Professional Doctorate theses

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

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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.
A qualitative study exploring the experiences of access and pathways to health care among BME community groups residing in Ayrshire
(Queen Margaret University, Edinburgh, 2017) McKenzie, Elizabeth
A review of the literature showed that Black and minority ethnic (BME) communities carry a disproportionately higher burden of illness than the general population and experience greater inequalities in health and health care provision. A growing body of research confirms that BME groups are under-represented in research. The main objective of the present study was to gain insights into the perspectives of BME community groups' experiences of accessing general and sexual health care services in Ayrshire. Semi-structured interviews were conducted with 11 participants, n = 5 men (age range: 32-65; mean age = 52.4 years), and n = 6 women (age range: 27-60; mean age = 47.67 years). Data were analysed employing Interpretative Phenomenological Analysis (IPA). The analysis is illustrated through the use of four super-ordinate themes: ‘It’s a Trust Thing’, ‘Minding the Gap(s)’, ‘Sexual Health: a Culture of Silence’, and ‘Personal Perception of Risk’. The findings both support and add to the existing trust literature by presenting a heuristic model of trust, and by showing that participants trust is dynamic in character, has a role, and serves various roles and functions that impact decisions about accessing health services. Significant gaps in knowledge about available health services and unique communication challenges that prevent full access to health care and health promotion information were found, resulting in unmet needs. Analysis charted culturally driven factors that prohibit discussions about sexual health concerns and found complex cognitions involved in the personal perception of risk that was meaningfully understood by participants that direct towards understanding risk in terms of a heuristic model. The implications for clinical practice, health promotion, health service development, and the direction of future research will be discussed.
A service evaluation study exploring the therapeutic effectiveness of a Reiki intervention in the local Community of cancer patients
(Queen Margaret University, Edinburgh, 2017) Kunvardia, Neha
Objective To explore the perceived therapeutic benefits of Reiki on health outcomes in a local community of patients attending treatment at a Cancer Treatment Centre (CTC). Background Reiki was introduced as a new therapy to enhance the provision of a holistic complementary care package to patients at the Cancer Support Centre (CSC). At the time of its delivery, not a great deal was known about its benefits, thus emphasising the need for a Reiki service evaluation to develop an understanding based on patient experiences concerning its perceived benefits. Method An exploratory service evaluation was conducted using an uncontrolled before-and-after design with a group of inpatients (n= 75) and outpatients (n = 25) from the CTC. Reiki therapy was evaluated using an in-house instrument comprising four surveys. Measures were taken at baseline assessment and same-day follow-up in both inpatients and outpatients, with two additional follow-up time points at week two and five for outpatients. Findings An exploration of the data indicated that Reiki can provide significant therapeutic relief for the rest of the day and up to one week. Participants felt Reiki was helpful in improving symptoms of pain, tension, calmness, anxiety, stress, low mood, and trouble sleeping. Positive correlations were also found between expectations of Reiki's perceived helpfulness at baseline and perceived symptomatic improvement in tension and calmness at follow-up. Overall, the experiences were positive; 88% of participants stated they were likely to seek Reiki elsewhere and 100% stated they would recommend it to others. These findings demonstrate that Reiki is a valuable complementary therapy that is able to attenuate the stress of cancer, and its provision within hospitals settings can improve supportive care services offered to patients.
ACQUISITION OF COMPLEX THERAPEUTIC PROCEDURES IN PRE-REGISTRATION PHYSIOTHERAPY EDUCATION USING MOTOR LEARNING PRINCIPLES
(Queen Margaret University, Edinburgh, 2019) Sattelmayer, Karl Martin
This thesis focuses on the acquisition of complex procedures in physiotherapy education using two motor learning principles and reports on five separate key studies: Chapter II: A study about the definition of procedural skills in physiotherapy education using a systematic review design and a text mining approach. Chapter III: A systematic review about the effectiveness of different attentional foci on the acquisition of complex motor skills. Chapter IV: A critical analysis of mental practice interventions in health professions education: A condensed review. Chapter V: The development and validation of a mental practice script for a transfer procedure for people with hemiparesis after stroke. Chapter VI: A randomised controlled trial evaluating the effectiveness and feasibility of two motor learning principles on the acquisition of complex procedures in physiotherapy education Chapter II: Randomised controlled trials and systematic review reporting about procedural skills were systematically searched. A qualitative analysis identified several relevant sub-concepts of procedural skills such as “execution of a motor task” or “decision-making”. A quantitative analysis was performed to identify term occurrences and to create a network of associations between the used terms. Based on both analyses a novel definition of “procedural skills in physiotherapy education” was proposed and operationalised. Chapter III: Studies comparing the effectiveness of an external focus of attention versus an internal focus of attention on the acquisition of complex motor skills were systematically searched in Medline, Embase, ERIC and SPORTDiscus. Findings of a meta-analysis were in favour of external focus of attention (SMD: -0.54; 95% CI between -0.86 and -0.22). Meta-regression identified “task complexity” as potential relevant predictor variable. Chapter IV: This study analysed how mental practice interventions designed for health professions were defined, structured and adhered to proposed best practice variables of mental practice. Chapter V: A mental practice script for a transfer procedure for people with hemiparesis was developed and validated in this study. Experienced physiotherapists were interviewed how they perform the procedure. Analysis of the interviews resulted in the development of a preliminary script, which was piloted to validate the manuscript. Chapter VI: The effectiveness and feasibility of two motor learning principles (mental practice and focus of attention) was evaluated on two different task procedures in pre-registration physiotherapy education. The difference between mental practice and no mental practice was not statistically significant. Findings of the comparison of the attentional focus differed between task procedures. An internal focus of attention was more effective for the acquisition of a transfer task procedure. For the second task procedure in vestibular rehabilitation the performance between the internal and external focus of attention groups was similar. Conclusions: This was the first study, to the authors knowledge, that investigated the acquisition of complex motor task skills in pre-registration physiotherapy students. The results presented in this thesis will help inform educators and researchers regarding the use of mental practice and different attentional foci to support the teaching approach for acquisition of complex skills in physiotherapy education.
ADVANCING NURSING PRACTICE IN THE FIELD OF HEPATOLOGY THROUGH A PROSPECTIVE OBSERVATIONAL RESEARCH STUDY IMPLEMENTING INNOVATIVE SCREENING FOR LIVER DISEASE IN A COMMUNITY ALCOHOL SERVICE WITH A PORTABLE FIBROSCAN® DEVICE
(Queen Margaret University, Edinburgh, 2019) Matthews, Karen
Background Alcohol related liver disease, including cirrhosis, is a major cause of death in the UK (Williams et al 2014). Liver disease is silent and usually presents late. FibroScan® is a non-invasive tool for measuring liver stiffness; an indicator for fibrosis/cirrhosis. Socially deprived patients with alcohol related liver disease are a “hard to engage” population (Watt 2013) therefore, simple screening methods may help early identification of liver disease. Aims 1. Monitor uptake of FibroScan® in individuals accessing one community alcohol support service in a deprived area. 2. Determine prevalence of undiagnosed fibrosis/cirrhosis in study sample. 3. Monitor engagement following referral to specialist liver services. Method A prospective observational study recruited self-identified harmful drinkers between November 2014 and April 2015 for a liver FibroScan®. Participants with a FibroScan® reading of ≥7.1kPa were referred to a nurse-led liver clinic for further investigations, results of which determined referral to a liver specialist in secondary care. Participants referred were monitored for engagement over 6 months. Descriptive statistics were used to determine prevalence of undiagnosed cirrhosis and to determine engagement. Results Seventy-nine consented individuals participated, an uptake of 67% of those informed of the study (n=118). Of the 79 scans performed, three were unreliable leaving 76 participants. After scanning, 20/76 (26%) had a FibroScan® reading ≥7.1kPa requiring referral on to the nurse led clinic. All 20 (100%) engaged in further assessment. Of those, 12 required onward referral to specialist services. Subsequent compliance with specialist services in this sample (n=12) was ≥ 90%. Conclusion This nurse-led intervention advances nursing practice in the field of Hepatology. It demonstrates high uptake and subsequent engagement in liver services, giving potential for early intervention and improved health outcomes in a previously considered hard to engage population (Watt 2013). Keywords: Alcoholic, FibroScan®, liver cirrhosis, nursing assessment, transient elastography, screening.
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.
Art Therapy and Poverty: A Study of the Alignment of Practices and Therapeutic Goals of Art Therapists working in Contexts of Multiple Deprivation in Scotland
(Queen Margaret University, 2016) Watts, Patricia
Background: The impact that poverty can have on children and young people (CYP) is pervasive and can affect their emotional wellbeing, educational attainment, future life chances and can put pressure on family relationships. It is known that the impact of poverty can also create a number of barriers to CYP and families accessing services that aim to promote their well-being. Furthermore, structural factors such as current welfare cuts and austerity measures on public services mean that professionals working with people affected by poverty will have to 'do more with less'. Practitioners could fail to acknowledge this if they have little experience of poverty through their professional discourses and training. This could reinforce barriers, create a social distance between service-users and practitioners and a misalignment of assessment of priorities which could lead to inappropriate interventions being offered. Aims: This study gathered the views of 10 Art Therapists working in areas of multiple deprivation with the aim of examining their perspectives and experiences of poverty and how it is explored - if at all - within their professional practice. Also examined is the impact that working in a context of multiple deprivation has - if any - upon (i) what constitutes 'therapy' and (ii) the practices of the art therapist. Methodology: The inclusion criteria for participants was that they were qualified art therapists working with CYP in West Central Scotland (WCS) in an area of Multiple Deprivation (MD) as determined by the Scottish Index of Multiple Deprivation (SIMD). The principle data collection method consisted of semi-structured interviews, and supplementary contextualising data was gathered via fieldwork in order to make observations of the context, settings and localities where participants worked. Reflexivity was also used to process personal and professional feelings regarding the data gleaned from interviews and fieldwork. The data was analysed using thematic analysis that took a general inductive approach to generating themes. This was then triangulated with the other data gathered to enhance the validity of emergent themes. Methodology: The inclusion criteria for participants was that they were qualified art therapists working with CYP in West Central Scotland (WCS) in an area of Multiple Deprivation (MD) as determined by the Scottish Index of Multiple Deprivation (SIMD). The principle data collection method consisted of semi-structured interviews, and supplementary contextualising data was gathered via fieldwork in order to make observations of the context, settings and localities where participants worked. Reflexivity was also used to process personal and professional feelings regarding the data gleaned from interviews and fieldwork. The data was analysed using thematic analysis that took a general inductive approach to generating themes. This was then triangulated with the other data gathered to enhance the validity of emergent themes.
Closing the stable door after the horse has bolted: exploring Charcot foot health literacy among individuals with diabetic peripheral neuropathy in Scotland
(Queen Margaret University, Edinburgh, 2022) Bullen, Benjamin
Charcot foot is a potentially devastating complication of diabetic peripheral neuropathy (DPN). The frequently asymptomatic nature of this condition may lead to delayed recognition, diagnosis and pressure relief, associated with a characteristic ‘rocker bottom’ foot deformity. Deformity may, in turn, precipitate diabetic foot ulceration (DFU), infection and, ultimately, lower extremity amputation (LEA). Podiatric diabetes self-management education and support (DSMES) strategies have historically focused on DFU and LEA prevention, reserving Charcot foot information for those with ‘Active’ disease. The World Health Organisation defined health literacy (HL) as those personal traits and social support mechanisms required to understand and apply health information and access appropriate services. Specific traits and social support required to recognise and respond to early Charcot ‘danger signs’ were defined as ‘Charcot foot health literacy’ (CFHL). A resultant ‘Charcot foot health literacy conundrum’ was proposed, as individuals with DPN, ‘At-risk’ of Charcot foot, were not informed of their risk status nor did they receive targeted education or support. The research hypothesis was that individuals with Charcot foot experience, classified as ‘In Remission,’ developed specific CFHL traits through exposure to podiatric DSMES and reflection on past experience. This pragmatic, mixed methods research compared general, multidimensional HL and ‘Knowledge,’ ‘Understanding’ and ‘Contextualisation’ CFHL skills between people with and without Charcot foot experience, with the Health Literacy Questionnaire and a novel CCHAIR Study Qualitative Questionnaire, respectively. Study findings confirmed ‘At-risk’ individuals lacked Charcot foot knowledge. All participants more readily associated this condition with late-stage complications, rather than early inflammatory signs. Charcot foot experience was associated with active self-management and those ‘In Remission’ remained engaged with specialist podiatry and/or multidisciplinary services. Future DSMES approaches should target all individuals with DPN, focusing on prompt self-recognition of, and self-referral in the event of, Charcot foot ‘danger signs.’
'Definitely she used the word poison, I liked that'. Elderly Sikh immigrants' experience of a culturally adapted preventative health intervention
(Queen Margaret University, Edinburgh, 2016) Bhatti, Krishna
Aims: Punjabi Sikh immigrants are more likely to develop and live with lifestyle related illnesses than the host population. Identifying factors that influence these health inequalities is challenging. Various socio-cultural factors have shown to pose barriers for this sub-group to access mainstream preventative health services. The current study aimed to explore how elderly Punjabi Sikhs made sense of taking part in a culturally adapted health promoting intervention (CAHPI), to facilitate physical activity and healthy eating behaviours. A newly developed behaviour change model: COM-B underpinned the intervention design and contents. Method: Semi-structured interviews were conducted with a purposeful sample of 7 Sikh immigrants who had taken part in a CAHPI. The resulting data was analysed using Interpretative Phenomenological Analysis, focusing on the participants lived experience of the CAHPI. Results: The following themes were revealed: 1) “for our good health, we are getting some help with our health”, 2) “It was in our Gurdwara”, 3) “We all got together, the time passed nicely”, 4) “We are in a different stage in our lives now, we are not the same people we were 10 years ago, and 5) “You can’t learn all the things in one day, we need some more”. Discussion: The in-depth analysis allowed this generally ‘unheard’ population, to voice their views of taking part in the CAHPI. The findings showed that by incorporating meaningful components relating to the design and delivery of such interventions, wider engagement of the target population can be achieved. The IPA approach helped capture the complexities that exist between individuals within these specific populations, and the meanings they attach to the phenomenon being explored. Conclusion and implications: The current findings show the importance of drawing on a range of disciplines and guidance from the newly developed COM-B model to help identify and understand the mechanisms that facilitate behaviour change in this context. Consequently, meaningful collaboration between health care professionals and local communities can help identify strategies for addressing some of the health inequalities that exist within this marginalised community. In particular, the utility of places of worship and fear appeal approaches for delivering such initiatives, have shown to be invaluable.
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.
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.
Doing Mad Studies: A Participatory Action Research Project to explore the experiences and impacts of being part of a Mad People’s History and Identity course and the relationship between critical education, activism and emancipation
(Queen Margaret University, Edinburgh, 2019) Ballantyne, Elaine
Mad People’s History and Identity (MPHI) is a Mad Studies course delivered at Queen Margaret University (QMU). The course is a partnership including academics at QMU, Consultancy and Advocacy Promotion Service (CAPS), NHS Lothian and people with lived experience of mental health issues. LeFrançois (2016, p. v) provides a coherent definition of Mad Studies stating that “mad activist scholarship, a form of knowledge production or collective intellectual contribution that is embedded in Mad community interventions and actions.” MPHI is an exercise in critical pedagogy to facilitate “conscientisation” through the exploration of individual and collective experiences of madness, psychiatrisation and oppression. It aims to engage students in challenging dominant discourses, creating counter-knowledge and activist resistance to the Epistemic Injustice and oppression experienced by the mad community. This PAR research proposed to explore the experiences and impacts of being part of the course. Its main focus was on the exploration of the relationship between participation on the course and activism. Congruent with the philosophy of the course, this research was committed to privileging the experiences, knowledge and histories of the user/survivor/mad MPHI students. A PAR group of four students, two partners from CAPS and the author co-produced this research. Data collection involved the peer interviews of nine MPHI students. The actions of the research were the generation of a Photovoice exhibition and the production of a film. The research revealed that participation in the course had facilitated change in both mad and intersectional identities. It had given voice to experiences of distress, psychiatrisation and oppression. The collective experience had fostered support, solidarity and increased social capital. This included accessing new communities, occupations and engagement with social movements. The course had raised consciousness of personal and collective oppression resulting in agency and engagement with advocacy and activism. Key words: Mad People’s History, Mad Studies, Participatory Action Research, Activism.
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.
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.
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.
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.
An exploration of intersectoral partnerships for people with multiple and complex needs: a realist informed qualitative study
(Queen Margaret University, Edinburgh, 2019) Irvine Fitzpatrick, Linda
The well-being of people with complex and multiple needs is impacted upon by the interplay of life experiences, social determinants, contextual factors, and health conditions. People with multiple and complex needs are considered to include but not be limited to  People with severe and enduring mental health problems  People who are in contact with the criminal justice system  People with substance misuse problems  People whose life opportunities are limited due to income  People who have experienced significant trauma Despite policy imperatives, there remains a lack of systematic knowledge and practice relating to what works, for which people, and under which set of circumstances. Evaluating the evidence base for interventions for people with complex and multiple needs is complicated by several factors. Historically (and currently), interventions tend to be focused on a diagnosis, behaviours, or for a particular age range. Too often, professional services look at behaviour and conditions without exploring the wider set of relationships and opportunities and life disruptions that people might have experienced or are experiencing. Within the Lothian area, a number of intersectoral partnerships (ISPs) have been developed, focused on improving health, well-being, and opportunities for people with multiple and complex needs. The partnerships are intersectoral in that they include statutory, private, and voluntary partners working together to provide innovative interventions and services for people with multiple and complex needs. Lothian’s ISPs provide support to individuals, in response to specific needs, and may be defined by geographical locations or in respect to service requirements. However, common features of good practice are obscured by differing models for provision, apparently dissimilar client groups, and a diversity of providers and contributors. Key success features and elements of effective practice require investigation and synthesis. The current research used qualitative and realist methods to propose a “programme theory” of effective intersectoral partnership based on ISPs within Lothian. Qualitative data were gathered from 18 key informants from 6 Lothian-based ISPs. A clearer, more rigorous, and systematic understanding of ISPs for people with complex and multiple needs has been developed, with recommendations for how programmes might be developed in other areas or otherwise expanded. The Incite model is the summary descriptor of the refined programme theory. The model contains the programme theory of context, mechanisms, and outcomes which should be considered in the development of an intersectoral partnership. How the Incite model may be operationalised is discussed in the thesis, as well as implications for policy, practice and research.
AN EXPLORATION OF MIDWIFERY PRACTICE VIEWED THROUGH A SOCIAL CONSTRUCTIONISM LENS IN ORDER TO GAIN AN UNDERSTANDING OF HOW MIDWIVES PROVIDE CARE TO PREGNANT WOMEN WHO ARE OBESE
(Queen Margaret University, Edinburgh, 2020) Greig, Yvonne
To enter pregnancy whilst obese carries risk for both mother and baby but obesity rates continue to rise. Community midwives are now the lead carers for all pregnant women and will inevitably encounter women whose health is at risk due to being obese. This qualitative study has explored how midwives construct their practice when delivering care and advice to women who live with a raised BMI≥30kg/m² and what it means for them to do so. Thirteen in-depth interviews were conducted with practicing community midwives in South East Scotland. Participants were invited to complete reflective diaries. Interviews took place between January and May 2018. Interviews were audio recorded and then transcribed verbatim. Data were analysed thematically using a stepwise approach, the software package NVivo 10 was used to assist in this process. Three main themes emerged – ‘The situational context of practice’, ‘Constructing relationships and partnerships with women’ and ‘Midwives as public health agents’. Findings suggest that both the situational context and the role of community midwives is complex. Midwives appear to construct a unique approach to antenatal care as they provide care to women structures that do not appear to be flexible. They appear to ‘move’ between the paradigms of traditional midwifery practice and that of obstetric medicine and simultaneously promote normality and manage risk, in so doing they construct a unique pattern of practice. The public health agenda competes for time during appointments with midwives being expected to deliver voluminous information to women leaving little time to develop woman-focused care. Midwives rely on clinical protocols to open dialogue pertaining to obesity and its risks. Midwives could develop more personalised care schedules in partnership with women, ensuring that the woman’s voice is heard and that her needs are met. Practice may be strengthened by equipping midwives with enhanced consultation skills, enabling them to raise sensitive issues. Exploring alternative ways to address public health components may also facilitate better use of time, allowing midwives to ensure the antenatal appointment is woman-focused. Keywords – Midwives, pregnancy, obesity, public health
An exploration of nurse preceptors’ perspectives of a pre-registration nursing clinical preceptorship programme in an acute hospital context in Egypt: A constructivist grounded theory approach
(Queen Margaret University, Edinburgh, 2020) Helaly, Omnia
Background: The proposed reforms of Egyptian nursing education are based on competencies to achieve well-educated nurse graduates. There is a shortage of clinical faculty and increasing demands for nurse preceptors to act as clinical instructors. There is no national framework to prepare nurse preceptors or clinical instructors, nor a clear framework for implementation of an evidence-based competency-based pre-licensure internship. Research is needed to explore factors influencing the preparation of preceptors and preceptorship programme priorities in the nursing context in Egypt. Aim: To explore preceptors’ perspective of their previous preceptorship experiences and the factors that influence their professional role and development while introducing competency-based internship in an acute critical care hospital in Egypt. Purpose: To develop a contextual preceptorship model to help prepare professional nurse preceptors as clinical leaders within their organizations. Methodology: A qualitative inquiry approach was used with two phases of spiral Constructivist Grounded Theory to develop the proposed theoretical themes. The first study phase engaged semi-structured interviews and comparative analysis of data to construct initial codes. The second phase shared theoretical sampling with participant focus groups. Further data verified initial codes and analysis continued until theoretical themes emerged. Results: The concepts of self-awareness and self-esteem become first steps in an over-arching theme of developing preceptors as lifelong learners. These concepts emerged from the core themes of, ‘Education misalignment issues’, ‘Preceptor selection criteria’ and ‘Developing preceptors as lifelong learners. Discussion: The study analyzed findings with comparison to relevant research literature. A contextualized developmental model of competency-based preceptorship programme is proposed as based on four key phases ‘Discovery’, ‘Selection’, ‘Socialization’ and ‘Development’. Conclusion: A critical component of the conceptual model is improving self-esteem through promoting self-awareness. The proposed program can help academic and hospital leaders to sustain the competency-based internship, orientation and preceptorship to improve the quality of nursing care.
Exploring clinical research nurses’ experiences of working with clinical nurses
(Queen Margaret University, Edinburgh, 2018) Hill, Gordon
Introduction Over the last 10-15 years the role of the clinical research nurse (CRN) has evolved, with many CRNs now participating in the design, planning, analysis and dissemination of research. However, from the literature it is evidenced that despite this, CRNs have difficulties in developing a positive working relationship with clinical (ward-based) nurses. Additionally, previous literature identified that liminality, isolation, perceptions of CRNs and issues related to the transition from a clinical nurse to a CRN appeared to be important. However, the experiences of CRN’s have never been fully explored in this context. Research Question How do CRNs make sense of their relationship with clinical nurses? Methodology A qualitative approach, using interpretative phenomenological analysis, was utilised for this research. This approach allowed an exploration of the lived experience of the CRNs interactions with clinical nurses and generated real-life information on their relationships. Methods Semi-structured interviews were conducted with ten CRNs. The rich data gathered from these informed a deeper understanding of the relationships between CRNs and clinical nurses. Analysis The interviews were transcribed by the researcher and analysed individually. Once this process was completed, the findings were combined to develop over-arching super-ordinate themes. This followed the process suggested by Smith, Flowers and Larkin (2009). Findings New understanding emerged from this study, including perceptions of harm, particular issues relating to CRNs from clinical research facilities, negative impacts of poor relationships with clinical nurse specialists and how relationships with doctors can impact on how CRNs are perceived. Additionally, theoretical constructs including duality, dramaturgy and injurious misconception were also identified and explored. Conclusion The study indicated that CRNs value their relationship with clinical nurses. This relationship assists in conducting successful clinical research and confirming the importance of the CRN role. However, there appear to be some difficulties that should be addressed, to further enhance this relationship for the benefit of patients, CRNs and the clinical nurses.