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This study set out to answer the question 'Which kinds of agency do refugees perform when dealing with mental health problems of themselves and their children?'. Aiming to gain more insight in why it seems harder for refugee parents and minors than for the native population to talk to health professionals about their mental health and wellbeing, we combined two theoretical notions of agency to investigate a broad spectrum of informants' behaviour. We conducted 25 interviews with 30 refugees from 8 countries (Syria, Yemen, Iran, Afghanistan, Armenia, Eritrea, Turkish Kurdistan, Vietnam), whose Dutch residence permit varied from 26 years to less than one year. Data were analysed through open and axial coding, followed by pattern analyses. Although sometimes refugees seek (mental) healthcare, at other times they show agency by doing 'nothing' or by deliberately using distracting activities to deal with severe stress. Making use of resources available to them, oftentimes refugees show agency in ways that are less visible to healthcare professionals, by surviving, showing resilience, and suffering. In these cases, we think healthcare for refugees should intervene in a non-medical way, e.g., by supporting them to obtain resources that help refugees to (re)gain agency.

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Health promotion provides a complementary scientific and practical approach to medicine, which may help to create, maintain and restore wellness even in the presence of disease and illness. Salutogenesis, as key concept, focuses upon the emergence of health and thus, leads to fortifying individuals' and communities' health determinants and resources. The potential integration of health promotion and medicine can contribute to a more person-centred focus of integrative care to address and realize individuals' health potential and needs, rather than merely an emphasis upon the underlying disease, such as congenital heart diseases. We posit that it is possible-and advisable-to address lifestyle modification aspects, and to change the focus of therapeutic encounters and health care programs to be more tailored to and aligned with individual needs, demands and expectations. By adopting a health promotional approach to the individual patient as person, their subjective biography, narrative and lifeworld can serve as resources for developing more beneficial coping styles, resilience and trajectories for personal growth over the life span, despite the occurrence and durability of chronic conditions, such as long-term cardiovascular disease. Implications, important contingencies and requirements for education and training of health-care professionals are addressed, as they are key issues that may affect the successful development and engagement of health promotion programs within health care systems at-large.

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OBJECTIVE: Building upon earlier research, a person-centred technology-enabled solution (the InnoWell Platform) is being co-designed and implemented into regional youth primary mental health services to improve clinical safety and service quality. DESIGN: Co-design methodologies of service pathway mapping and participatory design workshops as well as usability testing guide the development and implementation of the InnoWell Platform. SETTING AND PARTICIPANTS: headspace centres on the North Coast of New South Wales and their associated communities. MAIN OUTCOME MEASURES: Participation in co-design methodologies, implementation and uptake, identification of youth mental health care needs, and service provision. RESULTS: Nine service pathway mapping (N = 81 participants) and 10 participatory design (N = 48) workshops and usability testing sessions (N = 30) with youth, their supportive others, health professionals, service managers and administrators have been conducted. Four headspace centres have implemented the InnoWell Platform. To date, 120 youth are using the platform and 96 have completed an initial multidimensional assessment. Of these, the majority reported moderate-to-high psychological distress and a quarter reported experiencing high suicidal thoughts and behaviours with subsequent earlier provision of care. Young people have independently commenced recommended online tools and collaborated on clinical care options with their health professionals. CONCLUSIONS: Preliminary findings support co-design methodologies for the development of person-centred technology-enabled solutions embedded within youth primary mental health services in regional Australia. The findings further demonstrate that such solutions may improve clinical safety and service quality, which in turn may facilitate the delivery of the right care, first time!

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BACKGROUND: Cross-sectoral care comprises interdisciplinary and coordinated efforts for patients with complex care needs involving various competencies and professions across the primary health care sector, hospital sector, and municipal services. Cross-sectoral care can increase the effectiveness of rehabilitation programmes, but the treatment courses often lack coherence. Establishing successful treatment pathways requires a better understanding of the health care challenges faced by patients with low back pain. The aim of this study was to explore how patients with low back pain experience cross-sectoral care. METHOD: A qualitative interview study including 25 patients with low back pain. Patients were recruited in connection with their appointment at the Spine Centre of Southern Denmark. Recruitment stopped when the interviews no longer added new knowledge to the subject. The data were analysed using a systematic text condensation approach. RESULTS: Patients with low back pain experienced cross-sectoral care to be fragmented, with episodes lacking collaboration, information, and acknowledgement of their problem. They desired recognition of having a serious back problem and of being more than the diagnosis itself. Patients found it hard to keep track of their course of treatment due to a perceived lack of organisational support and collaboration between professionals. The patients called for more information about the treatment plan and the reasons for further referral in order to better understand and manage their treatment. CONCLUSION: Patients' experiences indicate a need for a stronger person-centred approach in cross-sectoral care, in which the individual's experiences of living with low back pain are taken into account.

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In this paper, I will show how philosophical theory can be applied in the most fundamental area of health care practice, the relationship between the provider and the receiver of care. I will look at the process of becoming a patient and remaining a person. This will begin with a discussion of Heidegger's notion of solicitude alongside the related notions of concern and care, leading to the affirmation of authentic solicitude as the most ontologically appropriate relationship between those who provide and those who receive care. I will then try to understand what happens to us when we become patients and to see what factors make it difficult for us to be persons as well as patients, within the health care environment. This will be followed by a brief discussion of the ancient idea of phronesis (wisdom) in which I will attempt to elucidate, from the side of the health care professional, the way that their relationship with patients can work in a way that recognizes personhood in their patients. I will also consider the dialectical nature of the relationship between patients and doctors (and everyone else who treats us) and try to understand how this points towards the conclusion of a person-centred approach to health care. Following this discussion, I will offer a couple of examples of what person-centred health care might look like in practice, as a means of illustrating, in practical terms, the philosophical approach that I have used.

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Something important is happening in applied, interdisciplinary research, particularly in the field of applied health research. The vast array of papers in this edition are evidence of a broad change in thinking across an impressive range of practice and academic areas. The problems of complexity, the rise of chronic conditions, overdiagnosis, co-morbidity, and multi-morbidity are serious and challenging, but we are rising to that challenge. Key conceptions regarding science, evidence, disease, clinical judgement, and health and social care are being revised and their relationships reconsidered: Boundaries are indeed being redrawn; reasoning is being made "fit for practice." Ideas like "person-centred care" are no longer phrases with potential to be helpful in some yet-to-be-clarified way: Theorists and practitioners are working in collaboration to give them substantive import and application.

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The search for causal explanations in medically unexplained syndromes such as burnout has not been resolved by evidence-based medicine. A biomedical model encourages a reductionist diagnostic practice and a dualist split between physical and psychological symptoms. Therefore, diagnosing and treating these syndromes remains a challenge. Depression is a common aspect in burnout and, as a result, clinicians often diagnose burnout patients as depressed. The Norwegian government expects medical efficiency to reduce sick leaves. Medically treating depression has a documented effect. This practice may pose threats to the increasing number of individuals experiencing burnout. The clinical guidelines in evidence-based medicine mirror what counts as knowledge in medical inquiry, which in turn shapes attitudes towards individual patients. The aim of this article is 2-fold: firstly, to assess how the values that accompany the biomedical paradigm affect clinical care, and secondly, to replace the biomedical model with a genuine person-centred approach. In the study described, an existential phenomenological method was applied. Eight individuals, who experienced burnout, were included. They had been on long-term sick leave (>1 year) due to symptoms of fatigue and pain and fulfilled the criteria for Exhaustion Disorder (ICD-10, F43.8A). Their symptoms were not medically explained, and almost all the participants were labelled as depressed. Four themes emerged that described how they experienced living with burnout: "unhomelike being in the world," "the limit of diagnosis," "naked in the eyes of the public," and "a path to hopelessness." I identify 2 main problems; firstly, the mismatch between the patient's experience of his or her illness and the doctor's interpretation of the condition can lead to ineffective treatment. Secondly, the interviewees struggled to be recognized as ill. Thus, the inherent values in the biomedical paradigm might have serious implications for the medical care of patients with burnout.

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RATIONALE, AIMS AND OBJECTIVES: Person-centred health care is prominent in international health care reforms. A shift to understanding and improving personal care at the point of delivery has generated debates about the nature of the person-centred research agenda. This paper purviews research paradigms that influence current person-centred research approaches and traditions that influence knowledge foundations in the field. It presents a synthesis of the emergent approaches and methodologies and highlights gaps between static academic research and the increasing accessibility of evaluation, informatics and big data from health information systems. FINDINGS: Paradigms in health services research range from theoretical to atheoretical, including positivist, interpretive, postmodern and pragmatic. Interpretivist (subjective) and positivist (objectivist) paradigms have been historically polarized. Yet, integrative and pragmatic approaches have emerged. Nevertheless, there is a tendency to reductionism, and to reduce personal experiences to metrics in the positivist paradigm. Integrating personalized information into clinical systems is increasingly driven by the pervasive health information technology, which raises many issues about the asymmetry and uncertainty in the flow of information to support personal health journeys. The flux and uncertainty of knowledge between and within paradigmatic or pragmatic approaches highlights the uncertainty and the 'unorder and disorder' in what is known and what it means. Transdisciplinary, complex adaptive systems theory with multi-ontology sense making provides an overarching framework for making sense of the complex dynamics in research progress. CONCLUSION: A major challenge to current research paradigms is focus on the individualizing of care and enhancing experiences of persons in health settings. There is an urgent need for person-centred research to address this complex process. A transdisciplinary and complex systems approach provides a sense-making framework.

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