Objective To synthesise the published literature on practitioner, patient and carer views and experiences of shared medical appointments (SMAs) for the management of long-term conditions in primary care. Design Systematic review of qualitative primary studies. Methods A systematic search was conducted using MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Web of Science, Social Science Premium Collection (Proquest) and Scopus (SciVerse) from database starting dates to June 2019. Practitioner, patient and carer perspectives were coded separately. Deductive coding using a framework approach was followed by thematic analysis and narrative synthesis. Quality assessment was conducted using the Critical Appraisal Skills Programme for qualitative studies. Results We identified 18 unique studies that reported practitioner (n=11), patient (n=14) and/or carer perspectivs(n=3). Practitioners reported benefits of SMAs including scope for comprehensive patient-led care, peer support, less repetition and improved efficiency compared with 1:1 care. Barriers included administrative challenges and resistance from patients and colleagues, largely due to uncertainties and unclear expectations. Skilled facilitators, tailoring of SMAs to patient groups, leadership support and teamwork were reported to be important for successful delivery. Patients’ reported experiences were largely positive with the SMAs considered a supportive environment in which to share and learn about self-care, though the need for good facilitation was recognised. Reports of carer experience were limited but included improved communication between carer and patient. Conclusion There is insufficient evidence to indicate whether views and experiences vary between staff, medical condition and/or patient characteristics. Participant experiences may be subject to reporting bias. Policies and guidance regarding best practice need to be developed with consideration given to resource requirements. Further research is needed to capture views about wider and co-occurring conditions, to hear from those without SMA experience and to understand which groups of patients and practitioners should be brought together in an SMA for best effect. PROSPERO registration number CRD42019141893.

Background: International data suggest that living in a rural area is associated with an increased risk of perinatal mental illness. This study tested the association between rurality and risk for two mental illnesses prevalent in perinatal women - depression and anxiety.Methods: Using a cross-sectional design, antenatal and postnatal women were approached by healthcare professionals and through other networks in a county in Northern England (UK). After providing informed consent, women completed a questionnaire where they indicated their postcode (used to determine rural-urban status) and completed three outcome measures: the Edinburgh Postnatal Depression Scale (EPDS), the Whooley questions (depression measure), and the Generalised Anxiety Disorder 2-item (GAD-2). Logistic regression models were developed, both unadjusted and adjusted for potential confounders, including socioeconomic status, social support and perinatal stage.Results: Two hundred ninety-five participants provided valid data. Women in rural areas (n = 130) were mostly comparable to their urban counterparts (n = 165). Risk for depression and/or anxiety was found to be higher in the rural group across all models: unadjusted OR 1.67 (0.42) 95% CI 1.03 to 2.72,p = .038. This difference though indicative did not reach statistical significance after adjusting for socioeconomic status and perinatal stage (OR 1.57 (0.40), 95% CI 0.95 to 2.58,p = .078), and for social support (OR 1.65 (0.46), 95% CI 0.96 to 2.84,p = .070).Conclusions: Data suggested that women in rural areas were at higher risk of depression and anxiety than their urban counterparts. Further work should be undertaken to corroborate these findings and investigate the underlying factors. This will help inform future interventions and the allocation of perinatal services to where they are most needed.

In this study, we explore the role that isolation and loneliness play in the narratives of women diagnosed with perinatal depression. Isolation and loneliness are increasingly seen as risk factors for depression, including in the perinatal period, but little is known about whether, and in what ways, women themselves associate isolation or loneliness with perinatal distress. Based on the thematic analysis of semi-structured interviews with fourteen mothers in England, we found that women often connected feelings of depression during and after pregnancy to feeling dislocated from their previous identities and relationships. Women felt lost, confined to their homes, and often unsupported by their partners and families. However, fears of being judged to be inadequate mothers made it difficult for women to make authentic connections with others or to express negative feelings, increasing isolation and depression. We drew on the intersectionality theory to illustrate how the intersect between motherhood and other aspects of women’s identities (being young, single, deprived and/or from an ethnic minority) could leave some women particularly isolated and marginalised. Our conclusions emphasise the need to challenge social constructions of the good/bad mother, advocate for social change to lessen pressures on mothers, and develop support that addresses women’s interpersonal contexts and social networks.

Qualitative interview studies on sensitive topics often draw on principles of feminist methodologies which focus on developing and maintaining non-exploitative, caring relationships with participants. For early career researchers, who may have less research experience, managing relational ethical issues that arise in research relationships can be difficult. Additionally, they could experience further pressures because of their junior roles and precarious employment. In the context of health research, early career researchers working on qualitative studies may experience specific challenges because of the predominance of the biomedical paradigm in this discipline. In this article, I explore some of the relational ethical issues I deliberated as an early career researcher when working in a medical faculty on a semi-structured qualitative interview study about women’s alcohol drinking practices. I focus on two overlapping themes from my experience of ethics in practice “Trying to building and maintain relationships” and “Trying to stabilize inequalities in research relationships.” With a primary focus on how I negotiated differing responsibilities, I draw on examples from the community-based face-to-face and virtual recruitment, the fast-paced face-to-face interviews, and the process of returning interview transcripts to women to review. With this analysis, I contribute to existing literature about ethics in practice for early career researchers by indicating the types of relational ethics that will need to be navigated and the resources needed to support them. These resources include having adequate time, opportunities for reflection, and good supervisory support. I also contribute to scholarship which critiques the wider health research context by considering the challenges it can pose for early career researchers when managing relational ethical spaces in qualitative interview studies. This article will be of relevance to novice researchers and those who supervise and manage them.

In the last thirty years there has been a rise in harmful alcohol use amongst White British women. Approaches to alcohol harm reduction typically position drinking as an individual behaviour, with an emphasis on people to make changes to and by themselves. Moving away from an individual approach, this paper works with a relational framework to develop understanding of non-dependent women’s drinking in the context of their everyday lives. It draws on Feminist Ethics of Care theory, to consider the importance of care in women’s lives and alcohol as an element of their ‘practices of care’ in different relationships. The study adopted an interpretive approach and drew on feminist principles of practice. Qualitative one-to-one face-to-face interviews were undertaken with twenty-six White women living in the North East of England. Participants were aged between 24 and 67 years. Thematic analysis of the data was carried out. Participants’ relationships came through the analysis as central to understanding the way alcohol did and not feature in care practices. In couple relationships drinking offered a way of doing ‘care’ together, yet when it was used too often it no longer became appropriate as a form of care. In non-family relationships alcohol enabled care giving and receiving, while disguising that care was being received. In relationships with mothers the use of alcohol was relatively absent in the care practices described. Participants’ relationship to alcohol as a form of care of self, particularly when drinking alone, was closely related to their roles and responsibilities to others. Overall the data suggests that interventions targeting women’s drinking should start from a position that women are relational. Moreover that when care by others is lacking or unavailable, alcohol can increasingly be introduced into care practices, and the reproduction of these practices may be leading to an increase in heavy drinking. By seeing alcohol use in the context of wider familial and non-familial relationships, this work has important implications for future interventions.