Leeds Beckett University

Doping in sport remains a persistent global challenge, eroding sporting integrity, athlete welfare, and public trust. Over the past 25 years, psychological research on doping has progressed from individual-level explanations to embracing more nuanced, systemic perspectives. This narrative review synthesises key developments in the field, addressing definitional ambiguities, dominant theoretical frameworks, and emerging trends in anti-doping research. Social cognitive theories have been particularly influential, with meta-analytic evidence highlighting psychosocial predictors such as attitudes, perceived norms, and supplement use. However, the field remains constrained by a reliance on proxy measures of behaviour and a narrow conceptualisation of doping, typically defined as the use of prohibited substances. This review calls for a broader understanding of the behavioural violations that constitute doping, alongside a shift toward systemic thinking and transdisciplinary collaboration. It emphasises the need to engage with the lived experiences of athletes and support personnel, and to design behaviourally targeted, context-sensitive interventions. Meaningful progress depends not only intervention content but also on their alignment with the lived realities of those involved in sport. Future research priorities include co-created, theory-informed interventions, longitudinal designs, and globally inclusive agendas that reflect diverse voices and sporting cultures. Sustained investment and stronger alignment between research, policy, and practice are essential to protect sport integrity and safeguard athlete and support personnel welfare.

Discussing pharmaceutical treatment for dementia is challenging because of variation in disease progression, lack of curative treatments, and communication difficulties. Research in the context of dementia suggests shared decision making is limited, this study examined how dementia medications are discussed in practice.

Focused video/audio ethnography of clinical appointments (n = 14), semi-structured interviews with patients/supporters (n = 23) and clinicians (n = 5) were employed to examine communication practices.

Two themes developed; Framing and understanding of information in the context of uncertainty explores how uncertainties around risks and benefits are understood. ‘Not worth the risk’ or ‘ nothing to lose ’ presents how patients/supporters and clinicians balance individuals’ contexts/perceived risks/benefits. In the absence of certainty around potential benefits, risk often informed decision-making, particularly for frailer or more vulnerable patients.

Clinicians should be aware of their influence on decision-making and be cognisant of the way that they frame opinions, which are largely based on clinical experience. Prescribers would benefit from a standardised information source which enables them to describe the likelihood and magnitude of benefits and side effects in a universal way. Accessible information for patients and relatives about the same is also recommended. Patients and relatives make their decisions to take medications in the context of relative uncertainty about the likelihood of benefits, with risk playing a pivotal role in decision making for some.

Post-stroke anxiety and depression symptoms are common after stroke and can persist long-term. Despite this, there is a lack of long-term psychological support for post-stroke anxiety and depression. Mindfulness-based interventions are emerging as feasible, acceptable and potentially effective interventions for post-stroke anxiety and depression. Sustained use of mindfulness practice can help stroke survivors to self-manage their anxiety and depression in the long-term. However, stroke survivors' experiences of continued practice following a mindfulness-based intervention have yet to be explored. This study aims to identify mechanisms underpinning sustained mindfulness practice by stroke survivors following completion of an adapted, stroke-specific mindfulness-based intervention called HEADS: UP (Helping Ease Anxiety and Depression After Stroke).

A secondary analysis of 6-month follow-up qualitative data from course participants (n = 12) in the HEADS: UP randomised controlled trial was analysed using critical realist thematic analysis.

Seven mechanisms were identified as determining sustained mindfulness practice: 1) Believing continued practice brings benefits, 2) Personal preferences and accessibility, 3) Continued learning, 4) Attitudes of others and society, 5) Togetherness and connection, 6) Structuring and scaffolding practice, and 7) Competing priorities.

The mechanisms provide explanations behind stroke survivors' experiences of sustained mindfulness practice following HEADS: UP. The findings highlighted the potential benefit of providing support following a mindfulness-based intervention to facilitate sustained practice. Awareness of the mechanisms could aid future intervention design and help clinical practitioners and stroke support professionals support continued mindfulness practice.