Aim: This study aims to understand pregnant women’s experiences of smoking cessation with an incentive scheme in a deprived UK city. This is important because smoking cessation with pregnant women is one of the most crucial public health initiatives to promote, and is particularly challenging in deprived areas. While financial incentive schemes are controversial, there is a need to better understand pregnant women’s experiences. The scheme combined quasi-financial incentives (shopping vouchers) for validated quits (carbon monoxide (CO) validated at < 10 ppm), enhanced support from smoking cessation advisors, the opportunity to identify a ‘Significant Other Supporter’ and nicotine replacement therapy. Methods: With the focus on understanding pregnant women’s experiences, a qualitative design was adopted. Semi-structured interviews were completed with 12 pregnant women from the scheme, and the three advisors. All interviews were transcribed, and thematic analysis conducted. Results: Pregnant women reported various challenges to quitting, including long-established routines, and stress. Participants were aware of stigma around incentives but were all very positive about the scheme. The relationship with advisors was described as fundamental. The women valued their advice and support, while uptake of the ‘Significant Other Supporter’ appeared low. Participants viewed the CO monitoring as ‘an incentive’, while the vouchers were framed as a ‘bonus’. Advisors perceived the vouchers as helping engage pregnant women and maintain quit status, and women appreciated the vouchers both as financial assistance and recognition of their accomplishments. Conclusion: This study highlights the great value women placed on the support, advice and monitoring from specialist advisors. The distinction between vouchers as a welcomed bonus, rather than ‘the incentive’ to engage, is important. How smoking cessation and schemes to promote this are communicated to pregnant women and health professionals is important, particularly given the stigma and controversy involved.

These findings highlight processes that can result in changes in drinking habits and routines. Whilst these processes can be associated with a reduction or cessation of alcohol use as people age, they can also be associated with increased risk of harmful alcohol consumption. Fractured or disrupted routines, particularly those associated with bereavement or the burden of caring responsibilities, through increasing the risk of loneliness and isolation, can construct increased risk of harmful alcohol consumption. These findings reframe the pathway of risk between ageing and alcohol-related harm by highlighting the vulnerability to harmful drinking practices brought by fracture or sudden change of routine. The findings point to a role for public health in supporting the reconstruction of routines that provide structure and meaning and can be used to actively manage the benefits and harms associated with drinking.

Hospital discharge for people experiencing homelessness is a perennial challenge. The Homeless Reduction Act 2017 (HRA) places new responsibilities on hospitals, but it remains unknown whether this has affected discharge practices. This qualitative study explores stakeholders' views on the challenges around hospital discharge for people experiencing homelessness, in the context of a deprived English city. Semi‐structured interviews were conducted with 27 stakeholders. Participants were purposively recruited from local authority, third sector and the National Health Service. Interviews were transcribed and thematic analysis conducted. Analysis generated three main themes. First, a need for better planning and communication with the third sector, particularly around medication, prescriptions and information sharing. Second, the need to improve awareness and ‘upskill’ hospital staff to work more effectively with people experiencing homelessness, including understanding their needs, the wider support available and HRA requirements. Third, there were calls for (re)investment in a different approach to better support this population, based on outreach and flexibility. The need for improved partnership working and investment was emphasised. Whilst recognising the challenges faced by hospitals, especially within the context of funding cuts, this study highlights the need to recognise the third sector's contribution in supporting people experiencing homelessness in the community. Developing site‐specific checklists for practice before discharge (and as early as possible) may help to ensure appropriate measures are in place. Improving legal literacy in the context of what an appropriate discharge is for people experiencing homelessness may help develop staff confidence to challenge the focus on ‘quick’ discharges.

This article is based on two qualitative studies related to women’s experiences of homelessness and multiple disadvantage in Stoke-on-Trent (one of the 20% most ‘deprived’ districts in England, with higher than average rates of statutory homelessness). This research utilised a participatory approach, with collaboration between researchers from Staffordshire University’s Centre for Health and Development (CHAD) and Expert Citizens C.I.C. Qualitative data collection occurred with 10 women with lived experiences of homelessness and local services (conducted by Expert Citizens) and 20 frontline workers/wider stakeholders (conducted by CHAD). For this article, we conducted thematic analysis to identify patterns across both studies. Three themes are discussed: ‘So much unmet need’ and revolving doors for women; the lack of safe accommodation for women and ‘risky’ alternatives; creating safe spaces for women and the need for longer-term investment and opportunities. There was surprise at how many women came forward for accommodation during ‘Everyone In’ and evolving recognition of gendered experiences of homelessness combined with other experiences. Next steps for action are discussed, highlighting the importance of partnerships and collaboration with people with lived experience. We have strong foundations to build on, and far more to be done, to improve women’s experiences within Stoke-on-Trent.

Purpose This paper reports the use of situational analysis as a systems methodology to evaluate the voices of independence change and empowerment in the Stoke-on-Trent (VOICES) partnership project. Design/methodology/approach Using situational analysis and drawing on a range of secondary data sources, a three-stage conceptual mapping process provided a detailed picture of both the non-linear interlinkage and complexity of the local system that VOICES was working to influence, as well as the processes that shaped the experiences of those who act within the situation. Findings Data highlighted the systemic challenges facing VOICES customers (e.g. stigma and marginalisation and lack of legal literacy), progress made by VOICES in each of their priority areas and an overarching theme of VOICES promoting equity (rather than equality) to address failure demand in the system of support for people with multiple needs and disadvantage. Originality/value The authors present the novel application of situational analysis to demonstrate a substantial impact of VOICES while demonstrating the value of this methodology for complex systems thinking research and evaluation.