, the group psychedelic journey experience, community and integration); Theme 2: Naturally occurring psychedelic communities as group therapy (Subthemes [as described in Table 2]: Belonging, authenticity, corrective experience, trust, touch).

Results suggest that existing knowledge about therapeutic group processes may be helpful in structuring and optimizing group psychedelic work. More research is needed on how to leverage the benefit of community connection in the therapeutic psychedelic context, including size and composition of groups, selection and dosing of psychedelic substances in group settings, facilitator training, and role of community integration. Psychedelic groups may provide benefits that individual work does not support.

Academic-community research partnerships focusing on addressing the social determinants of health and reducing health disparities have grown substantially in the last three decades. Early-stage investigators (ESIs), however, are less likely to receive grant funding from organizations like the National Institutes of Health, and we know little about the facilitators and barriers they face on their career journeys or the best ways to support them and their community research partnerships. This study examines ESIs’ experiences with a program that funded and supported their community-partnered pilot health disparities research.

Fourteen ESIs from five cohorts of pilot investigators participated in in-depth focus groups between April 2020 and February 2024. Two reviewers independently identified significant quotes and created codes. Thematic analysis was used to develop relevant themes.

The overarching theme was that the program was a launch pad for the ESIs’ research careers. Four distinct sub-themes contributing to the launch pad theme were: (1) ESI Growth & Adaptation; (2) Community and Support; (3) The Value of Collaboration and Partnership; (4) Need for Effective Mentorship. The results suggest the program offered ESIs and community partners substantial, unique support and resources, but challenges remained.

Future programs helping ESIs who conduct community-engaged research to launch their research careers should consider implementing tailored support while offering strategies to eliminate or reduce institutional barriers, including strengthening mentoring.

To explore mothers’ and early childhood (EC) educators’ experiences of breast-feeding/breast milk provision and breast-feeding support in child care centres (CCC) in the USA.

We conducted one-time, semi-structured phone interviews with mothers and EC educators to examine perceptions of support, accommodations and barriers to breast-feeding in CCC. We administered a background survey to assess participant characteristics and quantify perceived degree of breast-feeding support in the workplace (mothers) and CCC (mothers and EC educators).

US-based CCC

Fifty working mothers using CCC for their infants and twenty-two EC educators

Interview themes and background surveys reflected neutral feelings towards breast-feeding support received (mothers) and provided (EC educators) in CCC. Maternal expectations for breast-feeding support in CCC were generally low; workplace and social support for breast-feeding were perceived as the most important factors impacting breast-feeding. EC educators’ capacity to offer breast-feeding support was constrained by CCC infant feeding regulations, inadequate breast-feeding training and time limitations. Tensions arose when mothers attempted to manage low milk supply at the CCC level by requesting EC educators to individualise feeding or milk storage practices for their infant.

Breast-feeding efforts of working mothers are undermined in multiple settings, including the workplace and CCC. Improving breast-feeding outcomes for this population requires structural/policy changes that: (1) maximise opportunities for continued, direct breast-feeding and maternal/infant proximity and (2) enforce evidence-based CCC feeding protocols and standards and EC educator lactation training.

This study aimed to explore healthcare experiences of rural-living patients both with (attached) and without (unattached) a local primary care provider.

Primary care providers serve a gatekeeping role in the Canadian healthcare system as the first contact for receiving many health services. With the shortage of primary care providers, especially in rural areas, there is a need to explore attached and unattached patient experiences when accessing healthcare.

A cross-sectional survey of rural patients both with (attached) and without (unattached) a primary care provider was conducted July–September 2022. An open-ended question gathered participants’ thoughts and experiences with provider shortages.

Overall, 523 (Mean age = 51 years, 75% female) rural British Columbia community members (306 attached; 217 unattached) completed the survey. Despite similar overall health, unattached patients received care less frequently overall compared to attached patients, including less frequent non-urgent and preventive care. The vast majority of attached patients sought care from a regular provider whereas unattached patients were more likely to use walk-in, emergency department, and urgent care and 29% did not seek care at all. Overall, 460 (88.0%) provided a response to the open-ended doctor shortage question. Similar themes were found among both attached and unattached participants and included: i) the ubiquity of the doctor shortage, ii) the precariousness or fluidity of attachment status, and iii) solutions and recommendations. Greater attention is needed on the negative and cyclical impacts provider shortages have for both attached and unattached patients alike.