Now showing items 1-20 of 1020

    • Archaeology and modern reflections on death

      Dayes, Jennifer E.; Faull, C.; Büster, Lindsey S.; Green, Laura I.; Croucher, Karina T. (2018-09-22)
    • From Plastered Skulls to Palliative Care: What the Past Can Teach Us About Dealing with Death

      Büster, Lindsey S.; Croucher, Karina T.; Dayes, Jennifer E.; Green, Laura I.; Faull, C. (2018)
      Modern, advanced healthcare detects and monitors long-term and life-limiting illness more comprehensively than ever before. However, death is now often considered medical failure, and is a virtually taboo topic of conversation in daily life. At a time when the societal relevance of archaeology is under scrutiny more than ever before, the AHRC-funded Continuing Bonds Project – a collaboration between archaeology and palliative care – explores the potential of the past to promote discussion. Not only does archaeology illuminate the diversity of practice surrounding death, the past provides a safe, distanced platform for considering death, dying and bereavement today. Through archaeological and ethnographic case studies, health and social care professionals and students consider topics such as place, choice and identity, in both personal and professional life. This article examines participant responses to a variety of archaeological material and presents post-workshop reflections which demonstrate the success of archaeology in opening up conversations and increasing confidence in discussing this most enduring and problematic of life events.
    • The impact of comorbidity on the quality of life of people with dementia: findings from the IDEAL study

      Nelis, S.M.; Wu, Y-T.; Matthews, F.E.; Martyr, A.; Quinn, Catherine; Rippon, I.; Rusted, J.; Thom, J.M.; Kopelman, M.D.; Hindle, J.V.; Jones, R.W.; Clare, L. (2018)
      Background: The aim was to investigate the comorbidity profile of people with dementia and examine the associations between severity of comorbidity, health-related quality of life (HRQoL) and quality of life (QoL). Methods: The improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort consisted of 1,547 people diagnosed with dementia who provided information on the number and type of comorbid conditions. Participants also provided ratings of their health-related and dementia-specific QoL. Results: The majority of the sample were living with more than one chronic condition. Hypertension was commonly reported and frequently combined with connective tissue disease, diabetes and depression. The number of comorbid conditions was associated with low QoL scores, and those with severe comorbidity (≥5 conditions) showed the greatest impact on their well-being. Conclusions: Comorbidity is an important risk factor for poor QoL and health status in people with dementia. Greater recognition of the nature and impact of comorbidity is needed to inform support and interventions for people with dementia and a multidisciplinary approach to care provision is recommended.
    • Protocol for the IDEAL-2 longitudinal study: following the experiences of people with dementia and their primary carers to understand what contributes to living well with dementia and enhances active life

      Silarova, B.; Nelis, S.M.; Ashworth, R.M.; Ballard, C.; Bienkiewicz, M.; Henderson, C.; Hillman, A.; Hindle, J.V.; Hughes, J.C.; Lamont, R.A.; Litherland, R.; Jones, I.R.; Jones, R.W.; Knapp, M.; Kotting, P.; Martyr, A.; Matthews, F.E.; Morris, R.G.; Quinn, Catherine; Regan, J.; Rusted, J.M.; van den Heuval, E.A.; Victor, C.R.; Wu, Y-T.; Clare, L. (2018-10)
      Background: There is a major need for longitudinal research examining the experiences of people with dementia and their primary carers, as relatively little is known about how the factors associated with capability to ‘live well’ vary over time. The main aim of the IDEAL-2 study is to investigate how and why, over time, people with dementia and their primary carers might vary in their capability to live well with dementia, whilst exploring both their use of health and care services and their unmet needs. Methods: IDEAL-2 will build on the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort of 1547 people (who, at recruitment between July 2014 and July 2016, had mild-to-moderate dementia), and their 1283 primary carers in Great Britain. The existing cohort will be enriched with additional participants with mild-to-moderate dementia (and their primary carers where available and willing) from the following groups: people with rarer forms of dementia, and/or those who are ≥90 years or < 65 years of age at time of recruitment. We will assess the primary outcome, capability to live well with dementia, and the factors influencing it using questionnaires at yearly intervals for 3 years. Additionally, we will seek to link the cohort data with administrative data to obtain information about health service use. Some participants will be invited for in-depth face-to-face interviews. The cohort study will be supplemented by linked research focusing on: the co-production of new measures of living well; including the perspectives of people with advanced dementia living in residential care settings; including people with dementia from black, Asian, and minority ethnic groups; and understanding the experience of people living with undiagnosed dementia. Discussion: IDEAL-2 will provide evidence about the key indicators of, and factors associated with, living well over the course of dementia and how these differ for particular subgroups. It will tell us which combinations of services and support are most beneficial and cost-effective. Moreover, the IDEAL-2 study will gather evidence from underresearched groups of people with dementia, who are likely to have their own distinct perceptions of living well.
    • Reflections on PPI from the ‘Action on Living Well: Asking You’ advisory network of people with dementia and carers as part of the IDEAL study

      Litherland, R.; Burton, J.; Cheeseman, M.; Campbell, D.; Hawkins, M.; Hawkins, T.; Oliver, K.; Scott, D.; Ward, J.; Nelis, S.M.; Quinn, Catherine; Victor, C.; Clare, L. (2018-11-01)
      This article describes the work of the ‘Action on Living Well: Asking You’ group – an involvement group of people with dementia and carers attached to the IDEAL research study. The article describes the work of the group, the methods that have helped them to stay involved and people’s perspectives on their experiences of being involved and the impact it has had, for themselves and others. The article has been written following a reflective piece of work with the ‘Action on Living Well: Asking You’ group to review and remember the work of the past four years. An accompanying film brings to life the work and activities of the group, available at www.idealproject.org.uk/mclass/
    • Impact of body part thickness on AP pelvis radiographic image quality and effective dose

      Alzyoud, K.; Hogg, P.; Snaith, Beverly; Flintham, K.; England, A. (2018-10-03)
      Introduction: Within medical imaging variations in patient size can generate challenges, especially when selecting appropriate acquisition parameters. This experiment sought to evaluate the impact of increasing body part thickness on image quality (IQ) and effective dose (E) and identify optimum exposure parameters. Methods: An anthropomorphic pelvis phantom was imaged with additional layers (1e15 cm) of animal fat as a proxy for increasing body thickness. Acquisitions used the automatic exposure control (AEC), 100 cm source to image distance (SID) and a range of tube potentials (70e110 kVp). IQ was evaluated physically and perceptually. E was estimated using PCXMC software. Results: For all tube potentials, signal to noise ratio (SNR) and contrast to noise ratio (CNR) deceased as body part thickness increased. 70 kVp produced the highest SNR (46.6e22.6); CNR (42.8e17.6). Visual grading showed that the highest IQ scores were achieved using 70 and 75 kVp. As thickness increases, E increased exponentially (r ¼ 0.96; p < 0.001). Correlations were found between visual and physical IQ (SNR r ¼ 0.97, p < 0.001; CNR r ¼ 0.98, p < 0.001). Conclusion: To achieve an optimal IQ across the range of thicknesses, lower kVp settings were most effective. This is at variance with professional practice as there is a tendency for radiographers to increase kVp as thickness increases. Dose reductions were experienced at higher kVp settings and are a valid method for optimisation when imaging larger patients.
    • Does a more dynamic method of partial weight bearing instruction translate to improved protocols?

      Graham, Claire; Jeffrey, Sarah; Hellawell, Michael (2018-11-02)
      Background: Partial weight bearing protocols are commonly incorporated into rehabilitation to enhance recovery. Patients are often prescribed protocols that refer to a percentage of their body weight, such as 20% weight bearing, that should be placed through the healing limb during activities such as walking (gait). In order to achieve these partial weight baring protocols patients are usually provided with walking aids such as crutches. Accurate reproducibility of and compliance with these protocols could be considered essential to the rehabilitation process, however poor reproducibility of partial weight bearing protocols during crutch assisted gait using a current method of instruction has been shown. Aims: The aim of this study was to determine whether a more dynamic method of partial weight bearing protocol instruction, was more accurately reproduced. Methods: In total, 16 participants were randomly allocated to one of two groups and were taught 20% partial weight bearing using two different methods of instruction. A participant’s ability to reproduce their target load using crutch assisted gait was assessed using a force plate. Findings: The mean error for the static method of instruction was significantly greater than the more dynamic method. Conclusion: As seen previously, the static method of instruction of partial weight bearing protocols, using bathroom scales, does not seem to translate accurately to dynamic motion; however, the more dynamic method assessed in this study appears to result in more accurate reproducibility.
    • Qualitatively exploring the suitability of tablet computers to encourage participation with activities by people with moderate stage dementia

      Smith, S.K.; Mountain, Gail; Hawkins, R.J. (2018)
      Introduction: Opportunities to participate with enjoyable activities is one of the most frequently reported unmet needs by the person living with dementia. Enabling and intuitive technologies may offer accessible ways to engage with such activities. Objectives: To explore how tablet computers might encourage participation in enjoyable activities by people with moderate levels of dementia and to consider how such technologies might be incorporated into the repertoire of activities currently provided through day care settings. Methods: A focused visual ethnographic approach was developed specifically to meet the research objectives. Twelve participants attending a community day care centre and nine supporters (both volunteers and paid staff) consented to take part in the research. Technology facilitated group activity sessions took place twice a week for a period of four weeks and all were video recorded. Findings: Video analysis demonstrated that the majority of people with dementia found the technology an effective means of participating in enjoyable activities. Analysis also revealed the extent to which participation relies on the existence of effective support. It showed how maintaining focus on retained strengths and abilities enabled the group overall to meet and often exceed their own and others perceived capacity to participate. Finally, analysis confirmed the importance of enjoyment of activities ‘in the moment’ and the need for those supporting people in the moderate stages of dementia to acknowledge and work with this. Conclusion: The use of tablet computers to enhance participation in sociable and enjoyable activities in day care settings is realistic and achievable if supported appropriately.
    • Membrane sweeping at term to promote spontaneous labour and reduce the likelihood of a formal induction of labour for postmaturity: a systematic review and meta-analysis

      Avsiyovski, H.; Haith-Cooper, Melanie; Scally, Andy J. (2018)
      The aim of this study was to evaluate the efficacy and the safety of membrane sweeping in promoting spontaneous labour and reducing a formal induction of labour for postmaturity. Based on articles published between 2005 and 2016, 12 electronic databases were searched. Relative risk (RR) and its 95% confidence interval (CI) were used as pooled statistics. A total of seven studies consisting of 2252 participants were selected for the review and meta-analysis. The results revealed that membrane sweeping is advantageous in promoting spontaneous labour (RR = 1.205, 95% CI: 1.133–1.282, p = <.001), and reducing the formal induction of labour for postmaturity (RR = 0.523, 95% CI: 0.409–0.669, p = <.001). The studies reported several varying outcomes for both maternal and foetal morbidities; meta-analyses were performed where possible on each of these and found there to be no statistically significant differences in outcome between the intervention and control groups.
    • Patient safety culture in maternity units: a review

      Al Nadabi, W.; McIntosh, Bryan; McClelland, Gabrielle T.; Mohammed, Mohammed A. (2018)
      Purpose: To summarize studies that have examined patient safety culture (PSC) in maternity units and describe the different purposes, study designs and tools reported in these studies, whilst highlighting gaps in the literature. Methodology: Peer-reviewed studies published in English during 1961-2016 across eight electronic databases were subjected to a narrative literature review. Findings: Among 100 articles considered, 28 met the inclusion criteria. The main purposes for studying PSC were: (a) assessing intervention effects on PSC (n= 17); and (b) assessing PSC level (n=7). Patient safety culture was mostly assessed quantitatively using validated questionnaires (n=23). The Safety Attitude Questionnaire was the most commonly used questionnaire (n=17). Intervention varied from a single action lasting five weeks to a more comprehensive package lasting more than four years. The time between the baseline and the follow-up assessment varied from six months up to 24 months. No study reported measurement or intervention costs, and none incorporated the patient’s voice in assessing PSC. Practical Implications: Assessing PSC in maternity units is feasible using validated questionnaires. Interventions to enhance PSC have not been rigorously evaluated. Future studies should report PSC measurement costs, adopt more rigorous evaluation designs, and find ways to incorporate the patient’s voice. Originality/Value: This review summarized studies examining PSC in a highly important area and highlighted main limitations that future studies should consider.
    • A comparison of logistic regression models with alternative machine learning methods to predict the risk of in-hospital mortality in emergency medical admissions via external validation

      Faisal, Muhammad; Scally, Andy J.; Howes, R.; Beatson, K.; Richardson, D.; Mohammed, Mohammed A. (2018)
      We compare the performance of logistic regression with several alternative machine learning methods to estimate the risk of death for patients following an emergency admission to hospital based on the patients’ first blood test results and physiological measurements using an external validation approach. We trained and tested each model using data from one hospital (n=24696) and compared the performance of these models in data from another hospital (n=13477). We used two performance measures – the calibration slope and area under the curve (AUC). The logistic model performed reasonably well – calibration slope 0.90, AUC 0.847 compared to the other machine learning methods. Given the complexity of choosing tuning parameters of these methods, the performance of logistic regression with transformations for in-hospital mortality prediction was competitive with the best performing alternative machine learning methods with no evidence of overfitting.
    • Gendered migrations and precarity in the post-Brexit-vote UK: the case of Polish women as workers and carers

      Duda-Mikulin, Eva A. (2018)
      Polish migration to the UK post European Union enlargement has been studied extensively but limited attention has been paid to women and their gendered mobility. In this paper, I argue that it is key to turn attention to women migrants as those who are often responsible for reproductive labour and who raise future generations of workers and citizens. This is pivotal to consider in light of ageing European societies and the need for workers and Brexit. Arguably, precarity is characteristic of contemporary life. This applies to the post-Brexit-vote UK and the uncertainty linked to the future after 2019. Precarity is inevitably characteristic of many migrants’ lives often punctuated by a lack of job security which is linked to limited material and psychological well-being. For women migrants, this state of affairs is further compounded by their attachment to the private sphere which often constitutes a barrier to their engagement in the paid labour market on the same footing as men. This paper draws on qualitative primary data gathered from 32 Polish women migrants who were initially interviewed in 2012/2013 and subsequently some of them were re-interviewed in 2016/2017.
    • Pain and delirium in people with dementia in the acute general hospital setting

      Feast, A.R.; White, N.; Lord, Kathryn; Kupeli, N.; Vickerstaff, V.; Sampson, E.L. (2018-11-01)
      Background: Pain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting. Objective: To investigate the relationship between pain and delirium in people with dementia, on admission and throughout a hospital admission. Design: Exploratory secondary analysis of observational prospective longitudinal cohort data. Setting: Two acute hospitals in the UK. Methodology: Two-hundred and thirty participants aged ≥70 years were assessed for dementia severity, delirium ((Confusion Assessment Method (CAM), pain (Pain Assessment in Advanced Dementia (PAINAD)) scale and prescription of analgesics. Logistic and linear regressions explored the relationship between pain and delirium using cross-sectional data. Results: Pain at rest developed in 49%, and pain during activity for 26% of participants during their inpatient stay. Incident delirium developed in 15%, of participants, and 42% remained delirious for at least two assessments. Of the 35% of participants who were delirious and unable to self-report pain, 33% of these participants experienced pain at rest, and 56 experienced pain during activity. The odds of being delirious were 3.26 times higher in participants experiencing pain at rest (95% Confidence Interval 1.03–10.25, P = 0.044). Conclusion: An association between pain at rest and delirium was found, suggesting pain may be a risk factor for delirium. Since pain and delirium were found to persist and develop during an inpatient stay, regular pain and delirium assessments are required to manage pain and delirium effectively.
    • Addressing obesity in Roma communities: a community readiness approach

      Islam, Shahid; Small, Neil A.; Bryant, M.; Yang, T.; Cronin de Chavez, A.; Saville, F.; Dickerson, J. (2018)
      Participation in community programmes by the Roma community is low whilst this community presents with high risk of poor health and low levels of wellbeing. To improve rates of participation in programmes compatibility must be achieved between implementation efforts and levels of readiness in the community. The Community Readiness Model (CRM) is a widely used toolkit which provides an indication of how prepared and willing a community is to take action on specific issues. We present findings from a CRM assessment for the Eastern European Roma community in Bradford, UK on issues related to nutrition and obesity. We interviewed key respondents identified as knowledgeable about the Roma community using the CRM. This approach applies a mixed methodology incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling researchers to place the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework analysis to generate contextual information. An overall score consistent with vague awareness was achieved, which indicates a low level of community readiness. This score suggests there will be a low likelihood of participation in currently available nutrition and obesity programmes. To our knowledge this is the first study to apply the CRM in the Roma community for any issue. We present the findings for each of the six dimensions that make up the CRM together with salient qualitative findings.
    • Hidden hunger? Experiences of food insecurity amongst Pakistani and white British women

      Power, M.; Small, Neil A.; Doherty, B.; Pickett, K.E. (2018)
      Purpose: Foodbank use in the UK is rising but, despite high levels of poverty, Pakistani women are less likely to use foodbanks than white British women. This study aimed to understand the lived experience of food in the context of poverty amongst Pakistani and white British women in Bradford, including perspectives on food aid. Design: Sixteen Pakistani and white British women, recruited through community initiatives, participated in three focus groups (one interview was also held as a consequence of recruitment difficulties). Each group met for two hours aided by a moderator and professional interpreter. The transcripts were analysed thematically using a three-stage process. Findings: Women in low-income households employed dual strategies to reconcile caring responsibilities and financial obligations: the first sought to make ends meet within household income; the second looked to outside sources of support. There was a reported near absence of food insecurity amongst Pakistani women which could be attributed to support from social/familial networks; resource management within the household; and cultural and religious frameworks. A minority of participants and no Pakistani respondents accessed charitable food aid. There were three reasons for the non-use of food aid: it was not required because of resource management strategies within the household and assistance from familial/social networks; it was avoided out of shame; and knowledge about its existence was poor. Originality: This case study is the first examination of varying experiences of food insecurity amongst UK white British and Pakistani women. Whilst the sample size is small, it presents new evidence on perceptions of food insecurity amongst Pakistani households and on why households of varying ethnicities do not use food aid.
    • Using out-of-office blood pressure measurements in established cardiovascular risk scores: implications for practice

      Stevens, S.L.; Stevens, R.J.; de Leeuw, P.; Kroon, A.A.; Greenfield, S.; Mohammed, Mohammed A.; Gill, P.; Verberk, W.J.; McManus, R.J. (2018)
      Abstract Background: Blood pressure (BP) measurement is increasingly carried out through home or ambulatory monitoring, yet existing cardiovascular risk scores were developed for use with measurements obtained in clinic. Aim: To describe differences in cardiovascular risk estimates obtained using ambulatory or home BP measurements instead of clinic readings. Design and setting: Secondary analysis of data from adults aged 30-84 without prior history of cardiovascular disease (CVD) in two BP monitoring studies (BP-Eth and HOMERUS). Method: The primary comparison was Framingham risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements. The QRISK2 and SCORE risk equations were also studied. Statistical and clinical significance were determined using the Wilcoxon signed-rank test and scatter plots respectively. Results: In 442 BP-Eth patients (mean age = 58 years, 50% female) the median absolute difference in 10-year Framingham cardiovascular risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements was 1.84% (interquartile range 0.65 to 3.63, p=0.67). Only 31/ 442 (7.0%) of patients were reclassified across the 10% risk treatment threshold. In 165 HOMERUS patients (mean age = 56 years, 46% female) the median difference in 10-year risk was 2.76% (IQR 1.19 to 6.39, p<0.001) and only 8/165 (4.8%) of patient were reclassified. Conclusion: Estimates of cardiovascular risk are similar when calculated using BP measurements obtained as in the risk score derivation study or through ambulatory monitoring. Further research is required to determine if differences in estimated risk would meaningfully influence risk score accuracy.
    • Influences on uptake of a community occupational therapy intervention for people with dementia and their family carers

      Field, B.; Coates, E.; Mountain, Gail (2018)
      Living well with dementia is promoted nationally and internationally (Department of Health, 2009: Global Action Against Dementia, 2013). UK health policy recommends post-diagnostic support to enable people to live well in the community for as long as possible (Department of Health, 2015; NHS England, 2017; Scottish Government, 2017; Welsh Government, 2017). This is important given that a cure for dementia is not imminent. A growing evidence base demonstrates that psychosocial interventions can benefit people with mild to moderate dementia, by improving cognition, performance in valued activities or daily living skills, maintaining quality of life or carer coping. (Clare et al., 2011;2017; Graff et al.,2006,2007; Streater et al.,2016). Occupational therapists offer interventions to people living with mild to moderate dementia and family carers (Swinson et al.,2016;Streater et al.,2016;Yuill and Hollis,2011). The National Institute for Clinical Excellence and Social Care Institute for Excellence (2006) recommended occupational therapists provide skills training for activities of daily living. Also, the Memory Services National Accreditation Programme recommends people with dementia have access to occupational therapy and other psychosocial interventions such as reminiscence, life story work or cognitive stimulation therapy, for the cognitive, emotional, occupational and functional aspects of dementia (Hodge et al.,2016). Such interventions can be delivered by occupational therapists. The focus on the benefits of non-pharmacological interventions provides occupational therapists with an opportunity, to deliver services that improve lives and the experience of dementia (Collier and Pool, 2016). Understanding what may influence uptake of such interventions is important if people with dementia and their carers are to benefit from what occupational therapists can offer. Yet what supports the uptake of such interventions, specifically by people with mild to moderate dementia and their family carers, living in the community is poorly understood and limited research about this topic exists. ‘Uptake’, in this paper, is defined as initial acceptance of an offer, of intervention, support or services, rather than continued engagement or adherence to an intervention over time.
    • The experiences of pregnant migrant women in detention: A qualitative study

      Arshad, F.; Haith-Cooper, Melanie; Palloti, P. (2018-09)
      Background: Pregnant migrant women held in detention centres in the UK can be particularly vulnerable. They may have poor physical and mental health, which is exacerbated by their incarceration, and are at a disproportionally increased risk of maternal and perinatal mortality. Unpublished studies have found that pregnant migrant women have poor experiences in detention. Aim: To explore pregnant migrant women's experiences of living in detention. Method: Four migrant women who had been held in detention while pregnant and two volunteer health professionals were interviewed. Findings: Results suggest that migrant women have very poor experiences in detention. Four key themes emerged: ‘challenges to accessing UK healthcare’, ‘exacerbation of mental health conditions, ‘feeling hungry’ and ‘lack of privacy’. Conclusion: These findings could be used to review maternity care in detention and ensure that detention staff understand the experiences of detained pregnant women so that the needs of this vulnerable group can be met.
    • Using text messages to support recovering substance misusers

      McClelland, Gabrielle T.; Duffy, P.; Davda, P. (2018-09)
      Background: The use of digital technology in health and social care is developing rapidly. It is promoted in UK policy and research which suggests varied results surrounding its implementation and outcomes. Introduction: This article aimed to test the implementation and outcomes of a short messaging service sent to a dedicated phone. The target cohort were drug treatment clients in two sites in Northern England. Materials and methods: Through staff focus groups and interviews with a small cohort of clients, the implementation and perceptions of the system were examined. Results: Nineteen participants were recruited to site 1 (15 male, 4 female, average age=37.7 years) and 12 participants were recruited to site 2 (9 male, 3 female, average age=40.3 years). One outcome that was of interest was well-being in treatment which, in this study, was described as an overall sense of feeling better rather than just focusing on the rehabilitation aspect of the programme. Other outcomes included: the successful completion of treatment and any relapse or associated reported drug use. Discussion: The system shows some evidence of its ‘social actor’ role; however, its implementation was hindered by staff citing that it called for increased resources. For future implementation the use of client’s own phones may be considered which may help to embed the system more fully in recovery planning and targeting clients at a different treatment stage. Conclusions: Despite some indications of positive results for clients and a perception that the system may have value as an addition to existing clinical interventions, more evaluation is required to determine whether this system can be implemented in a drug treatment setting.
    • The incompatibility of system and lifeworld understandings of food insecurity and the provision of food aid in an English city

      Power, M.; Small, Neil A.; Doherty, B.; Pickett, K.E. (2018)
      We report qualitative findings from a study in a multi-ethnic, multi-faith city with high levels of deprivation. Primary research over 2 years consisted of three focus groups and 18 semi-structured interviews with food insecurity service providers followed by focus groups with 16 White British and Pakistani women in or at risk of food insecurity. We consider food insecurity using Habermas’s distinction between the system and lifeworld. We examine system definitions of the nature of need, approved food choices, the reification of selected skills associated with household management and the imposition of a construct of virtue. While lifeworld truths about food insecurity include understandings of structural causes and recognition that the potential of social solidarity to respond to them exist, they are not engaged with by the system. The gap between system rationalities and the experiential nature of lay knowledge generates individual and collective disempowerment and a corrosive sense of shame.