An in-depth thematic analysis is presented of 44 interviews, which examined why some debtors engage with their creditors before court action is taken and why others do not. The majority of our interviewees were in receipt of a social welfare benefit and juggled their bills and prioritized them when they could not meet all outgoings. The data emphasise the chaotic nature of many debtors’ affairs, with multiple creditors seeking to engage with them and no obvious prospect of being able to satisfy them all. Although many debtors' financial affairs do seem muddled, they do nevertheless use strategies, at least at the earlier stages of debt, to manage this chaos.
Lack of money was the primary reason for avoidance of payment. More effort was made by debtors to meet outgoings in the early stages of financial difficulty; when things got out of control interviewees could not see a way out and ignored creditor communications altogether. As a state of helplessness sets in, total avoidance is the only strategy that may seem viable. These findings highlight the importance of creditors identifying those with financial problems at an early stage and putting into place strategies that will help customers avoid getting into further difficulties.

Abstract
Background
Adolescence is a risk period for offending and for Traumatic Brain Injury (TBI). TBI is a risk factor for poor mental health and for offending. TBI has been largely neglected from guidance on managing mental health needs of young offenders.
Aims
We sought to determine the rate of self-reported TBI, of various severities, in a male, adolescent youth offending population. We also aimed to explore whether TBI was associated with number of convictions, violent offending, mental health problems and drug misuse.
Method
Young male offenders aged 11 to 19 years were recruited from a Young Offender Institute, a Youth Offending Team and a special needs school. A total of 197 participants were approached and 186 (94.4%) completed the study. They completed self-reports on TBI, crime history, mental health and drug use.
Results
TBI with a Loss of Consciousness (LOC) was reported by 46% of the sample. LOC consistent with Mild TBI was reported by 29.6% and 16.6% reported LOC consistent with Moderate-Severe TBI. Possible TBI was reported by a further 19.1%. Repeat injury was common – with 32% reporting more than one LOC. Frequency of self-reported TBI was associated with more convictions. Three or more self-reported TBIs were associated with greater violence in offences. Those with self-reported TBI were also at risk of greater mental health problems and of misuse of cannabis.
Conclusions
TBI may be associated with offending behaviour and worse mental health outcomes. Addressing TBI within adolescent offenders with neuro-rehabilitative input may be important for improving well-being and reducing re-offending.

BACKGROUND: Although circadian, seasonal, and other cycles have been observed for a number of chronic conditions, their impact on patient reported outcomes measurements (PROMs) has not been systematically explored, rendering our understanding of the effect of time of measurement on PROM scores very limited. The aim was to conduct a scoping review to determine what is known about how intra-individual cyclical variation might affect the way individuals with chronic conditions respond to patient-reported outcome measures. METHODS: a protocol of a systematic scoping review was registered on PROSPERO (CRD42017058365). We developed a search strategy based on previous relevant reviews and implemented it in: MEDLINE, Embase, PsycINFO, and CINAHL. No restrictions were placed on article types and backward and forward citation searches were conducted. Screening and data extraction were independently completed by up to four reviewers. An adapted version of CASP criteria was used to appraise the quality of included articles. Concepts that were important in understanding the impact of cyclical variation on PROM scores were elicited from the papers and iteratively refined through discussion amongst the authors. RESULTS: 2420 references resulted from the searches, with 33 articles meeting the inclusion criteria. Most study designs included observational research (particularly ecological momentary assessment), 2 were RCTs and 2 were systematic reviews. Studies mainly focused on specific health conditions: mental health, respiratory and musculoskeletal. There was a lack of qualitative research and theoretical framework to explore these concepts more fully. Five overarching concepts emerged: variation in outcomes, variation of scores, psychological status, individual factors, and environmental/situational factors. A conceptual model was developed outlining the relationships between these concepts. CONCLUSIONS: There is empirical evidence that supports cyclical variation in PROM scores across different chronic conditions, with potential very significant implications for administration and interpretation of PROMs. The proposed conceptual model can support further research in this area.

Objective. To establish whether poor parental supervision is associated with head injury and
self-reported reactive aggression (i.e. aggression in response to perceived provocation or
threat) in adolescents in a young offender’s institute, by examining correlations between
these variables. Understanding this population is important as they are at a key pivotal age for
intervention to prevent life-long re-offending.
Method. Ninety-six male participants aged 16-18 were recruited from a UK Young
Offender’s Institute. Self-report measures of remembered parenting, reactive aggression, and
head injury history were administered during individual interviews.
Results. 74% of participants reported having experienced a lifetime TBI, and 46% of
participants reported experiencing at least one TBI leading to a loss of consciousness (LOC).
We found that poor parental supervision, length of LOC following TBI, and self-reported
reactive aggression, were all positively correlated.
Conclusions. Findings show that there are correlational relationships between poor parental
supervision, length of LOC following lifetime TBI, and higher levels of self-reported reactive
aggression. This suggests there may be pathways resulting from poor parental supervision
leading to both TBI with LOC, and reactive aggression. We advocate for future research with
longitudinal designs and larger samples to examine the nature of these interactions, and to
establish whether poor parental supervision is a prospective risk factor for more TBIs leading
to LOC, and reactive aggression. This is key to understanding whether parenting
interventions could help to reduce the disabling effects of TBI in adolescents, and help to
prevent contact with the law.

Purpose: Paediatric traumatic brain injury (TBI) can have resultant ongoing significant impairments which can impact life outcomes. The primary aim of this research was to explore whether TBI contributes to the relationship between poor educational outcomes and offending trajectories.Materials and methods: Through analysis of a dataset consisting of self-reported health, educational, and offending histories of 70 incarcerated young males, structural equation modelling was used to explore the mediation of educational outcomes and patterns in offending behaviour by chronic symptoms following TBI.Results: Symptoms related to TBI significantly mediated the relationship between decreased educational attainment and more frequent convictions. It did not mediate any relationships involving age at first conviction.Conclusions: Traumatic brain injury appears to have more influence over frequency of offending patterns than age at first conviction. However, TBI remains a pervasive factor in both higher rates of offending and poorer educational attainment. In order to tackle this effect on adverse social outcomes, greater attention to the impact of TBI is required in education and criminal justice systems.IMPLICATIONS FOR REHABILITATIONHighlights traumatic brain injury as a contributory factor in some education to offending pathways, suggesting that greater focus on rehabilitation within the education and criminal justice systems is required.Reinforces that greater understanding of educational pathways post-injury is needed to better facilitate rehabilitation within the school system.

BACKGROUND: the internet is a potentially promising medium for delivering weight loss interventions. The current study sought to explore factors that might influence primary care patients' initial uptake and continued use (up to four-weeks) of such programmes to help inform the development of novel, or refinement of existing, weight management interventions. METHODS: Semi-structured interviews were conducted with 20 patients purposively sampled based on age, gender and BMI from a single rural general practice. The interviews were conducted 4 weeks after recruitment at the general practice and focused on experiences with using one of three freely available weight loss websites. Thematic Analysis was used to analyse the data. RESULTS: Findings suggested that patients were initially motivated to engage with internet-based weight loss programmes by their accessibility and novelty. However, continued use was influenced by substantial facilitators and barriers, such as time and effort involved, reaction to prompts/reminders, and usefulness of information. Facilitation by face-to-face consultations with the GP was reported to be helpful in supporting change. CONCLUSIONS: Although primary care patients may not be ready yet to solely depend on online interventions for weight loss, their willingness to use them shows potential for use alongside face-to-face weight management advice or intervention. Recommendations to minimise barriers to engagement are provided.

Multiple sclerosis (MS) is typically associated with life-long adjustment to wide-ranging, changeable symptoms and psychosocial disruption as all relationships are changed or lost. Despite accumulating evidence, the therapeutic impact of harnessing social group factors in MS management and rehabilitation remains largely unexplored. We investigated their role specific to adjusting to MS. A qualitative approach was used with thematic analysis to induce a rich and developing account of the impact of social groups on adjustment for 15 individuals with MS. An adjustment questionnaire was used to provide a framework for its organisation and discussion. The analysis revealed three themes associated with loss, change and social processes that influenced adjustment. These features distinguished between those who were more or less able to adjust, and resonated well with processes previously identified as central to identity loss and change. Social factors enhanced adjustment through easing transition between pre- and post-MS diagnosis lives. Notably, maintenance of pre-existing social roles and relationships was critical in providing a meaningful basis for integrating the old with new senses of self. The capacity to join new social groups was as key in adjustment as was awareness of having access to multiple social groups to avoid being solely defined by MS. These concepts provided a more stable grounding upon which to nurture value systems and employ collective support to counter the negative consequences of living with MS.

BACKGROUND: Cognitive behavioral therapy-based alcohol treatment programs have been widely used to break the link between alcohol and crime. While evidence exists on the connection between alcohol and crime, there is little data that demonstrate the effectiveness of different alcohol treatment programs in reducing criminal behavior. We tested whether male offenders who participate in alcohol treatment programs show lower rates of recidivism than a matched offender group who did not participate in an alcohol prevention program. METHODS: This is an observational matched case-control study. Participants were 564 male offenders with an alcohol problem related to offending. Participants were assigned by the courts to 1 of 3 alcohol treatment programs (141 offenders per treatment): Low Intensity Alcohol Program (LIAP), Alcohol Specified Activity Requirement, and Addressing Substance-Related Offending. A fourth matched group (n = 141) was not assigned to a program and served as a control group. Survival analysis was used to calculate participants' charged and reconviction rates over 4 time periods (0 to 3, 4 to 6, 7 to 9, and 10 to 12 months after completion of program or order). RESULTS: Offenders who did not participate in a program were more than twice as likely to be charged compared to offenders who participated in a program. Furthermore, offenders who did not participate in a program were over 2.5 times more likely to be reconvicted. Among the 3 alcohol treatment programs evaluated, the LIAP was the most cost-effective. CONCLUSIONS: Offenders enrolled in an alcohol treatment program showed a significant reduction in being charged with or reconvicted of a crime. With costs of keeping offenders in prison per year reaching close to £40,000 per offender per year (Mulheirn et al. 2010, www.smf.co.uk), assigning offenders to alcohol preventive programs-such as LIAP-are a promising way to reduce recidivism and reduce cost.

The present research investigated whether promoting cloth nappy use represents a viable method for local councils to reduce the amount of waste going to landfill. Focus groups were conducted with both cloth nappy users and disposable nappy users to gain a better understanding of the factors that underlie their choice. Interviews were analyzed using Thematic Analysis. Those using disposable nappies preferred them because they were marketed by trusted brands as offering a popular, efficient, healthy, good value system. They acknowledged the impact on the environmentbut rationalised this by referring to (a) the somewhat equivocal nature of these consequences, and (b) the ability to off-set these by engaging in other pro-environment behaviours. Those who choce cloth nappies did so initially because they saw them as more environment-friendly and cost-effective and because they disliked disposables. Once using cloth, participants noted additional benefits: performance, fashion, formation of bonds with other cloth nappy users, and getting a buzz out of using them, which served to reinforce their reasons for continuing to use cloth nappies. We discuss the theoretical and practical implications of these findings.

Purpose: the present research investigated parental attitudes towards using either cloth or disposable nappies, to better understand whether and how pro-cloth initiatives might impact parental decisions.
Design/Methodology/Approach: Focus groups were conducted with both cloth and disposable nappy users to gain a better understanding of the factors that underlie their choice. Interviews were analyzed using Thematic Analysis.
Findings: Parents using disposable nappies believed they were marketed as offering a popular, efficient, healthy, good value system. They acknowledged the environmental impact but rationalised this by referring to (a) the equivocal nature of these consequences, and (b) the ability to off-set this by engaging in other pro-environment behaviours. Parents choosing cloth nappies did so initially because they were more environment-friendly and cost-effective and disposables were disliked. Once using cloth, parents noted additional benefits: performance, fashion, formation of bonds with other users, and getting a buzz out of using them. This reinforced their reasons for continued use.
Practical implications: Cloth nappies are unlikely to gain mass appeal, but findings suggest a bigger take up if parents are better informed, and subsidies are provided to reduce set-up and laundering costs to tackle the ‘ease of use’ barrier. The positive aspects of cloth nappies should be better promoted.
Social implications: Marketing initiatives need to buy into the current ‘designer parents’ trend and play to the aspirational, fashionable aspects of cloth nappies.
Originality/value: This paper, the first to report on parental attitudes and decisions regarding both nappy types, could inform public policy and marketing decisions.

Associations between the sun exposure and sun protective behaviours of adolescents and their friends were examined along with the role played by authoritative parenting and other family and peer socialization factors. Four hundred and two adolescents (198 males, 204 females) participated in the research. It was found that these adolescents and their friends shared similar sun exposure and sun protective behaviours and had similar parenting backgrounds. Parental authoritativeness was positively associated with the use of sun protection, even after the effects of other familial and peer variables were controlled, but not with the time spent sunbathing which was associated with friends’ behaviours. The theoretical and practical implications of these findings are discussed.

Objectives: to explore how sickness certification occurred based on patients' reports of
medical consultations for a new episode of low back pain.
Design: Qualitative study using semistructured interviews and thematic analysis.
Participants: 16 employees who were currently or had recently been off work with an
episode of low back pain.
Setting: the New Zealand workers' compensation environment.
Results: Four sickness certification responses by doctors were identified: process, cued,
consultative and laissez-faire. Three of these responses allowed the patient some influence in
the sickness certification process.
Conclusions: Doctors may allow patients input into the sickness certification process for a
number of reasons. As yet, we do not know if this helps or hinders the return to work
process.

Previous research findings suggest that gay
men who find their partners on the Internet
are more likely to engage in bareback sex
than men who do not use the Internet in this
way. The present study investigated feelings
about risk of HIV and other sexually transmitted
infections (STIs) among gay men who use
the Internet to seek barebacking. Semistructured
interviews were conducted using
secure Internet chat software to understand
the experience of six single gay men living in
the UK who believed themselves to be HIVnegative
and had barebacked with at least
one man whom they had found using the
Internet. The data were analysed using Interpretative
Phenomenological Analysis (IPA).
Two superordinate themes emerged from the
analysis: conflict (physicality/emotionality and
dominance/submission) and management
(active engagement with risk management
and avoidance of risk management). These
themes are considered alongside existing theory
and research, with particular focus on how
gay men use the Internet to take care of
themselves whilst engaging in a valued behaviour
that carries significant risk. Implications
and recommendations for research and sexual
health care practice are explored.

Questionnaire research was carried out to identify factors that may encourage problem
debtors to take the first steps towards getting out of debt. Consumers with debt problems were
identified with the aid of creditor organisations and the Courts service for England and Wales. Responses were also sought from non-debtors from the same consumer groups as the debtors. Response rates from debtors were very low, but results confirmed the existence of a group of chronically poor consumers with widespread and long-lasting debt and also confirmed the demographic differences between this group of debtors and non-debtors found in previous research. These debtors showed marked attitudinal differences from non-debtors, with reduced optimism and financial self-esteem, and a less internal economic locus of control. They also showed a distinct social identity, identifying with fellow debtors and feeling stigmatised both generally and personally. Within
the debtor group, engagement with creditors was higher in people reporting lower debt levels, but seeking advice was more frequent in those reporting higher debts. Engagement was associated with a stronger attitude of financial self-efficacy and with a perception of the debtor identity as more permeable. Neither demographic nor psychological factors significantly predicted which debtors would seek advice.

In contrast to everyday use of the term discrimination, we propose that discrimination can be appraised as either illegitimate or legitimate, and a comprehensive analysis of responses to discrimination needs to account for both ways of experiencing discrimination. We examine how perceived pervasiveness of discrimination and legitimacy appraisals affect group commitment among women in academia (Study 1) and tobacco smokers facing an upcoming smoking ban (Study 2). We found support for our hypothesis that legitimacy of discrimination appraisals moderate the effect of pervasiveness of discrimination. In both studies group identification and collective action intentions were undermined most when the ingroup claimed that discrimination against them was legitimate and discrimination was perceived as pervasive. In both studies group identification mediated the effects on collective action intentions. The results highlight the important role of legitimacy appraisals in understanding disadvantaged group members’ responses to discriminatory treatment.

Purpose. To understand how work supervisors respond to sickness certification for an episode of low back pain based on employees' reports of employer-employee interactions. Method. Thematic analysis of semi-structured in-depth interviews with 16 employees who were currently or had recently been off work with an episode of low back pain. Results. Two types of initial supervisor response were identified: See you later and Take your time and get it right. Both of these relied on the employee returning to work once they were able to do their normal work tasks. Three types of subsequent response were identified: Proactive, Apathetic and Negative. Only the proactive response included actions to encourage and assist the employee to return to the workplace. Conclusions. The interactions described by participants suggest that employers and their representatives often postpone actioning to return to work interventions which potentially delays the rehabilitation of the employee.

Background
Adolescence is a risk period for offending. Traumatic Brain Injury (TBI) a potential risk factor for poor mental health and for offending. TBI has been largely neglected from guidance on managing health needs of offenders.
Aims
We sought to determine the rate of self-reported TBI, of various severities, in a male, adolescent youth offending population. We also aimed to explore whether TBI was associated with number of convictions, violent offending, mental health problems and drug misuse.
Method
Young male offenders aged 11 to 19 years were recruited. A total of 197 participants were approached and 186 (94.4%) completed the study. They completed self-reports on TBI, mental health and drug use.
Results
Prevalence rate of TBI of all severities was 65%. Repeat injury was common – with 32% having had more than one episode of LOC. Frequency of TBI was associated with more convictions. Three or more TBIs were associated with greater violence in offences. Those with TBI were also at risk of greater mental health problems and of misuse of cannabis.
Conclusions
TBI may be associated with offending behaviour and worse mental health outcomes. Addressing TBI within adolescent offenders may be important for improving well-being and reducing re-offending.

Background: TBI can lead to cognitive, behavioural and emotional difficulties. Previous studies suggest that TBI is relatively elevated in offender populations. We aimed to establish the rate of TBI of various severities in a representative sample of adult offenders and patterns of custody associated with TBI.
Methods:. We conducted a self-report survey of adult, male, offenders within a prison. of 453 offenders, 196 (43%) responded.
Results: We found over 60% reported “Head Injuries”. Reports consistent with TBI of various severities were given by 64%. of the overall sample, 16%. had experienced moderate to severe TBI, and 48% Mild TBI. Adults with TBI were younger at entry into custodial systems and reported higher rates of repeat offending. They also reported greater time, in past 5 years, spent in prison.
Conclusions: These findings indicate that there is a need to account for TBI in the assessment and management of offenders.

In this article we describe the use of the Internet to conduct online synchronous interviews on gay men's experiences of Internet sex-seeking and barebacking, using interpretative phenomenological analysis (IPA). We then present the results of a separate IPA of the issues we encountered during the research. The analysis is focused around four superordinate themes: positive experience, technological issues, boundaries, and requests/expectations. We argue that online qualitative research is valuable in its own right, and that the advantages considerably outweigh the difficulties. This is particularly true in accessing individuals who might not participate in other types of research settings to discuss experiences that would otherwise be too difficult to talk about. Several issues that are problematic in more conventional research still apply, albeit in a different guise, but these must be situated in the context of who or what is being researched, and why, and can be largely overcome with more creative methodologies and considered preparation.

It has been shown that prior exposure to words associated with an elderly stereotype slows down the rate at which participants walk to an elevator upon leaving the laboratory (Bargh, Chen, & Burrows, 1996). Yet neuropsychological evidence suggests that simple motor actions should not be influenced by such a prime. We investigated the effects of an elderly prime on a different type of simple action: a. reaching and grasping task. This task was chosen because particular emphasis can be placed on where the effects of an elderly stereotype prime lie within the overall action sequence. The results showed that relative duration of the gaps in between ballistic actions increased compared with the relative duration of the actions themselves, slowing down part of the action sequence. This work therefore effectively reconciles apparently conflicting accounts of how a stereotype prime can affect action.