School of Health Sciences
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Item 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 JaneThis 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.Item 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, HelenDrawing 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.Item Finding Our Way, Telling Our Stories: A Story-Informed Transformation Toward Person-Centred Culture and Practice after Australia’s Oakden Report: An introduction and critical appraisal in partial fulfilment of the Doctor of Philosophy degree by retrospective publication.(Queen Margaret University, Edinburgh, 2025-10) McKellar, DuncanThis doctoral study by retrospective publication examines the transformation of health, aged and social care environments from dehumanised and dysfunctional into compassionate, person-centred cultures. The research is grounded, firstly, in my experience as a reviewer of South Australia’s Oakden Older Persons’ Mental Health Service, a profoundly flawed institution whose exposure led to several national inquiries and, secondly, in my subsequent experience as the strategic clinical lead of systemic reforms occurring after the report’s publication. Through immersive, embodied scholarship, involving practice-based learning, reflective practice, and autoethnographic research, this study explores the role of storytelling as a mechanism for culture change. The thesis explores the relationship between storytelling, organisational culture, and person-centred care, synthesising insights from philosophy, theology, and social science. It argues that a story-informed approach—where storytelling and story-listening are embedded in work and care practices—enhances empathy, disrupts power hierarchies, and fosters psychologically safe environments. This principle, alongside the co-designed Culture Framework developed in the Oakden reform process, provides a strategic model for sustainably embedding person-centred values into health, aged, and social care services. The critical appraisal considers theologically informed personalism as an ontology, functioning as a wellspring for a dynamic embodied scholarly practice. It also positions storytelling as an epistemology that humanises care and builds ethical, empathetic, and inclusive cultures. It evaluates the study’s methodological foundation in evocative autoethnography and reflexive scholarship, addressing the ethical complexities of narrating lived experience. The findings affirm that systemic failures, such as those at Oakden, are often rooted in the erosion of personhood and relational care. By offering an applied model of cultural transformation, this thesis contributes new knowledge to the field of person-centred practice, advocating for narrative as a central mechanism in achieving sustainable, compassionate care environments.Item Technology is nothing, the terrain is everything: Factors influencing the implementation of point of care testing for Malaria, Human Immunodeficiency Virus (HIV) and Tuberculosis within East Africa.(Queen Margaret University, Edinburgh, 2025) Willetts, AnniePoint-of-care testing is a central strategy for controlling the infectious diseases Malaria, Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), especially in low and middle-income countries where access to laboratories is scarce. However, its routine implementation into frontline diagnostic practices remains inadequate to meet global targets. This study explored the factors influencing the implementation of malaria, HIV, and TB point-of-care (POC) testing by frontline health workers in primary healthcare settings in a rural county in Coastal Kenya. Adopting a pragmatic philosophical lens, this mixed-methods study drew on Normalisation Process Theory to explore how health providers implemented these POC testing interventions and how they became embedded in routine practice. Frontline health providers participated in a cross-sectional facility survey of 40 public and private primary health facilities, 11 semi-structured interviews, and 7 focus group discussions, providing a comprehensive understanding of the broad context and the in-depth experiences involved in implementing each POC testing process. Descriptive analysis of the survey data was performed using the statistical computing platform R. The qualitative data were analysed thematically using Ritchie & Spencer’s (1994) Social Framework Analysis Approach, with NVivo Version 11 software assisting in the management and systematic analysis process. Applying Cresswell's Convergent Mixed Methods Approach, the datasets were merged to provide a more comprehensive understanding of each POC testing process. The study identified three overarching contextual factors shaping the implementation of POC testing: the capacity to provide laboratory services, the value attributed to patient care and health providers’ work, and access to a supportive network, regardless of whether the POC testing focused on malaria, HIV or TB. In conclusion, the study highlights the dedication and resourcefulness of health providers who, despite the constraints typical of low and middle-income countries, work innovatively to embed the POC testing processes into routine diagnostic practices to enhance patient care.Item MU-BEING: MUSIC THERAPY WITH YOUNG PEOPLE FROM MULTICULTURAL BACKGROUNDS IN SOUTH KOREA(Queen Margaret University, Edinburgh, 2025-05) Oh, JoonThis study began with reflective questions regarding the fundamental meaning of music therapy in a multicultural context. The purpose of this study is to explore how music therapy can support the well-being of young people from multicultural backgrounds, how young people and their communities experience music therapy, and what role the therapist’s beliefs, values, and attitudes play in the process. Five young people participated in ‘Mu-Being,’ a music therapy programme developed from the values of Person-Centred Practice and an understanding of the unique contexts of young people and their community. A multimethod based on a multi-paradigmatic approach, consistent with the project’s motivating values and ideas evolved: it included measuring multidimensional well-being, interpretive phenomenological process guided by lifeworld existentials, and arts-based work. The improvement in the social aspects of well-being highlights the role of music therapy practice in challenging and unprecedented contexts. Young people’s music, histories, and the ways in which they participated played a key role in collaboratively developing the conditions for flourishing. Mu-Being facilitated a safe, creative space for young people to experiment and integrate their identities and needs, a transcendent time to cross various existential boundaries, and transformative relationships through shared musical experiences with the local community. Reflective music composition as a way of knowing demonstrated the potential of music to explore aspects of experience that are difficult to identify through numbers and text. The project places music therapy practice at the intersection of well-being theory, personcentred practice framework, and arts-based inquiry, and its transdisciplinary nature fosters multifaceted discussions and resources that can contribute to the development of programmes encompassing the authentic voices of young people and their context; offers an understanding of how person-centredness can be realised in practice; demonstrates how data from various sources can be used together to explore music therapy experiences and their impact.Item STRATEGIES TO SUPPORT COMMUNITY HEALTH WORKERS IN THE FRAGILE AND CONFLICT-AFFECTED BUEA HEALTH DISTRICT, CAMEROON(Queen Margaret University, Edinburgh, 2025-05) ALINEDOH, CARLSON MBI NKWAINCommunity Health Workers (CHWs) have been acknowledged as critical in providing essential health services, especially within under-resourced health systems and fragile contexts. There has been renewed interest in CHWs in recent years in relation to achieving universal health coverage due to their unique position in the community and their ability to link communities and the health system. However, the best way to optimise CHW programmes and support CHWs is debatable. The optimisation of CHW programmes is particularly relevant in urban, fragile and conflict-affected settings (FCAS), such as Buea Health District in western Cameroon, where challenges CHWs face are exacerbated by the unstable context and their needs are dire. At the same time, there is a dearth of evidence and research to guide policies and practices. This study seeks to explore strategies to support CHWs in the Buea Health District by understanding the current functioning and challenges of CHW programmes, how individual CHWs and their managers cope with and respond to shocks and uncertainty, and their views on the preferred support. Employing a mixed-methods approach, this study integrates key informant interviews (16) with CHW programme managers, supervisors, and community representatives alongside four focus group discussions with CHWs in the Buea Health District. In addition, participatory ranking exercises facilitated quantitative data collection, highlighting preferred support strategies from the CHWs’ perspective. Finally, the work-life histories (5) of selected CHWs were documented to capture their experiences before and during the armed conflict in the Anglophone Regions of Cameroon. The findings of this research highlight the lived experiences and challenges that CHWs encountered, including insecurity, which sometimes posed a risk to life, mistrust from the community, especially during the COVID-19 pandemic and population displacement. Some of these challenges, such as population displacement, eventually led to expanding roles for CHWs and a shortage of CHWs. Some of the coping mechanisms employed by CHW programme managers involved community engagement with local leaders, recruitment of temporary CHWs and remote supervision of CHWs. Overall, the analysis points to CHW's support strategies, such as compensation and benefits, operational support and work environment, and recognition and status for the CHWs, which are preferred strategies to support CHWs in the Buea Health District. These findings have significant implications when designing and implementing CHWs programmes and support packages for CHWs. Stressing the relevance of context-specificity in approaches to CHW programming, the study proposes and applies a framework to support CHWs in FCAS, which intersects the CHW programme features, the local context, and the individual characteristics of the CHWs. Considering the intersection of these three variables would inform effective CHW programme designs and support packages that are sensitive and tailored to the unique characteristics of CHWs and their programmes in different settings. It also has implications for the design of agile CHW programmes that are responsive to the rapidly changing nature of fragile and conflict-affected settings and that cater to the well-being of CHWs in such settings to ensure improved CHW motivation, performance, and retention, as well as improved community health outcomes.Item THE INFLUENCE OF THE PRACTICE ENVIRONMENT ON SHARING DECISION MAKING BETWEEN OLDER PERSONS AND NURSES IN RESIDENTIAL AGED CARE: AN AUSTRALIAN PERSON-CENTRED STUDY(Queen Margaret University, Edinburgh, 2025-05) Marriott-Statham, KellyBackground: With an ageing population and recent recommendations from the Australian Royal Commission into Aged Care Quality and Safety, there is a need to understand how older persons are enabled to participate in care decisions. While sharing decision making is promoted widely in healthcare, the practice environment plays a key role in shaping how these decisions are made and how older people are included in their care. Aims and Objectives: The aim of this research was to explore how the constructs of the practice environment domain within the Person-centred Practice Framework influence sharing decision making between older persons and nurses in residential aged care. Approach and Methods: Using a person-centred methodological approach, the research utilised emotional touchpoint interviews, observations of practice and practice development methods in a residential aged care facility in Australia. A creative hermeneutic analysis was used with participants to interpret how the practice environment shaped decision making. Findings: Seven components were found to influence the relational connectedness and sharing decision making between older persons and nurses: affirming personhood, reciprocal trustworthiness, time as presence, intentional way of being, negotiating relational boundaries, organisational values in action, and policies in practice. This research contributes a new perspective of sharing decision making as a relational process continuously influenced by people, processes and structures within the practice environment. Conclusions and Implications: This research highlighted the practice environment as key to how decision making occurs between older persons and nurses. To support sharing decision making processes, aged care organisations need flexible policies, power sharing structures, and workforce models that prioritise relationship building. Nurses should be supported to develop emotional intelligence and have the time to connect meaningfully. Creating conditions where older people are respected, heard and genuinely involved in care must be embedded within the elements of the practice environment.Item INVESTIGATING THE ASSOCIATION BETWEEN FEATURES OF THE ENVIRONMENT AND PARTICIPATION FOR PEOPLE WITH COMPLEX MENTAL HEATLH DIFFICULTIES IN MENTAL HEALTH REHABILITATION SERVICES(Queen Margaret University, Edinburgh, 2025-05) Jose, Akkara LionelBackground: This research investigates the influence of environmental features on the participation of individuals with Complex Mental Health Difficulties (CMHDs) in supported accommodation. The study aims to understand how physical and social environments affect the daily lives and rehabilitation outcomes of residents. Through a comprehensive literature review, the study highlights the importance of participation and participation-related factors such as motivation, habits, roles, responsibilities, and skills. The literature review emphasises the significance of social participation and explores its influence on creating a facilitative and supportive supported accommodation environment. Methods: The research consisted of two studies: a systematic review and a secondary data analysis. The systematic review aimed to identify participation and participation-related factors in the current literature. The review used available data in the studies to calculate an association between the level of support and participation. The secondary data analysis utilized a dataset from one NHS health board to identify an association between social and physical features of the environment and participation and the level of support. The study employed the Residential Environment Impact Scale to measure the features of the environment and utilized a series of univariate and multivariate regression models. Results: The results found a significant association between social features of the environment, specifically ‘Enabling Relationships,’ and both participation and the level of support. The results also identified a significant association between age and both participation and the level of support. The use of various models highlighted the importance of the features of the environment as a significant independent variable when accounting for various confounding variables. Conclusion: The study highlights the importance of the social environment over the physical environment when assessing participation. Results suggested that individuals with better social environments were more independent and had higher levels of social participation. The study challenges the current consensus on variables used to assess the quality of the support environment and highlights the importance of social features of the environment when assessing participation in supported accommodation. It encourages a shift to more holistic approaches and advocates for the use of reliable measures of the environment.Item RELIABILITY AND VALIDITY OF ACOUSTIC VOICE ANALYSIS USING SMARTPHONE RECORDINGS FOR CLINICAL AND REMOTE ASSESSMENT(Queen Margaret University, Edinburgh, 2025-05) Jannetts, StephenThis thesis addresses the critical need for reliable and accessible methods to assess and monitor vocal health, particularly among occupational voice users and patients accessing speech and language therapy remotely. Traditional clinical methods, including patient self-reports and acoustic analyses conducted during isolated visits, provide only limited snapshots of vocal health, often missing daily fluctuations essential for long-term well-being. Leveraging advancements in smartphone technology, which offers sophisticated audio processing and widespread accessibility, this research explores the feasibility and clinical utility of smartphone-based acoustic voice analysis. The research comprises four comprehensive studies. Studies 1, 1b and 1c evaluate the reliability of acoustic measurements obtained from four smartphone models compared to a professional studio microphone in a controlled environment. Results indicate that measures such as cepstral peak prominence (CPPS), harmonics-tonoise ratio (HNR), long-term average spectrum (LTAS) slope, and glottal noise excitation ratio (GNE) demonstrate acceptable random error, suggesting that smartphones can reliably capture these parameters under controlled conditions. Study 2 validates the use of loudspeakers to transmit pre-recorded voice signals for acoustic analysis. The study finds minimal systematic bias and acceptable random errors, particularly for reading passages, affirming the reliability of loudspeaker transmitted recordings for standardised voice assessments. Study 3 assesses the validity and reliability of smartphones in field environments, comparing their performance to a studio-grade reference microphone. Higher-end smartphones, such as the iPhone 6s, reliably capture fundamental frequency (F0), CPPS, LTAS slope, and GNE, although shimmer and jitter measures exhibit significant variability. Study 4 investigates the impact of ambient noise on smartphone recordings, revealing that spectral measures remain stable, while parameters like shimmer and jitter are adversely affected by background noise. This underscores the necessity for controlled recording environments or robust noise mitigation strategies in real-world applications. Overall, this thesis demonstrates that smartphones hold significant potential for remote and real-time vocal health monitoring, particularly when focused on specific acoustic measures and controlled recording conditions. The findings contribute to the development of standardised protocols, enhancing the integration of smartphone technology into clinical voice assessment and telehealth services.Item UNDERSTANDING HOW ENGLISH-SPEAKING EXPATRIATE NURSES CARE FOR EMIRATIS WHO HAVE BEEN INVOLVED IN SUBSTANCE MISUSE: A HERMENEUTIC PHENOMENOLOGY STUDY(Queen Margaret University, Edinburgh, 2025-05) Daradkeh, Fares AhmadIn the UAE, English-speaking expatriate nurses are the backbone of substance misuse treatment facilities. This research aims to study their experiences and perceptions, exploring their lived experiences while caring for Emiratis who have been involved in substance misuse. The study adopted hermeneutic phenomenology, to uncover the meaning of the nurses’ experiences. This study is the first to explore this phenomenon in the UAE. Twenty English-speaking expatriate nurses working in substance misuse treatment facilities in the UAE were purposefully recruited for face-to-face semi-structured interviews. The results were analysed structurally and compared to the existing literature. The findings of this phenomenological perspective provide new insights into the lived experiences of English-speaking expatriate nurses, highlighting the unique challenges they face, reflecting the essence of lived experiences, meaning, feelings, needs, and unique challenges while caring for Emiratis involved in substance misuse. Four main themes were identified: “Behind the Scene”, “Clinical Facilitators”, “Professional Identity of Nurses”, and “Expatriate Nurses’ Coping Strategies”, with significant findings concerning workplace violence, professional jealousy, a lack of specialist nurses, poor verbal communication and working language. In addition, the role of nursing leaders is crucial in providing specialist nurses and establishing professional development education programs and orientation programs that upscale the knowledge and skills of nurses. The concern of not “Being Trusted or Respected” by service users also negatively impacted the nurses’ motivations, feelings, thoughts, and coping strategies. The four themes reflect these findings. It is necessary to improve the working environment to address the identified issues and significantly improve the care provided by English-speaking expatriate nurses to Emiratis involved in substance misuse. These insights are relevant to contemporary nursing leaders and expatriate nurses and offer valuable directions for future research on nursing within the UAE, instilling a sense of optimism for the future of nursing in the region.