Lead (Pb) exposure has been a serious environmental and public health problem throughout the world over the years. The major sources of lead in the past were paint and gasoline before they were phased out due to its toxicity. Meanwhile, people continue to be exposed to lead from time to time through many other sources such as water, food, soil and air. Lead exposure from these sources could have detrimental effects on human health, especially in children. UNICEF reported that approximately 800 million children have blood lead levels (BLLs) at or above 5 micrograms per deciliter (µg/dL) globally. This paper reports on the potential risks of lead exposure from early life through later life. The articles used in this study were searched from databases such as Springer, Science Direct, Hindawi, MDPI, Google Scholar, PubMed and other academic databases. The levels of lead exposure in low income and middle-income countries (LMICs) and high-income countries (HICs) were reported, with the former being more affected. The intake of certain nutrients could play an essential role in reducing  or increasing  lead absorption in children. Elevated blood lead levels may disturb the cells’ biological metabolism by replacing beneficial ions in the body such as calcium, magnesium, iron and sodium. Once these ions are replaced by lead, they can lead to brain disorders, resulting in reduced IQ, learning difficulties, reduced attention span and some behavioral problems. Exposure to lead at an early age may lead to the development of more critical problems later in life. This is because exposure to this metal can be harmful even at low exposure levels and may have a lasting and irreversible effect on humans. Precautionary measures should be put in place to prevent future exposure. These will go a long way in safeguarding the health of everyone, most especially the young ones. Among such heavy metals is lead which is known to have come from a Latin word “plumbum” meaning “Lead”  has remained a serious environmental and public health problem worldwide due to its many uses over the past millennia. Its malleability and resistance to corrosion made it useful for many items, such as water pipes and vessels . It alsosugar of lead and scientifically known as lead acetate) as an addition to drinks, wine, liquors, cakes, sweets and all kinds of foods [For example, the Romans ate food cooked in leaded vessels and drank water supplied through leaded pipes. Apart from these, they used lead as an artificial sweetener widely called  and paint used to be the major sources widely reported as the causes of lead exposure in many countries of the world. Reports about the continued danger resulting from the use of leaded gasoline and paint from different nations of the world became a cause of concern to international bodies. This led to a decision to phase out lead from these substances globally.it is a national disgrace that so many children continue to be exposed at levels known to be neurotoxic …” [In 2002, an agreement was reached on the phase-out issue during the World Summit on Sustainable Development held in South Africa with representatives from every country . This detoxic …”  , especially children who were more vulnerable to the harmful effects [over 170 million Americans alive today were exposed to high-lead levels in early childhood, several million of whom were exposed to five times the current reference level …” [The  effects . In factlevel …” , p. 1. Olevel …” .Furthermore, it is reported that lead exposure was responsible for the loss of 824,097,690 IQ points in 2015 . The issAustralia is another country where there have been so many reports about lead exposure. This country is known to be “… one of the world’s largest producers and exporters of Lead …” [educating people about potential Lead sources in their homes and environments…” [ Lead …” , p. 1. L Lead …” . These,  Lead …” ,17,26. T Lead …” . Apart fnments…” , p. 11.Germany has also been threatened with the issue of lead exposure for many years now. Exposure was majorly from leaded gasoline, which began around the late 1930s and led to widespread elevations in children’s BLLs that were discovered around the late 1960s [te 1960s . Lead frte 1960s .Apart from those two major sources described above, other sources of exposure were industry, vehicular exhaust fumes and children being exposed to parents already exposed to lead at work. Exposure to all these sources led to high levels of BLLs in children, especially those living in deprived areas and of lower socioeconomic status .South Africa, the elimination of lead from gasoline and paint occurred in 2006 and 2009, respectively [Nigeria as well, lead was removed from gasoline in 2004 [The story is no different for low-and medium-income countries concerning the dangers of using lead in paint and gasoline. Countries from these areas have suffered for many years from exposure to lead from paint and gasoline, which has also put the health of many in jeopardy; as a result, lead was removed entirely from these substances. For example, in ectively . In Nige in 2004  and from in 2004 .Lead emission decreased in Germany continuously from the mid-80s due to different iterative mitigation steps …” p. 4. These authors monitored the BLLs of some young adults in Germany between 1981 and 2019. The results of this longitudinal study revealed a substantial decrease (by 87%) in the BLLs of these young adults. Furthermore, the United States’ elimination of lead from these substances at that time led to a drastic drop in BLLs which improved the health of many Americans. For example, there was an increase in the cognitive function and intelligence quotient of children [Several measures and mitigating steps were implemented by different countries in order to regulate the lead content of these substances. Some of these steps included constant clean-up of the past release of these pollutants, constant monitoring of BLLs to ensure they do not exceed recommended limits and educating people about the dangers of lead exposure. For example, Lermen et al.  reportedchildren . However, reports about the LMICs indicated that the BLLs of many people, especially children, continue to rise, and some have risen beyond 5 micrograms per deciliter (µg/dL) ,33,34 evLead can be found throughout the environment in which children live—including in the air they breathe, the water they drink, the soil they walk/crawl on, the food they eat, the paint on the walls that they touch, and even in some of the toys they play with …” [Apart from exposure to paint and gasoline, which have been widely reported in the literature, some other common and usual routes through which people are regularly exposed to lead and on a daily basis are food, soil, air and drinking water ,4,5. Exp with …” , p. 26.  with …” . The int with …” .Several studies have been conducted on the various common and usual sources  of lead exposure over the years. Some of these studies reported concentration values ,39, whilFood is one of the major pathways through which people (both young and old) can be exposed to lead. Ingestion or consumption of foods contaminated with lead could be the cause of many problems threatening human health today. For example, a study by Freeman et al.  reportedFurthermore, regarding the ingestion of lead-contaminated foods, a report from the US indicated that many people are exposed to lead by consuming game meat because of the use of lead-based ammunition for hunting this game, which is a big problem in the US . Lead frOn the other hand, apart from food grown on contaminated soils, studies have also reported that food items can be contaminated by dust containing lead from the roads, thereby causing health problems in individuals who ingest such foods. For example, Makhoka et al.  from KenThe results of the analysis showed that lead concentrations in all these food items were far above the maximum recommended limits which may lead to elevated BLLs in the exposed individuals. It was advised that, to prevent future contamination, foods in the open air should be covered with thin-sheet plastics . It was One other area through which people can be exposed to lead through food is the consumption of aquatic foods contaminated with lead. Wastewater or effluent discharged into water systems may also contain a high amount of lead. When this gets into any water systems (such as streams and rivers), it tends to contaminate the water life and, thus, the fish and when they are consumed by human beings, they can jeopardize their health. A group of researchers conducted a study around a lake in Kenya. Samples of some of the fish were taken and subjected to laboratory analysis. The results revealed that all the tested fishes had an amount of lead above the recommended limit of 0.2 (µg/g) . The autMany soils in different parts of the world are contaminated with heavy metals such as lead, which have deteriorated those soils. Some of the causes of soil contamination today could include proximity or being adjacent to smelting industries, lead mines, lead-acid batteries, automobile traffic and wastewater from industries. Food crops grown on any of these soils may contain high amounts of lead which may raise the BLLs of the people that consume these food items, thereby putting their health at risk ,46, for Apart from food items, samples of soils were collected from these mining communities and the results of the analysis also showed that the levels of lead in the soils were largely above the recommended guidelines . The autFarmers are also reported to be at a greater risk of lead exposure since they are permanently working with soil. In a situation where the soil is contaminated with lead, especially those farms close to mines or other related firms, they can easily be exposed to this metal .Lead levels ranged from <40 ppm to 140,000 ppm, with 81 per cent of soil samples having lead levels greater than 80 ppm …” [It was also indicated in a study by UNICEF  that lea0 ppm …” , p. 29.It should also be noted that dust from lead-contaminated soil can be blown by the wind into homes and school classrooms where children learn and also affect the general environment.The Hawaii Department of Education, in the USA, found that many soils are contaminated with lead in specific communities where children play and it may be unintentionally ingested. This prompted the Department to conduct a study where soil samples around 23 schools on the eastern side of Hawaii Island were collected and analyzed. The results showed that almost 60% of the schools had areas with elevated soil lead levels as a result of this contamination . The imp3, and health problems such as low educational scores and developmental vulnerabilities were reported.Laidlaw and Taylor  conducteAnother study was conducted in New Orleans among school children who lived in a community where the soils were mixed with lead and some other metals. This study determined the effects of lead on the academic performance of grade 4 children. The results of the study revealed that those children exposed to lead underperformed in the school standardized tests .Air is another widespread route through which people become exposed to lead. Pollutants, including lead, are generally emitted from industrial activities such as mining and the combustion of fossil fuels. People close to these polluting industries are at a higher risk of exposure. Apart from this, soil dust around these industries may be blown by wind and people around or even far away from these industries may be exposed to lead by inhalation, thereby putting their health at risk .Similarly, coal dust from coal mines may contain some amount of lead which can be blown by strong winds into the air, especially from storage yards or during transportation. Inhalation of this coal dust can result in chronic health problems to those exposed .Rasnick et al.  studied the lead industry caused serious environmental pollution that led to high BLLs in children living nearby …” [A similar study was conducted in China of 379 children that lived in seven (polluted) villages around lead mines and processing plants and another control group of 61 children from another village. This was achieved by determining the BLLs of the children and taking samples from their environments. The results of the study revealed that lead concentrations were higher in the lead-polluted villages compared to the non-lead-polluted ones. This indicated that the children in those lead-polluted villages had elevated BLLs compared to those from the non-lead-polluted village . The authors concluded that “… earby …” , p. 834.the water in one home tested contained 13,200 ppb of lead, more than two and half times the level of lead that could be classified as “hazardous waste” by the US EPA …” [Some studies have also reported on lead exposure through drinking water from different parts of the world. One example was the case of the Roman Empire , also, iS EPA …” , p. 42. Kordas et al.  conducteIn South Africa, Olufemi et al.  assessedThe authors of this study went further to aver that even though it might look as if the levels of lead reported from these three locations may not be that high as compared to levels reported in other studies, the issue being raised here was the presence of lead which at any level could be harmful. It was observed that the children in this community had been drinking this water from childhood, which may have a long-term effect on their health. Some of these children may sometimes fall ill and be absent from school, which may be due to the prolonged intake of water. To confirm this, Amadi et al.  reportedThe study of Ahangar et al.  focused Lead is melted by adults, often in the presence of children, and sometimes children themselves melt lead, for use in fishing activities or to play with…” [poverty, a large informal sector, competing for public health challenges, low levels of awareness of Lead hazards and weak capacity to enforce legislation …” [Other than the above-mentioned sources, there are some other known and unknown sources of lead exposure which have also been a major problem, especially in the deprived communities and poor areas of some wealthy countries. These other sources may include the manufacturing of local household products such as lead-glazed clay pottery , weldingy with…” , p. 183.y with…” . A simily with…” . It is ry with…” . In Mexiy with…” . These ay with…” . One majation …” , p. 1.Lead, a toxic metal, has been studied for many years by scholars worldwide who have consistently reported that exposure to this metal either by inhalation, ingestion or skin contact can result in various health problems in humans. Even though it affects both adults and children, it is to be noted that children are more vulnerable to the adverse effects due to their developing organs and nervous system. Several studies have reported that there is no safe blood lead level, and even small exposures can result in a reduced intelligence quotient (IQ), the inability to pay attention, poor academic performance and other health problems in children ,32.over 900,000 premature deaths per year are attributed to lead exposure …” p. 1. Studies conducted worldwide  ,65 compaAdults exposed to lead are reported to likely suffer from various health problems such as high blood pressure, kidney and brain damage, cognitive decline, cardiovascular diseases, irritability, headaches, and hallucination, which can later progress into convulsions, infertility in males, damage to the nervous system, miscarriage in pregnant women, paralysis, and even death ,67,68,69around 1 in 3 children—up to approximately 800 million globally—have blood lead levels at or above 5 micrograms per deciliter (µg/dL) …” [Lead exposure is a dreadful public health problem that affect many people all over the world and majority of those affected are children . To subsg/dL) …” , p.1.Numerous studies  due to severe measures that have been put in place to control it, the fact remains that there are still some poor or deprived communities in the HICs which are seriously affected by lead exposure from various sources .For example, Cincinnati, one of the poor communities in the USA, has been known for many years now to be a hot spot for lead exposure, with several children’s health being endangered due to continuous exposure to this metal . Over thFurthermore, Flint, in Michigan, USA, has for several years been threatened with the issue of lead exposure from drinking water which has affected the health of many in this deprived city, most especially the children ,57.Pradhan et al.  conducteA similar study was conducted in one local area of India of school-age children constantly exposed to lead. The authors of this study reported elevated BLLs, which were far above the recommended standard in these children compared to other children .children from deprived areas may be at higher risk of Lead exposure …” (p. 548).The United Kingdom, a high-income country, is being threatened by lead exposure . Levels of exposure are lower in urban areas than in rural areas due to legislation and measures put in place by the Government. However, those in deprived or poor areas are more affected by lead exposure compared to those in urban cities. For example, some lead-emitting companies are situated mainly in these rural areas. One can see from a study conducted in England by  where itA study was conducted in the rural part of Northern Mexico of children living around a metallurgy smelting company. These children were tested for lead at 0, 6, 12 and 60 months. The BLL concentrations obtained for each of these months  were: 10.12 μg/dL, 8.75 μg/dL, 8.4 μg/dL and 4.4 μg/dL, respectively. Risk of anemia was observed in these children .China, another high-income country, is known to be the largest producer of lead in the world. As a result, many Chinese populations  are affected by lead exposure, resulting in various health problems ,96. For It has been established that when it comes to lead exposure, LMICs and poor communities in the HICs or wealthier nations are more affected. Even though efforts to reduce lead exposure have always been in place and on a continuance basis, the fact remains that various challenges are being encountered in making this a reality. Some of these challenges are highlighted. For example, the study of  reportedOne of the best ways to reduce exposure in these poor communities is to totally ban or reduce the number of those manufacturing or small-scale businesses. However, because these businesses have long been operating, stopping them may be a challenge since this is what many of them have been depending on for a living. Other challenges may include people’s inability to stop regular practices such as the burning of waste.The marginalized or poorest of the poor populations are likely to live in proximity to lead exposure sites due to illiteracy and low levels or lack of awareness of the danger. One way to stop them from continuous exposure is for the government to think of relocating them far away from these exposure sites.Failure to reduce lead exposure will continue to lead to increased lead absorption, especially among vulnerable population groups such as children. One of those suggested precautionary measures to prevent the process of lead absorption is through proper nutrition .Nutrition or diet plays a vital role in reducing or increasing lead absorption in children and has been well documented in the literature. Certain foods with high fats, low minerals, low fibre, low iron, and excessive or low proteins are reported to increase the absorption of lead in the body . ContinuOn the other hand, it was reported that some children were continuously exposed to lead through a metal transporting company and that iron deficiency was responsible for elevated BLLs in those children . When itThe parents of children from the LMICs or poor areas of HICs feed their children just any type of food because many of them may be illiterate and not have any understanding or knowledge about these matters. Even if they are informed about these issues, they still might not be able to afford to purchase the correct food nutrients needed to fight lead absorption compared to parents of children from the HICs. In these HICs, most parents are literate, affluent, and have adequate information about lead-related issues and how to fight or prevent them, although lead exposure may be higher in the LMICs or poor areas of the HICs, as reported in many studies ,81. If cIn a situation whereby children are not given the necessary help to combat lead absorption, there will continue to be an accumulation of this metal in their blood through various sources as they grow. As the level of absorption increases, there is a tendency for the health effects also to continue to increase ,73. As twhich has put them at risk of diseases such as cardiovascular disease …” [With regard to cardiovascular diseases, a study  conductesease …” , p. 5. Ssease …”  reportedsease …”  also expsease …” .that the per capita consumption of leaded gasoline is strongly associated with all types of violent crime …” [Another major problem that could arise from prolonged exposure to lead, as reported in some studies from different parts of the world  lead exposure at a young age leaves children with problems such as learning disabilities, ADHD, and impulse control problems; and (2) those problems cause them to commit crimes as adults—particularly violent crime ,114,115.Millions of Americans now entering midlife and old age were exposed to high levels of lead, a neurotoxin, as children …” p. 1.It is to be noted that the potential futuristic effects of lead exposure mentioned above have mostly been reported in HICs, such as the United States, compared to the LMICs. Despite all the various measures put in place to combat lead exposure in these HICs, these issues remain public health problems in these countries. One important thing to remember is that lead exposure is higher in the LMICs compared to the HICs, and the LMIC populations are more affected by the consequences. It is therefore very important that urgent actions are taken to prevent people from LMICs, especially children, from being exposed to lead from any source. This is because exposure to this toxic metal has damaging and lasting effects on human health. Preventing lead exposure in early childhood will go a long way in preventing problems that may occur in adulthood or later in life. This is confirmed by  who asseAlthough lead exposure has been a serious public and environmental problem for several decades now, all over the world, it is unfortunate to note that many people all over the world have little or no information about this metal or its sources and even less of its’ resultant effects or dangers ,117. EveAdebamowo et al. [a limited awareness of the sources of lead exposure in the domestic environment and participants had little knowledge of the health effects of chronic low dose lead exposure …” p. 1. Looking at reports from other studies conducted around the world, it can be deduced that there is a general lack of awareness and knowledge about issues related to lead exposure [For example, a study conducted in South Africa among some pregnant women reported a low level of awareness among these mothers . Similaro et al.  conducteexposure . TherefoThe relevant literature used in this study was selected through a careful and thorough search and from various databases such as Springer, Science Direct, Hindawi, MDPI, Google Scholar, PubMed and other academic databases. The search was carried out by using string/keywords, which included: an overview of top priority heavy metals, such as mercury (Hg), cadmium (Cd), arsenic (As), chromium (Cr), zinc (Zn) and lead (Pb). After reading through some of these different heavy metals, even though they all pose a significant danger to human health, it was discovered that lead is the most dangerous because the effects are irreversible and cannot be corrected once exposed. So, the authors opted for lead which later became the focus of this study. Various other keywords searched were “Nature of lead”, “Origin and history of lead (with a focus on the Roman Empire)”, “Lead exposure generally”, “Major sources of lead exposure .” Other common sources of lead exposure which included “Lead exposure from air”, “Lead exposure from drinking water”, “Lead exposure from the soil” and “Lead exposure from food”, “Health effects of lead exposure on children”, “Health effects of lead exposure on adults”, “Lead absorption in children (compare LMICs and HICs)”, “Role of nutrition in combating lead absorption”, “Lead exposure from both HICs and LMICS”, “Lead exposure and preventive measures”, “Possible later life effects of lead exposure”, “Lead exposure and cardiovascular diseases from both HICs and LMICs”, “Lead exposure and violent criminal behavior”, “Lead–crime hypothesis”, “Lead exposure awareness”.Most articles searched and cited in this study were from 2000 and 2022, except for some articles published before 2000, which were selected based on their relevance even though they might seem old, i.e., ,99,100. This review reports on existing literature about the potential health risks of lead exposure from early life through to later life.Firstly, a brief description of lead and the various sources was made. This was followed by the general health effects, especially on children known to be the most vulnerable. These general health effects may begin to manifest right from birth through the childhood stage. As they grow with this metal in their bodies, they could develop more severe problems such as cardiovascular diseases and violent or criminal behavior later in life. There is no safe level for lead; even small exposures can lead to severe problems in the exposed individuals. Exposure to lead from any sources should be avoided as much as possible. This is because the effects are reported to be permanent and irreversible and may not be corrected once exposed. Precautionary measures should be taken to prevent exposure due to its lasting and irreversible effects. If lead exposure has detrimental effects on animal  and planReports from different nations have made it clear that even though there has been a phasing out of lead from gasoline and paint, which were the major sources of lead exposure in almost all the countries of the world during the past years, the fact remains that paint chips and dust from old houses are still a major source of exposure up till today ,120. HICThere is a possibility that the unleaded gasoline that replaced the old leaded gasoline might contain some toxic compounds  that unkProper medical checkups should be put in place to monitor children’s blood lead levels and health status from time to time.Proper awareness or education  should bHaving proper education  about thIn the case of areas where past use of leaded paint and gasoline has contaminated the soil, children must be kept away from such areas. In addition, soil remediation could be embarked on from time to time to prevent future exposure .Children from the LMICs should be given access to good healthcare, safe facilities and proper nutrition to fight lead absorption .Laws and policies should be enforced to keep the environments where children live and learn safe and free from lead exposure or other environmental contaminants .Many children born these days have already been exposed to lead right from the womb. To prevent this prevalence, it is very important that proper education be given to pregnant women to stay away from any sources of lead exposure as much as possible for the sake of the fetus in the womb. In addition to this, education should be given to mothers during pregnancy about the intake of foods rich in nutrients such as iron and calcium that can prevent the transfer of toxins to the fetus ,38.These are also applicable to lactating women .Global and international actions and measures that are put in place must be adhered to by every country concerning lead exposure from various sources and other related environmental pollutants to ensure that this planet is safe for all to live in .Research studies relating to the long-term and later life effects of lead exposure should be strengthened; for example, longitudinal studies are advised in order to reach concrete conclusions .There may still be other sources of lead exposure which may not even have been identified. These should be investigated.Extensive scientific data is needed for generalization .This paper reports on the potential health risks of lead exposure from early life through adulthood. Based on reports from several studies, individuals exposed to lead from the womb or at a young age will continue to manifest other health and behavioral problems as they grow up. If care is not taken, they tend to develop into more serious problems by the time they reach adulthood or old age. Based on this reality, preventive measures must be put in place to forestall such irreparable effects.


Following a large-scale, pandemic-driven shift to remote consulting in UK general practice in 2020, 2021 saw a partial return to in-person consultations. This occurred in the context of extreme workload pressures because of backlogs, staff shortages, and task shifting.To study media depictions of remote consultations in UK general practice at a time of system stress.Thematic analysis of national newspaper articles about remote GP consultations from two time periods: 13–26 May 2021, following an NHS England letter, and 14–27 October 2021, following a government-backed directive, both stipulating a return to in-person consulting.Articles were identified through, and retrieved from, LexisNexis. A coding system of themes and narrative devices was developed iteratively to inform data analysis.In total, 25 articles reported on the letter and 75 on the directive. Newspaper coverage of remote consulting was strikingly negative. The right-leaning press in particular praised the return to in-person consultations, depicting remote care as creating access barriers and compromising safety. Two newspapers led national campaigns pressuring the government to require GPs to offer in-person consultations. GPs were quoted as reluctant to return to an ‘in-person by default’ service .Remote consultations have become associated in the media with poor practice. Some newspapers were actively leading the ‘war’ on general practice rather than merely reporting on it. Proactive dialogue between practitioners and the media might help minimise polarisation and improve perceptions around general practice. Yet in July 2020 the government announced that a remote-first approach was to become default policy in England,6 at a time when the first wave of the pandemic had receded and many restrictions had been lifted. This was met with surprise and criticism by the media, as the authors of the current study have demonstrated in previous studies.7,8Policy on GP consultations in the UK has undergone several shifts during COVID-19. The initial move from in-person to remote consulting was first introduced in March 2020 as part of infection control measures.9 Later that year the new Secretary of State for Health and Social Care strongly supported this move and urged GPs to offer more in-person appointments,10 a sentiment echoed by the Prime Minister.11 In the context of ongoing condemnation of GP remote consulting in the media, the government released a directive, including a £250 million investment, to improve capacity for in-person consultations in general practice  did not reflect what was happening in practice. Although the number of in-person appointments at the time of this current study in 2021 was lower than pre-pandemic levels (5.3 million in August 2021 versus 8.8 million in February 2020), the number of telephone consultations almost trebled from 2.2 million in February 2020 to 6.2 million in August 2021.7,8 this current study examines newspaper coverage in 2021, and how this has evolved alongside policy (a return to in-person consulting) and wider media discourse (a rise in anti-GP rhetoric).Building on the research the authors had conducted into media representations of remote consulting during the first year of the pandemic (in 2020),How did national UK newspapers cover the policy shifts away from the initial remote-first approach towards a return to in-person GP consulting in 2021?How were messages around remote and in-person consulting framed?What metaphors, tropes, and other narrative techniques were used, and what do these symbolise?What are the differences in how the various newspapers reported on GP consultations?In this study the following research questions are addressed.8,17 The research team consisted of one postdoctoral researcher in languages, one social science academic, and one GP academic. From the authors’ previous research and general reading, the authors were aware that the media had covered remote consultations fairly positively in the past but had negatively portrayed general practice. Although the authors inevitably brought these perspectives and knowledge to bear on the research, the design of the study  helped minimise researcher biases.This study followed a qualitative approach to thematic analysis, which has successfully been used in previous research on news media representations of general practice.Daily Mail, The Guardian, Express, The Times, The Telegraph, The Sun, and Mirror, as well as their Sunday editions — and The Voice, self-described as ‘Britain’s favourite Black newspaper’. Together they comprise a wide range of political opinions and are read by different socioeconomic groups. They were the same newspapers analysed in the authors’ previous study,8 with consistency facilitating comparative analysis. Articles were collected from LexisNexis   and The Voice’s website (https://www.voice-online.co.uk).Nine newspapers were searched in this study: eight of the most widely read national newspapers in the UK — The search terms used were ‘GP(s)’ combined with eight further terms: ‘video’, ‘remote’, ‘virtual’, ‘digital’, ‘online’, ‘phone’, ‘telephone’, or ‘face-to-face’. These are the same search terms as used in the authors’ earlier study, with the exception of ‘face-to-face’, which is a new addition based on the shift in language.9 and the second (14–27 October) with the NHS England government directive12  with NHS England’s letter,ective12 . AlthougIn contrast to the early stages of the pandemic, a large volume of articles focused on or substantially discussed remote GP consultations. For this reason, articles that referred only briefly to the topic were excluded from the sample. Included articles could be news or opinion pieces, but blogs and letters to the editor were excluded.19 The lead author read all the articles collected, identifying key themes and narratives, which were then brought together under five main categories. These were chosen both deductively, based on those found in the authors’ previous work including empirical research on remote consulting,4,8 and inductively, based on the present data.Following this data collection, thematic content analysis was used to categorise articles according to themes or topics.A second researcher reviewed all articles and their categorisation. Both authors discussed their analyses to guide thematic synthesis and ensure consistency. The five categories were then revised and, in places, amalgamated, to present a comprehensive picture of the media’s coverage of GP consultations under three main storylines.The Telegraph, The Times, Daily Mail, and Express. Of these, 19 were written in response to NHS England’s letter, whereas the remaining six did not acknowledge it. Period 2 contained 75 articles, all in response to the NHS England government directive. Articles appeared in all newspapers, with the exception of The Voice, which did not publish any articles on GP consultations during the timeframes chosen for this study representation and abuse of GPs.Qualitative analysis led to the identification of three key storylines in the media’s coverage of GP consulting and relevant policy changes:‘like gold dust and face-to-face appointments even rarer’ , another described in-person consultations as being ‘as rare as hen’s teeth’ , and a third suggested that ‘securing a face-to-face consultation feels like hitting the jackpot’ .Many articles across both time periods drew attention to a need for better access to GP care and more in-person consultations. Various metaphors were used to emphasise depictions of in-person consultations as scarce in relation to demand. One journalist depicted GP appointments as being ‘vulnerable patients are struggling to get help, with some phoning more than 100 times a day to secure an appointment’ . This argument was supported by the story, widely circulated, of a daughter who called a GP surgery 286 times to book her 84-year-old mother an urgent eye appointment, only to be offered a phone consultation  were echoed by many journalists. Some articles took this stance further by suggesting that remote consulting may ‘have contributed to the death of some patients’ . To support this suggestion, two stories containing fatal outcomes appeared frequently. The story of the death of a 26-year-old from meningitis appeared in seven of the eight newspapers included in the current research. The articles reported that, during four remote consultations with GPs and nurses, in which the patient presented ‘with a range of escalating symptoms’ , none picked up his mastoiditis, which went on to cause a brain abscess. His father questioned the system .The second argument concerned risk and safety in remote care, with articles focusing their narratives on missed symptoms and misdiagnosis. Concerns reported by the Royal College of General Practitioners (RCGP) that remote-first care ‘[we] do not hear of these stories in the media’  .No articles from either time period reported on positive patient experiences. Only one article offered a more nuanced view on when remote consultations may be appropriate and reminded the reader that they do happen for a wide range of people and conditions; however, as these conditions tend to be minor and the outcomes positive, ‘perfectly sensible’ measure  ‘to protect patients and staff’  — the remote modality was thus depicted to a significant extent as causing safer care. Remote consulting — whether by phone, video, and/or email — was described as having the potential to save lives, but the wider context in which this could be realised  was often overlooked by the press.8The media’s mobilisation of patient stories to reinforce their push for a return to in-person GP care seemed to be underpinned by a deterministic logic. At the start of the pandemic, the shift to remote care was widely considered a ‘save lives’ , whereas other factors, such as long waiting lists in secondary care, and the need for additional tests and appointments to reach a diagnosis, were neglected. As the stories of patient experiences show, these deterministic narratives on remote consulting have also become fatalistic, with descriptions of the ‘harrowing consequences of diagnosis by phone, email or screen: symptoms missed, treatments delayed, lives ruined — and, too often, tragically lost’ .An equally deterministic logic was adopted in 2021, but remote consulting was now depicted as causing safety incidents, and in-person appointments described as being the ones that The Telegraph and Daily Mail, calling for more in-person consultations — so vehemently that they led The Guardian to describe the newspapers as ‘on the warpath’ against remote consulting . These campaigns played a key role in influencing the government to effect policy changes, which were widely praised by large portions of the media  saw it as newsworthy and reported on it in the sample included in the current study. In addition to welcoming the policy change, The Telegraph used the opportunity to congratulate itself and its readers for their contribution towards it: ‘Congratulations, everyone! Well done us’   .The Telegraph, Daily Mail congratulated itself for its contribution, describing the directive as ‘a major victory for the Daily Mail’s Let’s See GPs Face to Face campaign’  . In contrast, the left-leaning press was critical of the move, echoing GP concerns (below) around pressures facing general practice. One article went further, suggesting that it was ‘irresponsible’ for ‘Mr Javid to encourage the public to […] insist on their right to a particular service’, before describing the £250 million winter access fund a ‘slap in the face’ as insufficient to cover resourcing needs .The October directive was also praised in the right-leaning press. Like October) . The new‘angered’ by the letter and at NHS bosses for ‘adding fuel to falsehoods’ that surgeries were not offering in-person appointments . Martin Marshall, RCGP chair, was quoted in several articles saying that ‘this is good news and is what patients and GPs want to see’ , but his support was more for ‘shared decision-making between GP and patient’ rather than a blanket return to in-person consultations . Only one article quoted the RCGP as describing the letter as ‘misjudged’ and ‘demoralising’ . Richard Vautrey, British Medical Association (BMA) GP committee chair, was quoted describing the letter as ‘completely tone deaf’, with the BMA reportedly calling on NHS bosses to ‘clarify’ how GPs were to meet patient demand   from ‘a government completely out of touch with the scale of the crisis’  . They emphasised how the shortage of family doctors in the UK meant funding would not necessarily lead to recruitment as, according to one Shropshire GP, ‘there is no magic locum tree’ . They drew attention to more GPs retiring early or going part-time because of high stress levels and burnout, as well as fewer junior doctors training to become GPs  as key drivers of the GP shortage. The policy plan for league tables to ‘name and shame’ GP surgeries offering the fewest in-person consultations was also widely criticised. Although intended to increase the number of in-person appointments, GPs feared that the measures instead risked doing the opposite by adding to workloads and stress levels.GP responses to the October directive were reported in the media as almost exclusively negative. In addition to general criticism of the directive as a whole, such as Richard Vautrey’s description of the plan as a ‘decent, dedicated and hard-working’ individuals  who ‘take great pride in making their communities healthier and happier’ . However, these views tended to be voiced primarily by members of the healthcare profession, such as by Chris Whitty, the government’s chief medical officer for England, who, speaking at the RCGP’s annual conference, described the work of GPs during the pandemic as ‘outstanding’, adding that he was ‘massively admiring of what you all have done, and continue to do, in the biggest public health challenge in our professional career’ . Some journalists also praised GPs for their service during the pandemic, with descriptive terms including ‘outstanding’, ‘heroic’, or ‘marvellous’ . Notably, these positive representations were almost exclusively limited to individual doctors who invited their patients, reportedly without hesitation, for an in-person appointment.In the articles analysed there was mention of GPs traditionally viewed as ‘lazy’ , reluctant to work, and/or care little for their patients: ‘it just seems like GPs want to do as little as they can’ . These perceptions led one journalist to encourage GPs to ‘start doing what they’re paid to do — SEE patients’ . In the context of policy changes to encourage patient feedback .More frequently, GPs as a collective were berated in the media. Negative narratives around GP access — particularly the difficulty in securing an in-person appointment, with many patients being offered a remote consultation instead — led to the perception that GPs are feedback , one art‘a bunch of overpaid part-timers’ . The same article criticised GPs for struggling with their high workloads and blamed them for exacerbating the GP crisis: ‘I know there’s a GP shortage so why then are so many of them choosing to go part time? Why make a bad situation worse?’   . However, one GP suggested that ‘any further demonisation of general practice will perpetuate the problem we are trying to address’ . As such, an end to the government and media’s denigration of general practice may negate the need for such a campaign in the first place — while also, perhaps, beginning to alleviate the ‘GP crisis’ by improving both morale and GP–patient relationships.The government, aware of this abuse, responded by including a This study has examined UK newspaper coverage on remote consulting in 2021, and how this evolved alongside a policy drive for increasing the number of in-person consultations in general practice. Media reporting featured concerns around inequity of access  and patient safety  in remote care, illustrated through patient stories where detrimental outcomes were attributed to consultation format. Motivated by these concerns, portions of the right-leaning press led extensive campaigns for improved access in general practice, and subsequently praised the policy shift for in-person consultations. In contrast, GPs and GP representatives  were quoted as criticising policy changes for neglecting general practice pressures, including unmanageable workloads, high stress levels, and resource and staffing issues. Throughout 2021 remote consulting became increasingly contentious, creating tensions between government ministers, the media, GPs, and patients. A significant rise in anti-GP rhetoric was observed in the current study, with some journalists using remote consulting as a platform to criticise GPs for not fulfilling their professional duties, and thus further fuelling the GP crisis.‘matters of life and death […] are identified with a high degree of reportability’; positive patient experiences would therefore be considered less ‘reportable’. Labov adds that ‘credibility is inversely related to reportability’ [emphasis in original] — in other words, there is an inherent reporting bias against experiences where nothing went wrong.20The absence of positive stories about remote consultations in the current sample may be partly explained by the fact that several newspapers were not merely reporting on remote consultations but campaigning to reduce them, and any positive stories would diminish that argument. But it may also be because of their perceived lack of newsworthiness. According to William Labov, narratives concerning 7,8 in this period technology was cast in the role of ‘hero’, which — at least partially — saved society from a deadly pandemic. A year later, technology had become something of a villain, distancing the patient from the doctor’s therapeutic touch. These simplistic, polarised narratives around modes of consulting were not helped by a commodification of clinical care (patients were depicted as customers who had a right to see the GP in person). The reality of clinical diagnosis and management is, of course, far more nuanced, with multiple interacting influences contributing to safe and effective clinical care and the balancing of good care and patient satisfaction.4,21,22Whereas remote consultations were depicted positively (on one occasion as ‘miracles’) in the early weeks of the pandemic,7,8 this current study offers an updated analysis of newspaper articles published in 2021. A wide range of search terms was used to collect 100 articles with strong focus on remote and/or in-person GP consultations from an extensive database (LexisNexis). The large number of articles, from eight widely read national newspapers with different political leanings, and from two time periods, facilitated broad analysis by enabling the authors to consider differences in media coverage, both collectively and by newspaper, in response to specific policy changes and over time.The only previous explorations of this topic, to the authors’ knowledge, are the analyses of newspaper coverage from 2020;Despite the variety of search terms used and the extensiveness of LexisNexis, there is a risk that some articles were missed. For scoping purposes, only articles from national UK newspapers from two 2-week periods in 2021 were used .23 Drawing on Bourdieu, Lewis et al explain this tendency by examining the different positions newspapers assume in the media field, to sustain their cultural and economic capital, and the support of their audiences.23 In the current study, this translated into the right-leaning press echoing the sentiments of the government and arguing in favour of in-person care, whereas left-leaning outlets (echoing the comments of many GPs quoted) advocated retaining remote care to some capacity to avoid further strain on an already overstretched workforce. This polarised media landscape shaped public views in 2021, in sharp contrast to a relatively uniform media response on remote consulting in 2020.8Previous research on media representations suggests that public healthcare systems are often depicted in a negative light, with dramatic stories about inadequacies and inefficiencies outweighing positive ones.8 In 2021, this progress was no longer seen favourably, and remote care was instead blamed for patient harm and inefficiency. This echoes broader technology-focused narratives in COVID-19 with multiple different technologies being presented as ‘solutions’ to pandemic-related challenges, only to scale down expectations later on.24Although media views about the potential and limitations of remote consulting shifted as the pandemic progressed, the enduring appeal of attributing agency (positive or negative) to technology remained. In previous work, the authors found that the initial shift to remote care at the start of the pandemic in 2020 was generally supported by the media, which equated technological change with long-overdue progress in service provision.GP consulting has been gaining momentum as a topic of debate in the media, alongside (mis)representations of GP work and professional identities. But the complex matter of deciding on consultation format has been discussed without the necessary nuances, and without reflecting the complexity of care in general practice.25 and a social media analysis of GPs’ postings during the pandemic by the same authors,26 both found that negative media portrayals of general practice  were a significant factor contributing to low morale. The current authors’ own ongoing empirical research has begun to identify similar findings among GPs and their support staff.27Negative media coverage matters not just because it is inaccurate and unfair. It may also reduce patients’ confidence in general practice and prevent or delay them seeking care. There is emerging evidence that it also contributes to workforce stress and the retention crisis. A qualitative study of 40 UK GPs conducted in 2020–2021,More research is needed to understand how different consultation formats, and combinations, can maximise value for different patient groups and different providers. There is significant scope for researchers and practitioners to contribute to media reporting and to broader public engagement around the complexity of remote consulting in general practice. This might help to minimise polarisation, so practitioners and patients can be better supported with situated judgements on consultation formats, as we transition into the next phases of the pandemic.


Domiciliary carers (DCs) provide an invaluable service that enables people living with dementia (PLWD) to remain living in their own homes for as long as possible. We know a lot about the negative impacts of providing domiciliary care and recent evidence suggests that this was exacerbated by the COVID-19 pandemic. However, we know much less about how these DCs manage the stressors associated with their roles. The current study adopts a resilience perspective to identify the resources that DCs caring for PLWD draw on to manage the stress associated with their roles before and during the COVID-19 pandemic. We conducted semi-structured interviews with 19 DCs from across the UK. Data were analysed using a directed qualitative content analysis. Themes included: healthy boundaries; motivation to care; psychological attributes; managing work; and support. The findings have implications for employers and may go some way towards improving DC working conditions, retaining staff, and attracting new DCs in the future. There are currently at least 850,000 people living with dementia (PLWD) in the United Kingdom (UK), a figure that is projected to reach two million by 2050 . As demeHowever, supporting a PLWD to remain at home can be challenging for their primary carers. Dementia care has been associated with increased levels of stress, depression, and anxiety, with 50% of informal carers of PLWD experiencing burnout, burden, and physical health complications, including cardiovascular disease and poor immune responses ,4,5.One way of facilitating home care whilst maintaining the health, safety, and independence of PLWD and their carers is through domiciliary care (DC) . In 2014However, the work of DCs is often physically and emotionally demanding with varied and extensive hours . Client We know the risks and impacts associated with DC but we know relatively little about any rewards and factors that protect DCs in their important roles. For example, research has shown that adult social care workers report high levels of job satisfaction  attributResilience frameworks are being increasingly used by dementia care researchers to examine the protective factors, assets, and resources carers use to manage the challenges associated with caregiving . ResilieRecruitment took place between 2018 and 2020. Participants were eligible to take part in the study if they met the following inclusion criteria: at least 18 years old; fluent in English; worked full-time as a DC for at least six months; supported at least one PLWD in their role. We advertised the study via online social media communities for social care workers and through contacting directors of local and national DC agencies who could act as gatekeepers for the research. We asked for expressions of interest to be made either to agency management or to the research team directly. We then shared the participant information sheet with anyone who expressed interest in the study. DCs who met the inclusion criteria and wished to take part in the study were invited to an in-person or remote video interview, where written informed consent would be obtained. We obtained ethical approval from the University of Liverpool prior to the study being conducted (Ref: 1978).n = 13) and interviews during COVID were conducted remotely via Zoom or Microsoft Teams (n = 6). A.H., K.C. and C.M all had professional experience of being DCs themselves and so this informed the development of the interview schedule and improved rapport with participants. Each interview began with a summary of the research project followed by a series of demographic questions (section A), including: age; gender; place of residence; and experience working as a DC. The interview was then split into three sections. Section B asked participants how they came to work in the social care sector and which aspects of care they found rewarding. Section C covered challenges, asking participants to reflect on which aspects of their role they found most difficult and why, e.g., training, shift patterns, amount of travelling required, and the public perception of social care work. Finally, section D covered resources, asking participants to identify any resources that equipped them to manage their work well, including personal attributes, support networks, and external resources. Each section of the interview encouraged participants to reflect on not just their individual assets but their community and societal resilience resources that they drew on to manage the stress of their roles. Each interview ended by asking participants to provide advice to other DCs and whether there was anything else they would like to share that had not been covered by the interview.Semi-structured interviews were conducted by A.H., K.C. and C.M. and lasted between 29 and 90 min. Pre-COVID interviews were conducted in person at DC agency offices , East Midlands (n = 1), Northern England (n = 2), North West England (n = 6), Southern England (n = 1), Mid Wales (n = 1), and Central Scotland (n = 1). Participants had worked in DC for between six months and 30 years , worked between 35 and 55 h per week , and spent between 1.5 to 4 h travelling between calls each day . All DCs reported that their agency provided basic induction training, covering areas such as safeguarding, health and safety, safe handling of medication, and manual handling. Some of the DCs had completed additional care qualifications, either in their own time or within their agencies.A total of 19 DCs took part in the study (13 before COVID-19 and six during COVID-19). Most were female (84%) and aged between 22 and 59 years . DCs lived and worked across the UK, including the West Midlands , the community and societal resources  were no less important to DCs. Each theme represents an asset or resource that DCs drew on to manage the challenges associated with their role. Although separate interviews were conducted with DCs before and during COVID-19, the data are synthesised for the purposes of the analysis.Most of the DCs spoke about how the line between their work and home lives often became blurred. Key to resilience was the DCs ability to maintain work–life balance. In the quote below, Ann provides a candid account of how she compartmentalises work life and home life:There are times, don’t get me wrong, where I do take it home with me. But I have to respect that when I’m at home it’s home life. It does have an impact on it, there’s no two ways about it, but you need to find that line.Ann, pre-COVID, DC for 30 yearsDCs discussed various ways of maintaining a healthy work–life balance. For some DCs, this meant leaving work at work and switching off completely:When you’re at work you switch off everything from home, when you’re at home you switch off everything from work.Jasmine, pre-COVID, DC for seven yearsOther DCs practiced self-care techniques such as meditation and playing video games to reduce the stress associated with their roles. Self-care was particularly important during the COVID-19 pandemic when workload increased and resources decreased:Allowing yourself to have time to do things, to do the things you enjoy the most… Because you need a balance to work in care. You cannot take too much on your shoulders or you’d be making yourself ill.Craig, during COVID, DC for six yearsWith time and experience, the act of maintaining healthy boundaries between work and home life became easier for the DCs. In the quotes below, Anouska and Katie describe the process of leaving work at the door which improved their ability to relax:I was going home and thinking ‘ah that person from there…’ and I was saying to my husband, I don’t know whether I can do this job, and it was like that but then now over the years… I go into my house and that’s it.Anouska, pre-COVID, DC for 1.5 yearsAt first when I started I used to think have I done that right did I sign that… now it’s a lot easier to go home and be like, ‘oh, that’s today done’. But I think once you’ve mastered leaving it all at the door you can go home.Vicky, pre-COVID, DC for four yearsThe DCs initial motivations to work in social care varied. For some DCs, the job gave them the flexibility to work around family commitments. Below, Angela describes how her flexible working pattern enables her to look after her children:Luckily my hours are flexible and I am really lucky to be able to work around my two boys.Angela, pre-COVID, DC for eight yearsInterestingly, a number of the DCs had personal experiences of caring for their own family members which inspired them to pursue professional care work:I’ve learnt the most about dementia from my own personal experiences.Daisy, pre-COVID, DC for ten yearsWell I looked after my Grandad for quite some time, and his care company needed staff so that’s what got me into caring.Marie, pre-COVID, DC for 24 yearsDCs counterbalanced any negative feelings associated with their work with the enjoyable and rewarding aspects. These aspects were crucial in sustaining the DCs motivation to care:I did used to think it was wiping a*ses! Like you’ve got no qualifications, nothing… but you do come away smiling 90% of the time.Eileen, pre-COVID, DC for four yearsYes, definitely it is rewarding. If you see your clients happy, healthy, that’s the main thing.Noreena, pre-COVID, DC for four yearsIndeed, many of the DCs felt a sense of honour and pride in their work. This was especially pertinent with the unprecedented challenges posed by COVID-19. It is clear in the following quotes from Lisa and James that a sense of job pride helps them to deal with stressors and gain a sense of job satisfaction:Although some days you might be feeling sad, stressed or emotional, you will also feel so good and so rewarded for what you do.Lisa, during COVID, DC for 12 yearsIt proves how much it means and how much (job pride) can lead your life and job and make it easier dealing with the stress and stuff in this work setting.James, during COVID, DC for 1.5 yearsI think working in care and seeing how people react it’s one of the few times in my life when I can actually turn round and say ‘I’m really proud of what I do and how I do it’. James, during COVID, DC for 1.5 yearsDCs who could see the tangible impact that their care had on their clients and their families were more satisfied and motivated:I like helping people… going into somebody’s house and coming out knowing that you have made a difference to their day.Daisy, pre-COVID, DC for ten yearsDementia can be upsetting… so knowing you can calm them down, help them, make them feel more comfortable is brilliant, extremely rewarding.James, during COVID, DC for 1.5 yearsOver time, DCs developed close professional relationships with their clients. Building these relationships made the job mutually rewarding; the clients were being cared for and the DC felt they were making a difference:She began to accept me… I could do a bit more for her, she could… I wouldn’t say remember exactly who I was… but she knew I would be there for her.Noreena, pre-COVID, DC for four yearsWe’re able to support the families and give them a bit of rest, and they can give us extra insight into who the person was before dementia.Angela, pre-COVID, DC for eight yearsThe DCs possessed a range of psychological qualities that enabled them to manage stress and find positive meaning in their work. Many of the DCs had a stoic mentality; whilst this did not necessarily relieve the pressures of the job it strengthened them to continue caring:You have to be strong… when someone is relying on you.Louise, pre-COVID, DC for six yearsI think you just get on with it. It’s another day isn’t it so you just do your best!Florence, pre-COVID, DC for two yearsThe DCs demonstrated acceptance which enabled them to remain positive and upbeat, often despite significant challenges. In the quotes below, Louise and Noreena describe how they deal with the hardest part of their work, the death of a client:You’ve still got to be that bubbly person even though you’re thinking ‘this person has not got long to live and I will miss them’.Louise, pre-COVID, DC for six yearsIt’s very hard… but it’s just the circle of life I guess, and you just have to take it like it is, somehow.Noreena, pre-COVID, DC for four yearsDespite the hardship, some of the DCs were able to bring humour and laughter to their work which was mutually beneficial for themselves but also their clients. In her interview, Louise (pre-COVID) emphasised that ‘good conversation and laughter’ was often just as important as the practical aspects of care. In the quote below, Lisa outlines how her sense of humour helped to reduce the emotional impact of working in care during COVID-19:I use humour quite a lot, like, in situations that I find uncomfortable for example. That helps me so much.Lisa, during COVID, DC for 12 yearsThrough working closely with PLWD during the pandemic, Lisa developed a sense of gratitude and appreciation which facilitated personal growth and thankfulness for her own and her family’s health:You get to appreciate life more and be more thankful for what you’ve got, and that you and your loved ones are healthy… it’s a very difficult job, but it has helped me grow so much as a person.Lisa, during COVID, DC for 12 yearsIn addition to the above psychological attributes, the DCs described a number of other strategies that helped them to manage the challenges associated with their work. As with the theme of healthy boundaries, time and experience facilitated problem-solving and personal strength:Because I’ve done it for so long… I’ve been up against every kind of challenging behaviour or problem you can come across.Jasmine, pre-COVID, DC for seven yearsI think the job itself becomes easier with time, because you become stronger and things don’t affect you that much… I think it’s just part of the process really, you just have to adapt and learn how to deal with your own feelings.Lisa, during COVID, DC for 12 yearsThe DCs used every positive or negative experience as an opportunity to learn and gain more knowledge, thus growing as a social care worker. In the following quote, James reflects on his personal and professional growth during the pandemic:It (the pandemic) has helped me grow in terms of like… I’ve learnt a lot, I’m more aware. I’m more knowledgeable on not just cornoavirus but things that look like coronavirus but it’s not… like the flu or a cold.James, during COVID, DC for 1.5 yearsIn some cases, it was necessary for the DCs to skillfully adapt their care approach to accommodate the unique needs of their clients. In the quote below, Louise describes how she uses humour to encourage a client who is reluctant to take her medication:I have no idea what the tablets do! I just know she needs to take them, so I say ‘well this one could make you beautiful!’Louise, pre-COVID, DC for six yearsOther DCs take steps to maintain the independence and safety of their clients:Leaving everything as their own home, but unplugging the cooker… and putting medicines in a locked box.Marie, pre-COVID, DC for 24 yearsFinally, the DCs recognised when their clients needed emotional rather than practical support. In the following quotes, Louise highlights the importance of emotional support, maintaining continuity, and a sense of identity for the client:It was important that clients felt that DCs cared for them as well as actually provide care.Louise, pre-COVID, DC for six yearsIf they’ve always worn a suit, let them wear a suit.Louise, pre-COVID, DC for six yearsDCs drew on a range of supports to help them in their role, both from their own friends and families back home but also colleagues and management within their agencies. The primary source of support for most DDCs was their families. Family support provided physical and emotional strength to the DCs:(Family) gives you strength to do what you do.Noreena, pre-COVID, DC for four yearsDaughters yeah… well sometimes you’ve got to talk about it, you know, like what’s happened and if you done something nice for someone and the look on their faces, it is good.Zinnia, pre-COVID, DC for six monthsFamily support at home was particularly helpful during the pandemic as DCs were often physically exhausted due to increased job demands and staff shortages:I was getting home from my shift and finding out he (husband) had cooked my tea and set up the table with candles… he really wanted me to come from work and have absolutely nothing to do, and I can’t be grateful enough for that.Lisa, during COVID, DC for 12 yearsDCs also drew on the support of friends outside of work. In the following quotes, Ann and Craig describe the role that their friend networks play in providing emotional support and socialising:I’ve got a couple of friends… we’ve been friends a lot of years so we get together and have a little chat, and I know I can pick the phone up to any one of those so it is good. I think it helps having a friend or a number of friends.Ann, pre-COVID, DC for 30 yearsI have lots of friends online because I play online games, so I was still able to socialise with them and talk to them, and that felt great, it felt normal… it’s good to just talk.Craig, during COVID, DC for six yearsAlthough support from friends and family was highly valued by the DCs, support from co-workers was of special importance. Support from co-workers promoted a special sense of community, camaraderie, and unison. It provided a forum within which the DCs felt more understood and able to share their experiences:If you’re friends with them (co-workers) then you’ve got support, because 90% of the time they’re going through the same thing you are.Eileen, pre-COVID, DC for four yearsI’ve also got a good set of friends that work with me and we meet outside of work to go for coffee… because if we didn’t meet up for a coffee once a week and get it off your chest, you’ll be banging your head making yourself ill.Nastasya, during COVID, DC for eight yearsThis type of support was particularly important during the pandemic as many DCs spent increased amounts of time at work and may have felt isolated without their colleagues’ support:We’ve always been there for each other, not only as friends but as colleagues… and that helps. Having a supportive work environment does help a lot, because you know they’ve got your back.Lisa, during COVID, DC for 12 yearsMany of the DCs were lone workers, visiting clients without the tangible support of a co-worker. However, DCs made time to socialise online, continuing to build rapport with each other and stay connected when face-to-face contact was not possible:We did like game nights and stuff like that through Zoom. So that helped, because you still feel connected to them even though everyone is at home.Craig, during COVID, DC for six yearsEmployer and management support was also critical. DCs who felt that they had the support of their employers felt reassured which made their jobs feel more manageable:If there’s any issues with anything (manager) is here you know. She’ll always talk to us about any issues that we have got. But yeah, the support is always there. I’ve never felt like there hasn’t been any support.Grace, pre-COVID, DC for 15 yearsI guess I’m just lucky to have them (employers). Because it does make a difference, you know. Knowing they are there if you need them, even like… you might never need them. But if you do, just knowing they are there helps.James, during COVID, DC for 1.5 yearsSome employers provided the DCs with additional training and support to increase their skillset and coping resources. In the following quotes, Florence and Ann describe how training courses keep them up-to-date with dementia care and what to expect on the job:It helps when obviously you’re getting up to date erm like training courses and things like that erm to do like with dementia care or anything really. Just so you know what you’re expecting.Florence, pre-COVID, DC for two yearsI think the regular training is excellent, and I do think you need it… I’m just grateful that it’s there to keep you going because otherwise you’d be left behind.Ann, pre-COVID, DC for 30 yearsMarie was even offered psychotherapy from her employer which she perceived as helpful:They’re helpful in every way, they give you counselling or whatever you need… they’re always at the end of the phone.Marie, pre-COVID, DC for 24 yearsThe current study provides some of the first evidence on the resilience of domiciliary care workers both before and during the COVID-19 pandemic. Our qualitative analysis revealed that the line between DC’s professional and personal lives was often blurred, and this was particularly evident during the height of the COVID-19 pandemic. However, the DCs were highly resilient and adaptable. They remained motivated through a sense of acceptance, reward and job pride, and possessed a range of psychological qualities, such as stoicism, positivity, and gratitude, which strengthened them further. DCs who were flexible and adaptable and felt as though they were making a tangible difference to the lives of their clients were better able to manage the challenges associated with their roles. Finally, support from family, friends, and co-workers was important; the latter was particularly important because it created a community of shared experience in which DCs felt well-equipped to support their clients and grow as a care worker.Most of the evidence to date has focused on the impacts associated with DC work ,12,13,14Most themes from the current study related to the individual level of the framework, but community and societal levels were also represented and no less important. Indeed, the resilience framework posits that protective resources are non-hierarchical . This sun = 13) and post-COVID (n = 6) interviews. Although we did not set out to compare pre- and post-COVID experiences, we may have failed to capture the full extent of COVID-19 care experiences. Third, the demographic data could be considered incomplete as we failed to capture details such as ethnicity and socioeconomic status. These data could have been used to purposively sample a more diverse group of DCs and to contextualize the findings more.The current study had several limitations. First, although the sample was geographically diverse it may have represented a self-selecting ‘elite’ group of resilient DCs; i.e., those who had time to volunteer in research and willing to share their stories. We therefore may have overestimated the extent of resilience in the DCs and the resources available to them. Second, the sample was unbalanced in terms of pre- (Our findings identify potentially modifiable protective factors that could be targeted by policy and practice in the event of future healthcare crises. For example, our findings showed that healthy boundaries were key to resilience. DC agencies should therefore support their employees to take regular annual leave so that they can spend time with their families and friends and prioritise self-care. Furthermore, our findings showed that, with experience, work–life balance became easier and psychological attributes were more developed. Employers could create a ‘buddy system’ whereby new members of staff can learn from more experienced members of staff. Indeed, this peer support was found to be a powerful facilitator of resilience for DCs. Finally, we found that support and training from DC agency management was vital for resilience. Employers should ensure that there is an open channel of communication between DCs and management and that they are responsive in emergency situations when DCs need support. Additionally, by providing regular training courses, employers could ensure that their DCs keep abreast of developments within the social care field and know what to expect on the job which removes ‘fear of the unknown’. These kinds of activities/initiatives could go some way towards improving DC working conditions, retaining staff, and attracting new DCs in the future. Through promoting the resilience of DCs and aiming to increase their job satisfaction and motivations to care, this could also improve outcomes for PLWD and their families .The current study aimed to use the ecological resilience framework to identify the assets and resources that UK-based DCs draw on to protect and sustain them in their roles, both before and during the COVID-19 pandemic. We found that DCs were highly resilient and adaptable. DCs who maintained healthy boundaries between work and home lives and remained motivated through a sense of acceptance, reward, and job pride were better able to manage the challenges associated with their roles. Additionally, key to resilience was a sense of stoicism, positivity, gratitude, flexibility, and the knowledge that their work was having a tangible impact on the lives of PLWD. Finally, informal support from within and outside the agency meant that DCs felt well-equipped to support their clients and grow as a care worker. The findings support an ecological approach to resilience and may be of interest to DC employers; through knowing some of the resources that DCs draw on to manage job demands, employers can improve job satisfaction, staff retention, and turnover, all whilst indirectly improving the care of PLWD.