The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7193

Browse

Now showing 1 - 20 of 50

Addressing Non-Communicable Diseases in Fragile Lebanon: A Mixed-Methods Research Study
(Queen Margaret University, Edinburgh, 2023-06-28) Bou-Orm, Ibrahim
Introduction: Lebanon has faced a substantial increase in the burden of NonCommunicable Diseases (NCD) over the last decade. There is a dearth of research focusing on health systems and policy responses to NCD. This PhD thesis analyses how the NCD burden is addressed in the context of fragile Lebanon and identifies policy-, health system- and community-related factors affecting NCD prevention and control. Methodology: This thesis adopts a pragmatic paradigm and incorporates: 1. a political economy analysis of NCD, based on a literature review; 2. a system analysis of NCD prevention and control, based on semi-structured interviews and group-model building workshops with 79 health providers and community members in urban Greater Beirut; 3. a survey with 941 persons living with NCDs to identify the magnitude of key factors affecting NCD control in Greater Beirut. Findings: The political economy analysis revealed an unbalanced power relationship between NCD policy promoters (e.g. civil society) and blockers(e.g. private entities). This has led to a gap in the prevention policy landscape. Care is provided under the auspices of a highly privatized hospital-centric model where services are offered for commercial gain rather than public good. The systems analysis validated these insights, with health provider and community participants linking the challenging socio-political environment to lacking prevention policy/action. This increases NCD incidence and creates barriers in accessing care. Experiences with NCD care were noted to be varied and influenced by perceptions of service quality and trust in providers. The survey confirmed that inequities in access to care exist in Greater Beirut and highlighted that service delivery patterns differ by provider. Communities evaluated different dimensions of trust in healthcare and identified gaps in the reliability, fairness and fidelity of the current system. Conclusions: The thesis concludes with an overview of how to strengthen Lebanon’s response to NCDs.
Agency and wellbeing in the context of early marriage: A qualitative inquiry into the northern Nigerian context
(Queen Margaret University, Edinburgh, 2018) Zasha, Doosuur
According to the literature, early marriage remains a problem due to the limitations it places on the educational and economic opportunities of the young girls involved, as well as the variety of health complications they suffer as a result of this. Although early marriage is prevalent in Nigeria, regional differences indicate the northern part of the country as having a higher percentage of girls who marry before the age of 18 compared to the south. Most research and advocacy efforts, as well as related programmes and policies, rightfully focus on the prevention of early marriage but neglect the adolescent girls who are already married. This study focuses on the lives of young married girls, highlighting the process through which they get married as told from their own perspective, and explores their accounts of life after marriage particularly illuminating their health needs and overall wellbeing. Using semi-structured interviews, focus group discussions participatory techniques, and participant observations, 24 young married girls between the ages of 15-25 from Nasarawa state in Nigeria, were recruited for this study, adopting a mixture of principles borrowed from ethnography and grounded theory. The analysis highlights the personal agency exercised by some of the girls in their decisions to get married but also demonstrates how said agency is constrained by the context in which it is exercised. Analysis further reveals the underlying influences behind the constructions of health and illness held by young girls and explores ways in which they primarily seek to address their health and wellbeing. The accounts of these girls also point to strong associations between their wellbeing, economic factors, relationships and experiencing self-worth. This dissertation will contribute to knowledge around early marriage in Nigeria and Sub-Saharan Africa and highlight nuances around the decision-making process at the time of marriage. It also offers insights as to how young girls construct wellbeing in the context of marriage hereby contributing to knowledge around wellbeing in poorer populations in Nigeria and arguably, similar African contexts.
Alleviating psychosocial suffering: an analysis of approaches to coping with war-related distress in Angola.
(Queen Margaret University, 2001) Eyber, Carola
This study investigates the role that the notions of trauma and culture play in relation to the alleviation of distress within an war-affected population. It analyses how local, cultural conceptions of distress and those held by psychological service providers relate to one another, and how they contribute to improving the well-being of the displaced. Fieldwork was conducted with urban and rural displaced populations in the south-eastern province of Huila in Angola. Ethnographic, psychometric and participatory methods were used to examine issues of health, illness and distress amongst the displaced. Local idioms of distress in the form of pensamentos, mutima, madness and high and low blood pressure are common ways of expressing suffering related to war. The different explanatory models held about these illnesses and the various resources available in the popular, folk and professionals sectors of the health care system were explored. The religious and spiritual domains were found to be influential in the treatment of distress-related illnesses. The psychological services available in the war-displaced communities were examined in terms of their common theoretical and practical elements. These were then analysed in relation to the conceptualisations held by local populations, and points of similarity and difference were noted. Specifically, the conceptualisation of suffering as trauma and the cultural misunderstandings that arise as a result of this, and the representation of the displaced as traumatised and therefore dependent and passive people, are discussed. A particular subgroup in the community, the adolescents, was identified and participatory methods were employed to investigate the strategies and resources this group uses for coping with war-related distress. The youths predominantly make use of distraction, conselho, religious and cultural resources. The application of a PTSD scale, the EARAT, suggests that 71% of the adolescents had symptoms of trauma consistent with a diagnosis of PTSD. It is argued that for the vast majority such a conceptualisation does not reflect the adolescents' abilities to function on social, vocational, educational and physical levels. The implications of these findings for research and practice in the field of psychosocial work are discussed.
An assessment of the capacity of faculty-based youth friendly reproductive health services to promote sexual and reproductive health among unmarried adolescents: evidence from rural Malawi
(Queen Margaret University, 2009) Jimmy-Gama, Dixon
Despite the recognition of the influence of cultural norms on adolescent sexual behaviours in most societies (Kaler 2004; Chege 2005), less attention has been paid to the link between social norms and effectiveness of health facilities to promote adolescent sexual and reproductive health (ASRH). This thesis therefore examines the capacity of facilitybased youth-friendly reproductive health services (YFRHS) to promote ASRH in rural Malawian societies where culture strongly influences adolescent sexual behaviours. The study employs a social constructionist epistemology and a social interactionism theory to understand the capacity of YFRHS in ASRH promotion in rural Malawi. Qualitative and quantitative data were collected using a sequential exploratory design. Semi-structured in-depth interviews, participant observations, client exit interviews, survey, focus group discussions and review of health strategic and service utilisation documents/records were conducted. The results were generated by triangulating both qualitative and quantitative data. The findings of the study illuminate how social norms related to social identities influence adolescent sexual behaviours and ASRH promotion. An exploration of the cultural context reveals a major disjuncture between an ideal norm - no premarital sex - and a modelled norm where unmarried adolescents are expected to engage in unsafe sex. It also shows the conflicts between the cultural and scientific models of ASRH promotion. Structural gender asymmetry that emphasises subservience in females and hegemonic masculinity also reduces adolescents' rights and agency in SRH promotion. The health providers are cultural agents. They manage diverse roles both as 'moral guardians' and as 'health promoters' in a way that limits their effectiveness as health promoters. The thesis concludes that the way facility-based YFRHS is implemented has limited impact on SRH promotion among unmarried adolescents of rural Malawi. The study recommends that appropriate health promotion interventions based on conscientisationoriented empowerment theories directed at adolescents, community and health workers should be used in ASRH promotion in societies with strong cultural influence on sexual behaviours.
An economic analysis Of retail pharmaceutical market In Nigeria: towards access expansion and policy
(Queen Margaret University, 2014) Usar, Joseph Iornumbe
Rural areas in much of sub-Saharan Africa access needed health care from untrained and often poorly regulated drug vendor shops with concerns over the quality of products and services provided and their public health implications. The thesis undertook to understand market relationships in a rural retail drug market in the light of the structure-conduct-performance paradigm and isolate opportunities for potential policy interventions for improved access to quality and safer medicines. Data was collected from a sample of patent medicine vendors and drug purchasers in Katsina-Ala Local Government Area of Benue State, north central Nigeria, over 9 months in 2012. Information from drug vendors and drug consumers was generated through semi-structured questionnaires, in-depth interviews and systematic business transaction observations. Key state and national drug regulatory officials were also interviewed in-depth and related documentary data collected and evaluated. Data analysis focussed mainly on the relationships between market structure, provider conduct, consumer behaviour and the nature of regulation, with the aim of understanding market performance in relation to access to medicines and their rational use. The study established that patent medicine vendors were an important source of medicines for inhabitants of the local government for ambulatory primary health care. Drug retailers were said to be a reliable source of a wide range of drugs provided at relatively more affordable prices and in a convenient way that satisfied consumer expectations. However, a number of market failures existed: low quality of treatment due to poor provider knowledge of diseases and drugs and therefore inappropriate prescription and dispensing practices. Ineffective regulation was also demonstrated by way of inappropriate and inadequate regulatory regime, occasioned by wide spread regulatory infractions. To attain the desirable public health objective of sustained improvement in the quality of products and services obtainable at patent medicine vendor outlets, regulatory strategies must be contextually relevant, providers must be trained and offered financial and business incentives and consumers must be empowered by accessible and timely health information for informed choices against the backdrop of strengthened and better incentivized inspectorate unit in a systematically intertwined approach.
ANTENATAL CARE EQUITY & SOCIAL EQUALITY FOR WOMEN WITH FEMALE GENITAL MUTILATION (FGM) IN SCOTLAND: A MULTI-STAKEHOLDER VIEW
(Queen Margaret University, Edinburgh, 2023-10-25) Di Rosa, Amanda I.
This thesis describes a case study of an NHS Scotland antenatal care pathway for women with female genital mutilation (FGM), and includes recommendations for the field of antenatal FGM management. Over the last decade, reports of substandard antenatal FGM management from a rapidly growing population of affected women have increased demands for just and equitable healthcare. Consequently, in 2015, a health board in the central belt of Scotland established a multidisciplinary FGM management programme. To determine the impact of this programme on antenatal care equity and social equality for women with FGM its guidelines, interviews with community midwives (CMWs), FGM specialists, and women with FGM were conducted. The findings were analysed using critical communicative methodology (CCM). The findings on the development, organisation, and delivery of the pathway demonstrate the transformative impact of multidisciplinary resources for FGM management and support on equitable antenatal care access when embedded into routine antenatal policies and practices. The findings also show how the absence of robust monitoring and evaluation processes enables contested practices and limits care equity for non-pregnant women with FGM. Novel contributions of this study link social and emotional FGM training to reciprocal improvements in confidence, trust, and communication between CMWs and women with FGM. FGM specialists who empower women to advocate for themselves and their relationship with the practice of FGM are also found to be central to the delivery of sensitive, relevant, and person-led antenatal care. Furthermore, the interdisciplinary implications of this study offer relevant insight for research, development, and service provision beyond Insight. Most notably, until unjust educational and financial health system policies are challenged, experiences of unresolved intersectional discrimination will continue to disproportionately disadvantage migrant women with FGM.
Climate impacts, water quality and citizen science in coastal southern Connecticut: A review of factors supporting practical public health engagement - A qualitative study on citizen science & climate change.
(Queen Margaret University, Edinburgh, 2023-06-28) Pascucilla, Michael
Reflecting trends across the United States and globally, Connecticut’s coastal communities are facing climate change impacts. There is an agreed need to prepare for further, more substantial effects of climate change, including water quality impacts in Long Island Sound. This thesis examines citizen science's effectiveness in addressing local climate change and water quality impacts on shoreline communities. Through a retrospective analysis, the dissertation examines and extensively scrutinises five study outputs plus one U.S. Patent in order to explore the best strategies for community understanding and participation. The thesis discusses established public health frameworks and models and associated themes. It moves on to investigate linkages between stakeholder participation and education, and examines the relationship between community engagement on the one hand and successful public health practical epidemiology and academic work on the other hand. Through an inductive approach, this qualitative research also investigates a range of root cause strategies for creating public interest and building community resilience in a transparent and trustworthy manner, in the context of addressing climate change impacts and improving water quality. An exploratory approach examines best practice models and frameworks within the public health literature with the aim of explaining and understanding the relationships between successful public health implementation and the challenges and barriers faced. Study results demonstrate the use and capacity of citizen science, where using innovation is an effective collaborative approach that can empower local communities to address environmental concerns such as climate change and water quality issues. The thesis takes account of the boundaries and limitations to community engagement work, both as observed within the study outputs and as cited in academic literature.
A COLLABORATIVE CARE MODEL FOR PERINATAL MENTAL HEALTH CARE IN SIERRA LEONE
(Queen Margaret University, Edinburgh, 2023-12-13) Bah, Abdulai Jawo
This study explored idioms of distress and explanatory models for perinatal psychological distress, developed a reliable and validated screening tool, and culturally adapted a problem-solving and behavioural activation intervention. Based on the proposition of the biopsychosocial vulnerability distress and outcome model, I applied mixed methods research in three phases of the study to (1) understand how pregnant women and new mothers experience and express perinatal psychological distress, their coping strategies, and their help-seeking behaviour (2) develop and validate a ten-item screening tool for perinatal psychological distress and use it to assess the prevalence of and risk factors for perinatal psychological distress, and (3) culturally adapt a problem solving and behavioural activation intervention for these pregnant women and new mothers. The ethnographic phase showed women use their hearts and (heads, minds, and brains) to express their emotions and thoughts, respectively. Thinking too much and stress were the most frequently mentioned symptoms. Their distress was related to marital or partner disharmony, gender norms, problems with in-laws, poverty, ill health, and a lack of basic amenities. They consulted religious leaders, herbalists, friends, neighbours, and family members for help for the most part. Their coping strategies included prayers, sleeping, listening to music, and sometimes alcohol to forget about their problems. During the tool development phase, we developed a ten-item tool and established a cut-off point at eight using an emic-etic approach. In the survey phase, we recruited 420 participants and measured antenatal and postnatal psychological distress prevalence of 208 (55.3%) and 212 (64.2%), respectively. Hunger, insult or rude treatment from nurses during antenatal care, ill health, and hostile in-laws were found to be independent predictors of antenatal psychological distress. Furthermore, postnatal psychological distress was independently predicted by having an unfaithful partner, inter-partner violence, ill health, and hunger. However, an income-generating activity was found to be protective for both pregnant women and new mothers. During the intervention phase, using a mixed method approach, 39 perinatal women (control = 19, intervention = 20) were randomly allocated at the community level to culturally adapted problem solving and behavioural activation interventions and a control group. The effectiveness, feasibility, and acceptability of these interventions were explored. Primary outcomes included were psychological distress and functional capacity, which were assessed at baseline, after two weeks, and at the end of the 4-week period. The results showed a reduction in symptoms with a moderate effect size (Cohen’s d = 0.40) and an increased function with regards to their daily tasks. The intervention was deemed feasible and acceptable by the laywomen in the community that delivered the intervention as well as the pregnant women and new mothers. The study identified idioms of distress and explanatory models that can be used to improve communication during clinical encounters between perinatal women and healthcare workers, which will decrease stigma and increase engagement with services. The newly developed tool can be used to screen perinatal women into services and assess their response to these services over time. The study also showed that PST is likely to be feasible, acceptable and effective. There is a need to do further studies using a fully powered randomised control trial to demonstrate effectiveness and to understand how this intervention can be integrated into the primary health care and scaled up nationwide.
Corporate social responsibility in the Ugandan alcohol industry: its contribution towards the prevention and mitigation of HIV and Aids.
(2017) Bakojja, Nabulya Ninah Diana
This thesis sets out to determine the contribution made by the Alcohol Industry in Uganda towards HIV and AIDS treatment, care and prevention through Corporate Social Responsibility (CSR) activities. Adopting a qualitative case study approach from two multinational breweries; Diageo and AB InBev, data was collected during fieldwork in Uganda using individual interviews, participant observation, two group interviews and secondary data from breweries and partners’ annual and media reports. The main study participants were brewery managers, health workers from partner health centres and beneficiaries including farmers and people living with HIV at the health centres. It is argued that the CSR activities of companies are established as a response to the perception that the high alcohol consumption in Uganda leads to greater risk behaviours for HIV. The study adopts Corporate Social Performance Framework (Ten Pierick et al. 2004) to identify the motivation of breweries to engage in HIV related CSR and the key activities that the breweries engage in. CSR activities include awareness raising, testing and counselling for HIV and AIDS. In addition, the breweries have improved the livelihoods of farmers through the provision of regular contracts to buy grain for brewing. This is perceived by stakeholders to have both a beneficial and detrimental effect: the regular income lifts poor populations out of extreme poverty. However, improved livelihoods can also enable access to social activities which have the potential to increase the risk of HIV infection. Findings from this research highlight the stakeholders’ views that the CSR activities are perceived as strategic due to the fact they have greater benefit for the breweries themselves rather than being largely altruistic. Furthermore, the most significant contribution of the CSR activities is the improved livelihood for farmers, which results from regular and consistent contracts for purchasing grain. This study makes a significant contribution to the field by carrying out a stakeholder perspective of CSR activities in a resource poor setting in the global South. Two distinct disciplines, business studies and global health, have been brought together in order to deepen understandings and provide a rich insight into the ways in which CSR activities can contribute to global health issues with both intended and unintended consequences.
Crossing boundaries for maternal health: a qualitative investigation into the role of community health workers as frontline providers of maternal care in the Peruvian Andes
(Queen Margaret University, Edinburgh, 2015) Vidal, Nicole L.
Despite its status as a middle income country, Peru has one of the highest maternal mortality rates in the Americas. In the Andes region, poor, rural indigenous women are more likely to die from pregnancy related complications than their urban counterparts because they are denied the same level of maternal health services other women in the country receive. Barriers to care include geographic isolation, health staff members who do not speak indigenous languages, and cultural and ethnic discrimination. As a result, indigenous Andean women in need of maternal health services face a significant degree of social exclusion and institutionalized racism which hinders the accessibility, acceptability, and quality of maternal health services offered to them. One approach to improving access to health services has been through the use of Community Health Worker (CHW) programs. Although CHWs are recognized as an important frontline health source, there is a significant lack of literature concerning their role as community level providers of maternal health services. Using a combined grounded theory and case study methodology, this qualitative study investigates the experiences of CHWs working in Andean communities and their relationships with other community members and health and social service professionals. Findings from this study suggest that CHWs can be enabled to bring care directly to their communities in a way that community members can relate to and feel comfortable with while also forming part of the wider health system. Focusing on participants' reports of challenging cultural and ethnic boundaries through a process of ethnic bargaining and adopting professional affiliation, this study identifies CHWs as a potentially vital link between rural community members and other providers of these services. If the right factors are met, such as finding ways to navigate the tensions between traditional and biomedical health care models, CHWs can be considered critical community level health providers who can communicate the value of both models, thereby improving the accessibility, acceptability and quality of maternal health services. However, the root causes leading to social, structural and institutional boundaries to care still need to be addressed. As such, this study aims to fill a significant gap in current research on the role of CHWs in Peru, specifically in the ways they are enabled to negotiate ethnic discrimination within the health system.
Decentralisation in the post-conflict environment of Guatemala: a critical examination of the evaluation process of community participation in a health sector reform context
(Queen Margaret University, 2007) De Leon Estrada, Mario Sergio
This thesis focuses on a critical and comprehensive analysis of community participation within a health sector reform process in a post-conflict environment. The aim is to examine how evaluation of such processes should be guided, how decentralising policies should be implemented, and how the assumptions of existing evaluations limit their relevance and effectiveness. The thesis argues that comprehensive analysis demonstrates the need for a much deeper and more extensive understanding of the multiple complexities present in post-conflict environments than is often achieved. It is necessary to carry out a historical, comparative and analytical evaluative exercise, beyond mainstream structural-functionalist evaluations, because the latter generally do not address relevant external and internal variables affecting the conditions of the community. Utilising this proposed approach fieldwork in the communities of San Juan Chamelco and San Miguel Tucurú (in the northern department of Alta Verapaz) examined examples of the limitations of and potentials for the incorporation of traditional medicine into the institutional healthcare system. This fieldwork is used to inform development of a comprehensive framework for evaluation with wide potential as a technical-conceptual tool. The Guatemalan case is presented as an illustrative example of how this tool can be developed and elaborated within a specific historical, political, social and cultural context. Building on the findings of a sectoral evaluation carried out under the auspices of the Ministry of Health the comprehensive evaluation presented identifies key problems that prevented health decentralisation policies from having a significant and positive impact at the local level. In this complex post-conflict environment, local organisation and community participation are shown to be still in their infancy having been obliterated by the counter-insurgency policies during the course of prolonged conflict.
Delivering ART service in Thailand: predicting future workforce requirements and deployment patterns enabling and sustaining universal access through different models of care
(Queen Margaret University, 2014) Jirawattanapisal, Thidaporn
Thailand introduced universal access to Anti-retroviral treatment (ART) service in 2003. This became the main factor increasing demands for services with increasing numbers of People living with the Human Immunodeficiency Virus (HIV) and the Acquired Immune Deficiency Syndrome (AIDS), (PLHIV) and those people living longer. Since 2011, two other factors altered the ART service provision: changes in enrolment criteria to allow PLHIV with high CD4 count (a blood test that establishes the stage of immunosuppression), access to the ART service, and decentralisation changes allowing easier access to ART at peripheral levels. This study therefore examined how service providers at all levels of care deliver ART services, and developed a tool to estimate future requirements for those providers. The case study uses mixed methods including both quantitative and qualitative approaches. Two stages of data collection were conducted; fieldwork to collect data on activities and flow of ART services, and time required for each type of service provider. These become the input data for a second stage to project staffing requirements based on Markov and Monte Carlo analysis to 2025. Three models of ART services were found, across all levels of facility in the public sector operating in high HIV/AIDS prevalence settings,: community-based, doctor-led and mixed-comprehensive. All models adapted their ART services from the national guidelines by applying HR strategies: task shifting, skill mix and community-based approach, to maintain/increase accessibility and quality of care. The estimation of time required to provide ART service of providers was estimated. 60 full time equivalent (FTE) providers (doctors, nurses, pharmacists, pharmacy technicians and non-healthcare providers) in 2012, projected to almost double in 2015. This study found negligible gaps (0.02-0.05%) between needs and availability of healthcare providers to deliver ART service. The HR strategies investigated, were sufficiently widespread to be worth recommending for wide application in human resource planning. Moreover, the tool developed to estimate the requirements for healthcare providers from this study could further support forward towards planning for HIV/AIDS services in Thailand and possibly elsewhere.
Elderly carers: the experiences of the elderly caring for orphans and vulnerable children in the context of the HIV/Aids epidemic in Chiradzuru district, Malawi
(Queen Margaret University, Edinburgh, 2015) Kachale, Blessings
PURPOSE: This qualitative study explores the day-to-day care experiences and livelihoods challenges of the elderly carers of orphan and vulnerable children (OVCs) in rural Chiradzuru district in Malawi. The study aims to highlight the impact of AIDS mortality on Elderly Households' livelihood assets. METHOD: Using case study approach data was collected from 43 cases comprised of 23 individuals and 3 Focus Groups. The main study participants were elderly-headed households caring for OVCs. Data was collected and the evidence converged using the Sustainable Livelihood Framework (SLF) to analyse findings. FINDINGS: The main ten study participants were between the ages 55-90+ caring for thirty-eight OVCs; seven of whom were single females caring for OVCs aged between 2-16 years old-some of them caring for second generation of orphans(great grandchildren). Although this is crisis-led fostering, most of the elderly have accepted the responsibility regardless of their capabilities. This highlights the value of family based care in these families. Six of the ten elderly carers had lost a significant number of assets to AIDS sickness and death of family members. A few had given up their wage earning livelihoods to care for OVCs while for the very old (71-90) their physical old-age disabilities affected pursuance of livelihoods impacting their food security and acquisition of basic needs. There was mutual reciprocity between the OVCs and their carers to pursue livelihoods which increased household resilience. Conclusion: The elderly in Chiradzuru need social security support so that they must not give up care of their children to alternative care arrangements which can contribute to trauma on OVCs.
EVALUATION OF NARRATIVE PRACTICES INCLUDING TREE OF LIFE TO DEVELOP THE EMOTIONAL RESILIENCE OF REFUGEE YOUNG PEOPLE AND FAMILIES
(Queen Margaret University, Edinburgh, 2024-10) Hughes, Gillian
As the global migration crisis gathers pace, the severe emotional challenges inherent in forced migration emphasises the urgent need for effective mental health support for refugee communities. This thesis examines how to develop the emotional resilience of refugee children, young people, and their parents using strength-based collective narrative methodologies, including the ‘Tree of Life’ (ToL) and adapted versions. This work offers a response to critique western psychological models which, it is argued, are culturally limited and based on narrow conceptualisations of resilience. Four studies evaluating narrative interventions for refugee youth and their families are reviewed - within UK statutory mental health services and the contrasting context of an unofficial refugee camp in France. Drawing on constructivist and critical realist paradigms, mixed methods and practice-based evidence are used to identify outcomes reported by refugees which are likely to promote resilience. These included the development of self-confidence and positive self-identity; improvement in social relationships and connection with community; and a clearer sense of purpose and hope for the future. These findings challenge the predominant view of resilience embedded in western psychotherapy models, which focus on directly addressing symptoms of trauma with individuals. Narrative therapy moves beyond this medicalisation of mental health by positioning people as survivors who have resources, skills, and agency in their own recovery to build resilience. It emphasises a non-expert and collaborative stance which honours culturally determined views of healing through social connection and mutual support. This thesis poses timely and pressing questions about how individuals who have experienced extreme adversity and abuse are supported. As an intervention that does not rely on the expertise of highly trained professionals, narrative practices and specifically ToL are particularly relevant in the current UK context of diminishing resources and increasing need and may translate to humanitarian contexts, although this warrants further research.
FAMILIES OF CARE AND CONNECTION: A RELATIONAL EXPLORATION OF HOW REFUGEES NAVIGATE STRUCTURAL CONSTRAINTS TO INTEGRATION IN THE UK: A critical appraisal submitted in fulfilment of the requirements for the degree of PhD by Publication (Retrospective)
(Queen Margaret University, Edinburgh, 2025-10) Baillot, Helen
Drawing on data from three inter-related studies, the four papers considered in this critical appraisal foreground the role played by social connections – relationships with other people, organisations and statutory bodies – in integration. My central argument is that family and family-like relationships are critical to refugees’ experiences of navigating new systems and structures in countries of settlement. These relationships are defined, developed and sustained through practices of care. I therefore position both care and family as central vectors in integration and as sites where refugees are agentive decision-makers shaping their own integration trajectories. Empirically I call for researchers and practitioners to move away from individualistic notions of integration to fully incorporate the family and the care that flows through family-like relationships into the design and delivery of research and practice. Conceptually, I outline the ways in which this process of incorporation moves us away from integration and towards an alternative feminist post-migration ecological framework, within which orientations and practices of care play a crucial role.
FROM SCOPING TO SCALING: COLLABORATIVE INDIVIDUAL PATIENT DATA PLATFORMS FOR NEGLECTED INFECTIOUS DISEASES: A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy [PhD by publication]
(2025-10) Maguire, Brittany Jane
This thesis presents the rationale and theoretical context for a portfolio of published work examining the clinical study landscape across five different neglected and poverty-related diseases (NPRDs). It critically analyses the limitations of traditional aggregate meta-analysis for synthesising evidence for these diseases, demonstrating how challenges such as limited volume of trials and enrolled participants, methodological heterogeneity and inconsistent reporting necessitate alternative approaches. Meta-analysis of individual patient data (IPD) is proposed as an alternative; however, access to IPD raises legal, ethical, and technical barriers, which I critically examine, drawing on the experiences gained through stakeholder engagement. I engaged with the disease specific research communities to assess the feasibility of building global collaborative data platforms which can provide solutions to the many challenges of sharing IPD. The common difficulties identified in my publications across the NPRDs, together with the limited global attention, funding, and resources available, strongly reinforced the need for a unified data-sharing infrastructure to enable economies of scale. My work directly informed the evolution of the Infectious Diseases Data Observatory (IDDO) Roadmap, a framework of tools, templates, and resources to streamline platform scoping and development, reduce duplication, and adapt processes efficiently to new disease areas. I also demonstrate how systematic review outputs from my publications evolved into dynamic, openaccess tools that enhance the discoverability of IPD and promote data-sharing. I describe the development of a research community consensus-driven process for generating research agendas that enable the meaningful re-use of IPD to address critical knowledge gaps in these under-researched disease areas. My contribution helped shape and operationalise the vision of IDDO as a researcher-driven initiative to build data platforms, supporting the identification, collation, and harmonisation of IPD to promote meaningful data re-use and advance the treatment and control of neglected infectious diseases.
Healthcare markets in post-conflict settings: Experiences of formal private-for-profit healthcare organisations in Gulu District, Northern Uganda
(Queen Margaret University, Edinburgh, 2020) Namakula, Justine
There is a paradox between the post-conflict setting and the healthcare market in Northern Uganda. While there is a strong missionary sector and apparent ongoing rehabilitation of the government facilities, the popularity of the formal private for-profit sector has steadily increased in Gulu municipality, northern Uganda, which has a high poverty-afflicted population. Therefore, there is need to understand why and how we can leverage the potential of the formal private for-profit providers (FPFPs) to accelerate Universal Health Coverage (UHC) goals. The study explored the experiences of the FPFPs based in Gulu municipality regarding the market in which they operated during and after the conflict. In particular, the study sought to understand the characteristics of and changes in FPFPs over time, as well as the challenges, coping strategies, opportunities, and linkages with others in the market. This was a case study using mixed methods with a quant-qual sequential approach. The methods included organisational survey, life-history interviews, key informant interviews and observation. This study utilised the New Institutional Economics (NIE) theory as an analytical lens. Data analysis was conducted using SPSS, ATLAS.ti ver. 7.0 and UCINET ver. 11.0 software. The findings suggest that FPFPs increased in number and experienced internal changes within individual businesses across the conflict periods. Conflict provides the context in which the FPFP businesses started and operate (d) and explains their survival patterns and the emergent regulatory context. The FPFPs were faced with diverse challenges embedded in the active conflict that further complicated operational costs and regulatory mechanisms. Notably, some of the coping strategies compromise the quality of the services provided. There is a dense relational network for FPFPs in Gulu municipality, and these numerous relational links have positive implications for the broader coverage of the goal for UHC, the reduction of transaction costs as well as their continued relevance in the market. FPFPs were continuously faced with a dilemma of balancing optimization of their incomes with their altruism objectives. In the period following conflict, FPFPs attempted to implement various mechanisms to ensure that the poor could access health care. The mechanisms were enabled by the managers’ ad hoc judgements as well as partnerships with the local government and NGOs in the area. These ranged from price exemptions and reductions to price discrimination and breaking down doses. The study concludes by noting that FPFPs play a critical role in service provision in post-conflict northern Uganda. However, they cannot be ‘exclusively’ pro-poor, given that they are formed with a profit maximization objective. Some coping strategies and some mechanisms to enable the poor to access services may compromise quality. Hence, the government needs to enforce regulations to control the number of FPFPs opening business as well as quality. There is evidence of partnerships between the government and FPFPs. This needs to be continuous and expanded to include more FPFPs if UHC goals are to be achieved.
Humanitarian workers in South Sudan: Mental health, gender, and organizational staff support
(Queen Margaret University, Edinburgh, 2019) Strohmeier, Hannah
This study focused on humanitarian workers in South Sudan and the interrelation of mental health, gender, and organizational staff support. Based on the propositions of Job Demands- Resources (JDR) theory, I applied mixed methods research in three research phases to 1) investigate prevalence and predictors of common mental health problems among national and international humanitarian workers; 2) examine international humanitarian workers’ lived experiences, particularly with respect to gender; and 3) crystallize implications of these findings for humanitarian stakeholders, particularly with respect to organizational staff support. The survey phase estimated prevalence rates of post-traumatic stress disorder (24%), depression (39%), anxiety disorder (38%), hazardous alcohol consumption in men (35%) and women (36%), and the burnout components emotional exhaustion (24%) and depersonalization (19%). Chronic stress was most consistently associated with mental health problems. Dysfunctional coping predicted mental health problems among humanitarian workers, but emotion-focused and problem-focused coping were neither protective nor predictive of the outcomes studied. Surprisingly, gender was significantly associated with anxiety only, with women being more likely to experience symptoms associated with anxiety diagnosis. However, the focused qualitative phase indicated that gender substantially influenced international humanitarian workers’ lived experiences. Men perceived Juba as a convenient duty station. Women experienced a feeling of loneliness on site, and considered it challenging to combine their profession with family life. There was a gap between international humanitarian workers’ needs for psychosocial support, and the attention paid to these needs by themselves and their organizations. The evaluation phase showed that organizational staff support provided by NGOs was insufficient to address employees’ needs. As expected, national staff had less access to services than international staff, and organizations neglected gender in their staff support programs. This study provides tailored recommendations to address the identified challenges and gaps in staff support. It demonstrates that a more nuanced version of JDR theory is required to be applicable to humanitarian settings.
THE IMPACT OF COVID-19 ON THE CHILD PROTECTION SYSTEM IN BANGLADESH
(Queen Margaret University, Edinburgh, 2023-06-28) Calpona, Elisa
This dissertation reviews the impact of COVID-19 on the child protection system in Bangladesh and approaches adopted by UNICEF to address there. Bangladesh represents a very rich scenario for a case study on child protection and COVID-19, with several child protection issues of concern interconnecting. Prevalent issues include violence against children and women (VACW) and harmful practices such as child marriage and child labour, both intersecting with humanitarian crises for the Rohingya refugee population. The core research addressed is: “How has COVID-19 impacted the child protection system Bangladesh?”, which is addressed with a mixed methods approach. A definition of child protection is provided, presenting the criteria utilized to assess the child protection system and its adjustments in Bangladesh during the course of the COVID-19 pandemic. The thesis elucidates both the impact of COVID-19 on violence against children and harmful practices in Bangladesh as well as UNICEF support to the Government of Bangladesh. It is shown how COVID-19 provided an entry point for UNICEF Bangladesh to accelerate and expand some of its previous investments in the elimination of violence against children and the strengthening of a child protection system. The thesis concludes that there was a major shift at the government level from a project based and vertical programmatic response to a much more sustainable and scalable approach. This brought tangible progress in the establishment of a child protection system to prevent violence against children and women and harmful practices.
Impact of the performance-based payments on health workers in contracting out government health services: Cambodia's experience
(Queen Margaret University, Edinburgh, 2014) Abe, Kimiko
Contracting out government health services has been increasing in low and middle income countries (LMICs) and highly valued in improving health service delivery. In some cases, government health workers have been paid performance-based payments; such payments have been quoted to contribute to the achievement. However, impacts of the payments on the health workers' total income including income from their private practice and the government salaries have been little studied, while their private practice have posed serious issues in the service delivery with the constraint from low government salaries. The impacts at the household level have been unstudied.