The experience of high frequency gambling behaviour of older adult females in the United Kingdom: an interpretative phenomenological analysis

The prevalence of older adult female gambling participation and gambling disorder is increasing in the UK, and there is a paucity of published research available to understand possible risk factors for frequent gambling in this demographic. The aim of the current study was to identify and explore motivations and patterns of gambling behaviour in high frequency older adult female gamblers in the UK, from the perspective of individual and in the context of their experience of aging. Ten UK older adult female high frequency gamblers were recruited via stratified purposive sampling, with a mean age of 70.4 years. Data was collected via semi-structured interviews, and was analysed using Interpretative Phenomenological Analysis. Three core themes representative of the experience of this phenomenon emerged from the transcripts including: Filling Voids, Emotional Escape and Overspending. The present study has provided a contextualised understanding of motivating factors and several age-related vulnerabilities which may account for high gambling frequency in this population

Session 1-4-C: Gambling Behavior and Motivation across UK Older Adult Populations

Target Group: UK Older adults 65+ Aim: Develop knowledge and understanding of gambling related harm Background: limited empirical research - ignored High prevalence detecte

‘I Felt Welcomed in Like They’re a Little Family in There, I Felt Like I Was Joining a Team or Something’: Vape Shop Customers’ Experiences of E-Cigarette Use, Vape Shops and the Vaping Community

Background: Specialist electronic cigarette (e-cigarette) shops, known as vape shops, provide access to a less harmful alternative to smoking. This study aimed to understand customers’ experiences of vaping and vape shops, and the extent to which smoking cessation advice is and should be provided in these shops. Methods: We conducted telephone interviews with 22 customers recruited in vapeshops in the East Midlands region of England. Interviews explored participants’ smoking histories, reasons for using e-cigarettes, the role of vape shops in their e-cigarette use, and whether smoking cessation was discussed in vape shops. Interviews were analysed following framework approach principles. Results: Most respondents regarded e-cigarettes as a quitting tool and reported very positive experiences of vaping. Vape shops were central to participants’ positive experiences, in that they provided access to a wide variety of high-quality products and reliable product information and advice. The shop staff engendered a sense of loyalty in customers which, together with the community of other vapers, created a network that helped to support e-cigarette use. Vape shops were not regarded as a setting in which cessation advice was generally provided but were acknowledged as potentially appropriate places to provide quitting support. Conclusions: Vape shops have the potential to play an important role in tobacco harm reduction, which could be increased if their service model were to extend to help smokers to quit

Vape shops: Who uses them and what do they do?

BACKGROUND: 'Vape shops' are a popular source for buying electronic cigarettes (e-cigarettes) and related products. The products that vape shops sell, their marketing techniques and the extent to which they provide information or encouragement to smokers to quit tobacco use, as well as the patterns of tobacco and e-cigarette use of their customers are not well understood. METHODS: We conducted cross-sectional surveys in vape shops in the East Midlands region of the United Kingdom, one with shop staff (n = 41), and one with customers (n = 197). RESULTS: The majority of customers (84%) currently used e-cigarettes. Among current vapers, 19% were dual users and 78% had quit smoking. Over half of vapers reported using a lower level of nicotine in their current e-liquid than when they started using e-cigarettes. There was a wide variety in products and price ranges between the shops. Many staff reported that customers ask for information about quitting smoking (90%). Less than half reported providing smoking cessation advice, although 76% of staff reported feeling confident about delivering cessation advice to customers who ask for it. Just under half of customers and shop staff said they thought it was appropriate to deliver formal in-store smoking cessation support. CONCLUSIONS: The majority of vape shop customers are vapers who have quit smoking. Shop staff play a central role in providing customers with product information, and many provide smoking cessation advice. Further research is needed to investigate the potential for smoking cessation interventions in vape shops, including the extent to which these would appeal to non-vapers

Community First Responders – Their Identity and Relationship with Patients and the Ambulance Service: A Qualitative Interview Study

Background Community First Responders (CFRs) are volunteers who contribute to providing prehospital care. By 2014, there were more than 2,400 CFR schemes with more than 12,000 volunteers in the UK. Previous research focused on CFR contribution to EMS, practices and schemes. The identity of professionals is essential for understanding existing and emerging roles within a complex institutional and social identity. However, little is known about the volunteer-CFR identities within the CFR functions. This study aimed to understand how CFRs’ institutional and social identities are constructed by patients and ambulance staff. Methods We conducted 47 semi-structured interviews with participants from six ambulance service regions in England. The participants were comprised key stakeholders, including: ambulance staff; CFRs and CFR leads; GPs; and patients and relatives. They were purposively sampled. We collected data from April 2020 to December 2021. We conducted all interviews by telephone due to COVID social distancing restrictions. Interviews continued until data saturation and analysed using thematic analysis. Results CFRs see themselves as part of a, co-ordinated emergency response, particularly in rural areas. While some patients thought CFRs were ambulance crew, because of their uniforms and vehicles, others were reassured by their life-saving ability. Some ambulance staff were confused by their presence on-scene, but others valued their support. This suggests a mismatch in expectations and what CFR can deliver/practice. CFR schemes and the ambulance service are raising awareness through better communication with patients and staff, as well as fundraising at community events. Conclusion The identity of CFRs differed from institution to community. Institutions identified CFRs as supplementing the ambulance service. Communities viewed CFRs and the ambulance service interchangeably. CFR identity helped to improve awareness of CFR schemes. CFRs attending to more patients and working more often with ambulance crew may help to strengthen their identity among both groups

Wellbeing in Volunteers on Heritage at Risk Projects.

The Heritage at Risk and Wellbeing (HARAW) project aimed to explore the relationship between wellbeing and volunteering in completed Heritage at Risk (HAR) projects, in order to build capacity for future HAR projects to support wellbeing in volunteers more effectively and more widely. This report details the context, aims, methods, results, discussion and conclusions presented in the report, with the relevant section numbers in the main body of this report given

Nurse-delivered sleep restriction therapy in primary care for adults with insomnia disorder: a mixed-methods process evaluation

Background Sleep restriction therapy (SRT) is a behavioural therapy for insomnia. Aim To conduct a process evaluation of a randomised controlled trial comparing SRT delivered by primary care nurses plus a sleep hygiene booklet with the sleep hygiene booklet only for adults with insomnia disorder. Design and setting A mixed-methods process evaluation in a general practice setting. Method Semi-structured interviews were conducted in a purposive sample of patients receiving SRT, the practice nurses who delivered the therapy, and also GPs or practice managers at the participating practices. Qualitative data were explored using framework analysis, and integrated with nurse comments and quantitative data, including baseline Insomnia Severity Index score and serial sleep efficiency outcomes to investigate the relationships between these. Results In total, 16 patients, 13 nurses, six practice managers, and one GP were interviewed. Patients had no previous experience of behavioural therapy, needed flexible appointment times, and preferred face-to-face consultations; nurses felt prepared to deliver SRT, accommodating patient concerns, tailoring therapy, and negotiating sleep timings despite treatment complexity and delays between training and intervention delivery. How the intervention produced change was explored, including patient and nurse interactions and patient responses to SRT. Difficulties maintaining SRT, negative attitudes towards treatment, and low self-efficacy were highlighted. Contextual factors, including freeing GP time, time constraints, and conflicting priorities for nurses, with suggestions for alternative delivery options, were raised. Participants who found SRT a positive process showed improvements in sleep efficiency, whereas those who struggled did not. Conclusion SRT was successfully delivered by practice nurses and was generally well received by patients, despite some difficulties delivering and applying the intervention in practice

Nurse delivered Sleep Restriction Therapy for adults with Insomnia Disorder: process evaluation

Background: Sleep Restriction Therapy (SRT) is a behavioural therapy for insomnia. Aim: To conduct a process evaluation of a randomised controlled trial comparing SRT delivered by primary care nurses plus sleep hygiene booklet with sleep hygiene booklet only for adults with Insomnia Disorder. Design and setting: Mixed methods process evaluation. Methods: We used semi-structured interviews of a purposive sample of patients receiving SRT, practice nurses delivering it, and general practitioners (GPs) or practice managers. Qualitative data were explored using Framework Analysis, and integrated with nurse comments and quantitative data, including baseline Insomnia Severity Index score and serial sleep efficiency outcomes to investigate relationships between these. Results: We interviewed 16 patients, 13 nurses, 6 practice managers and 1 GP. Patients had no previous experience of behavioural therapy, needed flexible appointment times, and preferred face-to-face consultations; nurses felt prepared to deliver SRT, accommodating patient concerns, tailoring therapy, and negotiating sleep timings, despite treatment complexity and delays between training and intervention delivery. We explored how the intervention produced change, including patient and nurse interactions and patient responses to SRT. Difficulties maintaining SRT, negative attitudes towards treatment, and low self-efficacy were highlighted. Contextual factors, including freeing GP time, time constraints and conflicting priorities for nurses, with suggestions for alternative delivery options. Participants who found SRT a positive process showed improvements in sleep efficiency, whilst those that struggled did not. Conclusion: SRT was successfully delivered by practice nurses and was generally well received by patients, despite some difficulties delivering and applying the intervention in practice

Clinical and cost-effectiveness of nurse-delivered sleep restriction therapy for insomnia in primary care (HABIT): a pragmatic, superiority, open-label, randomised controlled trial.

Background Insomnia is prevalent and distressing but access to the first-line treatment, cognitive behavioural therapy (CBT), is extremely limited. We aimed to assess the clinical and cost-effectiveness of sleep restriction therapy, a key component of CBT, which has the potential to be widely implemented. Methods We did a pragmatic, superiority, open-label, randomised controlled trial of sleep restriction therapy versus sleep hygiene. Adults with insomnia disorder were recruited from 35 general practices across England and randomly assigned (1:1) using a web-based randomisation programme to either four sessions of nurse-delivered sleep restriction therapy plus a sleep hygiene booklet or a sleep hygiene booklet only. There was no restriction on usual care for either group. Outcomes were assessed at 3 months, 6 months, and 12 months. The primary endpoint was self-reported insomnia severity at 6 months measured with the insomnia severity index (ISI). The primary analysis included participants according to their allocated group and who contributed at least one outcome measurement. Cost-effectiveness was evaluated from the UK National Health Service and personal social services perspective and expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. The trial was prospectively registered (ISRCTN42499563). Findings Between Aug 29, 2018, and March 23, 2020 we randomly assigned 642 participants to sleep restriction therapy (n=321) or sleep hygiene (n=321). Mean age was 55·4 years (range 19–88), with 489 (76·2%) participants being female and 153 (23·8%) being male. 580 (90·3%) participants provided data for at least one outcome measurement. At 6 months, mean ISI score was 10·9 (SD 5·5) for sleep restriction therapy and 13·9 (5·2) for sleep hygiene (adjusted mean difference –3·05, 95% CI –3·83 to –2·28; p<0·0001; Cohen's d –0·74), indicating that participants in the sleep restriction therapy group reported lower insomnia severity than the sleep hygiene group. The incremental cost per QALY gained was £2076, giving a 95·3% probability that treatment was cost-effective at a cost-effectiveness threshold of £20 000. Eight participants in each group had serious adverse events, none of which were judged to be related to intervention. Interpretation Brief nurse-delivered sleep restriction therapy in primary care reduces insomnia symptoms, is likely to be cost-effective, and has the potential to be widely implemented as a first-line treatment for insomnia disorder