Recent Submissions

  • Morbidity and mortality in coeliac disease.

    Holmes, Geoffrey; University of Derby (2018-09)
    Celiac disease is a small intestinal immune-mediated enteropathy precipitated by exposure to gluten, a protein complex in the cereals wheat, barley and rye, in genetically susceptible people. Once considered an uncommon disorder restricted to children of European descent, it is now known to be one of the most common chronic diseases encountered in the Western world, with a serological prevalence of 1% that can be diagnosed at any age. Since it is so common much co-morbidity comprising malignant and non-malignant conditions will occur in association. Malignant complications particularly lymphoma were first described over 50 years ago but the natural history and how commonly these occurred were unknown until relatively recently. Similarly, many non-malignant conditions were known to occur but initially the risks were unclear. It was not until the frequency of coeliac disease could be determined accurately in the community and population-based studies of morbidity and mortality in coeliac disease patients carried out in defined cohorts that these questions could be answered. My research into these aspects of coeliac disease began in 1971 and a body of 35 of my publications spanning the years 1974 to 2018 on the morbidity and mortality of the disorder are presented in this thesis. I have introduced my research findings at many international and national meetings and these data have been influential in shaping the research agenda of other workers. One of my papers (Publication 9) published in Gut in 1989, was the most cited of all papers which appeared in the journal for that year. To date it has been cited 1122 times. Information exists for 24 papers presented here and for these the total number of citations stands at 3,887. This excludes references to book chapters. Anecdotal evidence indicates frequent mentions in lectures and clinical practice.
  • Me, myself, and I: Women’s perceptions of their body-image using clay making as a tool for exploration.

    Crocker, Trisha; University of Derby (2018-05-04)
    An expanse of research literature has confirmed that a significant percentage of women are concerned about their body size and appearance. Western cultures have emphasized that women must look good to be worthy. Media attention that alludes to the benefits of a thin, fit body exacerbates women's beliefs that they need to look a certain way to be acceptable and to fit in. How though, can the majority of women fit into a world of contrary ideals? Being strong and healthy does not absolutely mean a woman has to be model thin with conspicuous abdominal muscles and extreme body definition. In the field of art therapy, there has been no specific research to demonstrate the advantages of clay for the exploration of body-image, male or female. The research undertaken focuses on and evaluates the manner and methods in which clay can be employed as an enabling material for body-image issues with women within art therapy practice. With the help of small groups of female participants who were invited to attend sessions in my pottery to make their body-images from clay and join in discussion, I was able to explore within a safe and contained environment the ways in which clay can be utilised within an art therapy setting. None of the women who took part in the research had a diagnosis relating to body-image issues. By pursuing the methods of Participatory Action Research (PAR) for Study One I employed the fundamental features of Cycles of Reflection. The results of Study One assisted me in choosing Interpretative Phenomenological Analysis (IPA) to further the research. In this way, I would be able to identify the most robust of themes within the dialogues of the three women who attended the individual sessions that comprised Study Two. The final results of the research point to a positive and contained means of working with clients and patients in order to provide a significant resource to help women explore and be more accepting of their bodies.
  • The journey to adopt a child – A mixed methods study comparing aspiring parents’ perceptions of the adoption process with those of social workers and social work managers.

    Jakhara, Mohammed; Uninversity of Derby (University of Derby, 2018-03-23)
    The adoption of children in care who are legally referred to as “looked after”, (Children Act 1989, s22, HMSO, 1989) usually by local authorities is a key national Government objective (DfE, 2016a) where rehabilitation with the birth family is not viable. The desire to place more "looked after" children for adoption with greater speed is not new. It became increasingly apparent after the election of the New Labour Government in 1997 due to concerns about drift and delay in planning for children in care (DoH, 2000a) leading to poorer outcomes. This led to a series of measures aimed at increasing the use and speed of adoption. Eventually this resulted in the introduction of the Adoption and Children Act 2002 (HMSO, 2002) that also for the first time in English law recognised that the welfare of the child is of paramount concern when considering adoption. There is an abundance of published literature that considers the topic of adoption. However, there is a dearth of studies that have comprehensively considered the journey that adopters undertake to become parents. This practice based study was conducted by a researcher who is a senior academic manager and an active social work practitioner with extensive professional experience of adoption. A unique aspect of the study is the longitudinal mixed methods approach used to gather data in real time from a sample of adopters. The three part study tracks the journeys of the sample of adopters from when their application to adopt had been accepted by an adoption agency until after children were placed. The study was supported by five adoption agencies based in England. The data was collected over a period of two years from the adopters who described their experiences and perceptions of their journeys in real time. The information from the adopters is triangulated with data from adoption professionals from the agencies that supported the study. The professionals discussed their approaches to the adoption process, as well as their own experiences of working with adopters. The longitudinal nature of the study enables an analysis of how and why adopters’ experiences and perceptions changed over time. The research considered the changing power dynamics between adopters and professionals during the different stages of the journey to adopt. Furthermore, the long-term impact of professional interactions with adopters during the adoption process are discussed.  
  • The reliability, practicality and acceptability of using ultrasonography to monitor the progress of labour and delivery.

    Wiafe, Yaw Amo; University of Derby (2018-03-23)
    Introduction: It had been suggested by a number of recent studies that ultrasonography could become an alternative to digital vaginal examination (VE) for assessing the progress of pregnant women in labour. However, no systematic review and meta-analysis on the effectiveness of ultrasonography was available. Systematic Review: A systematic review and meta-analysis was conducted to investigate the success rate of ultrasonography in comparison with digital VE and the level of agreement between the two methods, in terms of estimating fetal head position, head station and cervical dilatation. Systematic Review Findings: This review found that ultrasonography has a higher success rate than digital VE in estimating fetal head position. Ultrasonography was also in high agreement with digital VE in estimating cervical dilatation, with insignificant difference in the success rate of the two methods in terms of detecting cervical dilatation. There was also a significant correlation between the two methods in estimating head station. However, it was also found by the review that, existing primary studies were mainly conducted in tertiary settings of developed countries. Further research was therefore needed from the perspective of non-tertiary settings and also from developing country settings. In addition, further research was also needed to assess the diagnostic performance of ultrasound in detecting active labour, since it is associated with cervical dilatation. The diagnostic performance of ultrasound in detecting engaged fetal head had also not been investigated, which is necessary because it is associated with head station. Primary Research Aim: As a consequence of these systematic review findings, a primary study was conducted in another clinical setting in a developing country. The aim was to investigate the reproducibility, practicality and acceptability of using ultrasonography to monitor the progress of pregnant women in labour. Research Methods: A cross-sectional study was conducted in a teaching hospital in Ghana. The agreement between ultrasound and digital VE was statistically analysed for the estimation of fetal head position, head station and cervical dilatation. Further statistical analysis was conducted on the diagnostic performance of ultrasound in detecting engaged fetal head, and the diagnostic performance of ultrasound in detecting active labour. A quantitative survey of mothers’ acceptance of intrapartum ultrasound was also conducted. Lastly, caregivers’ views on the practicality of using ultrasound in this developing country setting was also investigated in a qualitative survey. Results of Primary Research: The results regarding reproducibility were as follows: (i) a high between-method agreement was found in the estimation of cervical dilatation, with high ultrasound sensitivity and specificity in detecting active labour; (ii) a statistically significant between-method agreement was found in the estimation of head station, with high ultrasound sensitivity and specificity in detecting engaged fetal head; (iii) a weak between-method agreement was found in the estimation of fetal head position, with ultrasound having a higher success rate than digital VE. The results regarding acceptability showed that most mothers accepted the use of intrapartum ultrasound, and were willing to have the procedure for their future care during labour and childbirth. They also preferred ultrasound to digital VE. With regards to practicality, the responses of caregivers indicate that the introduction of intrapartum ultrasound in this setting could serve as a good complement to digital VE in a number of ways. However, putting it into practice would require wider availability of physical and technical resources. Conclusion: The findings of the reproducibility study were consistent with existing studies in other clinical settings which were investigated in the systematic review. This suggests that ultrasound is a reliable method for assessing the progress of pregnant women in labour. In addition, the unique contribution to existing knowledge obtained from this study was a high ultrasound sensitivity and specificity in detecting active labour and engaged fetal head which were reported for the first time. The findings on mothers’ acceptability were also consistent with existing studies in other settings, which is an indication that there is high acceptance of intrapartum ultrasound by mothers from different settings and cultures. Lastly, caregivers’ views on the practicality of the use of ultrasound during labour indicate that the regular use of intrapartum ultrasound for assessing the progress of labour in pregnant women may require additional resources to make it practicable in this and other similar settings.
  • How distress is understood and communicated by women patients detained in high secure forensic healthcare, and how nurses interpret that distress: An exploration using a multi-perspective interpretative phenomenological analysis

    Jones, Jane; University of Derby (University of Derby, 2017-09-15)
    ABSTRACT Background The context for this study is the National High Secure Healthcare Service for Women (NHSHSW). This service opened in 2007 following the closure of all other high secure healthcare services for women. Consequently the NHSHSW is the UK’s only facility to provide assessment and treatment for women detained under the Mental Health Act and who are classified as posing a grave and immediate danger to others. Care delivered within the NHSHSW is grounded within the guiding principles of trauma informed environments. This philosophy of care understands that women patients in high secure forensic healthcare experience heightened and usually chronic levels of distress which can be communicated through violent and dangerous behaviour (McMillan & Aiyegbusi, 2009). This group of marginalised women are an important but small group of people with unique experiences. These women patients’ experiences have yet to be explored from the perspective of the women themselves. This is the first study to explore how women patients detained in the NHSHSW experience distress and the impact that distress has on their behaviour from the perspective of the women patients themselves and their care-givers. The care-givers referred to are named nurses whose perspective provides perceptual and interactional context to this study. Insight into the women patients’ experiences is important to ensure that the development of healthcare can respond effectively to need. The importance of service user involvement has been increasingly recognised in general mental health settings. However, user involvement in forensic research is less well developed. This has now been recognised and for the first time this study included the women patients as research facilitators. Method Women patients were invited to attend discussion groups to identify a research project that would form a baseline evaluation for an evidence based development of the NHSHSW. A working party including the researcher and voluntary women patients was established to facilitate the research process. The number of women patients contributing to the working party ranged between eight and thirteen depending on availability. Feminist principles provided a framework for this enquiry (Lykke, 2010). The experiences identified for exploration were: How women patients in high secure healthcare understand their distress. How women patients in high secure healthcare communicate their distress. How nurses interpret the women patients’ distress. Multi-perspective Interpretative Phenomenological Analysis (IPA) was used to analyse semi-structured interviews (Loaring, Larkin, Shaw & Flowers 2015). Twenty three voluntary patient interviews, representing 57% of the overall patient population and thirteen voluntary named nurse interviews took place, representing 34% of the named nurse population. No participants dropped out or withdrew their contribution. Findings Themes regarding the women patient participants’ understanding and communication were identified as: Observable behaviours and responses; Blocks to getting help; Change over time; An entity to be endured; An emotional experience; A physical experience; Being alone. The themes identified from the nurse interviews were: Perception of the distress experience. What influences my response and what is expected of me? The patient and the nurse interviews evidenced differences in understanding related to the women patients’ experience of distress. The women patients placed emphasis on the physiological/sensory aspect of their distress, whereas nurses placed emphasis on the emotional aspect of the women patients’ distress. The implication is that at times of heightened distress the women patients did not feel they were understood. The findings also highlighted areas of unmet need including family involvement in care and a perceived lack of support to enhance family contact. In addition loneliness was emphasised as a significant stressor for the women patients as was being perceived as an on-going risk of harm. All the findings were validated by the participants and subject to peer review. Conclusion This study provides the first evidence base for healthcare practice specifically for women patients detained in the NHSHSW. This is also the first study to involve the women patients in the NHSHSW as co-facilitators of research. This experience was described as empowering by the women patients who took part and whose involvement ensured that the research subject was relevant and meaningful. The depth of the women patients’ involvement has set precedents for policy, procedure and practice development within the NHSHSW and evidenced the women patients’ ability to be co-producers of the services they use. The study was conducted for women by women and as such was guided by feminist principles seeking the right to provide services based on women patients’ needs and experiences. As a consequence this study has made a unique and significant contribution to available literature and the development and provision of services for women detained in high secure care. The study originally aimed to provide an evidence base for the development of the NHSHSW; however, continued interest from lesser secure services clearly demonstrates the applicability of the findings to services beyond the NHSHSW. Limitations There were limitations to this study which could have influenced the findings. The researcher was known to the patient and nurse participants. Established relationships between researchers and participants have the potential to bias an outcome; however it can also provide a baseline of trust. Service user involvement as both researcher and participant potentially allows participants to purposefully respond to questions with the aim to confirm their original pattern of thinking rather than exploring a concept to uncover new findings. The balance of findings in this research suggests that while some bias can be argued it did not invalidate the findings.
  • South Asian Indian ageing: A qualitative investigation into expectations of co-residence and care amongst second and third generation adults of South Asian Indian origin in Leicester

    Jethwa, Hansa K.; University of Derby (University of Derby, 2017-06-06)
    Abstract Today in the United Kingdom (UK), ageing is considered to be an important aspect of social life in general and although overall South Asian Indians (SAIs) are relatively young compared to the indigenous white population, the number over the age of 60 is rapidly increasing. Over the last decade or so evidence-based practice within social work has been given a great deal of emphasis in public and professional life. This study is based in this spirit and emanates from personal and professional experience of working with an ageing population from a South Asian Indian background and focuses on the second and third generation of this settled minority. The aspect of co-residence within South Asian Indian cultures has been given little attention both within academic and professional studies. The key aims underpinning this work and of the research reported in this thesis were to illuminate and explicate the problematical and challenging expectations of ageing, co-residence and care within different generations of SAIs in Leicester. Thus this study investigates the expectations of co-residence and care amongst a cohort of second and third generation SAIs who have been settled in the UK for 30 or more years. Using interpretivist theoretical perspectives, 12 participants (8 from the second generation and 4 from the third generation of SAI ‘settlers’) were interviewed using in-depth semi-structured one-to-one interview techniques to collect data regarding their views and understandings of co-residence and care within the context of living in the UK. The data collected was thematically analysed and three themes, co-residence, expectations and acculturation/enculturation were identified for detailed exploration and analysis. Using interpretivist perspectives, these themes were used to identify meaningful patterns of behaviour and sentiment and to analyse the underlying symbolic sociocultural systems within the context of ageing within the SAI community in the United Kingdom. The research highlighted the onset of some enculturation processes and a rapid change in social attitudes, particularly in relation to altruism, concepts of family, a gap in understanding the expectations of co-residence between generations and the impact of these on second generation SAIs. The older participants yearned to be looked after by their adult children, feared being on their own and displayed anxiety at the prospect of not being looked after in their old age. They experienced and expressed concern at a loss of control in the decisions relating to co-residence for their current and future lives. The study points to the lack of wider scale academic and practice-based research studies focused on the impact of changes in culture and family expectations, particularly in relation to co-residence, and recommends that :(a) the academic and professional discourses and theories on ageing incorporate aspects and experiences of migration and diversity of cultures and (b) researchers, practitioners and policy makers examine the needs of the ageing SAI communities in the UK in order to explore policies, procedures and initiatives that could enhance various forms of family living and to develop relevant evidence - based practice. The outcomes of the research have implications for teaching and for practice. This is particularly so in cases where there has been a perceived failure to adopt understandings and practices in response to the identified changes. To this end a flow chart was developed that is recommended to be used as a guide and a tool for initial assessment for practitioners when working with this vulnerable group. It is hoped that this guide will have utility in terms of scope and reach when applied to the analysis and understanding of ageing in SAI communities in the UK.
  • Working with psychological trauma: an interpretative phenomenological analysis of trauma-focused CBT and EMDR

    Folland, Caroline H; University of Derby (2017-04-12)
    Purpose: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD), acknowledged repeated or extreme indirect exposure to aversive details of traumatic event(s) in the course of professional duties, can lead to symptoms of PTSD. This has led to discussions around impact and prevalence of vicarious trauma in psychological therapists treating trauma clients. This study considers how therapists delivering trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) make sense of their experiences and protect themselves from any negative effects of the work. Furthermore, it considers if there is a distinction in therapist experience between the two modalities. Methodology/Method: An Interpretative Phenomenological Analysis (IPA) was conducted to explore how trauma-focused CBT and EMDR therapists engaged in trauma work, interpreted and made sense of their experiences; with a view to identifying any protective practice that informed clinical practice and helped ameliorate vicarious trauma. Recorded, semi-structured interviews were conducted with CBT and EMDR therapists (N=11). Before analysis, interviews were transcribed verbatim and sent to individual participants for validation of their authenticity. Data was analysed using descriptive, linguistic and conceptual comments to identify an initial seventy nine emergent themes. When refined, four master themes of ‘Nature of Trauma’, ‘Participant sense of self and managing the process of hearing trauma narrative’, ‘Participant experience of delivering the trauma models’ and ‘Protecting and sustaining the participant sense of self’ were identified to answer the research question and are discussed herein. Findings: This study forms part of the growing body of evidence towards understanding therapist vicarious traumatisation. It both supports and challenges findings of previous studies. It also introduces new concepts in relation to the vicarious trauma phenomenon. Whilst there are clear limitations associated with making generalisations from an IPA study, the findings from the study suggest EMDR may be a protective factor against the negative effects of hearing repeated trauma narrative. Furthermore, certain strategies such as time management, comprehensive trauma training and specific trauma supervision, may also reduce the negative effects of hearing trauma narrative. Finally, regardless of the difficulties faced, therapists enjoy their trauma work and feel a great sense of professional satisfaction. Implications/Recommendations: Indications from the findings of the study are that therapists working within primary care in particular, are becoming increasingly pressurised by cuts to funding within mental health services. Recommendations are that those components of trauma work which promote therapist wellbeing should be supported. In particular, realistic timeframes within which to work, good quality training and supervisors, ideally external to the workplace, who can provide trauma-specific supervision.
  • An action research study concerning how clinicians formulate treatment choices for people with personality disorder: using hermeneutic and IPA methods.

    Graham, Judith; University of Derby (2017-04-10)
    Background: Personality Disorder treatment is a contentious subject in health care. Despite available research concerning the diagnosis itself and also available treatments, there is little research regarding treatment thresholds or defining how treatment decisions can be formulated. This problem has been identified by clinicians, patients, supervisors and specific organisations, particularly linked to recent healthcare changes associated with austerity measures. Research Question: How can mental health care staff use a formulated decision process concerning therapeutic interventions for people with PD, when considering the recent service changes and rationalisation of available treatments? Methods: An Action Research study has been conducted over a four year period, using predominantly qualitative methods including: a hermeneutic literature review (n=144 papers), patient questionnaires (n=15) and Interpretive Phenomenological Analysis (IPA) of clinician and supervisor semi-structured interviews (n=10). Results: Difficulties have been found when making decisions with people who either do not accept their diagnosis and/or do not accept the current evidence-based treatments for personality disorder. Other challenges have been identified regarding the patient/clinician relationship, the level of distress the patient presents with, and also the clinician view concerning the individual, the diagnosis, and the available treatments. The IPA produced five super-ordinate themes related to decision-making regarding treatment choices for people with personality disorder, including: difficulties with boundary management, diagnostic stigma, a focus upon time, metacognitive ability, and the potential for iatrogenic harm. Conclusions: Multiple factors require consideration when examining treatment choices for people with a personality disorder, concerning the patient's individual symptom profile, needs, attitude towards treatments; the clinician's profession, attitudes, opinions, and wellness on the day of the assessment, and also the treatments available within the locality. A diagram has been presented summarising these formulation factors. Recommendations have been made based upon the results, analysis, synthesis and discussion sections, indicating potential practice changes and areas for future research.
  • A Formulation and Critical Evaluation of an Inter-Personal Communication Skills Objective Structured Clinical Examination (OSCE) in Pre-Registration Occupational Therapy Education

    Rowe, Pauline; University of Derby (2015-05-28)
    Abstract Occupational Therapy is a client centred, holistic allied health profession in which the quality of a supportive, empowering therapist-client relationship is seen as having a key and central role in effective therapy. A minimum of a 1000 hours of practice placement education (PPE) must be successfully completed in pre-registration programmes, which are charged with ensuring graduates are fit for practice and purpose. This Work Based Project focussed on how pre-registration education can best equip students for a first PPE in terms of sufficient inter-personal communication skills. Primary data collection was conducted between November 2008 and March 2010. The project firstly employed thematic content analysis of data elicited from two rounds of focus group surveys of practice placement educators (PPEds) to identify a baseline of inter-personal communication skills required prior to embarking on a first PPE. This data was used to formulate an objective structured clinical examination (OSCE) checklist of inter-personal communication skills, which was then utilised as a formative assessment and in role play scenarios in taught sessions with one first year pre-registration occupational therapy cohort. This cohort was surveyed via a questionnaire and in addition five students were interviewed. Subsequently a group of third year students, who role played clients for the OSCE, participated in a facilitated discussion on their perceptions of the OSCE. The data on students’ perceptions and an analysis and comparison of staff and student ratings of performance in the formative OSCE, were utilised in a critical evaluation of the use of this OSCE as a teaching and assessment tool. The findings indicate a level of agreement on the content of the OSCE checklist, providing content validity to this particular assessment. PPEds, and first and third year students are positive about the use of an OSCE when it is used as a formative experience. Students recommend that if used as a summative assessment the OSCE is combined with a reflective piece. Objective structured clinical examinations have long been established in other health care professions such as medicine and nursing. This project has provided evidence indicating that an OSCE of inter-personal communication skills is a valid assessment tool for occupational therapy pre-registration students, and that it can also facilitate student reflection, self-awareness and learning. It has also identified profession specific inter-personal communication skills required for embarking on a first PPE.
  • Assessment and training in breast cancer detection.

    Cowley, Helen Claire.; University of Derby (1999)
  • “I couldn’t move forward if I didn’t look back”: Visual Expression and Transitional Stories of Domestic Violence

    Bird, Jamie; University of Derby (2015-02-13)
    Psychological, sociological and feminist models of understanding domestic violence have contributed to the development of interventions that seek to raise awareness, keep women safe, and help them to create new lives for themselves and their families. Research literature has extensively paid attention to the ways in which women both live with and move away from domestic violence, documenting how they employ strategies of survival and resistance. The research methods employed to investigate domestic violence includes a range of quantitative and qualitative methods with particular emphasis placed upon enabling women to tell their stories in as authentic a way as possible. This thesis adds to the literature by considering how women construct what will be referred to as transitional stories of domestic violence, within which they imagine their future selves and develop the means to become what they hope for. The methodology used is original within the study of domestic violence in its synthesis of arts-based, feminist and participatory methods. The adopted epistemology sought to value the use of embodiment and imagination in the construction of knowledge, both of which are considered to be situated. The use of an arts-based method is chosen to enable a different way for women to tell their stories about their response to living with and transitioning away from domestic violence. The evaluation of this methodology shows that it is a valid form of enabling women to have the embodied subjectivity of their experiences and imagination witnessed in a way that complements the written and spoken word, whilst better allowing the physical and metaphorical quality of their stories to come to the foreground. Following a feminist agenda, attention is paid to the influence of gender upon the researcher’s findings, and upon the participants’ and researchers’ reflexive engagement with the research process. The research shows that the home has special significance for women as they transition away from domestic violence and plan for their future. The home becomes a physical manifestation and container for women’s hopes and fears for a harmonious future that often incorporates the desire for the return to the idea of a complete family. Relationships with family, friends and services are shown to be both enablers of women’s agency and resistance. Those same relationships are also shown to be capable of acting as barriers to women’s positive transitional journeys. The findings show that attention needs to be placed upon the appearance of women’s agency within the everyday tasks of creating and maintaining a home and managing relationships as they move away from domestic violence. The findings also point to the need for services to work harder on empowering women, both by adequately listening to the stories told about their pasts and hopes for the future, and by helping them to achieve their plans through challenging the limitations imposed by policies and economics.