Professional Doctorate theses

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7300

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An investigation into the effects of the Scottish smoking ban
(Queen Margaret University, 2009) Musiello, Toni
Aim. This study examined the effects of the Scottish smoke-free legislation on smokers’ behaviours and attitudes using the transtheoretical model of change (TTM) as a framework. Design and participants. A longitudinal design was employed and data was collected from 127 Scottish smokers prior to the smoking ban introduction (T1), and at three (T2) and six (T3) months after the ban had been implemented. Findings. Results demonstrated that smokers failed to decrease their cigarette consumption when pre and post ban rates were compared. After the introduction of the ban, positive attitudes towards the smokefree legislation increased by 20%. Whilst processes of change were used less frequently in the precontemplation stage, and increased in the contemplation and preparation stage, the results did not support the changes hypothesised by stage classification. Furthermore, no differences in the pros of smoking were observed between the stages. However the cons of smoking were rated as less important by those in the precontemplation stage (F(2,122) = 20.871, p = .001, partial η² = .26). Conclusion. Whilst findings obtained in relation to attitudes towards smoking were promising, results failed to support the theoretical predictions of the TTM and advocate its use as an explanatory framework for behavioural change. In general, findings failed to corroborate the notion of distinct and quantitative stages of change.
The psychological and social processes influencing health and safety in small to medium-sized enterprises
(Queen Margaret University, 2009) Dieghan, Carolyn
AIM: Small and medium sized enterprises have notable difficulties in engaging with health and safety activity and experience proportionally higher levels of accidents than larger businesses. SMEs have also been described as problematic to access for research and intervention purposes. The aim of this research was to investigate the role of psychosocial factors in health and safety behaviour among small or medium sized enterprises (SMEs). METHODOLOGY: The research employed a mixed method design over two phases of study. In the first phase, fifty semi-structured telephone interviews were used to derive behaviours that the SMEs considered relevant to their type of business. In addition, the SMEs provided views on the rationale for, perceived effectiveness and facilitators of health and safety behaviour they had undertaken. In the second phase, a questionnaire survey was conducted using key SME health and safety behaviours and health and safety-related attitudes derived from the telephone interviews and key theoretical construct domains. Three hundred and thirteen SMEs completed questionnaires distributed at trade shows in Scotland and England. RESULTS: Overall, the level of health & safety activity undertaken by SMEs was reported to be low (with 59% spending one hour or less in a typical week according to questionnaire responses, the figure was 60% for the telephone interviews). Smaller businesses notably the micro business, spent significantly less time on health and safety activity compared with larger organisations. Those spending approximately one day per week or more on health and safety activity were found to be the largest SMEs in the sample. Hierarchical regressions performed on the survey data highlighted five key predictors of health and safety activity. These were positive and negative beliefs regarding resources, relationships with suppliers, and decision making by middle and junior level staff. It is notable that after taking into account the influence of the size of the company, these factors remained of significant importance. This suggests that the influence of these factors persist despite previous findings related to the size of the SME. Results also suggest that beliefs associated with the consequences of health & safety behaviour tend to lead to increased activity. Further, organisational design was found to mediate this effect. CONCLUSION: Interventions designed to increase health and safety in SMEs would be advised to take into account the psychosocial influences on health and safety behaviour, in particular those highlighted in this study, as these may have implications for uptake and sustainability of any new initiatives requiring such activity.
Exploring psychosocial risk factors for stroke in young women exposed to domestic violence
(Queen Margaret University, 2009) Smith, Yvonne
Background and purpose: The incidence of stroke is projected to increase worldwide and reduction of risk of the first stroke is therefore important. First stroke in young women often poses a diagnostic challenge but it has been suggested the risk is associated with hightened exposure to domestic abuse. This UK study was conducted to determine the incidence and examine the predisposing risk factors for early stroke in young women suffering domestic violence. The effect of a range of psychosocial variables and health behaviours on the incidence of strokes in young women in an abusive relationship is assessed. Methods: A cross-sectional survey collected information by self-report questionnaires on 237 women aged 18-56 exposed to domestic violence. The survey instrument measured the negative consequences of abuse and comprised demographic information, health status assessment, physical health illnesses and history of abuse. The GHQ-12 a stress measure was employed to gauge the effects of exposure to threatening life events. Correlational analyses and factor analysis were performed. Data was matched for women aged 20-44 with the average annual incidence rates of risk of first stroke in young women according to the Oxford Vascular stroke project register Results and conclusions: Unsurprisingly, a high incidence of depression was found in this study even when the majority of women were on medication. A number of high-risk behaviours were also associated with strangulation, alongside the physical trauma. The incidence of first stroke found in the study was 5 cases classified as 3 ischemic and 2 hemorrhagic strokes, such a high frequency has not previously been described in the research literature. According to Oxford data the incidence of stroke among women aged 20-44 in the UK is 0.14/1000 per year. Stroke sub-type incidence rates were found to be 10 fold increased risk for ischemic and 15 fold increased risk for hemorrhagic stroke compared with the matched control. Trauma was found to be the most common predisposing factor to stroke other reported risk factors to increase the risk of stroke included poor health profile, migraine, and heavy alcohol consumption. These incidence rates may be underestimates as a consequence of women not attending for medical care, hence tragically managing stroke-related symptoms in the home. However, due to the small numbers of stroke victims the results must be viewed with caution.
Learning Motivational Interviewing: a thematic analysis exploring Health Professionals' training experiences
(Queen Margaret University, 2011) Wallace, Lloyd
Aims: This study explores how training in Motivational Interviewing (MI) is experienced and given meaning by 23 multi-disciplinary health professionals. It uses a qualitative interpretative thematic analysis, aiming to identify key elements in the process of learning and applying MI consultation skills in their clinical practice. Setting/method: The health professionals were recruited from two MI training programmes in Scotland, they worked in either cardiac rehabilitation or substance abuse settings. The time elapsed since training workshops for each participant varied between 4 months and three years. Data were collected electronically via E-mail and participants completed either an open-ended questionnaire or a reflective diary. Results: The data obtained via these data collection methods was rich and informative and it revealed several key experiences and factors for successfully learning and applying MI. MI training is an emotional experience before, during and after workshops. Learning MI is challenging, and a shift in professional identity with clinicians feeling temporarily deskilled is a common experience. Practice with real clients, supervision and other reflective practices, facilitate and are crucial for learning effective MI skills, and developing competency can take years. MI is also seen as powerful and concerns about sensitive disclosure may arise, that may inhibit practicing MI skills. Clinicians also find it challenging to adjust to new ways of thinking and behaving, and often revert to the more traditional authoritarian expert approach they are used to. When clinicians become more competent and skills are consolidated, they experience an increased sense of professionalism and confidence in their ability to facilitate clients in making informed choices about their health and about illness management. They also experience less stress and dissatisfaction with resistant clients. Several additional facilitators and barriers are discussed. Conclusion: The study raises implications for MI training theory and practice and adult learning theories. The findings suggest that learning MI is emotionally demanding and tiring, and that building MI competency requires a considerable amount of time and resource. This needs to be taken into account, when planning and implementing MI training programmes if these are to succeed in embedding MI culture in health services.
How the experience of living with an Implantable Cardioverter Defibrillator influences the educational needs and concerns of patients and their partners.
(Queen Margaret University, Edinburgh, 2012) Ferguson, Julie
Background: The aim of this study was to develop an understanding of how the experience of living with an Implantable Cardioverter Defibrillator (ICD) influenced patients and their partners' educational needs and concerns. An ICD is a device that is designed to treat patients who have life-threatening arrhythmias. The quality of life (QoL) of the ICD recipient is not only influenced by the disease itself but by adjustment to an altered life situation. Providing patient education can be an effective intervention to improve patient adjustment to the device. However, there is little qualitative research on the educational needs and concerns of these patients. It is therefore argued that qualitative research focussing on the lived experiences of patients is needed to identify appropriate educational interventions to facilitate this adjustment. Methodology: The constant comparative method of constructivist grounded theory was employed for data collection and analysis. Semi-structured face-toface interviews were carried out with fourteen ICD patients and four partners. Findings: A grounded theory model was developed which described how patient's experiences of getting back to normal following the insertion of an ICD influenced their educational needs and concerns and ultimately led to their acceptance of the ICD. The model had two key components, getting back to normal and being informed. How the patients and carers experienced getting back to normal consisted of adapting lifestyle, focusing on the positive, effect on the family and living with the uncertainty regarding experiencing an ICD shock. Their experience of the ICD influenced their educational needs in that the information needed to be tailored to their individual experiences. Discussion: This study found a strong need to feel informed, which is a major part of Mishels theory of uncertainty. The model is also compared to the crisis theory and the common-sense model of illness representations. The chapter ends with a conclusion and recommendations for future resea
Experiences of women with endometriosis: An Interpretative Phenomenological Analysis.
(Queen Margaret University, Edinburgh, 2012) Clark, Michelle
Background: Endometriosis is a common, yet enigmatic chronic gynaecological condition, with an unknown aetiology and no cure, affecting approximately 6-10% of females of a reproductive age. Symptoms include heavy menstrual bleeding, pelvic pain, fatigue and infertility which has a negative impact on daily living. Clinical research aiming to establish the cause of the condition and to develop treatments is ongoing; however, there is a lack of research investigating what it is like to live with the disease. Aim: The aim of the study was to examine the experiences of women with a surgical diagnosis of endometriosis. Methods: Semi structured interviews were carried out with 13 women. Interviews were transcribed verbatim and data analysed using Interpretative Phenomenological Analysis (IPA). Analysis revealed five key themes: making sense, impact on daily life, identity, taking back control and legitimisation. Results: Women reflected upon the journey they travelled in trying to make sense of their symptoms. Diagnosis enabled a fuller understanding of their condition and facilitated increased knowledge and support. The condition impacted on all aspects of daily life and psychological outcomes to the point where women felt controlled by the disease. Identity and sense of self was challenged through changes in their ability to fulfil expected social roles, with women trying to maintain their past identities by minimising the reality of their symptoms. A variety of coping skills were employed to take back control over their lives. Finally, normalisation of symptoms by medical professionals, family members and lay public reduced the legitimacy of the condition and made self-management difficult. viii Conclusion: There is a general lack of knowledge, acceptance and support for women with endometriosis. Qualitative studies such as this one add the contextual information required to understand what it means to live with endometriosis. However, improving the quality of life of women with this debilitating condition requires further understanding of their lived experiences.
Stress and coping in university employees: a longitudinal evaluation of stress, personality, coping and psychological distress
(Queen Margaret University, Edinburgh, 2013) Connolly, John Francis
Background: Internationally, high levels of stress and Psychological Distress have been identified in university employees. There have been calls to investigate stress over time and to include measures of coping and personality. This study provides the first longitudinal assessment of stress and Psychological Distress and examines the role of personality and coping in university employees during campus relocation Method: All 500 employees in Queen Margaret University were invited to complete standardised measures assessing Psychological Distress and sources of stress (HSE Indicator Tool) before (N = 143) and after relocation (N = 116). Participants also completed measures assessing Job Satisfaction, Personality, Coping and additional demographic information. Findings: High levels of Psychological Distress were identified before relocation (42%) and at 6 months (38%). Academic staff had a higher prevalence of Distress following relocation. Matched pair analyses (N = 48) showed the majority of stress sources remained stable from T1 to T2 with one significant decrease in reported levels of Control. Stressors explained 31.8% of the variance in Psychological Distress even when the effects of pre-specified variables (Neuroticism, Coping and age) were controlled. Employees with higher levels of Neuroticism and Emotion focused coping had significantly higher levels of Psychological Distress. Discussion and conclusions: Psychological Distress was higher than in population norms and other occupational groups. The primary stressors were identified and targets (based on national benchmarks) suggested. On-going monitoring and actions aimed at reducing stress and improving Psychological Distress are warranted. This is one of the first studies to assess the relationship between the management standards (indicated by the HSE Indicator tool) and stress outcome, and to use a matched participant design to assess change in the management standards. That the Management standards predict Psychological Distress lends support to the use of the management standards approach.
Red flag screening for serious pathology presenting in cervical spine musculoskeletal disorders
(Queen Margaret University, Edinburgh, 2013) Redmond, Colin
Aim To develop a list of red flag clinical indicators for possible serious pathology masquerading as, or presenting alongside, neck related musculoskeletal disorders in the adult population. Background Musculoskeletal physiotherapists provide assessment and treatment for pain and functional impairments relating to musculoskeletal disorders, such as back and neck pain. In order to apply safe and effective treatment to these conditions it is vitally important that any underlying serious complaints have been excluded. Clinical indicators known as 'red flags' have been developed for diagnostic triage in back pain to help identify serious underlying conditions, such as cancer and infection. Red flags for serious pathology in neck pain or neck related pathology has not received the same level of attention as red flags in back pain. A literature review identified inconsistent evidence for clinical tests and clinical indicators for serious pathology in neck related musculoskeletal disorders. This presents a serious clinical challenge for musculoskeletal physiotherapists. Method A mixed method study design was developed involving: a) Qualitative descriptive method through Physiotherapy focus group; and, b) Three round Delphi survey method involving consultant neurologists and consultant neurosurgeons. The Delphi method involves combined qualitative and quantitative data phases. Thematic content analysis was used to analyse the qualitative data. A combined descriptive and inferential (non-parametric) statistical analysis was used to analyse the quantitative data. Kendall's W (Kendall's coefficient of concordance) was used to evaluate the level of consensus across all participants for the quantitative phase of the Delphi method. Findings A list of neck related red flag clinical indicators within five specific categories were developed: 1. progressive pain; 2. cancer, infection, trauma; 3. neurological deficit (spinal cord compromise); 4. headache (associated with neck pain/stiffness); 5. brainstem, cervical arterial and cranial nerve dysfunctions. An increase in Kendall's W was demonstrated between Rounds 2 and 3 in four out of five categories, indicating an increase in consensus levels between participants. This process highlights the complexity of interpreting clinical features within musculoskeletal presentations.
Experiences of freedom and personal growth in a community arts group for mental health: An Interpretative Phenomenological Analysis
(Queen Margaret University, 2013) Turner-Halliday, Fiona
Background: The relationship between art and mental health has evolved from a main focus on art therapy to include community arts approaches with wider and more socially-based links to health. The proliferation of community arts approaches across the UK is not met, however, with a research focus that provides insight into the mechanisms by which the activity might contribute to improving mental health. Aims: The aim of this study is to qualitatively explore the meaning of taking part in community arts for those with mental health problems and to learn about the process and ethos of group experience that was interpreted to form a necessary foundation for mental health benefit. Methods: The community arts experience of six art group members was explored through semi-structured interviews (four of whom participated in a second round of interviews). Data was analysed using Interpretative Phenomenological Analysis (IPA). Findings: Community arts for mental health, in this particular study, span multiple aspects of participants' life contexts that were found to fall into two main aspects of meaning; that is, a sense of freedom from expectation and a trajectory of personal growth. When taken together, these two superordinate themes further represent the meaning of art group experience as a process whereby the art group culture can allow, and facilitate, positive change and long-term development. Conclusions: The investigation of benefit and outcome in relation to community arts for mental health can only go so far in providing insight into the journey of participatory experience. Instead, this study's exploration of the meanings of art engagement within a group context goes beyond description of benefit to suggest a complex process whereby the 'ingredients' of the art group culture is pivotal to the role of community arts in improving the lives of those experiencing mental health problems. The journey of growth that was experienced by participants evokes important and complex questions for community arts in relation to public health goals, therapeutic approaches to improve mental health and concepts within mental health arenas, such as the nature of 'recovery.' Furthermore the study suggests a pivotal role for health psychology in sparking a collaborative dialogue about the learning that can be gained from community arts approaches, as well as in facilitating community arts in designing approaches to working with mental health groups that are based on the insightful reflections of those who engage in them.
Realising evidence based practice: a systemic investigation of core knowledge processes in mental health
(Queen Margaret University, 2013) Pentland, Duncan
Aims To investigate the systemic circumstances required for mental health professionals to engage in the core processes of evidence based practice. Background Successful evidence based practice is the function of inter-related processes including knowledge acquisition, generation, and application, which occur in complex and dynamic circumstances. Dominant models and approaches to facilitating the use of knowledge in practice by health professionals remain based on linear, technical processes which aim to instigate behavioural changes at the individual level. Emergent conceptualisations argue the need for strategies that consider systemic factors which can impede or facilitate the processes underpinning the operation of evidence based practices in mental health. As yet no efforts have been made to actively apply systems thinking in efforts to improve evidence based practice in mental health. Method A collective case-study research design was developed by adapting Soft Systems Methodology. Three cases were examined, each selected due to their ability to provide information about one of the core processes under investigation; knowledge acquisition, knowledge generation and knowledge application. Data was collected iteratively from thirteen participants through focus groups and semi-structured interviews. Analysis was undertaken through the inductive open coding of data into sub-categories, following which key categories were identified and considered against individual, group and organisational systems levels. Findings This study identified twenty-four key categories across the cases and located these against the three systems levels. As anticipated, complex dynamic interactions between different elements at the different levels were identified including, the role of motivation, perception and skill at the individual level, the importance of team wisdom, support and decision making, and the need for organisations to provide adequate infrastructures, ensure access to specialist expertise and a number of elements contributing to a culture of space and support for evidence based practice.
The parent programme: a psycho-educational intervention for parents of children with autism
(Queen Margaret University, Edinburgh, 2013) McCreadie, Michael
Background Having a child with autism places significant demands on parents. Few interventions address parental understanding of the meaning behind child behaviour, and the relationship this has with parental stress. Parent-mediated interventions focus on behaviour exhibited by the child and ignore parental stress. This study assesses the impact of a psycho-educational intervention, which assists parents to derive meaning from their child’s behaviour. Aims The overall aim was to investigate if an intervention targeted exclusively at parents would: • Reduce parent stress associated with Child Characteristics • Reduce parent stress associated with Parenting Characteristics • Facilitate changes in parental coping styles Methods A quantitative approach was adopted to evaluate the impact of the intervention. Measures of parental stress (Parenting Stress Index) and parental coping (Ways of Coping, Revised) were taken at three time intervals; prior to, at a mid-point, and at the end of the intervention. Results Questionnaires were completed by 71 parents and the results were computed using a repeated measures analysis of variance (ANOVA). There was a statistically significant change within the parent and child domains of the Parenting Stress Index (p. 0.0005), with parents showing less stress associated with interpretations of their child’s behaviour, and significant changes in their use of problem-focussed coping. Conclusion Parent-mediated interventions that target parent characteristics associated with child behaviour, are inexpensive and have significant benefit. However, we require further research to explore the relationship between stress and coping variables in parents of children with autism to inform the future direction of intervention.
Negotiating healthcare through partnership: An exploration of the perceived and observed factors that enable or inhibit partnership between young “expert” patients with Cystic Fibrosis and the Healthcare Professionals with whom they interact.
(Queen Margaret University, 2014-01-06) MacDonald, Kath
Since the late eighties healthcare policy has seen a shift from a paternalistic model of care to that of an inclusive partnership approach which encourages engagement, responsibility and self-management of long term conditions. This paradigm shift has given credence to the notion of the “expert patient” (EP); an individual with a long-term condition whose knowledge and skills are valued and utilised in partnership with healthcare professionals. However, there is debate as to the definition of the EP, and an assumption that all patients would want to adopt this role and a partnership model of care. There is also scepticism about the motivation behind the introduction of the EP and the perceived benefits of EP Programmes. This study aimed to explore how young “expert patients” living with cystic fibrosis (CF) and the healthcare professionals (HCPs) with whom they interact perceive partnership and negotiate care. Adopting a qualitative methodological strategy, informed by Interpretivism and Symbolic Interactionism, thirty three consultations were observed between eight patients, two accompanied by a carer and twelve healthcare professionals (HCPs). Following the observed sessions the eight patients, two carers and eleven HCPs were interviewed. Data were analysed thematically using the five stages of “Framework” a matrix-based analysis approach. Three major themes emerged from the data: experiences of partnership, attributes of the expert patient and constructions of illness. Multiple sub themes are also presented, including the power of the nurses, normalcy, the expert patient as navigator and the ceremonial order of the clinic. Implications for practice suggest the need for ground rules outlining both parties’ roles and responsibilities in partnership, a remodelling of the clinic format to ensure patient- centredness and a consideration of the role of decision tools and Telehealth in any new proposed model.
A cognitive behavioural therapy in the form of self-help for patients with sleep disturbance and chronic health conditions
(Queen Margaret University, Edinburgh, 2015) kazamia, Nicola
Background: Sleep disturbance, including insomnia disorder, is common among patients with chronic health conditions, and is associated with psychological difficulties and impaired health-related quality of life (HRQoL). Less is known about whether a similar relationship exists in individuals with chronic health conditions who do not have a clinical diagnosis of sleep disturbance (NCSD). Recent evidence suggests that Cognitive Behavioural Therapy (CBT) in the form of self-help (SH) is an effective treatment for individuals with chronic health conditions and has the advantage of low cost and ease of access. Any form of sleep disturbance may be perceived as problematic for individuals with chronic health conditions. This study aims to: a) examine whether the NCSD population with chronic health conditions at baseline have poor sleep quality, insomnia symptoms, high levels of psychological distress (anxiety, depression and stress), sleep-related dysfunctional beliefs and impaired HRQoL, and b) assess the effectiveness of the CBT-SH booklet. Method: Participants were recruited from outpatient clinics and received a 6-week CBT-SH booklet for sleep-related problems. Outcome measures included evaluations of subjective sleep quality and the severity of insomnia symptoms, psychological distress (anxiety, depression and stress) sleep-related dysfunctional beliefs and HRQoL. Measures were completed before and after the intervention. Results: Forty-nine participants (44 females) completed the study. Prior to the intervention, 46 participants reported poor sleep quality and 47 participants reported clinical or subthreshold insomnia. Mean scores for the measures of psychological distress indicated moderate levels of anxiety, depression and stress and sleep-related dysfunctional beliefs respectively. HRQoL was also impaired. Following the CBT intervention, participants showed significant improvements in sleep outcomes, sleeprelated dysfunctional and stress levels. No significant differences were found in HRQoL depression and anxiety outcomes. Conclusion: A brief CBT-SH booklet for sleep-related problems is effective for patients with chronic health conditions and NCSD in clinical settings.
Efficacy and acceptability of an online intervention to increase physical activity and perceived behavioural control
(Queen Margaret University, Edinburgh, 2015) Maltinsky, Wendy
Aim: Physical activity has long been recognised as a means of enhancing and protecting health, but the levels of engagement are far from optimal in Scotland. Previous research has demonstrated that increasing perceived behavioural control alongside the use of action and coping plans can be effective in changing physical activity behaviour. The aim of this study was to evaluate the efficacy and acceptability of combined techniques for planning and increasing perceived behavioural control alongside assessing the need for practitioner support for online intervention delivery. This study also set to examine the relationship between the targets that individuals set and how these compare to behavioural outcomes, which previously had not been undertaken. Method: An online intervention designed to increase perceived behavioural control and support the creation of action and coping plan was delivered over two weeks in a 2 x 2 factorial random allocation study. The two factors were practitioner support and the intervention with a fourth group acting as a control. Participants completed a pre and post-test theory of planned behaviour questionnaire and recorded physical activity over 4 weeks using pedometers and self-report diaries. Results: PBC increased across all participants however there was no statistically significant difference between conditions and so this increase could not be attributed to the intervention. A trend of increased walking was observed in the intervention and practitioner support condition. However while the differences were bordering on being clinically significant, they did not reach statistically significant difference. Of those who completed action and coping plans, 73 % achieved self-set targets. Acceptability of the intervention was high with 79% indicating that they would use it again, and recommend it to others. Conclusion: Examining action and coping plans revealed that individuals will set moderate goals in response to an intervention guiding them to do so and incrementally increase towards these. Longer time-frames may be able to reveal a gradual increase of physical activity engagement which can be of benefit to health, over and above the effects of participation in a physical activity study.
Effectiveness of an internet-based pain self-management intervention for individuals living with chronic pain
(Queen Margaret University, Edinburgh, 2015) Giannopoulou, Chrysoula
Background: Chronic pain is a prevalent healthcare problem which influences each aspect of an individual's life. A biopsychosocial approach is the dominant one to be taken in the understanding and treatment of chronic pain as not only physical but also psychological factors influence the pain experience. Multi-disciplinary interventions based on a biopsychosocial approach provide an effective treatment strategy for the management of chronic pain. However, the availability of these interventions is limited. Research indicates that internet-based self-management interventions can address this limitation. Aim: The aim of this study was to assess the effectiveness of an internet-based pain self-management intervention, for individuals with chronic pain that were recruited from various clinical settings. The intervention is a well-known pain self-management website known as the 'pain toolkit'. This is the first study that we are aware of which examines the effectiveness of the 'pain toolkit' intervention in a 'real-world' clinical context. It was hypothesised that the participants' fear of movement/(re)injury, pain-related anxiety, pain catastrophizing, pain (intensity and interference) and passive coping strategies (i.e. diverting attention, catastrophizing, praying/hoping) would decrease after engagement with the 'pain toolkit' website.Moreover, it was hypothesised that the participants' self-efficacy and active coping strategies (i.e. reinterpreting pain sensations, coping self-statements, ignoring pain sensations, increasing activity level, the ability to decrease pain and to control pain) would increase after engagement with the 'pain toolkit' website. Finally, it was hypothesised that the participants' readiness to engage in pain self-management would increase from the onset to the completion of the intervention. Specifically, engagement with the 'pain toolkit' intervention would facilitate participants' movement into a more advanced stage of pain self-management. Methodology: Self-report questionnaires, including: Pain Stage of Change Questionnaire (PSOCQ), Tampa Scale for Kinesiophobia (TSK), Pain Anxiety Symptoms Scale (PASS), Brief Pain Inventory (Short-Form: BPI), Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ) and Coping Strategies Questionnaire (CSQ) were completed by the participants - both before and after the intervention. Participants engaged with the intervention for 6 weeks.Results: Forty-eight chronic pain patients (27 females and 21 males) aged 22 to 77 completed the study. Participants showed significant reductions in pain related anxiety, fear of movement/(re)injury, and pain catastrophizing and there was significant improvement in their ability to decrease pain. Conclusion: These findings indicate that internet-based, pain self-management intervention, such as the 'pain toolkit' is an effective intervention on a variety of measures for individuals living with chronic pain.
Does gaining control of smoking behaviours have a positive impact on glycaemic control in patients with Type 2 diabetes?
(Queen Margaret University, Edinburgh, 2015) MacMillan, Margaret-Anne
Background Smoking cigarettes is a well-documented cause of ill-health and is associated (Cigarette smoking among people with diabetes increases the risk of developing long-term complications. Although smoking cessation is considered important for all, it is especially significant for people with diabetes and is recommended throughout the literature. Few studies have investigated the impact of a smoking cessation intervention tailored to the needs of people with Type 2 diabetes. This study attempts to address this. Aims The overall aim was to assess the impact of a smoking cessation psychological intervention for people with Type 2 diabetes and whether the intervention had a positive impact on their glycated haemoglobin levels.
Do you hear the people sing? The impact of a community choir in a forensic setting.
(Queen Margaret University, Edinburgh, 2015) Robertson, James
This study considers the health benefits that may be experienced by patients and staff in a medium secure forensic setting when singing in a choir. It also investigates how shared participation in choral experiences might influence the relationships between patients and staff. In addition, framed within the context of Community Music Therapy1 (Pavlicevic and Ansdell 2004; Stige et al. 2010; Stige and Aarø 2012), this study explores how – and to what extent – the researcher’s identity as a music therapist may be altered as a result of including a community-based approach to his work in addition to a clinically-oriented model. The investigation was undertaken throughout a six-month period in which weekly rehearsals comprising up to eight patients and six members of staff were held; a short performance was arranged at the culmination of the project. Whilst studies exploring the use of choral singing in music therapy for people with chronic mental illness have been undertaken (Eyre 2011), there would appear to be a dearth of literature specifically investigating the potential benefits of this intervention with patients in a medium secure forensic setting. A qualitative methodological stance was adopted. Data were collected and analysed using Participatory Action Research (Stige 2005a; Elefant 2010) and key principles of grounded theory (Glaser and Strauss 1967). Findings suggest that people may experience overall feelings of wellbeing such as enjoyment, warm-heartedness, excitement and fun as well as an increased awareness of posture and breathing. A sense of belonging, hope and contributing to a group may similarly be felt. In addition, opportunities for learning are provided and a sense of empathy towards others may be fostered. The results also suggest that shared participation in choral experiences can positively influence the relationships between patients and staff through feelings of benevolence for each other, a removal of boundaries and a deeper realisation of being a person in one’s own right. Finally, results indicate that the researcher’s identity as a music therapist is altered through the inclusion of a more didactic approach, a conscious working towards musical outcomes and a heightened sensitivity regarding the needs and abilities of service-providers as well as service-users.
Investigating the psychosocial outcomes of young adult survivors of childhood and adolescent cancer
(Queen Margaret University, Edinburgh, 2016) Brown, Morven C.
While several studies report survivors of childhood and adolescent cancer to have affected outcomes in areas such as health-related quality of life, psychological health, education, employment and relationships, other studies report positive findings. Inconsistencies in the measures and methods used across studies hinder our ability to draw conclusions from the research and there is also a lack of measures which are designed specifically to capture the concerns of these survivors. In addition, survivors' subjective perceptions have been identified as potentially crucial risk factors for poorer psychosocial outcomes, but receive less attention than traditional risk factors involving disease and demographics. The research for this thesis employed a mixed methods design, in the form of an exploratory sequential design, with the purpose of providing a comprehensive investigation of the psychosocial outcomes of young adult survivors of childhood and adolescent cancer. The first study aimed to qualitatively explore survivors' own perceptions of the impact of cancer and the influence it has had on their lives. The second study aimed to quantitatively investigate the outcomes and concepts identified in the qualitative study, and in a review of the literature, in a larger sample of survivors. In both studies, the survivors own views, experiences and concerns were of central importance. Overall, survivors reported high levels of achievement and functioning. However, it was evident that a minority of survivors may benefit from further support and information with regards to fertility, education, employment, concerns about the impact of cancer and future health. Results of the questionnaire study indicate that survivors' views, as assessed by the Impact of Cancer for Childhood Cancer Survivors scale, may be associated with health-related quality of life and distress outcomes. Results suggest that overall the mixed methods study enabled a comprehensive investigation of psychosocial outcomes. The research indicates that health professionals should monitor the psychosocial health of even long-term survivors of childhood and adolescent cancer.
Needs of female offenders with substance misuse issues: offenders' and service workers' perspectives
(Queen Margaret University, Edinburgh, 2016) Findlay, Claire Louise
Background Female prisoners in Scotland have been found to have higher levels of drug dependence when compared too male prisoners. Females require gender-specific interventions designed to address their needs. Many of the services that women encounter within the prison sector are not designed to address the needs of female offenders. Aims The study aims to assess female offenders' and service workers' perception of needs from prison addiction services. The study intends to investigate ways in which prison addiction services can be adapted to support clients with their recovery journey. The study also aims to identify barriers that prevent female substance users from accessing treatment whilst in custody. Method The research was conducted within Scotland's only national establishment for women HMP (Her Majesty's Prison) &YOI (Young Offenders Institution) Cornton Vale. Five female offenders and five prison addiction workers were interviewed using semi-structured interviews. The data were transcribed and thereafter analysed using thematic analysis. 4 Results The study highlighted some of the key needs of female offenders with substance misuse issues. Six key themes were identified for female offenders: need for intensive support; importance of gender-specific provision; need for person-centred provision and choice; service provision is outdated; importance of through care, and barriers to treatment. Five key themes were identified for service workers: need for more communication and collaborative working; importance of gender-specific provision; service provision needs reviewed; improve access to psychological therapies, and barriers to delivering service. Conclusion The findings identified both female offenders' and prison addiction workers' views on treatment needs, interventions and potential barriers to treatment. The study highlighted the need for prison addiction services to develop interventions that take into consideration the demographics and history of female offenders.
Investigating Egyptian student nurses' perception towards working in mental health nursing
(Queen Margaret University, Edinburgh, 2016) El Baqary, Amira
This research aims to explore Egyptian undergraduate nursing students' perceptions of working with mentally ill patients and to explore factors that influence student nurses' perceptions of mental health nursing. The study took place at the school of nursing in Cairo University. The research approach for the study is qualitative and descriptive since it aims to explore opinions and perceptions of participants and describe meanings about researched topic (Creswell 2014, Willing 2013, Hancock et al 2009). The method for data collection used in the study was focus group discussion: 8 focus groups were conducted that included 32 participants, all of them female students. A pilot focus group took place at the faculty of nursing in Modern University for Technology and Information (MTI) where fourth year students were asked to participate. The remaining focus groups were held at the school of nursing in Cairo University. Participants were chosen from fourth and fifth year students of the undergraduate programme. The participants had accumulated knowledge as students and they were about to graduate and to start their nursing career. Data analysis stage of the study employed thematic analysis to develop codes and themes that constitute the results of the research. Results of the study revealed that stigma associated with mental health nursing (MHN) is one of the main factors that keep students away from this specialty. Students expressed their fear and lack of a sense of safety within mental health facilities. The main stereotype as expressed by participants was that patients are violent and potentially aggressive. Other factors contributed to a negative view about MHN such as lack of positive role models, insufficient clinical training and the need for clinical supervision within mental health clinical placement. Few participants expressed an opposite opinion and were motivated to work in MHN but were not sure how to start this career. The gender issue appeared to be influencing perception of MHN since many considered MHN as a male job