Background Stroke patients are often inactive outside of structured therapy sessions – an enduring international challenge despite large scale organizational changes, national guidelines and performance targets. We examined whether experienced-based co-design (EBCD) – an improvement methodology – could address inactivity in stroke units. Aims To evaluate the feasibility and impact of patients, carers, and staff co-designing and implementing improvements to increase supervised and independent therapeutic patient activity in stroke units and to compare use of full and accelerated EBCD cycles. Methods Mixed-methods case comparison in four stroke units in England. Results Interviews were held with 156 patients, staff, and carers in total; ethnographic observations for 364 hours, behavioral mapping of 68 patients, and self-report surveys from 179 patients, pre- and post-implementation of EBCD improvement cycles. Three priority areas emerged: (1) ‘Space’ (environment); (2) ‘Activity opportunities’ and (3) ‘Communication’. More than 40 improvements were co-designed and implemented to address these priorities across participating units. Post-implementation interview and ethnographic observational data confirmed use of new social spaces and increased activity opportunities. However, staff interactions remained largely task-driven with limited focus on enabling patient activity. Behavioral mapping indicated some increases in social, cognitive, and physical activity post-implementation, but was variable across sites. Survey responses rates were low at 12–38% and inconclusive. Conclusion It was feasible to implement EBCD in stroke units. This resulted in multiple improvements in stroke unit environments and increased activity opportunities but minimal change in recorded activity levels. There was no discernible difference in experience or outcome between full and accelerated EBCD; this methodology could be used across hospital stroke units to assist staff and other stakeholders to co-design and implement improvement plans.

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I question the notion of food choice and consider how much food choice someone living on low income actually has. In my fieldwork, it became clear that food choices, and hence one's nutritional and health state, cannot be viewed in separation from the participants' individual stories and the complexities of their lives. Daily routines, financial situation, and food accessibility have an impact on people's food choices. In realising this, I found Amartya Sen's (1979Sen's ( , 1985 capabilities approach useful, which moves beyond food entitlements. More specifically, a health capabilities approach as introduced by Venkatapuram (2007Venkatapuram ( , 2011 and the association made between health and capabilities by others (e.g. Ruger Yale Joural Law Humanities 18 (2): 3, 2003) views health as the combination of the influence of socioeconomic structures, as well as personal agency resulting in choices. I present the main learnings from viewing Foodways and Futures through the 'capabilities lens' and thus view food choices as the combination of the complex interrelations between socio-economic structures and agency.

This study looks at volunteering at parkrun, a weekly 5k run/walk event held at almost 2,000 different locations worldwide, which relies on volunteers. Despite large numbers of parkrunners, and an ethos encouraging occasional volunteering, some parkrunners do not volunteer which can lead to recruitment difficulties for events. Ten parkrunners were interviewed about volunteering to explore why there might be reluctance. Data were transcribed and analysed using thematic analysis, and three interlinked themes found: becoming "hooked" on parkrun, "obligation to give back", and "reluctance to miss a run".Conflict between obligation and a desire to run or walk led to strategic volunteering to facilitate both, despite this approach potentially challenging event delivery by leaving nonrun/walk roles uncovered. Findings indicate a complex and somewhat conflicting system of preference, intrapersonal and structural constraints, mutual aid and social exchange.Gamification and the triggering of reward mechanisms may be increasing motivation to run rather than volunteer.