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Treatment assignment for patients with personality disorders (PDs) involves a complex process consisting of diagnostic assessment and deciding on the most appropriate psychotherapeutic treatment. This article describes the development of a checklist for systematic analysis of life stories to support reflective and transparent assignment of patients to either dialectical behavioral therapy (DBT) or schema-focused therapy (SFT). In a first study, an email survey, focus group, and member check were conducted among eight clinical experts to identify relevant dimensions in life stories in patients with PDs. In a second study, a checklist based on these dimensions was developed in three rounds of testing with nine clinical experts and nine psychology students. Checklist results were compared to actual assigned treatment for 20 patients. Systematic evaluation of life stories, is promising in supporting the allocation of patients with PDs to a suitable treatment approach by focusing on specific and consensual dimensions in patients' life stories.

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BACKGROUND: It has been advocated that the development of medical school curricula must be informed by students, doctors in training, educators, employers, other health and social care professionals and patients, families and carers. Patients are widely employed to teach clinical and interpersonal skills, and while recognised as crucial in health education, they have mostly been offered a passive role. We assessed the impact of patients contributing personal illness narratives in the master curriculum of allied health care professionals on students' learning experiences. METHODS: We designed a module (Patient and Society) for a master's degree programme in Health Sciences at the University of Southern Denmark in collaboration with six patients. The patients contributed to the teaching by sharing and discussing their personal illness narrative. At the end of the module, as part of the exam, we asked the students to reflect on the patients' contribution to the module and how this affected their learning experiences. The 500-word exam responses of 29 students were analysed, in collaboration with six patients, using thematic analysis. RESULTS: Including patients' illness narratives lifted students' academic learning, and their personal and professional development. The stories brought theoretical concepts to life; it helped the students to obtain, retain, and apply academic knowledge. Actively and uninterrupted listening to patients' illness experiences promoted empathy and critical reflection on clinical practice. Faced with the impact of a disease on a person's life, seeing the healthcare system through a patient's lens made students reflect critically on the medical positivist model ruling the health care system focused on just fixing the medical problem with very little room for the illness experience. CONCLUSION: Our analyses support previous findings indicating that patient narratives are a powerful tool to achieve academic and professional development. Working with patients in health education has the potential to work towards a more inclusive epistemological stance in the health care system and health research.

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Objective: Counteracting feelings of loneliness among older adults underscores the need to improve social well-being, for example, by sharing small stories. Interestingly, virtual representation of nature (VN) can stimulate social aspirations and trigger associations, which could be used as conversational material. Especially nature's characteristics of mystery and spaciousness seem promising. Therefore, it was investigated whether VN can elicit small stories in older adults using a randomized 2 (mystery: low vs. high) × 2 (spaciousness: low vs. high) design. Methods: In total 118 participants (60 years and older) were recruited. Small stories, nature-relatedness, available nature opportunities and demographics were measured. The small stories were analysed with respect to story elements (sum range: 0-4) and storytelling characteristics (ease of storytelling, valence, social intention). Results: The VN were able to elicited small stories: 97% (N = 115) contained at least one story element. Moreover, when participants felt more related to nature and assigned more positive valence to their story, they also had stronger intentions to use their story for social interaction. The VN characteristics of mystery and spaciousness showed no effects. Conclusion: Not so much the characteristics of nature (mystery and spaciousness) as the characteristics of the participants (nature-relatedness) played an important role in eliciting and sharing small stories.

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Background: Differences in the way autistic children experience the world can contribute to anxiety and stress. Carol Gray's Social Stories™ are a highly personalised intervention to support children by providing social information about specific situations in an individual story. Objectives: This randomised controlled trial aimed to establish whether Social Stories are clinically effective and cost-effective in improving social responsiveness and social and emotional health in children on the autism spectrum in schools. Design: A multisite pragmatic cluster randomised controlled trial comparing Social Stories with care as usual. Setting: Eighty-seven schools (clusters) across Yorkshire and the Humber. Participants: Two hundred and forty-nine children were randomised via a bespoke system hosted at York Trials Unit (129 Social Stories and 120 care as usual). Recruitment was completed in May 2021. Participants were children aged 4-11 years with a diagnosis of autism, alongside teachers, interventionists and caregivers. Recruitment was via schools, NHS trusts, support groups and local publicity. Intervention: The intervention included training for educational professionals and caregivers covering psychoeducation and implementation of Social Stories. Stories were written around contextualised goals around the child's need for social information. Interventionists read the Social Story™ with the child at least six times over 4 weeks during school. Main outcome measure: The primary outcome was the Social Responsiveness Scale-2 completed by teachers at 6 months (the primary end point), which measures social awareness, cognition, communication and behaviour. Data were collected from caregivers and educational professionals at 6 weeks and 6 months through questionnaires. Blinding of participants was not possible. Results: At 6 months, the estimated difference in expected teacher-reported Social Responsiveness Scale-2 T-score (the primary end point) was -1.61 (95% confidence interval -4.18 to 0.96, p = 0.220), slightly favouring the intervention group. The estimated differences for the parent-reported secondary outcomes at 6 months were small and generally favoured the control group except the measure of children's quality-adjusted life-year (+ 0.001, 95% confidence interval -0.032 to 0.035) and parental stress (-1.49, 95% confidence interval -5.43 to 2.46, p = 0.460), which favoured the intervention group. Children in the intervention group met their individual goals more frequently than children who received usual care alone (0.97 confidence interval 0.21 to 1.73, p = 0.012). The intervention is likely to save small costs (-£191 per child, 95% confidence interval -767.7 to 337.7) and maintain a similar quality of life compared to usual care. The probability of Social Stories being a preferred option is 75% if the society is willing to pay £20,000 per quality-adjusted life-year gained. Limitations include considerable disruptions during the coronavirus disease 2019 pandemic. Conclusion: Social Stories are used in schools and represent a low-cost intervention. There is no clinically evident impact on social responsiveness, anxiety and/or depression, parental stress or general health. Benefits were observed for specific behavioural goals as assessed by the teacher, and Social Stories may serve as a useful tool for facilitating dialogue between children and school staff to address specific behavioural challenges. Usage should be at the school's discretion. Future work: Given the uncertainty of the results in light of coronavirus disease 2019, further work to establish the impact of Social Stories is merited. Trial registration: This trial is registered as ISRCTN11634810. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/111/91) and is published in full in Health Technology Assessment; Vol. 28, No. 39. See the NIHR Funding and Awards website for further award information.

Autism affects the way children experience the world, and some children find social situations stressful. We wanted to know whether Social Stories™, developed by Carol Gray, helped children with their social skills and behaviour in school and whether they offered value for money. A randomised controlled trial design was used, which gave schools an equal chance of being asked to deliver Social Stories or to continue providing care as usual. Two hundred and forty-nine children from 87 schools took part and we trained school staff and parents to write and deliver Social Stories. We agreed with teachers and parents, what each child needed help with and wrote stories with this in mind. Trained staff read the Social Story with the child at least six times over 4 weeks. Follow-up information was collected from parents and school staff at the start of the study, after 6 weeks and 6 months. After 6 months, teachers completed a questionnaire called the Social Responsiveness Scale-2 which measures the child's social skills. Using these measures, the results suggest that Social Stories do not lead to any significant changes in social skills, mental health, parent stress, general health or quality of life but children in schools allocated to Social Stories met their goal more frequently and incurred less costs than children who did not. Parents and educational professionals found the Social Stories intervention and training beneficial. Based on our findings, Social Stories do not appear to improve general social skills in primary-aged autistic children. Benefits were observed for specific goals, and school-based costs were reduced.

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We present an explainable artificial intelligence methodology for predicting mortality in patients. We combine clinical data from an electronic patient healthcare record system with factors relevant for severe mental illness and then apply machine learning. The machine learning model is used to predict mortality in patients with severe mental illness. Our methodology uses class-contrastive reasoning. We show how machine learning scientists can use class-contrastive reasoning to generate complex explanations that explain machine model predictions and data. An example of a complex class-contrastive explanation is the following: "The patient is predicted to have a low probability of death because the patient has self-harmed before, and was at some point on medications such as first-generation and second-generation antipsychotics. There are 11 other patients with these characteristics. If the patient did not have these characteristics, the prediction would be different". This can be used to generate new hypotheses, which can be tested in follow-up studies. Diuretics seemed to be associated with a lower probability of mortality (as predicted by the machine learning model) in a group of patients with cardiovascular disease. The combination of delirium and dementia in Alzheimer's disease may also predispose some patients towards a higher probability of predicted mortality. Our technique can be employed to create intricate explanations from healthcare data and possibly other areas where explainability is important. We hope this will be a step towards explainable AI in personalized medicine.

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People who suffer from advanced cancer may experience a loss of ability to participate in everyday life and meaningful activities, challenging their sense of identity and social relations. Social support in patient-to-patient interactions and the sharing of experiences with people in similar situations may help alleviate distress. This article is based on an ethnographic field study carried out in relation to three residential narrative courses, which included 36 persons with advanced cancer. In this study, we aimed to explore whether the courses were perceived as significant by the participants and, if so, in what ways. The field work included 185 hr of observations, six focus group interviews and nine individual interviews. The data were analyzed using an abductive thematic approach. Our findings indicate that the residential courses were generally experienced as meaningful and that in particular the setting, the community, and gaining hope were experienced as significant.

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Social Stories (also known as social narratives) help individuals participate in and understand social situations. This scoping review identifies and synthesizes social narrative research targeting behavior change in individuals with ASD. Using the following questions as a guide: (a) What is the scope of social narrative interventions used for individuals with ASD, (b) What behavior change outcome measures are evaluated, and (c) What research designs are used; five databases were searched from 2007-to-2018. Fifty-six articles met the criteria. Primary outcomes were sorted into two macro-categories: Reduce Disruptive Behaviors and Increase Desired Behaviors. Most, but not all, studies were found to be effective for various behaviors such as aggressive actions, verbal protests, identifying emotions, executive functioning, following directions, and responding in social situations. Social narratives can be used to promote skills/behaviors in individuals with ASD to enable participation, an important goal in occupational therapy practice. They are an accessible and feasible intervention that can be implemented in various settings for behaviors including activities of daily living, social skills, independence, and self-regulation. Most research reviewed the single subject design, which is a limitation of the research as it makes results difficult to generalize. However, through replication, functional relationships can be determined. Additional research utilizing randomized control trials is recommended.

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BACKGROUND: One in 57 children are diagnosed with autism in the UK, and the estimated cost for supporting these children in education is substantial. Social Stories™ is a promising and widely used intervention for supporting children with autism in schools and families. It is believed that Social Stories™ can provide meaningful social information to children that can improve social understanding and may reduce anxiety. However, no economic evaluation of Social Stories has been conducted. AIMS: To assess the cost-effectiveness of Social Stories through Autism Spectrum Social Stories in Schools Trial 2, a multi-site, pragmatic, cluster-randomised controlled trial. METHOD: Children with autism who were aged 4-11 years were recruited and randomised (N = 249). Costs measured from the societal perspective and quality-adjusted life-years (QALYs) measured by the EQ-5D-Y-3L proxy were collected at baseline and at 6-month follow-up for primary analysis. The incremental cost-effectiveness ratio was calculated, and the uncertainty around incremental cost-effectiveness ratios was captured by non-parametric bootstrapping. Sensitivity analyses were performed to evaluate the robustness of the primary findings. RESULTS: Social Stories is likely to result in a small cost savings (-£191 per child, 95% CI -767.7 to 337.7) and maintain similar QALY improvements compared with usual care. The probability of Social Stories being a preferred option is 75% if society is willing to pay £20 000 per QALY gained. The sensitivity analysis results aligned with the main study outcomes. CONCLUSIONS: Compared with usual care, Social Stories did not lead to an increase in costs and maintained similar QALY improvements for primary-aged children with autism.

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AIM: To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital. BACKGROUND: Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability. DESIGN: A narrative inquiry. METHODS: Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data. RESULTS: The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation. CONCLUSION: Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly. REPORTING METHOD: The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting. PATIENT OR PUBLIC CONTRIBUTION: The consumer researcher was involved in design, data analysis and publication preparation.

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BACKGROUND: Personal recovery is operationalized in the CHIME framework (connectedness, hope, identity, meaning in life, and empowerment) of recovery processes. CHIME was initially developed through analysis of experiences of people mainly with psychosis, but it might also be valid for investigating recovery in mood-related, autism and other diagnoses. AIMS: To examine whether personal recovery is transdiagnostic by studying narrative experiences in several diagnostic groups. METHODS: Thirty recovery narratives, retrieved from "Psychiatry Story Bank" (PSB) in the Netherlands, were analyzed by three coders using CHIME as a deductive framework. New codes were assigned using an inductive approach and member checks were performed after consensus was reached. RESULTS: All five CHIME dimensions were richly reported in the narratives, independent of diagnosis. Seven new domains were identified, such as "acknowledgement by diagnosis" and "gaining self-insight". These new domains were evaluated to fit well as subdomains within the original CHIME framework. On average, 54.2% of all narrative content was classified as experienced difficulties. CONCLUSIONS: Recovery stories from different diagnostic perspectives fit well into the CHIME framework, implying that personal recovery is a transdiagnostic concept. Difficulties should not be ignored in the context of personal recovery based on its substantial presence in the recovery narratives.

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BACKGROUND: Integrated care is based around values of involvement and shared decision-making, but these are not often reflected within planning and implementation. Barriers include continued emphasis on professional and managerial perspectives, skills gaps on how best to engage people and communities and insufficient investment in involvement infrastructure. Despite such challenges, people with lived experience have still led changes in policy and services. DESIGN: Qualitative study involving 25 participants with lived experience from 12 countries. Participants shared their background stories and engaged in semistructured interviews relating to leadership identity, experience of influencing and personal learning. Transcripts were analysed through a framework approach informed by narrative principles. RESULTS: Participants were motivated by their own experiences and a wish to improve care for future individuals and communities. Sharing their story was often the entry point for such influencing. Participants gained skills and confidence in story telling despite a lack of support and development. Many felt comfortable being described as a leader while others rejected this identity and preferred a different title. No common alternative term to leader was identified. Influencing services required considerable personal cost but also led to new networks, skills development and satisfaction when change was achieved. DISCUSSION: Leadership within integrated care is often awarded to those with structural power related to management or clinical seniority. People with lived experience are though uniquely placed to identify what needs to change and can develop inspiring visions based around their personal stories. Claiming identity as leader can be challenging due to traditional notions of who is eligible to lead and unwillingness by professionals and managers to grant such identity. CONCLUSIONS: People with lived experience should be recognised as leaders of integrated care and have access to developmental opportunities and practical support to strengthen their skills, including that of storytelling. PATIENT AND PUBLIC CONTRIBUTION: The research was instigated on the request of a community advisory board of people with lived experience who shaped its design, contributed to the analysis and informed the conclusions and implications.

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AIMS: To (a) seek examples of nursing caring success stories and (b) identify the common contributors to these successes. By focusing on the successes of nursing care rather than critically examining failures, this research seeks to provide examples of proven and feasible approaches and processes for improving care. DESIGN: This study used a narrative inquiry design. METHODS: Data were collected through group interviews. Four interviews were conducted with a total of 20 nurse participants working in inpatient settings in South Australian hospitals. A thematic analysis approach was used to analyse the data. RESULTS: Two dominant themes concerning the contributors to caring success were identified. These contributors were (1) the provision of holistic care and (2) the influence of the caring community, which includes family members and other patients. The findings also indicated that the definition of caring success according to nurses is not aligned with organisational performance indicators but is more closely represented by caring values. CONCLUSION: Success, according to nurses, is not exclusively defined by patient outcomes but includes the approach to, and process of, care delivery. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses value the caring process while working in an environment that primarily values clinical and systems-level outcomes. Nurses want patients and their families, allied health professionals and hospital executives to be involved and invested in the process of care. IMPACT: This study addressed a gap in the current literature to identify commonalities in nursing success stories, the contributors informing these successes and how these contributors can facilitate improved patient care. Understanding nursing definitions of caring success provides an opportunity to expand upon current accepted industry definitions and perspectives such as key performance indicators. REPORTING METHOD: Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. PATIENT OR PUBLIC CONTRIBUTION: No direct patient or public contribution.

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BACKGROUND: Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to reduce its incidence have seen limited success. A notable gap exists in the awareness among women of childbearing age (WCA) regarding both the risks of premature birth and the preventative measures they can take. Research suggests that enhancing health beliefs and self-management efficacy in WCA could foster preventive health behaviors. Interactive webtoons offer an innovative, cost-effective avenue for delivering engaging, accessible health education aimed at preventing premature birth. OBJECTIVE: This protocol describes a randomized controlled trial to assess the effectiveness and feasibility of a novel, self-guided, web-based intervention-Pregnancy Story I Didn't Know in Interactive Webtoon Series (PSIDK-iWebtoons)-designed to enhance self-management efficacy and promote behaviors preventing premature birth in WCA. METHODS: Using an explanatory sequential mixed methods design, this study first conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. Participants are randomly assigned to 2 groups: one accessing the PSIDK-iWebtoons and the other receiving Pregnancy Story I Didn't Know in Text-Based Information (PSIDK-Texts) over 3 weeks. We measure primary efficacy through the self-management self-efficacy scale for premature birth prevention (PBP), alongside secondary outcomes including perceptions of susceptibility, severity, benefits, and barriers based on the health belief model for PBP and PBP intention. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and the 4-week follow-up. The feasibility of the intervention is assessed after the end of the 3-week intervention period. Outcome analysis uses repeated measures ANOVA for quantitative data, while qualitative data are explored through content analysis of interviews with 30 participants. RESULTS: The study received funding in June 2021 and institutional review board approval in October 2023. Both the PSIDK-iWebtoons and PSIDK-Texts interventions have been developed and pilot-tested from July to November 2023, with the main phase of quantitative data collection running from November 2023 to March 2024. Qualitative data collection commenced in February 2024 and will conclude in May 2024. Ongoing analyses include process evaluation and data interpretation. CONCLUSIONS: This trial will lay foundational insights into the nexus of interactive web-based interventions and the improvement of knowledge and practices related to PBP among WCA. By demonstrating the efficacy and feasibility of a web-based, interactive educational tool, this study will contribute essential evidence to the discourse on accessible and scientifically robust digital platforms. Positive findings will underscore the importance of such interventions in fostering preventive health behaviors, thereby supporting community-wide efforts to mitigate the risk of premature births through informed self-management practices. TRIAL REGISTRATION: Korea Disease Control and Prevention Agency (KDCA) KCT0008931; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25857. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58326.

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PURPOSE: Childhood or adolescent cancer survivors (CACS) are an understudied population in Colombia and, in general, in Central and South America. Worldwide, studies typically focus on high-income settings while approaching CACS' experiences from a biomedical or psychological perspective. However, both perspectives miss an important aspect of survivorship after childhood or adolescent cancer: the affected individual's subjective experiences of having a disabled body. This qualitative study aimed to explore the embodied experiences of Colombian adults who survived cancer during their childhood or adolescence to better understand how CACS relate to their altered body and world. METHODS: By integrating phenomenological insights and conducting comprehensive life-story interviews, we explored the various ways in which survivors' cancer experiences affect their bodily sense of self-from the acute phase of the disease until well into adulthood. A total of ten life-stories interviews and one focus group were carried out with seven CACS. All participants were survivors of a different type of childhood/adolescent cancer. The results were analyzed thematically, focusing on the embodied aspects of participants' experiences. RESULTS: We developed three main themes regarding the embodied cancer experience among participating CACS: Firstly, participants' body changes because of the cancer and its treatment, which makes them aware of their body. Secondly, they adapt to this experience in different bodily ways. Finally, they carry bodily traces of their cancer experience in the present as well as into the future. CONCLUSIONS: The CACS participating in this study report that their experience with cancer has been embodied throughout their lives, changing their sense of their body and how they relate to it, and leaving traces into the present and their imagined future.

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Narrative gerontology considers how people age biographically as well as socially and biologically. Vulnerability as a process category and state of being remains undertheorized in the context of narratives of later life. It is argued that the narrative space for stories from old age privilege backward-looking stories that focus on positive milestones and support cultural narratives of a "life well lived." Sad, emotionally laden or uncertain/unfinished stories that reveal vulnerabilities are rejected and potentially viewed as problematic. Using an illustrative case example of a study of resilience narratives and aging, this paper considers how the study authors position and identify resilience. Some interpretative judgements used in the research regarding who is resilient based on expressions of vulnerability are highlighted. Overall, the tensions between cultural and personal narratives that position older people as vulnerable subjects are considered and it is argued that vulnerability can be a great source of strength and meaning in later life.

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INTRODUCTION: Almost one third of people affected by leprosy in Colombia suffer from disability, which often results from delayed diagnosis and treatment. We aimed to explore the experience of people affected by leprosy during the process of diagnosis and treatment and if and how this experience was influenced by peers. METHODS: A qualitative study using body map stories was conducted from October 2019 to February 2020 in Colombia. Adult people affected by leprosy were recruited through patient associations in different cities. We conducted three sessions with an average duration of 2-3 h per participant, during which the participants created a painted map of their body and chose symbols to represent their experience, while being engaged in an informal interview. The sessions were audio recorded, transcribed verbatim and analyzed thematically by an interdisciplinary team, consisting of physicians, social workers and a person affected by leprosy. RESULTS: The 17 study participants (11 female) were aged 20 to 70 years. Leprosy-related manifestations ranged from no to advanced disability. Some participants were active members of associations for people affected by leprosy. Three main themes were identified during analysis: (1) A long pathway to diagnosis, (2) Therapy as a double-edged sword and (3) The influence of other people affected by leprosy. The participants described an often years-long process until being diagnosed, which was marked by insecurities, repeated misdiagnosis, and worsening mental and physical health. Delayed diagnosis was related to late health care seeking, but also to inadequate health communication, lack of leprosy-related knowledge and negligence among health care workers. A high desire to cure motivated the participants to take their medication rigorously, despite the high treatment burden. Support from peers, either within the own social environment or provided from associations, contributed to a faster diagnosis and increased therapy adherence. Peers helped to recognize the symptoms, urged patients to seek care, recommended physicians with leprosy-related knowledge and provided a realistic example of both disease severity and curability. CONCLUSION: People affected by leprosy experience a significant burden during the process of diagnosis and treatment. Involving well-trained peers could foster early diagnosis, treatment compliance and prevention of disability.

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The Revised Hasegawa Dementia Scale (HDS-R) is the most widely used instrument to screen for dementia in Japan and is similar to the Mini-Mental State Examination (MMSE). The development of a quicker and simpler screening tool, the Japanese Old Stories Cognitive Scale (JOSS), was previously reported. A total of 953 new outpatients from 8 memory clinics in Japan completed the JOSS, HDS-R, and MMSE at first visit. We investigated the relationship of JOSS score with both the total and individual domain scores on the HDS-R and MMSE. We found a significant relation between JOSS score and total HDS-R and MMSE scores. In addition, JOSS score was significantly related to scores on 8 of the 9 HDS-R domains and 7 of the 11 MMSE domains. We obtained regression lines for JOSS score versus HDS-R and MMSE scores. JOSS score could be useful for predicting HDS-R and MMSE scores and thus in estimating cognitive functioning.

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Introduction: Social Stories (SS) is a socially-valid intervention for autistic children and young people (CYP) which is used widely by professionals and parents. Research suggests that whilst parents are in an ideal position to deliver interventions for their autistic CYP, a lack of procedural integrity can result in a great deal of variability in parent-mediated intervention outcomes. Methods: This exploratory study investigated the extent to which SS can be effectively developed and delivered, through digital mediation, by parents with little to no researcher input (n = 17, sample 1) and the factors that impact effectiveness. Furthermore, the study also investigated the extent to which digitally-mediated SS can support autistic CYP to develop and deliver their own stories, thereby utilising the intervention as a means for self-support and self-management (n = 5, sample 2). Results: The outcomes of the study indicate that digital mediation can effectively support parent-led SS intervention. Findings also indicate that receptive/expressive language skills of autistic CYP, their level of systemizing, as well as the practice of consulting with the autistic CYP whilst identifying goals and developing stories, are individual and procedural characteristics which positively influence the effectiveness of the parent-led intervention. The study also found that digitally-mediated SS can be utilised as a self-support tool by autistic CYP themselves. Discussion: The results inform the developing literature on digital interventions and support tools that aim to engage with, and involve further, the autistic community in the setting and authoring of interventions and research.

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Instagram is one of the most used platforms, and ephemeral stories are proving to be the most used medium for users to share content on the platform. However, there have been few studies examining this type of content in relation to emotional well-being. This study examined the association between the number of published Instagram stories, psychological well-being, personality traits, and gender in a sample of 734 Instagram users from Italy, including 281 men and 453 women, with a mean age of 25.19 years (SD = 7.08). Participants were recruited online and asked to complete an online questionnaire. Differences were found between genders in terms of time spent on Instagram, but not in terms of the number of stories posted in the past week. In the overall sample, a small positive correlation was found between the number of Instagram stories posted and extraversion. When considering gender differences, small effect sizes were observed for emotional dysregulation, agreeableness, and neuroticism, indicating a stronger association with Instagram stories in the female group, and for openness, indicating a stronger association in the male group. Results of multiple regression analyses suggest that among females, psychological variables, including personality and emotional distress, may have a stronger association with Instagram stories. To our knowledge, this is the first study to report these differences. The findings help to clarify how certain characteristics of social media platforms relate to psychological well-being and personality differently in men and women in their journey to using social media.

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OBJECTIVE: To examine which met and unmet needs are discussed in stillbirth stories shared on YouTube with the aim to improve obstetric care. DESIGN: Inductive thematic analysis of 19 English-language stillbirth stories uploaded to YouTube. SETTING: Online setting, YouTube video content. SAMPLE: Women who experienced stillbirth and shared a video on YouTube talking about their experience. METHODS: We conducted a thorough textual reading of the transcripts following Braun and Clarke's guidelines for thematic analysis. MAIN OUTCOME MEASURES: Codes were developed and grouped into themes. RESULTS: Although some women actively used their birth videos to call out shortcomings in their care, most others used their platform for other purposes such as destigmatisation, awareness and support, and rather unintentionally provided insight into their met and unmet needs. When analysing their birth stories, three major themes emerged: choice and decision-making, education and information, and behaviour of healthcare providers. CONCLUSIONS: This study demonstrates the value of birth stories in research. We identified three major opportunities for improvement of obstetric care: being provided with options and being able to make choices in the decision-making process are clearly valued, but there are some caveats: women and other childbearing individuals need timely and continuous information, and more attention is needed for emotional intelligence training of healthcare providers.

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