'I don't think I ever had food poisoning'. A practice-based approach to understanding foodborne disease that originates in the home.

Food stored, prepared, cooked and eaten at home contributes to foodborne disease which, globally, presents a significant public health burden. The aim of the study reported here was to investigate, analyse and interpret domestic kitchen practices in order to provide fresh insight about how the domestic setting might influence food safety. Using current theories of practice meant the research, which drew on qualitative and ethnographic methods, could investigate people and material things in the domestic kitchen setting whilst taking account of people's actions, values, experiences and beliefs. Data from 20 UK households revealed the extent to which kitchens are used for a range of non-food related activities and the ways that foodwork extends beyond the boundaries of the kitchen. The youngest children, the oldest adults and the family pets all had agency in the kitchen, which has implications for preventing foodborne disease. What was observed, filmed and photographed was not a single practice but a series of entangled encounters and actions embedded and repeated, often inconsistently, by the individuals involved. Households derived logics and principles about foodwork that represented rules of thumb about 'how things are done' that included using the senses and experiential knowledge when judging whether food is safe to eat. Overall, food safety was subsumed within the practice of 'being' a household and living everyday life in the kitchen. Current theories of practice are an effective way of understanding foodborne disease and offer a novel approach to exploring food safety in the home.

Food safety and older people: the Kitchen Life study.

Foodborne illness (FBI) is a major public health problem in the UK. Recent increases in cases of listeriosis in older people have focused attention on consumer food-related practices. Previous studies highlight poor relationships between what people know, what they say they do and what they actually do in the kitchen. The aim of the Kitchen Life study was to examine what actually happens in the domestic kitchen to assess whether and how this has the potential to influence food safety in the home. Drawing on a qualitative ethnographic approach, methods included a kitchen tour, photography, observation, video observation, informal interviews and diary methods. Ten households with older people (aged 60+) were recruited across the UK. It was found that trust in the food supply, use of food-labelling (including use-by dates), sensory logics (such as the feel or smell of food) and food waste were factors with the potential to influence risk of foodborne illness. Practices shifted with changing circumstances, including increased frailty, bereavement, living alone, receiving help with care and acquiring new knowledge, meaning that the risk of and vulnerability to foodborne illness is not straightforward.

Dimensions of lay health worker programmes: results of a scoping study and production of a descriptive framework.

BACKGROUND: Approaches that engage and support lay health workers in the delivery of health improvement activities have been widely applied across different health issues and populations. The lack of a common terminology, inconsistency in the use of role descriptors and poor indexing of lay health worker roles are all barriers to the development of a shared evidence base for lay health worker interventions. OBJECTIVES: The aim of the paper is to report results from a scoping study of approaches to involve lay people in public health roles and to present a framework for categorisation of the different dimensions of lay health worker programmes. METHODS: Our scoping study comprised a systematic scoping review to map the literature on lay health worker interventions and to identify role dimensions and common models. The review, which was limited to interventions relevant to UK public health priorities, covered a total of 224 publications. The scoping study also drew on experiential evidence from UK practice. RESULTS: Research-based and practice-based evidence confirmed the variety of role descriptors in use and the complexity of role dimensions. Five common models that define the primary role of the lay health worker were identified from the literature. A framework was later developed that grouped features of lay health worker programmes into four dimensions: intervention, role, professional support/service and the community. DISCUSSION AND CONCLUSION: More account needs to be taken of the variations that occur between lay health worker programmes. This framework, with the mapping of key categories of difference, may enable better description of lay health worker programmes, which will in turn assist in building a shared evidence base. More research is needed to examine the transferability of the framework within different contexts.

'Think differently and be prepared to demonstrate trust': findings from public hearings, England, on supporting lay people in public health roles.

Professional support processes are critical for the establishment and maintenance of community health worker programmes. This paper reports on three public hearings held in England, UK, that were conducted as part of a national study into approaches to develop and support lay people in public health roles. Individuals with relevant theoretical or practical expertise, including lay activists, presented evidence in public as expert witnesses. Formal presentations, questions and plenary discussions were recorded and later analysed as qualitative data. This paper presents the results and critically examines emergent issues relating to the sustainability of lay health worker programmes. Consideration is given to the diversity of contemporary practice in England. Barriers seen to affect sustainability included organizational culture and onerous bureaucratic processes. Major themes emerging from the expert evidence included recruitment and training strategies, financial support and the need for a robust infrastructure. The expert hearings, in creating a public space for deliberation, opened up discussion on the levels and type of programme support required to foster lay health worker programmes. The paper concludes that professional support needs to be accompanied by a reorientation of public services to support lay engagement in programme delivery.

Thinking 'taller': sharing responsibility in the everyday lives of children with asthma.

AIMS: To explore negotiation of responsibilities for asthma self-care between a group of preadolescent children aged 7-12 and their parents/carers and to explore the meaning of responsibility to these children and their adult carers. BACKGROUND: Living with asthma requires the distribution of a range of responsibilities between children and their adult carers, highlighting tensions between protection and promotion of autonomy. Previous studies have identified diverse factors associated with transfer of responsibility but a better understanding is required of the meaning of responsibility in children's lives and how parents and children negotiate responsibilities. DESIGN: The design was qualitative. METHODS: Eighteen child participants aged 7-12 years and their parents/carers participated in open-ended, conversational-style interviews. The framework approach was used to analyse the data and interpretation of data drew upon both feminist epistemology and sociological understandings of children, health and the body which relocate subjective experience at the heart of scientific enquiry. RESULTS: Children demonstrated responsibility by avoiding asthma exacerbators and limiting the effect of asthma on themselves and their parents but there were limitations on children's opportunities to exercise some responsibilities. CONCLUSIONS: It is possible to consider responsibility as the exercise of agency by children rather than simply as compliance with adults' instructions and prescriptions. RELEVANCE TO CLINICAL PRACTICE: Some parents would like more assistance from health professionals in managing the process of increasing independent self-care by children. It is important to maintenance of the health of children with long-term conditions that the distribution of responsibilities between adults and children both ensures children's safety and provides appropriate preparation for independence in adult life. Understanding the process by which parents and children negotiate distribution of responsibilities for long-term conditions could provide a basis for development of interventions to respond to parents' requests for more professional support for managing this process.