Teachers’ occupational anxiety is a kind of negative emotional state of teachers, which is prevalent in Chinese teachers. Unfortunately, in the existing research, teachers’ occupational anxiety caused by China’s ‘double reduction’ policy has not been paid attention to. Based on the grounded theory, this study conducted in-depth interviews with 45 in-service primary and junior high school teachers, and used NVivo 12 to process recording materials. Through a series of steps such as open coding, axial coding and selective coding, we found that the core feature of teachers’ occupational anxiety caused by the ‘double reduction’ policy was that the implementation of the ‘double reduction’ policy was incomplete matching the actual educational ecology. Then we constructed a theoretical model of the formation mechanism of teachers’ occupational anxiety caused by the ‘double reduction’ policy. The study showed that due to the influence of teachers’ own personality characteristics and incomplete match between external factors, although teachers insisted on self-adjustment, it was difficult to fundamentally solve the teachers’ occupational anxiety caused by the ‘double reduction’ policy. With th1.1.Anxiety is an unpleasant and complex emotional state of tension, uneasiness, worry, and annoyance that an individual experiences in response to an impending and potentially dangerous or threatening situation. 1.2.Regarding teachers’ occupational anxiety, studies had found that the types were mainly related to subject anxiety, such as mathematics , EnglishIt was precisely because of the concern about the widespread existence of teachers’ occupational anxiety that researchers gradually turned their focus to explore the source of teachers’ occupational anxiety. Some studies suggested that teachers’ occupational anxiety was not only related to internal factors such as teachers’ negative experiences or behaviors in the classroom , low phyAlthough the above research has analyzed teachers’ occupational anxiety from different dimensions, there is no research to explore teachers’ occupational anxiety against the background of national education policies. In the application of research methods, more research has been done using cross-sectional questionnaire surveys, anxiety scales and tests, and less research has been done using qualitative methods to analyze teachers’ occupational anxiety. In addition, previous studies have mostly interpreted the negative impact of teachers’ occupational anxiety on students’ learning, and less and difficult to focus on the negative impact on teachers’ own development. Therefore, this research takes China’s ‘double reduction’ policy as the background, and uses grounded theory to deeply explore the main characteristics, root causes and teachers’ self-adjustment of teachers’ occupational anxiety, in order to further clarify the internal mechanism of teachers’ occupational anxiety, which will be of great significance to how to effectively alleviate teachers’ occupational anxiety and promote teachers’ professional development.1.3.Since ‘double reduction’ is an education policy with Chinese characteristics, it is also extremely necessary to understand the existing research on ‘double reduction’. The so-called ‘double reduction’ means that on July 24, 2021, the General Office of the Central Committee of the Communist Party of China and the General Office of the State Council issued the Opinions on Further to Ease the Burden of Excessive Homework and Off-campus Tutoring for Students undergoing Compulsory Education. In this context, all sectors of society focus on how to effectively reduce the burden on students, how to effectively rectify off-campus training institutions, and continue to observe the effectiveness of ‘double reduction’. Educational researchers have thought about the implementation of the ‘double reduction’ strategy from multiple perspectives, such as innovating after-school service mode, enhancing after-school service guarantee, improving primary and secondary school homework to meet students’ personalized homework needs , and imp2.This study adopts the grounded theory method invented by We use the grounded theory method in qualitative research to systematically collect and analyze data, mainly for the following reasons. First, since the purpose of this research is to explore the internal formation mechanism of teachers’ occupational anxiety caused by the ‘double reduction’ policy, the deductive method does not apply to such research. As a method based on inductive reasoning, the grounded theory is conducive to generating a theory based on data and formed by the views of participants, to really go beyond description and toward a theoretical interpretation of processes or phenomena . Second,2.1.Since China’s ‘double reduction’ policy was mainly aimed at the compulsory education stage (primary and junior high schools), the researchers recruited 45 qualified in-service primary and junior high school teachers by issuing electronic recruitment leaflets, and took them as the research objects. In order to improve the representativeness of the sample, the researcher also comprehensively considered various factors such as teacher’s gender, length of service as a teacher, region, difference in schooling stages and disciplinary differences during recruitment. Specifically, considering the different length of service as a teacher, their occupational anxiety would also be different. Therefore, the researchers divided the teaching experience of teachers into three growth stages: novice teacher, proficient teacher and expert teacher. The research showed that the teachers with teaching experience of 1–3 years and relatively high level of pre-class teaching strategies, but lack of flexibility in teaching process, belonged to novice teachers, the teachers with teaching experience of 4–14 years and higher level of in-class teaching strategies, and were familiar with the content and procedures related to the class, belonged to proficient teachers, while the teachers with teaching experience of 15 years or more, who had stronger innovation and reflection consciousness than proficient teachers, belonged to expert teachers . As many2.2.The grounded theory is not only a methodology, but also a method for exploratory research . There a2.2.1.This stage was to initially construct the interview system and coding system. First of all, the researchers worked out an interview outline around the theme and purpose of the study see . Due to 2.2.2.In this stage, the coding system developed in the first stage was further confirmed and improved. The researcher chose 15 in-service primary and junior high school teachers as the subjects of this round of research, and still adopted the online one-to-one semi-structured interview method, aiming to enrich the attributes and dimensions of the emerged categories and further explore the underlying reasons behind teachers’ occupational anxiety caused by the ‘double reduction’ policy. After this round of interviews, the researcher continued to code the interview texts in the same way as in the first stage. At this stage, the existing categories were further enriched. The relationships among the categories were also clarified through the paradigmatic model of axial coding. Based on this, the researcher established the core category through selective coding and developed a theoretical model of the formation mechanism of teachers’ occupational anxiety caused by the ‘double reduction’ policy.2.2.3.This stage was mainly to confirm or revise the theoretical model formed in the second stage. The researcher continued to select 10 subjects for a new round of online one-to-one semi-structured interview. After this round of interviews, the researchers found that there were no new categories or attributes, and the theoretical model of the formation mechanism of teachers’ occupational anxiety caused by the ‘double reduction’ policy formed in the second round was further confirmed here. This meant that the study achieved theoretical saturation so far, and no new data need to be collected.2.3.Coding is a necessary step for empirical data to gradually form a theory. This study was based on the three-level coding strategy of ‘open coding-axial coding-selective coding’ invented by The first stage of data collection and analysis was open coding, which aimed to disassemble, compare, label, conceptualize, and categorize the data. For example, the label ‘teacher growth’ was given to ‘the introduction of the policy of double reduction has forced some teachers to change the old and conservative teaching methods, which can force teachers to grow’. As the new label ‘richer curriculum’ emerged in the supplementary interviews, a new correlational concept ‘positive effect’ could be created based on the existing labels, and further categorized into the category ‘teachers’ policy cognition’. Through the use of induction and in-depth comparison, five major categories were created at this stage see . For the2.4.Using the grounded theory approach, the researcher needs to continuously collect and analyze data and selectively code them until saturation is achieved, resulting in a comprehensive and parsimonious theory based on the data . In orde2.5.Because qualitative research values the depth of the study and has a more complex research process, for sample size, qualitative research is not like quantitative research that selects a large sample, but rather the sample is generally more appropriately controlled at 30 or less . This st2.6.The need for ethical approval was waived by the university. No personal identifiable information was gathered, such as name, living address, ID, and telephone number. The study adopted one-to-one semi-structured interviews. The duration of each interview was between 30 and 60 min.3.Through theoretical sampling and a rigorous three-level coding procedure, this study clarified the basic representations of teachers’ occupational anxiety induced by the ‘double reduction’ policy, teachers’ objective perceptions of the policy and anxiety, and their personal perceptions of how to cope with anxiety. The responses to these questions formed a solid theoretical foundation for teachers’ occupational anxiety caused by the ‘double reduction’ policy. This part will take the three-level coding as the clue to promote the data analysis layer by layer until the theory comes into being.3.1.Through fine coding of all interview texts, in the open coding stage, this study summarized all the data into 12 initial concepts: positive effect, negative influence, self-development, student learning, role conflict, the ‘double reduction’ policy, teachers’ individual factors, parents’ weak coordination, internal adjustment, external support, subjective level and objective condition. After further comparative analysis, five categories were extracted: teachers’ policy cognition, anxiety performances, anxiety sources, self-adjustment and coping suggestions see . With re3.2.On the basis of the open coding, according to the paradigm model of It can be seen from 3.3.The selective coding is a process of finding the internal relationship between the main categories and systematically selecting the categories to find the core category. This study used selective coding to describe the relationship of each sequence, focusing on the story of ‘the causes of teacher’ occupational anxiety caused by the double reduction policy’. This part first explains the meaning of each category and its sub categories in detail.3.3.1.Teachers’ policy cognition referred to teachers’ understanding of the implementation effect of the ‘double reduction’ policy, mainly including positive effect and negative influence.Positive effect. Teachers, based on their own education and teaching experience, believed that for teachers themselves, the introduction and implementation of the ‘double reduction’ policy would help teachers break through the old educational concepts and methods, as a whole could ‘force teachers to grow’ , and teachers would also be more active or conscious ‘to improve the teaching efficiency in the classroom’ . For students, under the ‘double reduction’, the more obvious changes were ‘the reduction of students’ homework’ , ‘the increase of students’ after-school time and rest time’ . At the same time, the overall school curriculum was also more abundant, and ‘students’ activities have become more’ .Negative influence. Due to different schooling stages and disciplines, some teachers believed that the implementation of ‘double reduction’ had ‘seriously increased the burden on teachers’ , ‘increased the workload of teachers’ , and ‘significantly extended the working hours’  when reducing the burden on students and parents. When it came to the lower grades of primary school and the first grade of junior high school, the ‘double reduction’ in reducing the pressure on students, on the contrary, ‘the test of students’ consciousness was very big’ (T14). Some teachers even thought that the relevant requirements of the ‘double reduction’ had affected the students in the first and second grades of primary school to lay a solid foundation to a certain extent. By the third grade, there would be a ‘big gap in academic level’  and ‘pseudo behavior’ . In addition, although the number of after-school training institutions had decreased, parents’ attention to the quality of education and the objective impact of the pressure to enter higher education, such as ‘tutoring’ , ‘secretly coaching’ , still existed, which had not really reduced the pressure on students.Even though students may have to finish after-school services at five or six o’clock in school, parents will still choose tutors for their children, because some parents don’t care how much their children gain in school, they only care how much better their children are than others. Therefore, students just have less homework, but there is always pressure from exams and grades. It can be said that students’ original pressure has not decreased, and some even greater. (T3)3.3.2.Anxiety performances were specific states of teachers when they were anxious, which mainly included three aspects: self-development, students’ learning and role conflict.Self-development. During the implementation of ‘double reduction’, teachers had to improve their own teaching quality, because ‘students’ performance was actually linked to the stability of teachers’ work’ , especially for teachers who were not authorized, they faced the risk of being dismissed at any time. The ‘double reduction’ policy not only alleviated students’ homework burden, but also put forward higher requirements for teachers’ teaching and homework design. Some teachers ‘feared that they could not do well and complete the task’  and ‘doubted their teaching ability’ . In addition, due to the impact of the COVID-19 and regional economic development, many teachers said that ‘the salaries for after-school services could not be paid’ , ‘teachers’ pay and income were not equal’ , and even for the moonlight clan, ‘it might be difficult to guarantee even basic life’ .Student learning. Whether the teaching effect was good or not was also one of the teachers’ occupational anxiety caused by the ‘double reduction’ policy. Therefore, the ‘uncertainty and unknown’  of students’ learning had been bothering in-service teachers.With the implementation of the ‘double reduction’ policy, I am not particularly sure whether students’ knowledge is solid or not, and whether it will affect their knowledge acquisition in the future. That is to say, I cannot guarantee that they will be able to learn well under this background. Therefore, on the whole, I am not very sure about students’ learning effectiveness. (T2)Role conflict. The role of teachers was diverse, and the implementation of ‘double reduction’ had led to many role conflicts for teachers to some extent. As far as students were concerned, they were ‘educators and helpers’. As far as families were concerned, they were children and parents. Some teachers found that many parents tried to find better resources, and they would also have the idea of ‘finding ways to narrow the gap between their children and other children’ . At the same time, due to the increase of after-school services, homework design and other tasks, many teachers said that ‘they had no time to accompany their children and feel sorry for them’ . In addition, teachers also played the role of colleagues or peers. Some believed that the implementation of ‘double reduction’ made teachers ‘more involved and competitive’ , and all competed for time to train students at different levels. Between family and school, teachers also played the role of ‘communicators’, but in reality, many in-service primary and junior high school teachers faced serious problems, because the continuous existence of family-school conflicts had led to teachers’ anxiety. .3.3.3.Anxiety sources referred to the root causes of teachers’ occupational anxiety. The interview and analysis results showed that teachers’ anxiety mainly came from the ‘double reduction’ policy, teachers’ individual factors and parents’ weak coordination.The ‘double reduction’ policy. During the implementation of the policy, some in-service teachers found that the ‘double reduction’ policy triggered teachers’ occupational anxiety.I think my anxiety is also related to ‘double reduction’, because students really have many ways to acquire knowledge, but now their only approach is to study at school. Therefore, teachers are bound to be anxious under greater pressure. (T43)Teachers’ individual factors. Many in-service teachers said that on the one hand, occupational anxiety was caused by their own ‘sense of responsibility’ , which wanted to teach students well and let them learn more under the ‘double reduction’. Especially for junior high schools, the reality of ‘general-vocational separation’ was the trend. Teachers who were in junior high school wanted to make students go to general high schools as much as possible , so teachers would bear more pressure and generate anxiety. On the other hand, ‘double reduction’ put forward higher requirements for teachers. Some teachers adapted slowly, which led to difficulty in coordinating time and task planning, ‘imbalance between life and work’, ‘chaos when busy’ and other situations were appeared. .Parents’ weak coordination. As a key participant in the education process, many parents believed that the implementation of ‘double reduction’ was a unilateral task of teachers. They blindly ‘exerted pressure on teachers’ and ‘did not cooperate with teachers’ , which undoubtedly brought a lot of inconvenience to teachers’ work, and was one of the root cause of teachers’ occupational anxiety.3.3.4.Self-adjustment was a personal adjustment mode that teachers chose when facing anxiety, mainly involving internal adjustment and external support.Internal adjustment. Through the interview, it was found that the in-service primary and junior high school teachers mentioned the importance of self psychological adjustment, and believed that a good attitude could transform anxiety into work motivation to a certain extent . In addition, some teachers also chose to adjust themselves through ‘eating delicious food’ , ‘supplementing sleep’  and ‘reasonably planning teaching work and time’ .External support. In addition to the necessary internal self-adjustment, in-service primary and junior high school teachers said that external support was very important. For teachers with children, having someone at home to help with childcare could reduce the pressure of busy teaching work . At the same time, under the ‘double reduction’ policy, schools could provide necessary humanistic care, create a good working atmosphere and a united colleague relationship, which were also effective ways to alleviate teachers’ occupational anxiety. .3.3.5.Coping suggestions referred to the specific strategies proposed by teachers to alleviate anxiety based on their own experience, including subjective level and objective condition.Subjective level. When talking about solving anxiety problems, in-service primary and junior high school teachers thought that teachers needed to learn to adapt to the ‘double reduction’ policy and actively support the implementation of the policy , and needed to ‘adjust their mentality’ in time  to improve their psychological building ability. At the same time, teachers also needed to constantly improve their work efficiency , adhere to active learning , and learn to speak out or reduce responsibility appropriately . Anxiety could be gradually alleviated only if teachers’ professional quality continued to improve.Objective condition. Based on the consideration of the problems such as unequal pay and return, heavy burden and so on, many teachers said that the ‘double reduction’ policy needed to be further improved and ‘implemented from top to bottom’ . In addition, in-service teachers also believed that society should give more tolerance to teachers, schools should create a harmonious and democratic environment, and teachers also needed to actively cooperate , which would help teachers break through the dilemma of occupational anxiety.To sum up, the implementation of the ‘double reduction’ policy was affected by many factors, which led to the gradual exposure of social, school, family and other contradictions in the education system, thus affecting the orderly teaching of in-service primary and junior high school teachers and causing their anxiety. As a result, the core category of research emerged, that is, the implementation of the ‘double reduction’ policy was incomplete matching the actual education ecology. Based on this, the researchers further clarified the attributes and dimensions of the core category see .Through an in-depth analysis of core category, this study found that the implementation of the ‘double reduction’ policy and actual education ecology were affected by many factors, and there was a complex relationship see .3.4.In order to deeply explain the generation mechanism of teachers’ occupational anxiety, this study constructed a theoretical model of the formation mechanism of teachers’ occupational anxiety with the core of ‘the implementation of the double reduction policy was incomplete match actual education ecology’ see . FocusinHowever, focusing on teachers’ occupational anxiety itself, it could mainly be summarized as three manifestations: perplexed by the uncertainty of their own development, panic about the unknown learning effect of students, and helplessness in coordinating role conflicts. Specifically, in terms of their own development, teachers felt more confused about their career development due to the instability of their posts, insufficient teaching ability and unequal pay and return. For students’ learning, teachers always worried about whether students could achieve effective learning under the ‘double subtraction’ policy. At the same time, teachers’ occupational anxiety was also aggravated by the conflicts of multiple roles such as ‘educators’, ‘peers’ and ‘communicators’. In fact, in the face of the objective existence of anxiety, in-service primary and junior high school teachers had always insisted on making efforts to self adjust, but the effect was often poor. Therefore, they sincerely hoped that external help could be provided to better help them alleviate anxiety. However, in reality, external support was obviously insufficient. It was obvious that the occupational anxiety of teachers caused by the ‘double reduction’ policy was the result of multiple factors, among which, those factor influence and restrict each other. In a word, although teachers were affected by the mismatch between their own personality characteristics and external factors, they could relieve their anxiety in a timely manner through active self-adjustment, which was actually conducive to further promoting the smooth implementation of the ‘double reduction’ policy and the construction of a good educational ecology.4.4.1.With the help of the grounded theory, this study analyzed the formation mechanism of teachers’ occupational anxiety caused by the ‘double reduction’ policy. The main findings of this study would be further discussed in depth in comparison with existing relevant studies.First of all, this study found that in-service primary and junior high school teachers had different understanding of the ‘double reduction’ policy, which affected the development of their anxiety state to a certain extent. Faced with the rapid and complex educational reform, teachers were easy to have occupational anxiety. This anxiety was not only caused by the objective factors of the uncertainty and fuzziness of educational reform itself, but also mainly depended on the subjective understanding of different individual teachers on educational reform. Therefore, teachers’ beliefs and state always played an important role in educational reform . In esseSecondly, during the interview, this study also found that there was widespread ‘role anxiety’ among in-service primary and junior high school teachers. Especially for in-service primary school teachers, in addition to being teachers, they also acted as ‘nurseries’, ‘security officers’ in afternoon care and after-school care, ‘activity planners’ before carrying out activities, ‘grid members’ who collected various health codes or itinerary codes during the COVID-19, and ‘accountant’ to assist school leaders in accounting statistics. Outside the school, teachers also played the role of ‘parents’ and ‘children’. As a result, in the face of the heavy teaching tasks under the ‘double reduction’ policy and the multiple role conflicts, teachers’ occupational anxiety arose spontaneously, which became the dominant force hidden behind the teachers’ role and constituted the psychological motivation for teachers to complain, resist and escape. At the same time, through interviews, this study verified the view that ‘teachers had role conflicts between work and family’  from an Finally, through in-depth interviews, many in-service primary and junior high school teachers reported that their contributions and rewards were completely unequal, and they believed that their sense of teaching achievement and work enthusiasm had been eroded year by year. Especially in after-school services, some teachers said that they had worked hard to design courses and implement activities, and finally they might only receive a few yuan for each class. For young teachers, some said that it was difficult to maintain their basic salary and they often needed help from their parents. This was the same as the view put forward in the existing research that teachers’ pay and return were unbalanced in their work .In addition to many similarities with previous studies, this study also highlighted some new factors. For example, different from previous studies on teachers’ occupational anxiety, this study was based on the new era background, that was, to explore teachers’ occupational anxiety caused by the ‘double reduction’ policy, the perspectives or information of ‘students’ pseudo learning behavior’, ‘teachers’ anxiety about after-school services’ and ‘worried about students’ narrow access to study’ were innovative. At the same time, focused on teachers themselves, although teachers generally had anxiety caused by the ‘double reduction’ policy, they were still driven by their educational conscience and sense of responsibility. On the one hand, they always insisted on passing on what they knew to students in a positive way, on the other hand, they actively adjusted themselves through diet, sleep and other ways to digest their negative emotions promptly. In addition, through in-depth interviews, this study also obtained teachers’ heartfelt coping suggestions on alleviating anxiety, which to some extent provided strong support for the follow-up in-depth research.4.2.Of course, limited by the research data and materials, we had not yet used quantitative research methods to verify the conclusions of this study. We will conduct statistical tests on the conclusions in the next study. At the same time, as the ‘double reduction’ is still in the process of dynamic development, it is worth continuing to think about whether the problem of incomplete match between the policy implementation and the actual education ecology will ease with the development of time. Although this research has constructed the formation mechanism of teachers’ occupational anxiety caused by the ‘double reduction’ policy, it is still open to the possibility of its development, which is also the continuous motivation for us to continue our research.5.In order to deeply explore the problem of teachers’ occupational anxiety caused by the ‘double reduction’ policy, this study conducted in-depth interviews and data coding analysis on 45 in-service primary and junior high school teachers using the method of grounded theory. The study found that during the implementation of the ‘double reduction’ policy, teachers had occupational anxiety, which had a negative impact on their work and life. Although this finding has verified the relevant conclusions of existing studies to some extent (see Section 4.1 for details), the main contributions and highlights of this study, in addition to clarifying the objective existence of the phenomenon, have also built a theoretical model of the formation mechanism of teacher’ professional anxiety caused by the ‘double reduction’ policy with the help of grounded theoretical methods. Among them, teachers’ occupational anxiety is mainly manifested in their concern about their uncertain development, students’ learning effectiveness and multiple role conflicts, which is not only the result of the incomplete match between the implementation of the ‘double reduction’ policy and the actual education ecology, but also affected by teachers’ personality characteristics. In addition, this study has also produced some new insights, that is, teachers are not passively exposed to occupational anxiety, but can actively alleviate anxiety through self-adjustment. At the same time, teachers also expressed their own aspirations, and further put forward suggestions on the subjective level, including actively adapting to policies, adjusting mentality, improving their own work efficiency, as well as on the objective level, such as improving policies and building collaborative relationships. However, it is far from enough to rely on the efforts of teachers alone, because the improvement of the ‘double reduction’ policy and the implementation of teachers’ after-school service pay all need the help of the relevant national departments. To create a harmonious, democratic and cooperative working atmosphere in the school, reasonably arrange teachers’ work tasks and other urgent needs the effective management of the school departments at all levels, and the comprehensive development of students also requires family education to bear the natural responsibility. Therefore, only when all parts and members perform their own duties, can the ‘double reduction’ policy be truly implemented, teachers’ anxiety will gradually ease, and then return to the true role of ‘teaching’.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.WY, LY, and YY contributed to the ideas of educational research. WY contributed to the contacting participant and collection of data. LY, YY, and WY contributed to the data analysis, design of research methods, and tables. WY, LY, and YY participated in writing and revision. All authors contributed to the article and approved the submitted version.This research was funded by the Major Project ‘National Research on Environment and Sustainable Development Education’ Funded by the Ministry of Education of the People’s Republic of China in the Post-funded of Philosophy and Social Science Research in 2022 (Grant Number 22JHQ018).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Psychological distress in the early postpartum period can have long-lasting deleterious effects on a mother’s well-being and negatively affect her infant’s development. Intervention approaches based in contemplative practices such as mindfulness and loving-kindness and compassion are intended to alleviate distress and cultivate well-being and can be delivered effectively as digital mental health interventions (DMHIs).To understand the feasibility of engaging perinatal women in digital interventions, this study aimed to document participants’ experiences in the Mums Minds Matter (MMM) study, a pilot randomized controlled trial comparing mindfulness, loving-kindness and compassion, and progressive muscle relaxation training delivered in a digital format and undertaken during pregnancy. To assess the different stages of engagement during and after the intervention, we adapted the connect, attend, participate, enact (CAPE) framework that is based on the idea that individuals go through different stages of engagement before they are able to enact change.The MMM study was nested within a longitudinal birth cohort, The ORIGINS Project. We aimed to recruit 25 participants per randomization arm. Data were collected sequentially during the intervention through regular web-based surveys over 8 weeks, with opportunities to provide regular feedback. In the postintervention phase, qualitative data were collected through purposive sampling.connect rate]) enrolled to participate in MMM. Of the remaining 226 women who did not proceed to randomization, 223 (98.7%) failed to complete the baseline surveys and timed out of eligibility (after 30 weeks’ gestation), and 3 (1.3%) displayed high psychological distress scores. Across all program groups, 17 (20% [attend rate]) of the 84 participants actively opted out, although more may have disengaged from the intervention but did not withdraw. The main reasons for withdrawal were busy life and other priorities. In this study, we assessed active engagement and ongoing skills use (participate and enact) through postintervention interviews. We undertook 15 participant interviews, conducted 1 month to 3 months after the intervention. Our results provide insights into participant barriers and enablers as well as app changes, such as the ability to choose topics, daily reminders, case studies, and diversity in sounds. Implementing a DMHI that is brief, includes frequent prompts or nudges, and is easily accessible is a key strategy to target perinatal women.Of 310 eligible women, 84  12620000672954p; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000672954pRR2-10.2196/19803 Anxiety and depression are the most common postpartum difficulties experienced by women globally , with anA recent systematic review  indicateGiven the need to provide scalable and low-cost support for women in the perinatal period, an important consideration for contemplative interventions is whether they can be taught effectively as digital interventions ,12. Therhome practice ) enrolled to participate in MMM. Of the remaining 226 women who did not proceed to randomization, 223 (98.7%) failed to complete the baseline surveys and timed out of eligibility (after 30 weeks’ gestation), and 3 (1.3%) displayed high psychological distress scores. The participants who were randomized in MMM (n=84) had a mean age of 32.7 (SD 4.0) years. The majority  identified as Australian, British, or European; 67% (56/84) of the participants fell in the advantaged or most advantaged socioeconomic status quintiles, with only 8% (7/84) falling in the disadvantaged or most disadvantaged quintiles ), the most frequent theme was that participants were too busy, had other commitments, and found the program an additional duty:“While I would like to continue, I do not see me finding the time with my child and worry that I will find I have more issues...Not being able to find the time has also added to my stress because I felt like I was failing.”Others in group 1 found the tool helpful in their daily activities:“It’s been helpful and doing the meditation at night, I’ve remembered during the day to stop and take some deep breaths.”Fortnightly comments from participants in MMM group 2 (loving-kindness and compassion training [LKCT]) included the perception of the program as a “treat”:“This was my first week, and so far, I have absolutely loved it. Just learning to check in and treat myself like a friend and be conscious of the way I talk to myself in my head with compassion rather than judging or being super critical or worrying about others being critical.”Other feedback indicated that it was difficult to concentrate on the program:“Sometimes I find it very difficult to focus on the program and my mind wanders, it would help for more strategies for this.”Participants in MMM group 3 (mindfulness training [MT]) provided a number of comments on program dislikes:“I found it hard to be in the moment when walking. I was a lot more distracted.”“I find the program a bit repetitive doing the same exercise every day.”Participation is operationally defined as the completion of intervention activities, that is, active engagement with the intervention material  almost doing it for you guys rather than doing it for myself.MMM-31: PMRTA partner can be both a barrier and enabler: some partners were encouraging, whereas a few participants expressed concerns about taking time away from their partners:The only thing is that when I told my husband that, “Sorry, I’m away for 10 minutes,” sometimes it wasn’t the best part of the day for him to be left alone.MMM-38: LKCTUnsurprisingly, participants acknowledged the importance of taking time out for themselves. This was frequently reported as a key benefit of an emotional well-being program:So, I think using this, just to give myself that half an hour just for me, and actually be okay with it, being a little bit more selfish for myself as well, I think, really helped me stick to it.MMM-32: LKCTI think because it’s never a bad thing to take time for yourself and especially when life can get so busy, and, you know, stopping to take a few deep breaths is never going to be a bad thing.MMM-36: LKCTParticipants reported emotional changes and variations in mindset as a benefit of undertaking the program:I’d say it probably helped me acknowledge that I have been struggling with things because it asked that question.MMM-25: PMRTThere was recognition of the value in the program, and many found it enjoyable:I think mental health is really, really important, and so anything to check in with myself but also contribute to efforts working towards that is really valuable.MMM-24: MTSo, at the beginning, it was every day. I absolutely adored it...I really think—especially the beginning, when I was very disconnected from myself, I think it really helped me get back on board with the positive side of being pregnant and not keeping my head in the past and all the issues that could go wrong with the pregnancy.MMM-32: LKCTThe training also aided sleep, which is acknowledged as important to pregnant women:Just before bed, it just was able to relax me so that I can have a better night’s sleep. Sometimes when you’re tossing, and turning so much, you can’t relax when you get into bed. So, it’s just helpful to help wind down at the end of a busy day.MMM-08: MTOne of the predominant reasons in finding value was a sense of calmness that the training evoked and an opportunity to slow down:So, it kept me calm throughout the—I think it’s 8 weeks...It kept me really calm with the way things were going in my life. So, that really helped me, 10 minutes a day was not hard for me, just sitting there and listening to it.MMM-16: PMRTI think dealing with your own mental health whether you have mental health problems before or not, here’s a good thing to look at before coming into, I guess, the biggest change of your life...Spending that time in your pregnancy, I guess, trying to learn some of those practices and just slow down life, you know, visualize, stop, relax, yeah, and learn those sort of coping mechanisms.MMM-43: LKCTWe were interested to learn what supports facilitate participation and engagement in a DMHI. Finding a regular time of day helped many women as did viewing it as similar or adjacent to regular exercise:First thing in the morning...particularly if I’ve done some exercise, then it’s a really good way to cool down from the exercise and also get ready for the day. I found that’s actually been the nicest time to do it.MMM-24: MTIt was setting the time to do it every day and having the routine of it.MMM-43: LKCTBeing part of a wider research study acted as an enabler, as reported by several women:I just think it’s really important to help with studies, so I’m happy to put my hand up for, you know, studies, especially being on mat. [maternity] leave. You know I’m not at work anymore; so, it’s good to have other things to feel that you’ve been productive with.MMM-33: MTI probably wouldn’t have even looked into it if I wasn’t doing The ORIGINS Project.MMM-27: LKCTMany participants discussed a range of functional enablers, such as the importance of regular reminders via SMS text message or email and the fact that the training app needs to be accessible and easy to use on different devices:It needs to be easy, quick, you know, you don’t want to be logging in and out of an app all the time ‘cause often, obviously as a mum, you don’t have time to fiddle around with passwords and logging on and off.MMM-33: MTThe perception that it was a useful tool was also acknowledged:[J]ust to give myself a bit of a focus every day.MMM-32: LKCTIn addition, it was convenient:I think what helped was basically if I didn’t necessarily have to make any changes to my routine.MMM-20: MTPredominantly, partners were perceived as supportive of the training, and a few participants reported undertaking the modules together:I think there are some nights where I’m a bit tired, he’d be like, “No, let’s do it.”...So, it’s like going to the gym and having a gym buddy, somebody else to encourage [you] to do it.MMM-08: MTParticipants discussed their motivation for participation, with several citing a personal or family history of mental illness and mental health problems, including bipolar disorder, postnatal depression, and anxiety:I was more anxious in the beginning of the pregnancy, obviously, not knowing what I’m going to be expecting down the track. So, I was quite nervous and anxious at that point in time, but then with this program, it’s actually calmed me down, it’s made me peaceful.MMM-16: PMRTParticipants disclosed a range of functional dislikes about the web-based training. These included the trainer’s voice , the repetitiveness and similarity of the modules, and the frequency of daily practice:It’s quite long. I think maybe trying to do it every single day got a bit much.MMM-27 LKCTA common theme was the dislike of the walking mindfulness practice, which was an exercise in the MT condition:About week 3, it became a walking mindfulness, and I found that’s a lot harder to incorporate into life.MMM-20: MTThere was a lot of like walking...and if I’m going to do a meditation, I want it to be me lying down and chilling out.MMM-33: MTThe web-based platform itself was difficult to use, requiring participants to log on to a website, which some found frustrating and not “user friendly.”Participants also reported many functional likes about the web-based training, with some perceiving it as a “treat”:I think it was always a real treat anytime I’d have to do it.MMM-20: MTAdditional likes included the tone, the pace, the music, and the brevity:Ten minutes a day was not hard for me, just sitting there and listening to it.MMM-16: PMRTInterview feedback provided a breadth of suggested changes to the programs as well as other preferences, including human contact, such as telephone calls or group sessions:Physical sessions would be good, and it might help mums connect with other mums in the same situation.MMM-13: LKCTIn terms of program changes, suggestions included the ability to choose topics, daily reminders, inclusion of case studies, a calendar function, and more variety, such as diversity in sounds:Different sounds, like sometimes water, sometimes forest...even different voices sometimes.MMM-31: PMRTLinks to additional information or further reading were also suggested.Repeatedly, participants described initial enthusiasm for the training that waned as the weeks progressed. There was a clear sense of personal pressure to perform the exercises, and often more realistic goals were set:The goal would be to two to three times a week. I found that that seems to be enough to maintain but also not feeling too pressured that I have to get it done.MMM-24: MT:Others maintained regular daily practicesSo, we just set a time at 9 o’clock, we’d stopped doing whatever we’re doing, go to bed, so devote that 15 minutes beforehand for meditation.MMM-08: MTThe overall aim of this study was to characterize participant engagement and experience in a prenatal digital well-being pilot program using an adaptation of an existing participant engagement model (CAPE). Our results provide insights into the barriers and enablers to participation as well as functional enhancements, including variety in sounds and content, but not necessarily notable differences in engagement by the type of intervention. These findings are useful contributions to understanding participant experience and engagement to adapt for a full trial.connect, that is, the proportion of participants who were eligible and interested from the available cohort  and those who were randomized to start the intervention . Across all program groups, 20% (17/84) of the participants actively opted out, although more participants may have disengaged from the intervention but did not actively withdraw. The predominant reasons for withdrawal were busy life and other priorities. There seems to be a paucity of literature reporting on the available population of individuals who are exposed to digital well-being interventions and who then enroll and continue in the training programs [First, we explored the construct of programs . This stResearchers should consider issues related to participants’ motivations for engaging in research  comparedattend, that is, the amount of the intervention completed and presence in the programs, also referred to as “stickiness” [Second, our results reported on ckiness” . One of ckiness” . Capturickiness” . Althougckiness” , but it opt out and why. The time required to complete the program was the predominant factor for opting out and cited frequently as a weekly barrier to participation. This information is unsurprising, considering the target audience of pregnant women and new mothers, and informs the design of future apps, whereby programs need to balance perceived time constraints against the fact that having time to slow down and self-reflect is likely one of the active ingredients of the program. In terms of enablers, setting aside dedicated time or space facilitated increased program engagement, which we would actively promote in future program design.In this study, we were limited in our ability to interpret intervention compliance but were able to report on those who actively elected to participation and enactment, that is, the completion of intervention activities and the application of intervention strategies in daily life. Our results yielded additional information about participant barriers and enablers, the benefits of the programs, and suggestions to enhancing functionality, including the ability to choose topics, daily reminders, the inclusion of case studies, a calendar function, and more variety and diversity in background sounds. Participants struggled with the physical challenges associated with pregnancy, such as back pain, and some commented on their dislike of performing walking mindfulness exercises while pregnant. A systematic review and meta-analysis of MBIs suggests that, among healthy perinatal populations, MBIs had smaller effects than those found from MBIs in other health populations [Third, we explored ulations . Our resulations  to desigIn general, women report that time is the prevailing issue, and although they understand the potential benefits of the intervention, in reality, their lives already feel too busy. Future intervention design approaches should consider making an intervention as minimal and as engaging as possible to achieve the desired result . In our previous study, pregnant women indicated their preferences for these types of interventions of <4 modules per week, <15 minutes in duration, delivered over a 4-week period . In addiEvidence suggests that meditation and related contemplative practices decrease stress levels and increase mindfulness, often accompanied by the experience of inner calmness, self-worth, and self-respect, as well as promote well-being . A meta-nudges. Some participants indicated that they would like more interaction and direct contact with trainers or peers. This is in line with research predicting engagement with a digital psychosocial intervention for psychosis [Understanding the pragmatic use and functionality of digital training programs will contribute to optimal design strategies. Our results indicated that participants want brief, easily accessible, and tailored web-based training programs, with frequent reminders or sychosis  based onOverall, our findings contribute to the rationale that DMHIs need to be tailored to the type of population targeted. Although a recent systematic review provided preliminary evidence that web-based interventions can be a promising and advisable form of intervention during the prenatal period , there iFinally, consideration should be given to the unknown impacts of the COVID-19 pandemic during this time. Throughout this study, there were periods of enforced lockdown restrictions, both locally and globally. The large-scale impacts of lockdown restrictions on social, emotional, and economic well-being are predicted to have unparalleled and extensive implications for mental health in general populations, independent of the biological effects of infection . It has This study has several limitations and strengths to consider. As already noted, participants in the study are part of a longitudinal research cohort and could be considered biased in their willingness to engage, although the direction of this bias is unclear. Nonetheless, the richness of the qualitative data provided opportunities to capture their motivations, with several participants confirming that they were undertaking the study to contribute to research rather than for personal benefit. A limitation of this study was our inability to access program use through the participants’ web use of the Teachable platform. These data were unavailable but could have provided extra insights into participant behaviors such as log-on duration, frequency, and time of day. In addition, there is limited population diversity within the ORIGINS cohort, who are predominantly White women, degree educated, and from moderately high socioeconomic backgrounds. This limits the generalizability of our findings, and we recommend undertaking future research with prenatal women from more diverse backgrounds.In addition, our results, particularly the interview data, did not identify any major differences among the experiences of participants exposed to the 3 different intervention arms. The interview questions were centered on skills development, enablers and barriers to the intervention as well as its benefits, and confidence to practice. This meant that there was consistency in themes, irrespective of program allocation, and the project team reached data saturation after 15 interviews. Future research in this field should consider the inclusion of questions related to the type of practice to determine whether engagement is influenced by the practice itself.Although the EPDS was administered as a screener, we did not exclude participants who had moderate or severe scores, although some self-selected to withdraw. Numbers were low in these categories, but we were able to compare the EPDS scores between those who discontinued with those who did not, and there was no significant difference. There was also no difference between those who did not complete any of the surveys and those who completed at least 1 survey. We did not explore any direct associations between moderate to severe depression and program engagement. It would be useful to factor this into future studies.In general, there are few studies of digital interventions that follow expectant mothers from pregnancy and through childbirth . This ma


The cost of social care, the work conditions experienced by care workers and the quality of care provided by residential homes for older people are all linked, yet we know very little about how this relationship works in practice. Drawing upon an ethnography of two differently priced residential care homes for older people in Southern England, I examine the implications of different financial regimes for care‐giving practices. I show how the scheduling and allocation of resources—conveyed, for example, in formal routines and staffing levels—structure the care workers’ time, tasks and activities in each setting. This acts to symbolically demarcate what, or who, is valued. I argue that the availability of resources facilitates and impedes the symbolic culture of care work, shapes care workers’ ability to afford dignity to the individuals in their care and affects how care workers experience, and relate to, their labour. I conclude by discussing how current practices of funding and pricing social care have effects seeping beyond the practical and measurable, and into the realm of the symbolic. It is estimated that 421,100 people aged over 65 years live in care homes in the UK Age UK, . Homes oConcerns have been raised that the supply of social care for older people is not meeting the rising demand Cottell, . MoreoveI begin this article by outlining key contributions in the literature on care work. From here, I sketch out my study, describing the fieldwork sites and the (ethnographic) research design. In what follows, I examine the implications of different financial regimes for care‐giving practices. I show how the scheduling and allocation of resources—conveyed, for example, in formal routines and staffing levels—structure the care workers’ time, tasks and activities in two care settings. This acts to symbolically demarcate what, or who, is valued. I argue that the availability of resources facilitates and impedes the symbolic culture of care work, shapes care workers’ ability to afford dignity to the individuals in their care and affects how care workers experience, and relate to, their labour. I conclude by discussing how current practices of funding and pricing social care have effects seeping beyond the practical and measurable, and into the realm of the symbolic.Health and social care research is not the province of a single academic discipline. It draws upon a range of frameworks and methodologies from business studies, human resource management and economics to medical and health‐care sciences, public health, social gerontology, policy studies, sociology and anthropology. Yet, common themes and points of congruence emerge. For instance, there is a wealth of research on the quality of care provided to older people . Scholars have highlighted this political–economic context of social care: its funding, marketisation and commodification . I applied for a position at Millstead and was offered an interview where I was asked where I had worked before, told which tasks I would be expected to carry out and asked when I would be available to start working. Shorefield’s recruitment process was more formal than that at Millstead. I completed an application form collected from the home after I noticed that they had a ‘carer’ vacancy online. Two weeks after returning this form, I was asked to participate in a group interview with three other applicants. I was offered a ‘bank’ care worker  position at Shorefield 3 days later. I was also asked to attend a training for this role. I discuss my research design and the ethical issues involved at length elsewhere Johnson, .Located in a local authority area in the South of England, Millstead and Shorefield were 1.5 miles apart, but were located in different wards. In the 2010 indices of deprivation, Millstead’s ward was ranked among the top 5% most deprived wards in the UK, whereas Shorefield’s ward was ranked in the bottom 50%. Millstead was a single, private residential home which accommodated 33 residents. It was identified as ‘low‐cost’ due to the low fees that were charged to its 24 local authority and nine private‐paying residents . Shorefield was a large‐scale corporate home provider. In January 2013, it offered care to 99 residents and the cost of receiving care varied depending on which room a resident occupied and their assessed care needs. The lowest priced fee—including accommodation, meals and activities, but not direct care—was £750 per week. Of the 38 homes in the local authority which formed my initial sample, the cost of care for private payers at Shorefield was the highest, even before taking direct care charges into account. Of the 99 residents at Shorefield, four received funding from the local authority, which paid an average of £540 a week for their care. Shorefield was a purpose‐built home which was marketed as a luxury alternative to more traditional care homes, with advertisements often emphasising its activities, entertainment, cuisine and hotel‐like facilities.My iterative approach to data analysis required a constant conversation between theory and data, rather than early formulations of codes that can limit subsequent analysis. I used this analysis to guide areas of future inquiry, whilst being aware of new ideas. Practically, my approach involved (re)reading field notes and interview transcripts, and creating analytical notes. For observations, analytical notes were made alongside handwritten notes in a fieldwork diary. In order to distinguish between data and analysis, a simple process of using different coloured pens was used. This analysis entailed identifying, studying and analysing patterns in the data and noting similarities/differences between observations and interviews with care workers. Ethical approval was granted by the Cardiff University School of Social Sciences Research Ethics Committee.good quality care. I focus particularly on three components here: (1) daily routines, (2) the content and philosophies of care and (3) the care worker role.In what follows, I outline the key claims of the article. I describe how the everyday routines of care homes at both ends of the market shine a light on what resources are available to care workers, the impact of economic cost on this and how this shapes the symbolic culture of work required to provide The economic cost of care can affect what facilities or services are offered, who these are provided to and the source of payment . Indeed, appreciating how the provision of care is assessed, costed and paid for allows us to consider the order, content, and pace of care work/care‐giving, and the culture and ethos of a home. Millstead, for instance, conveyed a readiness to house residents with ‘challenging behaviours’, particularly individuals with a recognised history of unsuccessful placements elsewhere. This was often perceived by care workers as a profit‐seeking practice because local authorities are likely to pay more for their care. Notably, for workers, this was not followed by staffing changes, additional training or managerial acknowledgement of their enhanced workload.At Shorefield, in contrast to Millstead, the cost of residency was directly linked to the amount of care residents were contractually expected to receive; care ‘packages’ were agreed prior to entry with the sales team, formalised in an ‘Individualised Service Plan’ (ISP). In addition, whilst admitting people with high care needs would likely have boosted income, Shorefield’s marketing strategy was not based on securing local authority funding or seeking (profitable) residents with high/complex needs; they were ‘not the Shorefield type’ . The ‘Shorefield type’ was, primarily, a wealthy individual (or couple) ineligible for publicly funded care provision, both in terms of need and finances, and with no/few care needs.This all had implications for the amount and type of work undertaken by care workers. Indeed, while the ratio of care workers to residents per shift was alike at Millstead and Shorefield (both in daytime and nighttime shifts), the amount and type of work undertaken by care workers in both homes was significantly different. However, although in part due to variances in residents’ need, it was, also, a result of their different routines (as well as the content/philosophies of care and the care worker role itself).At Millstead, each day followed a strict routine, organised around residents’ predetermined mealtimes. A basic outline of this routine was displayed on posters placed in communal spaces and staff areas  and senior care workers regularly reminded care workers of the fixed nature of deadlines by which they should complete tasks. Care workers occasionally treated the timetable with more flexibility , but this could mean bringing forward supper to 4:30 PM and some residents being ‘put to bed’ long before evening (sometimes as early as 4:30 PM). For morning shifts, care workers were responsible for ‘getting up’ either ‘singles’ (residents requiring assistance from one care worker) or ‘doubles’ (requiring assistance from two care workers). Because of short‐staffing, a single care worker would frequently be responsible for assisting all ‘singles’. Likewise, the senior care worker on shift would usually assist with ‘doubles’ and was responsible for dispensing medication, completing paperwork and handover. Usually, the senior and three care workers from the morning shift would stay on for the afternoon shift, working a ‘long day’ (8:00 AM–8:00 PM). In the afternoon, one care worker would be responsible for serving tea/biscuits in the lounge as well as washing up dirty dish, cooking supper, serving in the dining room and doing laundry. The 2 other care workers oversaw the personal care of all 33 residents as well as ‘moving’ them between the lounge, dining room and bedrooms at the times specified in Millstead’s schedule.Structured around mealtimes, Millstead’s routine classified residents into groups: ‘early eaters’ (residents requiring assistance with eating) and ‘late eaters’ (who did not require assistance). Classifying residents as early/late eaters or singles/doubles was a form of ordering that functioned to divide and routinise work to minimise the effects of short‐staffing  and on workers .At (low‐cost) Millstead, then, the limited resources available to care workers—such as time and staff members to share the (work)load with—impacted the working conditions and in turn, the quality of care provided to residents. Strict routines were established, it appeared, to In contrast, daily routines were flexible at Shorefield. Residents’ needs/preferences dictated the order and nature of care workers’ activities. Each mealtime at Shorefield, for example, was scheduled over the course of two‐to‐three hours to afford residents a degree of choice over when, and where, to eat. Equally, residents could choose when to receive assistance from care workers and how to spend their time. At the beginning of each shift, one care worker would be allocated to each colour‐coded ‘corner’ of Shorefield and would be responsible for residents whose bedrooms were in that area. On morning and afternoon shifts, two care workers would be allocated the role of ‘med tech’, which meant dispensing medication. Every morning, two care workers were allocated ‘breakfast’ (serving in the dining room) and three were ‘floaters’. ‘Floaters’ were tasked with assisting with the care‐giving of residents who required the assistance of two care workers and with answering residents’ pendants . In the afternoons, one care worker would be a ‘floater’ and one would be assigned to the dining room.their residents, encouraging each other to provide individualised care. This included an emphasis on workers treating residents ‘as if’ they were family; marketing materials and service principles, for instance, used phrases with familial undertones, focussed on ‘individualised care’ and ‘resident choice’ and borrowed terms from the hospitality industry. My contention, here, is that the flexible schedule and  relationship building, though the latter presents problems  and I are responsible for washing and dressing thirteen residents this morning. Usually , there would be a third care worker to wash and dress the “singles”, but due to two care workers leaving in the last two weeks, we are short‐staffed. Lidia and I must therefore work together to care for seven “doubles” and six “singles”, as well as making sixteen beds and answering residents’ call bells. It is 8.10am and we must complete this work before 10.30am. Lidia suggests that, in order to complete work at a faster pace, we should hoist more than one resident onto their commodes, work separately to wash each resident, before finding one another to hoist the residents from their commodes into wheelchairs…Lidia and I hoist two residents from their beds onto their commodes and separate to wash and dress each resident…I wash Deidre’s (resident) face, torso, and limbs, but am unable to wash her loins yet, as this will require hoisting…Deidre is ready to be hoisted, washed, and transferred into her wheelchair, but there is no sign of Lidia or the hoist. I apologise to Deidre and leave her room to find Lidia. She is not in Jim’s room, where I left her, but Jim, like Deidre, is half‐washed and half‐dressed and sat on his commode. After checking several residents’ bedrooms, I find Lidia with Judith. Judith is bed‐bound…two care workers must assist with her personal care because she requires turning. Lidia has started washing the parts of Judith’s body which she can reach. As I enter Judith’s bedroom, the call bell starts to ring loudly in the hallway, where a room number is displayed on a screen. Geoff, whose room is upstairs, asks me to help him onto his commode. Another resident presses the call bell as I slowly walk with Geoff towards his commode, but I am unable to answer it. When I have finished with Geoff, I return to help Lidia with Judith, but she has left Judith, half‐clothed, in order to answer the other call bell. When Lidia returns, we return to “the doubles” to complete their personal care.At Millstead, life was frequently fragmented and chaotic. Handovers, where basic information is conveyed about residents between care workers as they enter or leave work, for instance, were informal and muddled. The scheduled number of care workers was rarely reached. The manager (Brian) refused to employ agency workers as they were too costly, so staff were told to ‘spread out’ and ‘make do’ . There was no time or resource dedicated to taking notes , which meant workers were not aware of residents’ needs, let alone personal preferences, religious affiliations or histories. Priority was placed mostly, if not entirely, on direct care activities. The requirement to save time also had implications for At Millstead, life was hectic and unpredictable, leaving care workers with little option but to muddle through tasks as quickly, and pragmatically, as possible. Residents would regularly be left halfway through direct  care‐giving, until two care workers were available to hoist or turn them. Meanwhile, call bells rang continuously. Residents pressed call bells when requiring assistance, and the result was a loud, repetitive alarm sounding until the bell was answered. Most often, care workers would be otherwise occupied when the alarm sounded, and the result was that care workers would rush backwards and forwards between residents, commonly to deactivate the alarm. The answering of residents’ call bells was one of the few daily tasks at Millstead not amenable to the daily routine: it was unpredictable and unquantifiable. As such, care workers frequently complained when residents pressed their call bells, made clear to residents that they were felt to be a burden and attempted to dissuade them from requesting assistance again.appearance of care was regarded as just as, if not more, important than the substance of care  often hoisted residents alone if they were unable to find their ‘double’; Sorin and Mahesh would attempt to implicitly persuade residents to say they did not need to be washed or claim that they had been given a ‘thorough’ wash yesterday (particularly if the resident was forgetful). In such cases, washes became quicker and less thorough, soap was not rinsed off and having privacy when using the commode  was a privilege only granted when care workers were summoned elsewhere. One less harmful way to save time at Millstead would have been to reduce the time spent on housekeeping tasks like bed‐making. Puzzlingly, this was the one time‐saving measure care workers were reproached for by the management, perhaps because it was the one method with an aesthetic impact clearly visible to visitors and inspectors. In such moments, the Despite the lack of time for care workers to complete all of their allocated tasks and activities, there were also periods when it was less busy. Afternoon shifts were normally quieter than mornings, yet this available time was not usually spent caring for, or talking, to residents. During afternoons, I was often told by senior care workers and care workers to ‘look busy’ or to ‘just wander around’. Care workers were not permitted to sit in the lounge and, when I talked to residents, I was regularly told that I needed to ‘find some work’. Care workers, thus, would simply pace the corridor, popping in and out of bedrooms which they knew were empty as though looking for someone or something. Another strategy was to keep out of sight completely. Care workers would often fill time by taking long trips to the toilet located upstairs or by claiming they were caring for a bed‐bound resident, when, in reality, they were eating a snack or using their phone in an empty bedroom or, even, in the corner of a bedroom where a resident was confined to bed. One constant was that ‘finding work’ never entailed spending more time with residents.en suite, Helena knocks and enters Beatrice’s bedroom and asks her what she would like to wear. We stand on either side of Beatrice’s bed and undress her. Helena wipes her down with a soapy flannel, followed by a non‐soapy flannel, and then I use towels to dry Beatrice’s arms, legs, and chest. Beatrice tells us stories about her GP career whilst, turning her from side to side, we wash and dry her buttocks. We apply creams and perfume to Beatrice’s body before dressing her in her chosen clothes, explaining with each step what is happening. We hoist Beatrice into her armchair. Helena boils the kettle and assists Beatrice with inserting her dentures and applying make‐up whilst I clean up and make Beatrice’s bed. “Homes Under the Hammer” is on television and Beatrice tells us how sad she is that she has had to sell her house. We sit and comfort her for around five minutes, asking if there is anything we can do. Beatrice thanks us and hugs each of us, joking we should live with her. We tell Beatrice we will come back to make her another cup of tea soon.Helena goes to collect the hoist from the storage cupboard and says she will meet me in Beatrice’s room. I head to Beatrice’s room, wish her a good morning, and ask her if she would like a bed‐bath or shower. Beatrice decides upon a bed‐bath. I prepare two bowls of warm water, wipes, gloves, and an incontinence pad. Whilst I am in Beatrice’s Life at Shorefield, in contrast, was less hurried, not least due to a flexible schedule adhering to residents’ pace and preferences, lower resident needs and an overestimation of required care‐giving. Personal care took time (sometimes over an hour with each resident) and this was rarely fragmented, sped up or split between residents. Consider the act of care‐giving for Beatrice (resident) which lasted over an hour and involved Helena (care worker) and I carrying out both physical and emotional labour:Time with residents at Shorefield was never rushed or monitored. Caring well involved talking to residents along with carrying out physical tasks and was adapted to everyone’s needs and preferences. When there were few physical direct care tasks to perform (particularly in the afternoons when residents participated in activities), care workers would usually sit and talk to residents or take hot drinks and snacks to residents’ bedrooms. In contrast to Millstead, Shorefield’s care workers were explicitly, and actively, urged by the management to use any available time at work ‘getting to know’ residents. Moreover, care workers spent lots of time writing notes, completing forms and reading information about residents. Handovers involved exchanging information, documentation, using medical language, and abiding by procedural regulations. I argue that such practices allowed for the cultivation of a collective professional identity that motivated workers to have a shared sense of responsibility for individuals in their care Meagher, . This noIt’s 3.40pm. I have been asked to walk to the shops to buy packs of potato waffles for the residents’ supper, which Henrietta (care worker) and I must prepare before 4.00pm. Care workers are responsible for cooking supper every day, since the cook leaves at 1pm, but sometimes there are not enough ingredients in the kitchen. Brian (manager) seems to be adding tasks outside of direct care activities to our job role more frequently…This week, I have worked as a kitchen porter, cook, cleaner, bed‐maker, launderer, and I have been asked to chop vegetables for Mrs G’s [proprietor] private dinner party.At Millstead, there was a simple division of labour that meant care workers undertook several tasks during each shift:The boundaries between care work and other kinds of work were blurred at Millstead. Care workers undertook duties usually undertaken by other low‐paid workers , including washing, drying, sorting, folding and returning clothes to residents’ bedrooms; tidying storage cupboards; unpacking food and linen deliveries; restocking gloves and paper towels; peeling vegetables; making breakfasts and suppers; serving meals; cleaning the kitchen; cleaning the dining room after each meal; washing up; making and changing beds; cleaning toilets and commodes and emptying bins. In addition, just as care workers were expected to double as cooks and cleaners, so too Millstead‐employed cleaners would frequently be asked to ‘fill in’ as care workers . Whilst the tasks of ‘care work’ were blurred, so too was care workers’ definition of what/who a care worker was and what/who the subject of their labour was.During fieldwork, I was able to observe several instances where, instead of explicitly defending or advocating for the boundaries of the care worker role, care workers typically behaved in ways that were at the expense of older persons, such as taking a (not‐sanctioned) break. A superficial observation may see Millstead’s care workers’ acts of resistance as ineffective and petty or, worse, as selfish. It was not long after I started working at Millstead, though, that I realised the preciousness of having moments to yourself and, even, having time to eat. There was one occasion when, having worked for over 9 hours without eating, I ate a resident’s uneaten sandwich in the lift (elevator). Here, moments of resistance  were often degrading.Room checks usually take less than five minutes per bedroom, but care workers are assigned up to twenty‐three bedrooms on a shift and, sometimes, all of these rooms must be checked by an individual care worker. I have been told by Jade (care worker) to “just not do a very good job of it” when making beds. The care workers are aware that several housekeepers are meticulous when checking the residents’ bedrooms and believe that doing a poor job…will result in room checks being made the housekeepers’ responsibility again. This appears to be working: several messages from housekeepers regarding “how to do hospital corners”, “who likes their bed sheets tucked in”, and “when to change sheets” have been passed on in handover. Each time, the care workers respond with: “we just don’t have time to do it properly”.In contrast, the role of the care worker at Shorefield was clearly demarcated. Workers had a strong sense of worker identity and made a more concerted, collective effort to defend the specificity of their jobs. Ideas about what was, and was not, part of the care worker role were facilitated by Shorefield’s complex division of labour. Most cleaning tasks were undertaken by housekeepers, but care workers were, at the start of fieldwork, responsible for conducting morning ‘room checks’ on bedrooms not scheduled for housekeeping. This involved emptying sanitary waste bins, making beds and cleaning sinks and toilets. Six months later, room checks became the housekeepers’ responsibility. Another 3 months later, after housekeepers constantly informed Shorefield’s management that they were overworked, room checks were passed back to care workers. The following field note documents were the care workers’ resistance to this:Care workers’ attempts to take control over their work were successful: several weeks later, room checks were again made the responsibility of housekeepers. Here, care workers enacted small acts of separation to distinguish what they perceived as ‘proper’, legitimate and valued care work and what was inappropriate to their role. Along with close relationships with colleagues, it allowed care workers to carve out a positive (expected) professional identity. Whilst, for Millstead’s care workers, resistant acts were more demeaning than empowering; for Shorefield’s workers, acts of resistance (like not doing a ‘very good job’ of making beds) allowed for greater control of the boundaries of their work. Indeed, at Millstead, issues such as short‐staffing meant that care workers often performed tasks that were not part of the usual care worker role and that this, inevitably, had a negative impact on the quality of care offered to older residents—symptoms, I contend, of an anomic working environment. Moreover, such issues did not allow for a collective, cohesive professional identity among workers and the establishment of a clear moral economy. Without the necessary resources, care workers rarely found joy or value in their labour, nor did residents always receive care that afforded them dignity, belonging and respect.The major impulse behind this study was a concern that care in later life is subject to wide variations in quality and that older people who are reliant on public funding or subsidising of their care are at a much greater risk of receiving poor quality care. By examining the everyday work practices of care workers at low‐cost Millstead and high‐cost Shorefield, my intention was to consider what residents were receiving in terms of the quantity and quality of care. Moreover, I wanted to establish what such care—whether good, bad or unexceptional—rested upon. What roles were played by management, training, material resources and the normative and symbolic culture of work, for example, in (good) care provision? Since previous research has indicated that the quality of care is linked to the quality of work conditions in residential homes, my pursuit of answers to these questions required that I examine the moral, emotional and material stresses that are experienced and managed by care workers.In this article, I highlighted and unpacked the interplay between the cost of care, conditions of work and the quality of care provided for older people. By focussing particularly upon daily schedules, the institutional philosophies of Millstead and Shorefield and how the care worker role itself is configured and enacted, I show how care work, and notions of good quality care, are affected by what normative resources—both material  and symbolic —are available.To be clear, I depart from problematic conceptions of care as that leaving a recipient feeling ‘recognised and valued as an individual, emotionally supported, emphatically connected, or in shorthand, loved’  care. This article, and particularly the case of Shorefield, has shown that good quality care is rooted in symbolic systems—and that cultivating and maintaining a culture of good care, which allows and encourages care workers to convey moral regard and respect for individual residents and each other, requires the presence of particular resources. This includes, as I argue elsewhere  their labour. The availability of normative resources necessary for delivering good quality care, as the cases of Shorefield and Millstead shows us, is increasingly entwined with the costing and funding of care. The current funding and regulation of residential care is not working to ensure good quality care for


For data analysis, a content analysis approach is employed, supported by NVivo 12. The findings reveal that beliefs about reading primarily fall into two dimensions: academic and personal, with the former exhibiting clearer definition and characterization. This can be attributed to the influence of the disciplines integrated into their education, namely literature and linguistics. In conclusion, it is imperative to address the social dimension of reading during the initial teacher education program, as this aspect is not emphasized by preservice teachers, despite its pivotal role in shaping their identity as reading mediators within the context of their teaching practice.This study aims to analyze the beliefs that future Language and Literature teachers hold regarding reading. This work is part of a broader research endeavor focused on the reading habits and practices of teachers in training and their role as prospective mediators since the way in which they perceive reading significantly impacts the mediation processes they undertake in their teaching practices to cultivate readers. To achieve these objectives, a multiple case study is conducted, involving interviews with 1st-year students ( This is understood in light of the fact that beliefs consist of cognitive propositions that are not necessarily structured and are derived from a personal dimension . Thus, aBuilding upon this notion, an investigative panorama is presented, enabling an understanding of the beliefs held by future Language and Literature teachers regarding this construct. However, it is important to note that this review is constrained, given that studies in this vein with future secondary Language and Literature teachers are scarce. Hence, reference will be made to research related to in-service and preservice teachers in primary and early childhood education to augment the theoretical framework.In regard to service teachers, it is relevant to mention the insights put forth by In the realm of initial teacher education, studies concerning the relationship that preservice teachers maintain with reading reveal its inadequacy. This is affirmed by international research wherein a significant percentage of future educators exhibit reading profiles indicative of weak reading habits, as well as a limited interest in autonomous reading  alongsidMeanwhile, the study by Regarding the beliefs of preservice teachers, about reading, it is pertinent to mention the study by The results presented above are not promising and tend to be general in nature; thus, we believe that qualitative studies are needed to delve into the beliefs that future Language and Literature teachers hold about reading. As seen, teachers’ belief systems directly impact classroom performance, and since this group will serve as future mediators and will need to foster reading habits in secondary education, it is pertinent to understand how they conceptualize reading based on their beliefs. This is relevant because it offers insight into an essential aspect of their connection with reading.2.This work, framed in educational research, is a qualitative investigation which applies an interpretative approach . A multi2.1.The study includes a total of 45 students enrolled in first year (15), third year (15), and fifth year (15) of Pedagogy in Language programs from 3 universities belonging to the Chilean Council of University Rectors (CRUCH), as shown in 2.2.For data collection, semi-structured interviews  were con2.3.Between the months of June and November 2022, after adhering to ethical procedures and obtaining the relevant informed consents, participants were contacted via email to invite them to take part in the project and conduct semi-structured interviews. These interviews could be conducted via Zoom or in-person, depending on each participant’s availability. For the purposes of this study, a total of 45 interviews were transcribed and prepared for analysis. Each interview was assigned a code, and a pseudonym was used for each student. It’s important to note that the transcriptions are verbatim and faithfully represent the statements made by each participant.2.4.In this study, a content analysis was employed following the guidelines outlined by 3.To present the findings, a preliminary exploration of reading beliefs will be provided. This initial examination highlights the assessment preservice teachers make of this construct. Subsequently, the focus will shift to the dimensions primarily elicited during the interviews when participants were queried about their perceptions of reading. This analysis encompasses both the academic dimension and the personal dimension, underscoring that this construct is linked to both matters of knowledge and to enjoyment and leisure activities primarily.3.1.Across all analyzed interviews, a positive evaluation towards reading was consistently observed. Participants converge on the notion that reading is an enjoyable activity. Moreover, they underscore the significance of reading for personal development. According to the perceptions of the prospective teachers, reading brings about changes and broadens perspectives. We highlight two representative statements that encapsulate these notions; the first from a first-year student and the second from a fifth-year student, indicating a shared sentiment within the participant group.EU1_N1_02_Kira: I really like it because I feel that, this is how… getting to know different perspectives.EU2_N5_04_Rodolfo: “But I stick with this idea that reading truly changes people, perhaps it broadens our perspective, tells us that there are things we were not seeing before.”The metaphor of “broadening one’s perspective” alludes to the concept of gaining access to knowledge, a circumstance that would be facilitated by reading, as it enables an acquaintance with various perspectives and viewpoints, ultimately fostering a deeper learning experience. Nevertheless, this notion is limited as it refers to an instrumental approach to reading and literature, pointed out by 3.2.The academic dimension pertains to a perspective of reading centered on accessing knowledge and fostering learning. Prospective teachers draw upon their own experiences as students to articulate the significance of reading for them. It is noteworthy that the findings are consistent across the three groups, encompassing students in their 1st, 3rd, and 5th years of study. Among 5th-year students, references to disciplinary knowledge in relation to reading are more prevalent than among 1st-year students.Within this dimension, two primary notions of reading are situated, conceptualized based on insights gleaned from the prospective teachers. Key associated concepts were considered in their analysis. The outcomes are presented in Below are some excerpts from the interviews where references can be found that have contributed to the formulation of the conceptualization presented regarding learning:EU1_N5_04_Fabiola: “To me, reading is an epistemic skill… Yes, for me, reading is first and foremost a skill or a competency that comprises many sub-skills contributing to learning, whether personal or for academic-disciplinary work.EU1_N1_02_Kira: “For me, that’s it, learning, whatever one reads, to me, it’s learning.”Regarding knowledge, the following statements are considered:EU1_N1_02_Kira: “Above all, as I mentioned, it’s a contribution of culture… to people.”EU2_N1_05_Carlos: “I really like it because I feel that, this is how… getting to know different perspectives.”These notions are regarded as limited and inadequately developed in conceptual terms by the prospective teachers, which aligns with the findings of 3.3.The personal dimension of reading has been approached through the beliefs of the prospective teachers, wherein they affirm that reading is a leisure activity, a source of enjoyment, and relaxation. To comprehend the presented ideas, examples from the category labeled as “leisure activity” are provided, wherein reading becomes a moment of evasion or escape from reality:EU1_N1_03_Josefa: just like some people have dedicated their entire lives to ballet, I’ve been reading my whole life… It’s been my hobby.EU3_N3_05_Claudio: as a moment of disconnection where I can be with the book, and I know no one else is going to bother me and I know that what’s happening outside does not interest me at that moment.Regarding enjoyment, the following example is relevant:EU2_N5_02: with more literary reading, with juvenile classics, Narnia, Harry Potter to a certain extent… it’s a pleasure, for example, to imagine that story in one’s head and read it and think, “Oh! I’m enjoying this.”In this way, it is possible to observe how the prospective teachers position reading as a pleasurable activity, one they enjoy and that allows them to escape from reality. However, it is noteworthy that the notion of disconnection or escape with which they associate reading is noticeable. This concept echoes the traditional notion of engaging in the act of reading a book. In this scenario, the reader sets aside their usual tasks to immerse themselves where the focus is on enjoyment through literary reading. This is evident in the discussed interventions, which explicitly refer to the book as a literary artifact.4.In this preliminary study, it is possible to observe that the reading beliefs elicited from future Language and Literature teachers lack substantial conceptual elaboration, which can be attributed to their weak connection with reading . NeverthEqually relevant to mention is that fifth-year students employ more abstract concepts to refer to reading compared to first-year students, who tend to use more generic concepts not directly associated with their field of study. This indicates that the education received while pursuing a pedagogy program has an impact on their beliefs regarding reading, although these beliefs still remain limited. Therefore, it is essential to explore potential approaches that empower future teachers to contemplate reading and their own personal reading habits. This should be supported by a reference framework that allows them to access various conceptualizations of reading from different spheres of knowledge, enabling them to construct definitions beyond their own experience. In this regard, it is considered relevant to emphasize the study of the social dimension of reading while they undergo initial teacher training programs. This is a key element for the development of their role as reading mediators in their teaching endeavors, as they will need to read with others and for others.Furthermore, it is noteworthy that despite finding enjoyment in the activity, a utilitarian perspective of this construct prevails among them. Upon analyzing the interviews, no mentions were found that could account for the social dimension of reading, understood as a practice that enables them to become part of the reading community . InsteadLastly, it is important to acknowledge the limitations of this study, which are primarily related to the data collection instrument. As it was an interview, participants primarily drew upon their spontaneous experiences and memories to respond. This may, to some extent, affect how they articulate their thoughts and beliefs about reading. Similarly, it is crucial to continue prioritizing the reading processes of future educators, aiming to enhance their relationship with reading and ultimately solidify their reading habits by the conclusion of their educational journey.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving humans were approved by Bioethics and Biosafety Committee of Pontifical Catholic University of Valparaíso (code: BIOPUCV-H486-2022). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.CG: Conceptualization, Investigation, Methodology, Writing – original draft, Writing – review & editing. EP: Conceptualization, Investigation, Methodology, Writing – original draft, Writing – review & editing.