Coproduced, arts interventions for nurturing care (0-5 years) in low-income and middle-income countries (LMICs): a realist review.

OBJECTIVES: Community-based arts interventions have the potential to support contextually relevant nurturing care programmes and policies that adapt to different settings. Understanding the distinctive features of using the arts in local, culturally specific ways in low/middle-income countries (LMICs); how this varies by context; and gaining a better understanding of the perspectives on desirable outcomes for communities is important evidence that this review generates. DESIGN: We conducted a realist review of papers that covered outcomes related to child health or development (0-5 years) AND arts-based approaches AND community-based, participatory approaches AND based in LMICs using a range of databases and other networks. A coding framework was developed covering context, intervention, outcomes, mechanisms, study, sustainability, transferability and scalability. RESULTS: The included papers reported 18 unique interventions. Interventions covered 14 countries, with evidence lacking for South America, Arab countries and parts of Africa. Lead authors came from mostly clinical science-based disciplines and from institutions in a different country to the country/countries studied. Intended outcomes from interventions included clinical, health systems/organisation, changes in practices/behaviours/knowledge/attitudes, and wider social and educational goals. We identified three demi-regularities (semi-predictable patterns or pathways of programme functioning): participatory design based on valuing different sources of expertise; dynamic adaptation of intervention to context; and community participation in arts-based approaches. CONCLUSIONS: Our findings suggest that arts-based, nurturing care interventions have greater potential when they include local knowledge, embed into existing infrastructures and there is a clear plan for ongoing resourcing of the intervention. Studies with better documentation of the lessons learnt, regarding the intervention delivery process and the power dynamics involved, are needed to better understand what works, for whom and in which contexts.

The ebbs and flows of empathy: a qualitative study of surgical trainees in the UK.

BACKGROUND: Empathy is widely recognised as an important element of medical practice contributing to patient outcomes and satisfaction. It is also an important element of collaborative work in a healthcare team. However, there is evidence to suggest that empathy towards patients declines over time, particularly in surgical specialities. There is little qualitative research on this decline in surgical trainees, particularly in the UK. Therefore, the aim of this study was to explore how trainee surgeons experience empathy over the course of their career, both towards patients and colleagues and how they perceive it in others. METHODS: 10 semi-structured interviews were carried out with surgical trainees of different grades and specialties in January and February 2022. Framework analysis was used to interpret the data. RESULTS: Participants experienced an evolution in empathy over their career as their personal and professional experience was added to. They drew a distinction between desensitisation and actual decline in empathy and identified more with experiencing the former in their careers. Participants also felt interprofessional relationships require empathy, and this could be improved upon. Finally, they highlighted specific impacts of the COVID-19 pandemic upon their training, including reduced theatre time. CONCLUSIONS: Participants felt training could be improved in regard to accessing training opportunities and relationships with colleagues, although many felt empathy between colleagues is better than it has been in the past. This project highlighted areas for future research, such as with surgeons in later stages of their careers, or mixed-methods projects.

Women's Experience of Depressive Symptoms While Working From Home During the COVID-19 Pandemic: Evidence From an International Web Survey.

The COVID-19 pandemic led to significant changes in workplace practices as social distancing requirements meant that people were asked to work from home where possible to avoid unnecessary contact. Concerns have been raised about the effects of the pandemic on mental health and, in particular, the effects of social distancing on employed women's mental health. In this study, we explore the experiences of working women during the initial stages of the COVID-19 pandemic and explore the factors that may be associated with women experiencing the symptoms of depression. Findings from a cross-sectional survey of European working women (across five countries: France, Italy, Poland, Sweden, and the UK) conducted between March and July 2020 are reported. The data are analyzed using linear regression and mediation analysis. For women, working from home was associated with higher prevalence of the symptoms of depression compared to traveling to a workplace. The study also considers the mechanisms that may explain a relationship between working from home and depressive symptoms. Maintaining contact with people face-to-face and participating in exercise were both significant protective factors against experiencing symptoms of depression during a period of social distancing.

Hidden healthcare populations: using intersectionality to theorise the experiences of LGBT+ people in Nigeria, Africa.

Minority population groups are often excluded or marginalised within health systems and in health research and policy. This article argues that theories of intersectionality can help us to understand these issues and develops the concept of 'hidden healthcare populations' - using the case of people who identify as Lesbian, Gay, Bisexual, Transgender Plus (LGBT+) in Nigeria, in sub-Saharan Africa. The findings present original qualitative data from a seldom heard population group about instances of abuse, rejection and marginalisation by healthcare providers working in public and private healthcare facilities, and the attempts of LGBT+ people to resist and survive in that context. We extend theoretical understandings of intersectionality in global public health and explore how the concept relates to the social determinants of health. The article has significant implications for policy and healthcare education and responds to a call from the World Health Organisation to generate context-specific data to guide interventions targeted at minority population groups. Additionally, our discussion has wider significance because it highlights the Western-centric nature of much theory in health policy - and offers analysis and reinterpretation that incorporates queer, postcolonial, African perspectives.

From body-talk to body-stories: body work in complementary and alternative medicine.

This paper explores the 'body work' undertaken by practitioners of complementary and alternative medicine (CAM), in the light of ethnographic research on the education of osteopaths and homeopaths. The data presented focus on practitioners' experiences of learning to communicate, touch and facilitate the healing process for their patients. Two new concepts are introduced: listening to body-talk and constructing body-stories, which are discussed as aspects of body work. Body-talk expresses the idea that the embodied patient is not a passive recipient of healthcare, but that the 'body' is able to communicate its distress and its needs. The body-story concept highlights the interactional nature of the therapeutic encounter and the profound interrelation between the treatment and case-taking aspects of the practitioner's clinical tasks. By drawing on key sociological concepts of the body and embodiment, reflexivity and narrative, I argue that the dialogical construction of body-stories challenges Cartesian dualism. Finally, I discuss what the data might mean for the future development of the sociological concept of 'body work', drawing particular attention to the necessity to problematise the concept of the 'body' and to pay great attention to body work as embodied work.