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Professional identity formation in healthcare professions education (HPE) is a complex and often fraught process. Physicians and trainees experience identity struggles as they navigate their personal and professional development, along with the conflicting expectations, cultural norms and systemic pressures within the healthcare environment. Despite growing attention to these challenges, conceptual clarity around identity struggle remains limited. To advance theoretical understanding of identity struggle, we conducted a critical narrative review of identity theories from developmental psychology, social psychology and sociology. We selected three major theoretical traditions-Neo-Eriksonian, symbolic interactionist and social identity theories-and analysed their conceptualizations of identity, identity development and identity struggle. We examined these diverse perspectives to inform research and educational practice on professional identity formation in HPE. Each theoretical tradition offers distinct insights into identity struggle. Neo-Eriksonian theories emphasize exploration and commitment as central processes, framing struggle as developmental and potentially productive. Symbolic Interactionist theories highlight the role of socialization and identity dissonance, viewing struggle as emerging from tensions between personal agency and societal norms. Social Identity theories focus on group belonging and intergroup dynamics, conceptualizing struggle at both individual and socio-contextual levels. We provide common critiques and limitations of each theoretical tradition. These perspectives illuminate varied mechanisms through which identity struggle manifests and evolves. This review underscores the multifaceted nature of identity struggle and the value of theoretical pluralism in understanding professional identity formation. Struggle is not inherently negative; rather, it can be a catalyst for growth when appropriately framed and supported. We propose how educators and researchers might use these theoretical lenses to design interventions that foster productive identity development and address systemic contributors to identity struggles. We invite scholars drawing on critical perspectives of power and structure to challenge and deepen the conversation on identity struggle in HPE.

Influential theories and extensive research suggest that interoception significantly affects an individual's cognition and emotions, yet the neural mechanisms involved remain incompletely understood. This study aims to clarify the neurophysiological dynamics of how interoceptive attention modulates cognitive control. Participants completed a classic Stroop task preceded by cue stimuli designed to bias processing toward cardiac/interoceptive information (normal vs. abnormal heart-rate cues) or externally salient threat-related information (fearful faces). Neural electrophysiological data elicited by the cues and stroop task were recorded and analyzed. The results show that both interoceptive attention and external fear cues enhance individual inhibitory control. Neurophysiological findings reveal both common and distinct mechanisms by which interoceptive attention and external fear cues improve inhibitory control. Microstate analysis further suggests that interoceptive attention may uniquely enhance cognitive control by integrating interoception with salience networks, whereas both cue types converge on the dorsal attention network under high conflict. This study, from a neurophysiological perspective, reveals the specific neural mechanisms through which interoceptive attention influences executive functions, providing initial scientific evidence for further exploration of the interplay between interoception and individual psychology, including psychopathology.

Structural inequities in neonatal care may influence human milk (HM) feeding outcomes. We examined whether allied health service (AHS) availability differs between safety-net (sn) and non-snNICUs and its association with HM use at discharge among very low birth weight (VLBW) infants. Population-based cohort study of California Perinatal Quality Care Collaborative (CPQCC) data (2022-2023) for infants born <29 weeks' gestation or <1500&#x2009;g birth weight (BW). Multivariable models assessed associations between AHS availability (lactation, occupational/physical therapy, social work, psychology) and HM use at discharge, adjusting for infant, maternal, and hospital factors. Among 138 NICUs, 35% were snNICUs; 64% of VLBW infants were discharged home. AHS availability did not differ between sn and non-snNICUs. Individual AHS availability was not associated with increased HM use, while greater cumulative AHS availability was associated with lower HM use. HM use at discharge was higher in non-snNICUs (70.2% vs. 63.1%, p&#x2009;<&#x2009;0.001). Higher infant gestation, BW, Apgar score, maternal Asian race, absence of infection and prenatal care were positive predictors; maternal Black and Hispanic race were negative predictors. Cumulative NICU AHS availability was not associated with higher HM use. Structural presence of AHS alone may not reflect integration into effective feeding practices. This statewide analysis examined relationships between allied health service (AHS) availability and human milk (HM) nutrition among preterm infants in California NICUs. Contrary to expectations, AHS availability did not differ between safety-net and non-safety-net hospitals. Individual AHS availability showed no association with HM use at discharge, while greater cumulative AHS availability correlated with lower HM use. Findings challenge assumptions that more AHS automatically improves HM outcomes and highlight the need to evaluate how allied health resources are integrated, coordinated, and aligned with family-centered lactation support in the NICU.

Religious obsessive-compulsive disorder (religious OCD; scrupulosity) presents unique challenges in psychotherapy due to the interaction between religious beliefs and obsessive-compulsive symptoms. Understanding how individuals benefit from psychotherapy in this context can inform more effective and culturally sensitive treatment approaches. This study aimed to explore the factors that make psychotherapy effective for individuals experiencing religious obsessions and compulsions. A qualitative design based on a phenomenological approach was employed. In-depth semi-structured interviews were conducted with nine participants diagnosed with religious OCD. The collected data were analysed using thematic analysis to identify the core themes that contribute to therapeutic benefit. The findings revealed several dimensions that enhanced the therapeutic process. The therapist's competence in religious knowledge and ability to apply this knowledge meaningfully contributed to treatment effectiveness. Participants emphasized that the therapist's religiosity fostered trust and a sense of being understood. Additionally, evidence-based psychotherapeutic methods, such as normalization and psychoeducation, added value to the process. A key finding was that an integrative approach combining religious and scientific psychotherapy knowledge substantially improved outcomes. The therapist's non-judgemental, empathetic and sincere attitude further facilitated clients' sense of safety and engagement in therapy. Effective psychotherapy for religious OCD requires a holistic approach that integrates religious sensitivity with evidence-based therapeutic skills. Such integration plays a crucial role in enhancing client trust, understanding and overall recovery.

Aging in adults is associated with a decline in speech-in-noise (SiN) recognition, yet the neural mechanisms driving this decline remain insufficiently characterized. Most neural evidence on age-related SiN performance has relied on correlational approaches that describe how SiN ability is related to age, but it is not yet clear how changes in specific brain structures mediate this relationship. Moreover, it remains unclear how such mediation manifests when hearing sensitivity is clinically normal. The present study applied a brain-wide, region-level mediation framework to identify the neural pathways through which regional brain atrophy mediates age effects on SiN performance. We studied data from 208 adults (aged 20-80 years; M&#x202f;=&#x202f;49.5, SD&#x202f;=&#x202f;19.6) who participated in the Aging Brain Cohort (ABC) Study at the University of South Carolina. Participants completed pure-tone audiometry (PTA) test, the Words-in-Noise (WIN) test, and underwent high-resolution structural MRI. Regional gray- and white-matter volumes were derived using the Johns Hopkins University atlas, and mediation was assessed using the graphical Brain Association Tool (gBAT) to systematically examine how reduced brain volume mediates age-WIN recognition link. A secondary analysis examined mediation effects in a subgroup of 150 participants with clinically normal hearing sensitivity. Behavioral results showed that each additional decade of life was associated with approximately 1.3 dB SNR increase in WIN thresholds. Whole-brain mediation analyses showed that age-related atrophy in regions supporting selective attention, error monitoring, working memory, motor control, and multimodal cue integration mediated age-associated declines in SiN recognition. These neural mediation effects persisted, though with reduced magnitude, in the subgroup with clinically normal hearing sensitivity. The results identify brain structural mechanisms underlying SiN difficulties and emphasize that age-related changes in brain structure impair SiN performance even when audibility remains intact.

The new Universal Health Insurance (UHI) reforms aim to improve equity and quality of healthcare delivery; however, their sustainability depends on engagement and retention of the nursing workforce. Psychological empowerment has been identified as a key factor influencing nurses' attitudes and work-related behaviors, yet the evidence on how it relates to job embeddedness among nurses working in the early phase of UHI implementation in Egypt remains underexplored. This study aimed to assess the association between psychological empowerment and job embeddedness among nurses under the umbrella of the new Universal Health Insurance in Egypt. A descriptive cross-sectional design was employed from August 2025 to November 2025. A total of 213 nurses working at Aswan Specialized Hospital, affiliated with the UHI system in Upper Egypt, were recruited. Data were collected using a demographic questionnaire, and psychological empowerment was measured using the Psychological Empowerment Scale, and job embeddedness was assessed using the Global Job Embeddedness Scale. Descriptive statistics, Pearson correlation analysis, and hierarchical linear regression were used for data analysis. Among 213 nurses, the mean score of psychological empowerment was reported at high overall levels of 5.75 (SD&#x2009;=&#x2009;0.77), particularly in the dimensions of competence and meaning, alongside moderately high levels of job embeddedness, with a mean score of 4.76 (SD&#x2009;=&#x2009;0.89). Psychological empowerment showed a significant positive correlation with job embeddedness (r&#x2009;=&#x2009;0.512, p&#x2009;<&#x2009;0.001). In hierarchical regression analysis adjusting for demographic and professional covariates, psychological empowerment emerged as a strong and independent predictor of job embeddedness (&#x3b2;&#x2009;=&#x2009;0.55, 95% CI: 0.398-0.701, p&#x2009;<&#x2009;0.001), explaining an additional 16.5% of the variance after controlling for covariates (&#x394;R2&#x2009;=&#x2009;0.165). In adjusted analyses, the covariates were not independently associated with job embeddedness. Psychological empowerment was positively associated with nurses' job embeddedness in the UHI implementation setting. Higher levels of empowerment-related factors were positively associated with greater embeddedness, suggesting their relevance to workforce engagement and retention during health system reform. Our study findings highlight that psychological empowerment plays a crucial role in fostering nurses' job embeddedness, which is critical for sustaining workforce retention and stability. Enhancing supportive leadership and nurses' involvement in decision-making is critical, especially during the early phase implementation of the universal health insurance system reform.

Child maltreatment is a significant risk factor for mental and metabolic health, with negative effects that can persist into adulthood. Using data from a U.S.-nationwide study, the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examined the associations between child maltreatment, specifically childhood threat (i.e., harm or threat of harm) and deprivation (i.e., absence of expected environmental inputs), and young adult mental (i.e., depressive symptoms) and metabolic health (i.e., metabolic risk). The moderating effect of social support was also examined, focusing on both quality of different types of support (i.e., from teachers, friends, and other adults) and variety of support sources. Results showed that young adults who experienced more threat during childhood exhibited higher levels of depressive symptoms in young adulthood, and those exposed to more deprivation reported elevated levels of metabolic risk. This study also highlighted the protective-stabilizing role of quality of teacher support in buffering the impact of deprivation on depressive symptoms, and the protective-stabilizing role of high-quality other adult support in the link between childhood deprivation and metabolic risk, such that the benefits of social support remained stable across increasing levels of deprivation. Additionally, the variety of social support showed a protective-reactive pattern in moderating the link between deprivation and metabolic risk, wherein the benefits of variety of social support were released under low deprivation but not high deprivation conditions for metabolic risk. These findings underscore the importance of eliminating child maltreatment experiences and highlight potential interventions, such as enhancing teacher-student relationships and broadening adolescents' access to diverse support networks, to buffer the long-term mental and metabolic health consequences associated with early experiences of threat and deprivation.

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Medicine, as both clinical and moral practice, is increasingly complex. As such, there is growing appreciation for the importance of practical wisdom (phronesis), a multidimensional capacity that clinicians develop as they navigate practice. Narrative serves as a mode by which clinical exemplars communicate wisdom and therefore provides a rich structure through which practical wisdom can be observed as manifest in lived experience. The purpose of this study was to analyze clinical phronesis narratives to uncover how participants understand practical wisdom through the real-life challenges of clinical encounters. This article describes a qualitative study using structured interviews of 62 participants (40 medical students and 22 physicians). Phronesis narratives describe a particular clinical situation involving an ethically or professionally challenging patient case in which respondents thought practical wisdom was demonstrated. Narratives frequently identified practical wisdom as being needed in encounters involving patient advocacy, individualized patient care, and communication skills. Character traits associated with practical wisdom included empathy, patience, and emotional intelligence. Narratives most often revealed dimensions of practical wisdom such as person-centeredness, poise, or goal-directed decision making. Findings confirm the clinical relevance and multiple dimensions of practical wisdom in medicine "in vivo" that had previously been described theoretically "in vitro." Analysis also revealed that clinical medical students appear able to observe practical wisdom in their supervising physicians, highlighting the need for role-modeling by wise exemplars. The moral content of clinical medicine can be illuminated by rich narratives that can assist in the formation of wise clinicians. Based on the richness of moral content found in these phronesis narratives, the inclusion of narrative-based practices in medical education may help cultivate practical wisdom in medicine.

Aims Links between food insecurity and poor oral health are increasingly well evidenced. However, research on addressing the associated challenges in dental settings is scarce, and little is known about the priorities of members of the public. The aim of this research was to investigate the experiences and priorities of people with lived experience of food insecurity in relation to their oral health to: a) understand whether dental professionals are addressing their needs related to food insecurity; and b) to identify priorities for future research.Methods Key stakeholders and people with lived experience of food insecurity were invited to speak with the project team via face-to-face consultations, virtual meetings, telephone calls and emails. This process established their key dental care priorities.Results Thirty-five people from community food networks and spaces identified the following priorities for dental care: 1) improving access to dental care; 2) improving the dental team's understanding of living in poverty and its impact on oral health; 3) patient education; and 4) signposting.Conclusions People with lived experience of food insecurity highlighted the importance of improving the dental profession's understanding of and response to food insecurity, providing valuable insight for future research directions.

Most of the literature on micro- and macroaggressions from the perspectives of physicians and learners derives almost exclusively from surveys and focus groups. A more thorough understanding of individual perspectives is necessary to further advance this subject. The objective of this study was to explore physicians' and physician trainees' experiences with micro- and macroaggressions in the clinical setting and their thoughts on how to address such aggressions. This was a nationwide, qualitative study. Virtual one-to-one interviews were conducted between October 2021 and March 2022. A volunteer sample of 18 faculty physicians and trainees (medical students, residents, and fellows) representing all regions of the United States were interviewed. Grounded theory was used to analyze transcripts and create a code book. Codes were finalized through constant comparison and developed into themes and subthemes. Thirteen participants identified as female. Eight were non-White. Eleven were faculty. All levels of learners were included. The average interview duration was 43 minutes. Participants described a wide range of aggressions, their resultant emotions and thoughts in response to an event, the complexity of addressing aggressions, and their self-reflection on what transpired and their roles within medicine and society. Most participants, regardless of level, felt responsible to respond to micro- and macroaggressions when individuals more junior to them were present. Most also admitted feeling unprepared and unsure of how to respond, however.

Despite most of the world's population having poor access to mental health services, scalable interventions delivered by trained non-specialists are implemented widely in low-income and middle-income countries (LMICs). Many people do not respond to these interventions, which has led to initiatives to adopt stepped care frameworks that provide people who do not respond to initial interventions with more intensive interventions. However, to date, the efficacy and cost-effectiveness of stepped care frameworks for scalable interventions have not been evaluated in LMICs. This trial aims to evaluate effectiveness and cost-effectiveness of psychological stepped care for distressed adults in an LMIC. We did a single-blind, parallel, randomised controlled trial in Jordan with psychologically distressed adults who were randomly assigned (1:1) to a single intervention or stepped care model. Participants were required to be aged 18 years and older, Jordanians or refugees residing in Jordan, and have scores of at least 20 on the Kessler Distress Scale. Exclusion criteria were imminent suicide risk, psychotic disorder, severe cognitive impairment, risk to the person's safety, plan to return to Syria in the next 12 months, or no telephone access. Computerised software was used for randomisation to generate random number sequences in blocks of four, stratified according to nationality status by personnel independent of the trial. Assessors were masked to intervention condition. All participants received WHO's Doing What Matters in Time of Stress (DWM) programme, which comprised a five-session guided self-help programme. For participants who reported psychological distress after DWM, those in the single intervention group received enhanced usual care, whereas those in the stepped care group received WHO's Problem Management Plus, a five-session group psychological intervention. The primary outcome was between treatment group change in anxiety and depression severity assessed at 3 months after treatment (primary outcome timepoint) based on intention-to-treat analysis. Cost-effectiveness was also assessed. The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry, ACTRN12621000189820, and is completed. Between June 8 and Oct 8, 2023, 1233 individuals were screened for study inclusion and 432 were excluded (371 due to minimal distress, 30 due to a suicide risk, and 31 decided not to proceed), resulting in 801 participants being enrolled into the study. 400 participants were randomly assigned to the stepped care group and 401 were randomly assigned to the single intervention group. 753 participants were female (94%), 48 (6%) were male, and the mean age was 40&#xb7;7 years (SD 11&#xb7;1). At the 3-month assessment, participants enrolled in stepped care reported greater reduction of anxiety (mean difference 1&#xb7;9 [95% CI 0&#xb7;6-3&#xb7;2; p=0&#xb7;0030; effect size 0&#xb7;3 [95% CI 0&#xb7;1-0&#xb7;5]) and depression (mean difference 2&#xb7;9 [0&#xb7;9-5&#xb7;0]; p=0&#xb7;0050; effect size 0&#xb7;3 [0&#xb7;1-0&#xb7;5]) than participants in the single intervention group. The incremental cost per quality-adjusted life-year gained for stepped care (in international dollars [INT$]) would be INT$23&#x2009;641 and has a 76% likelihood of being cost-effective at a threshold of INT$31&#x2009;879 in Jordan. Stepped care of WHO's evidence-based scalable interventions can provide greater benefits in reducing common mental disorders compared with a single intervention. Although a more resource-demanding treatment strategy, stepped care can be cost-effective in terms of its capacity for relatively greater improvements in mental health in LMICs. Elrha through the Research for Health in Humanitarian Crises (R2HC) programme. For the Arabic translation of the abstract see Supplementary Materials section.

This study aimed to determine whether healthcare professionals' breastfeeding-related training and certification are associated with breastfeeding support knowledge, self-efficacy, and attitudes. An online survey was created by modifying existing instruments. Items assessed Alabama healthcare professionals' certification in breastfeeding support, breastfeeding support-related training experience, knowledge, self-efficacy, and attitudes. Participants were healthcare providers and administrators serving infants and expectant or new mothers in Alabama, recruited by e-mailing through Alabama professional organization listservs and personal contacts. Multiple linear regression models were used to examine the relationship between breastfeeding support-related variables. A total of 82 surveys were analyzed. Multiple linear regression showed that higher perceived training preparation was associated with higher self-efficacy (&#x3b2;=0.53, P<0.001) and attitudes (&#x3b2;=0.27, P=0.040), but not higher knowledge (&#x3b2;=0.22, P=0.072), after controlling for sex and experience in breastfeeding their own infant. Certification status was associated with higher knowledge (&#x3b2;=0.34, P=0.005) and higher self-efficacy (&#x3b2;=0.32, P=0.003). Enhancing breastfeeding training for healthcare professionals in Alabama may help address the state's low breastfeeding rates and improve health equity for mothers and infants. Certification in breastfeeding support provides an additional level of training and should be encouraged. These findings underscore the need for targeted training interventions among healthcare professionals in Alabama.

Intermittent theta burst stimulation (iTBS) targeting the dorsolateral prefrontal cortex (DLPFC) shows promise for enhancing cognitive performance. However, behavioral findings remain inconsistent, likely due to methodological limitations in prior research and the poorly understood role of individual variability in neural responsiveness. Only one prior study has utilized individualized targeting. The effects of iTBS on resting-state functional networks remain unexplored. We employed fMRI during an N-back task to identify individualized left DLPFC stimulation targets, based on the 2-back > 1-back contrast. A total of 56 healthy participants were randomly assigned to receive a single session of either active or sham iTBS (28 per group). Resting-state and task-based fMRI (2-back and 3-back) were acquired before and after stimulation. Compared to sham, iTBS increased neural activity in the middle cingulate cortex (MCC) and calcarine cortex during the 3-back task. Moreover, iTBS increased FC between the stimulation target and insula whilst reduced FCs within the default mode network (DMN) and between the DMN and frontoparietal network (FPN). Notably, in the iTBS group, greater MCC activation and enhanced target-insula FC were associated with faster 3-back reaction time (RT), whereas greater DMN FC reductions correlated with improved 3-back accuracy. Behaviorally, individuals with slower baseline 3-back RT in the iTBS group exhibited faster post-stimulation RT - an effect absent in the sham. These findings suggest that individualized iTBS modulates neural activity and distributed functional networks to support cognitive improvement - particularly in individuals with lower baseline ability - and highlight its potential for personalized cognitive interventions.

The moral obligations of emergency nursing as a profession supersede personal ethical positions. Challenges to moral integrity include environmental dysfunction, poor leadership, and policies and procedures that do not respect persons. Moral distress is related to secondary traumatic stress and burnout as both cause and effect, leading to high turnover and ethical desensitization.

Self-reported low positive mood is common in youth anxiety disorders and has been associated with poorer treatment response. Functioning of neural affective systems may have distinct associations with treatment relative to self-reported measures and be useful for understanding biological processes related to treatment. This study examined associations between self-reported mood and pre-treatment functional connectivity network patterns during positive mood and treatment response in 73 youth (mean age&#x202f;=&#x202f;11.1) diagnosed with anxiety disorders. Participants engaged in an fMRI autobiographical memory-based mood induction task in the scanner that successfully improved mood. Participants then completed 16 sessions of cognitive-behavioral or child-centered anxiety treatment. We found no significant differences in how mood changed during the induction task between youth who did and did not recover or respond to treatment. We then used a person-centered method to estimate effective connectivity networks at group, subgroup, and individual levels for each participant. No subgroup-level paths were identified that distinguished treatment responder subgroups. However, treatment responders showed stronger homologous connectivity in the bilateral nucleus accumbens and bilateral amygdala. Responders also showed greater centrality (network influence) of the nucleus accumbens, amygdala, and medial prefrontal cortex on the broader connectivity network. Findings suggest that greater influence of the nucleus accumbens and amygdala on distributed reward and emotion systems is associated with better treatment response, supporting a view that treatment responders capitalize on more responsive reward- and emotion-related brain networks. Future studies should replicate this finding in larger samples and investigate implicated networks as possible treatment targets.

Oxytocin plays an important and well-known role in promoting social interaction in maternal, sexual and interpersonal behaviors. In addition, it has been increasingly linked to the modulation of pain, fear and cognitive processes such as attention and memory, which seems to be supported by the presence of oxytocin receptors in various brain areas. With this in mind, this study aims to investigate the effects of inhaled oxytocin on fear, pain perception and aversive memory in humans, as well as the relationship between them. The study involved 65 healthy female volunteers who were randomly assigned to receive either intranasal oxytocin (40&#xa0;IU) or a placebo. The participants were divided into two experimental designs, A and B, with within-subject comparisons conducted. Its effects on pain were investigated by means of the Cold Pressor Test, keeping records of pain threshold and tolerance, as well as of its intensity using the Visual Analog Scale (VAS) and its classification using the McGill Pain Questionnaire. The effects on fear were investigated using the Trauma Film Paradigm, with the intensity of fear measured by means of the VAS, as well as aversion, attention and immersion in the film. A questionnaire was deployed to assess aversive declarative memory at different intervals. Intrusive aversive memories were analyzed by means of quantitative and qualitative records taken over 7&#xa0;days. Our results showed that oxytocin increased dislike of pain when the painful stimulus occurred in an aversive context, which may have contributed to a negative mood state. In addition, oxytocin attenuated intrusive memories in such a way as to reduce their frequency and the suffering they caused. Altogether, the results suggest that intranasal oxytocin can modulate the subjective perception of pain, fear and aversive memory in humans, depending on the context in which the stimuli occur and their biopsychosocial relevance.

No research has explored Theory of Mind (ToM) development in Lebanon, a culturally diverse country that defies the East-West dichotomy. This pilot study aims to adapt a ToM tool for Lebanese children, while examining age-related trends, developmental sequencing, and parental cultural influences. Forty-six children aged 3-11&#x2009;years, completed the ABC-TOM and standard tasks. Parents completed an Individualism-Collectivism Scale. The internal consistency of the ABC-TOM was correct for the total and cognitive subscales, but questionable for the affective subscale, with good convergent validity with standard measures. An earlier acquisition of knowledge access was observed, with age-related variations. Sequencing patterns also varied according to parental individualism-collectivism. Overall, findings support the ABC-TOM's use and underscore the role of individual-level environmental factors in ToM development.

At the end of 2024 over 3,500 women were living in prison in England, many of whom have experienced prior trauma and domestic abuse and are more likely than men in prison to self-harm. Compared to women living in the community, they also have higher levels of social care needs, yet little research has been conducted to explore social care provision for this population. We conducted surveys of healthcare managers and governors in eleven women's prisons in England and their corresponding nine local authorities (LAs), to establish how they addressed their responsibilities for women with social care needs eight years on from the 2014 Care Act. Numerical and pre-coded data were analysed in Microsoft Excel using simple descriptive methods (e.g., frequencies, percentages). Descriptive qualitative analysis was used on free-text data. The LA survey was completed by 9/9 LA staff; the prison governor survey by 8 staff (representing 10/11 prisons); and the healthcare manager survey by 7/11 staff. Considerable variation was found between establishments in Care Act assessment rates (1% to 36%). Some prisons relied on prison officers or peer supporters who had not received adequate training/supervision to identify social care needs, although all respondents agreed that social care provision had improved since the Care Act. There was less agreement regarding arrangements for transferring assessments between LAs on release. Qualitative analysis provided insight into this and other problems, including identifying women with social care needs; transferring information; gaining access into the prison; and resolving disputes/disagreements between LAs. Several proactive initiatives to improve identification/provision, and promote wellbeing, were described (e.g., regular drop-ins; scoping the use of telecare; linking with external agencies (e.g., neurodiversity and sensory services); an enablement/reablement pathway; and advocacy). This paper is the first to explore social care provision for women in prison in relation to the 2014 Care Act. Although provision has grown and improved since the implementation of the Act, it is patchy and often suboptimal or "gets forgotten". Potential ways forward include standardised, flexible screening processes; gender-specific adaptation of screening/assessment tools; and social care training and supervision for officers and peer supporters.