eTheses

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This community contains an online collection of PhD theses and selected undergraduate and postgraduate dissertations written by QMU students and researchers.

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Now showing 1 - 13 of 13

CLOSING THE HEALTH GAP—INTERVENTIONS FOR ADRESSING POOR MEN’S HEALTH IN SUB-SAHARAN AFRICA: A SCOPING REVIEW
(2018)
The issue that this study addresses the poorer men’s health outcomes as compared to women in Sub-Saharan Africa (SSA). To address this problem, the purpose of this study scoping review was to take stock of health interventions conducted in SSA to engage men. A search of six electronic databases, a search of reference list of relevant systematic reviews and meta-analysis; and a search of grey literature, all reported in international languages spoken in Africa, were conducted. All studies evaluating health interventions that aimed to engage male young, adults and aged people in SSA, published between January 2000 and January 2018, were included. The electronic literature search identified 2815 original citations, full texts of 25 studies were screened and 12 studies were included. Additionally, 20 studies were retrieved from screening of reference lists of relevant articles and reviews, hence were also included. Main themes that were analysed included: geographic distribution of studies, the type of studies and main study focus, the type of gender programming, and the type of evidence gathered. This review found that Gender transformative interventions, delivered in community settings, using group discussions and workshops, were shown to be the most effective in reaching their goals. However, there is a significant literature and research bias toward HIV and SRH issues, paired with a scarcity of published studies in most SSA countries. Furthermore, the widespread use of cognitive variables to measure effectiveness of interventions may limit reliability of their findings.
Community Leaders’ Perception Regarding Practices And Outcomes Of Child Sponsorship Programs Implemented By International Non-Governmental Organizations Towards The Improvement Of Their Communities In Leon, Nicaragua.
(2018)
Child Sponsorship Programmes (CSPs) were created in the late 20’s as a response to the adversity and havoc resulted from I World War’s in central Europe; in this scenario, these programmes helped the orphans by offering improvements to their vulnerable life conditions such as: shelter, meals and clothing (Watson 2014). Nowadays, CSP type of work in developing countries has evolved worldwide by adjusting to the foreign culture and developing tailored programs to meet the needs of the communities they work at; for example- as described by Watson and Clarke (2014)- some INGO’s CSP work directly with children and other work in advocacy and assistance for disadvantages groups. Also, their number in developing countries (i.e.: Nicaragua) has increased as well. INGOs in Nicaragua flourished in the 80s, these worked in rural areas negatively affected by Sandinistas-Contras war and natural disasters (Hasse 2011); in order to develop communities of direct influence through education, INGOs use CSPs as tools to reach this goal. In this research, I explore the perception of community development from the perspective of Community Leaders (CLs) from rural areas in Leon, Nicaragua. It will highlight positive aspects perceived from the CLs regarding CSPs; such as support to the poorest families in education, medical attention and nutrition. On the other hand, this investigation will describe what CLs observed as challenges associated with the relationship between the INGOs and the community (unequitable distribution of aid, creation of tensions and divisions within communities and no coordination with CL); also, how CSP are implemented (creation of dependency and Non-continuity and unsustainability of CSP). More involvement of CL is suggested in order to improve the positive impact of CSP.
A comparative analysis of the contextual factors that were associated with Bangladesh and Zimbabwe achieving relatively high rates of contraceptive prevalence.
(2018)
Background: Family planning is termed one of the best investments a country can make to improve women’s lives by decreasing unwanted pregnancies and unsafe abortions. Hence, many countries have invested in the promotion of family planning by strengthening their family planning programmes. However, despite this, there are currently 214 million women in low and middle-income countries who would like to prevent pregnancy but are not using any modern method of contraception. However, Bangladesh and Zimbabwe are two countries that have shown trends of an increased contraceptive uptake over the years despite their slowed economic growth. Aim: To summarize the contextual factors that are associated with an increased contraceptive uptake in Bangladesh and Zimbabwe. Study Design: A review of literature (Desk Review). Databases: CINAHL, SCOPUS and Medline. Review Methods: The selected studies were published from 1994 to 2018 and were focused on family planning/contraceptive use in Zimbabwe and Bangladesh. The measure evaluation reproductive Health programme conceptual framework was used to organize the study findings and discussion. Results/Findings: 287 articles were retrieved and 19 made the final studies selection. Of the 19 studies,16 were quantitative studies and 3 qualitative studies. It was found that women’s education, older age, place of residence (urban), desire to delay pregnancy/stop childbearing, marital status, male influence – such as discussing FP with husband, being employed, access to FP services, FP workers and FP promotion were the most significant factors influencing contraceptive uptake in both countries. Conclusion& recommendations: To increase contraceptive uptake well thought out information, education and communication (IEC) programmes must be instituted that targets both males and females in rural and urban regions. Further, family planning services must be easily accessible, acceptable, free or extremely low cost and culturally sensitive. Keywords: Contraceptive prevalence, Contextual factors, Unmet need, Bangladesh, Zimbabwe.
EXPLORING THE RISK FACTORS OF GENDER BASED VIOLENCE AGAINST FEMALE SYRIANS IN HUMANITARIAN SETTINGS IN GREECE - A REVIEW OF THE LITERATURE
(2018)
Gender based violence towards female Syrians is a common issue in humanitarian settings in all of the host countries including Greece. This thesis is a review of the literature about the risk factors of violence against female Syrians of all ages in the camps in Greece. It incorporates explanations of the concept of gender based violence and describes the magnitude and severity of the issue. The methodology section includes the strategies in order to develop the topic and the research questions as well as the inclusion and exclusion criteria. For the analysis of the risk factors has been developed an adapted ecological framework of violence that applies to female Syrians who live in humanitarian settings. This analytical framework conceptualizes the Gender Based Violence in the Individual, Microsystem, Exosystem and Macrosystem level. It was found that not only the existing various risk factors from each of the four levels interplay with each other, but new ones emerged due to war and displacement in the Individual and the Exosystem levels. Gender based violence is a sensitive research topic and there are limited researches that took place in Greece amongst displaced Syrians. Researching the risk factors of violence among Syrian women and girls is a challenging and recent topic which requires further and deeper research in the future. People who live in camps deserve decent living conditions, redemption of their reputation in Greek communities and access to tailored health and social services. Key words: GBV, Syrians, Greece, Camps, Risk Factors
FACTORS DETERMINING THE UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN NEPAL
(2018)
Nepal has made an enormous progress in declining maternal mortality and increment in utilization of various maternal health related services. However, there is still a large group of women left behind without access towards maternal health services and maternal mortality is still high if compared to other developed nations. This study aims to find out what are the various determining factors that are responsible for utilization or non- utilization of maternal health care services in context of Nepal. A scoping literature review was used as a method of study where various published journal articles and documents related to maternal health in Nepal were studied and analysed for the derivation of results and discussion. The analysis was based on Andersen’s Behavioural Model for health service utilization, various factors like socio-cultural, physical and economic accessibility and perceived need were identified as major determinants for utilization/non-utilization of maternal health care in Nepal. This study shows the huge disparity in the utilization of maternal health care services among women in rural and urban areas because of above mentioned factors. The government of Nepal in collaboration with various national and international partner is running various programs related to maternal health for coverage and utilization of maternal health care services in Nepal. However there seems to be lack of effort in addressing socio-cultural factors in relation to health care delivery system. Nepal must now focus on sustaining the major priority towards improvement in overall maternal health and should focus on growing financial, structural and human resources to improve the coverage of maternal health services and community -based approach to meet the need of marginalized population specially women from remote areas.
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.
Increasing Adherence to Treatment Regimens for Ethnic Minorities Affected by Cardiovascular Disease in High Income Countries: The Role of Mind-Body-Interventions
(2018)
Background: Adherence to treatment regimens is vital for the control and management for CVDs. Yet only 40-60% of patients adhere to their treatment plan, increasing the likelihood of adverse cardiac events, re-hospitalization or even death. The symptom burden of CVD’s, low self-efficacy, and lacking confidence in foreign health systems makes patients from ethnic minority groups (EMG) especially vulnerable to low adherence. As current interventions to address low adherence have fallen short of effective long-term increases, Mind-Body-Interventions (MBI) might provide a novel secondary prevention approach to close this gap. The aim of this desk review was to shed light on whether MBIs have the potential to increase adherence in EMG in high income countries diagnosed with CVD. Method: A systematic literature search has been conducted using MEDLINE, CINAHL, and PsychINFO databases. In total, 17 studies have been critically reviewed. Results: Findings for EMGs are poor, however, evidence for the general population demonstrated predominantly positive effects of MBIs on adherence, self-efficacy, health outcomes, and quality of life. Yet, heterogeneous study design and methodology prohibits the generalizability of evidence. Conclusion: Overall, the evidence present encouraging findings on the potential of MBIs to increase adherence in the general population. Nonetheless, further research is warranted to investigate whether this holds true for EMGs. Moreover, research should consider potential cultural implications in EMGs and address the lacking consensus in the operationalization of adherence and MBI. Keywords: Adherence, Self-efficacy, Cardiovascular-Disease, Mind-Body-Intervention, Ethnic-Minorities
Influences of social family dynamics in women’s decision making during pregnancy and child birth in rural Morocco.
(2018)
Maternal mortality (MM) is a global health issue with the birth of 130 million babies born in the world every year. Eight hundred women die every single day while giving birth. There are many reasons that lead to their deaths during child-birth and one of these reasons is not attending health care facilities, which could be due to lack of medical facilities, financial barriers and distance. The decision making process to seek such health care is rarely done by mothers on their own. The aim of this research is to explore the decision making process amongst women living in rural areas of Morocco and find what and who influence the mother’s decisions. Findings: Living with in-laws or living separately did not influence the mother’s autonomy to make decisions. Furthermore male involvement was found to be a strong influencing factor in promoting positive health behaviours. Examples of positive health behaviours are: attending antenatal check-ups; eating correct and healthy foods; attending the hospital to deliver the baby; and encouraging mothers to vaccinate their children. The maternal health care facilities had mixed reviews; mothers reported both positive and negative treatment. Conclusion: The decision making process mothers go through during pregnancy, child-birth and during child-rearing is complex with many influencing factors. It is clear from the findings that there is no single change that can be made that will directly encourage women to attend professional health facilities throughout pregnancy and at the time of child-birth. However promoting male involvement, education for both men and women, monitoring and evaluating healthcare facilities and the workforce are several ways that can lead to improvements in mother’s attendance of healthcare facilities and aid in reducing maternal mortality.
Policy Interventions to address childhood and adolescent obesity linked to 'Junk Food' consumption: 'Lessons for Nepal'
(2018)
Childhood and adolescent obesity is increasing at an alarming rate and is a public health concern worldwide. Childhood and adolescent obesity, once considered as a problem only in developed countries, are now causing double burden of malnutrition in developing countries. Junk food industry and its consumption are also increasing in South Asia in the past decade. This study provides a comprehensive overview of the recent documents, articles and reports on childhood and adolescent obesity and different food policies to prevent obesity. Methods: Different articles, documents, reports were searched using QMU online library, Cinahl, Scopus, Medline, PubMed, Google Scholar and Science direct to conduct scoping review. Findings: Risk factors of overweight and obesity among children and adolescent in South Asia are lack of physical activity, watching television and playing with modern technologies, family history of obesity, socio-economic status (SES) and dietary behaviour. Due to nutrition transition in South Asia, the dietary behaviour has been changed to junk food due to change in lifestyle and adaptation of meal patterns, popularity of street foods, growing business of supermarkets, fast food industry and role of advertising. Junk food creates enabling environment for physical inactivity, high calorie intake and replaces other nutritious food and causes childhood and adolescent obesity. Different food policies like national nutrition guideline, nutrition labelling, school focussed food policy, economic policy and food marketing policies have been adopted across the globe. National nutrition guideline and nutrition labelling is somehow being implemented and other policies requires enabling environment to implement in Nepal. However, no policies have been intended directly to address childhood and adolescent obesity due to 'junk food' consumption. Key words: childhood, adolescent, obesity, food policy, and junk food.
The relationship between nurse staffing levels and patient outcomes: A scoping review of the evidence from high-income countries.
(2018)
Aims This dissertation aims to explore the relationship between nurse staffing levels and patient outcomes. It proposes to summarise the evidence regarding this link and expose and discuss the gaps and limitations in these studies. Background As healthcare has developed, quality of care has become a focal problem for the healthcare system and nurses. Increasing concerns about patient outcomes and the quality of care have resulted in several studies, focused on identifying adequate nurse staffing levels and the relationship between nurse staffing and quality of care. An extensive amount of literature over the last 10 years reports the importance of the role of nurses and their duty to provide safe, good quality care and the relationship between low nurse staffing levels and adverse patient outcomes, for example: falls, missed care and even death. Despite the size of the existing evidence, there are numerous limitations in these studies that have not been reported extensively. Amongst these gaps is the theory of endogeneity, which is a form of bias that occurs when estimating causal effects between variables. While there are no discrepancies in current literature about the causal pathway between nurse staffing and patient outcomes, endogeneity points to the fact that the scope of the effects may be biased or incorrect. This topic is of great importance, as the research is still unclear about what constitutes as adequate nurse staffing levels that will promote high-quality patient outcomes. Design Scoping review to synthesise existing knowledge in the literature on the relationship between nurse staffing levels and patient outcomes. Methods 29 primary studies conducted in hospitals in high income countries were reviewed between 2008 and 2018. Findings Numerous gaps were found in the literature. This scoping review found that most of the current evidence did not discuss the forms of bias that could affect the causal path between nurse staffing and patient outcomes. Overall, the evidence shows an increase in nurse staffing levels has a positive effect on patient outcomes. However, a majority of the studies showed that although nurse staffing levels were vital to patients’ safety, there were other confounding factors that mediated this relationship or by themselves had a strong impact on patient outcomes. Conclusion As previous research suggests, this paper confirms that there is a indeed a correlation between nurse staffing levels and patient outcomes. However, many studies have also revealed that nurse staffing is not the only variable involved in patient outcomes. More research is warranted, to identify other variables that affect patient outcomes, so that recommendations can be made for policy and guidelines will be able to assure the best possible care is provided. Keywords Nurse staffing, patient outcomes, relationship
“THE STRESS IS ALL ABOUT SEX” Conceptualisations of intimate relationships amongst school attending youth in Sierra Leone
(2018)
Background Sierra Leone (SL) has persistently high levels of adolescent pregnancy and reducing this is a priority. Data that captures the experience of young people (YP) and the decisions that they make about sexual and reproductive health (SRH) is required to help inform education and public health interventions. Objectives This study aims to establish how YP at school in SL understand their rights and responsibilities around sex and relationships, and to find out what the facilitators and barriers to making positive decisions in this area are, with a view to informing locally developed SRH programs. Methods An adapted version of the Participatory Ethnographic Evaluation and Research (PEER) approach was used to involve the YP throughout the research process. Six male and six female students were trained in research methods and met in gender group sessions (GGS) to develop the tools for data collection. Each then interviewed 3 friends and fed these interviews back to the visiting researcher in debriefing sessions. Initial findings were discussed with the participants in GGS for clarification and interpretation. Key informant interviews and notes from the GGS also contributed to the data set. Results Evidence demonstrated the pervasive nature of gender inequalities between the groups. Expectations of the communities and pressure to achieve at school weighed heavily on the young women, and yet the power in relationships remained decisively with the young men. While romantic notions of “good” relationships and the acknowledgement of the benefits of equality were commonplace, sex was referred to negatively by both genders. It was described as a tool of control, with transactional sex and “sexual harassment” portrayed as normal. Relationships were kept secret from all but trusted friends, and the stresses that were associated with navigating them were vividly described as physical and mental illness. Anxiety surrounded pregnancy and there was strong pressure to abort in secret despite the danger this entails. There was no mention of contraception. Conclusion The study demonstrates the need to consider the broad social context when considering SRH interventions. Messages about risks create anxiety amongst females in school, but structural factors significantly limit their ability to influence outcomes. This study suggests the need to work with boys, men and the wider community to share the burden of responsibility, improve knowledge and develop strategies for change.
Understanding factors influencing adolescent girls who run away from home in an arranged marriage society: implications for policy An exploratory qualitative study from Tigray, Ethiopia
(2018)
Little is known about adolescent female runaways in Ethiopia. The study examines the main factors influencing adolescent girls who run away from home in Tigray, northern Ethiopia. An exploratory qualitative approach was adopted to address why and how the seven runaway girls of the sample decided to escape. Data was collected through in-depth interviews, key informant interviews and field observation in two different settings, Wukro town and Mekelle city. Although the runaway girls´ cases are the foci of the study, semi-structured interviews and a focus group discussion with a second cohort of older women married off at an early age, were conducted in order to explore community response toward adolescent female runaways, and contrast changing human behaviour across generations. Findings reveal that the immediate trigger that led all young participants to run away was to escape arranged marriage, except in one ‘romantic’ elopement case. Individual and structural factors, such as child maltreatment and educational aspirations, and new family legislation and campaigns against early marriage, respectively, also contributed to a parental resistance and the decision to escape. At a theoretical level, looking through the lens of Giddens' (1984) structuration theory, the study indicates a possible shift in social norms that affect gender roles in Tigray, and from a social constructivist perspective, it seems that adolescent runaways might be an ‘unconstructed’ child protection problem, as most runaway participants were supported temporary by relatives and the decision to run away is considered part of the migration phenomena. Thus, these vulnerable girls remain unprotected and exposed to a range of risks, such as early and unwanted pregnancies, labour exploitation, dropping out of school, and transactional sex relationships. Therefore, it is recommended that the issue of adolescent girl runaways is elevated to the policy agenda in Tigray. Keywords: adolescent female runaways; elopements; arranged marriage; early marriage; child protection; reproduction and social change, Ethiopia.