• Transition to a Health Visitor Role: A Constructivist Grounded Theory

      Whitehead, Bill; Strickland-Hodge, Barry; Henshaw, Lorraine (University of Derby, 2021-12-22)
      There has been a scarcity of studies which explore transition to the health visitor (HV) role. This is in stark contrast to research into the transition from student nurse to a newly qualified nurse (NQN) role, which is known to be a difficult and challenging time, impacting upon overall retention in the nursing role. As a nurse lecturer, I have witnessed very similar difficulties and challenges as aspirant HVs undergo the transition to the HV role. However, this transition differs fundamentally to that of a student nurse to NQN, due to the prerequisite for a registered nurse/midwife status before entry into training for the HV role. The student HV is therefore moving from a role in which they are already established, often highly skilled and autonomous practitioners, into to a new professional role. Using a constructivist grounded theory approach, this longitudinal study has explored this transition to the HV role, providing in-depth understanding of the experiences of the participants. It incorporated focus group and interview methods over a series of data collection points, throughout the transition. The aim to develop a substantive theory of the transition to the HV role. The transition is multifaceted and is influenced by a range of factors including changes to role identity and community of practice, alongside individual resilience, and the support provided by the wider HV team. The three core categories of Role Identity, Way of Working and Living the Journey are encompassed within the developed conceptual model, which also provides a framework to support this complex transition process. The transition from qualified nurse/midwife to HV is a multidirectional process and is fraught with challenges. Hence, the greater understanding of the transition provided by this study, will help both inform and support future HV students, the wider HV team, practice assessors/supervisors, employers and education providers. Recommendations include wide dissemination of the findings and conceptual model to allow exploration of the complexities of the transition with student and aspirant HVs, practice colleagues, educators and other stakeholders. Thus, enhancing the support for those undergoing this transition. There should also be greater recognition and valuing of individuals and diversity in the workforce and a focus on building resilient tendencies and wellbeing. Future research should include further exploration of managing multiple role identities, heightened definition of the HV role and the impact of difficult areas of practice (e.g., safeguarding). Other methods of entry into the HV role, rather than from a pre-existing registered nurse or midwife status, are recommended as this could alleviate some of the specific challenges faced within this important transition. There should also be further research to test this substantive theory in other role transitions, where there is a move from one professional role to another.
    • Mapping Stress and healthy balance with the workable ranges model in mindfulness-based stress reduction: First-person embodied reflections

      Sheffield, David; Hogan, Susan; Rose, Sally (University of Derby, 2021-12-14)
      During Mindfulness-Based Stress Reduction (MBSR) courses, participants are taught to be more present with stressful experience in order to respond to it more effectively. The meditation-based experiential pedagogy is supported by didactic teaching about stress to increase awareness of patterns of reaction and to support the application of mindfulness to self-regulation. The content of teaching about stress, and how it is best taught within the pedagogy, is an important practical and theoretical consideration. This thesis addresses a gap in knowledge by focussing on this little-regarded area of practice. The aim of this research was to develop practical and theoretical knowledge about the inclusion in the MBSR curriculum of the Workable Ranges Model of stress and emotional regulation, developed by the author. This visual model lays out regulated states and both mobilised and immobilised threat-based reactions in relation to each other. The main research question was: how does the Workable Ranges Model complement MBSR? Three key themes were identified in the literature and began to address the research questions. They were: the role of didactic teaching about stress; the notion that how difficult experiences are negotiated is a paradoxical mechanism; and that the Workable Ranges Model provides a novel perspective on participants’ progression through mindfulness-based programmes. Qualitative research was conducted as an illuminative evaluation of the practice innovation. An enactivist, embodied-mind epistemology was used to consider both embodied and verbal forms of knowledge. The application of mindfulness-based, first-person phenomenological methodology, within the frame of the conceptual encounter method, functioned as both learning and data-collection processes. The first phase focussed on the inclusion of the model in three MBSR courses. Data were gathered from participants in classes using diagrams and a question schedule. A template analysis elucidated engagement and resonance, awareness of the features of regulated and dysregulated states and patterns of reactivity, ways of responding to dysregulated states and applications linked with MBSR. In the second phase, seven course graduates engaged in a diary exercise, post-meditation reflective inquiry and a group discussion. Thematic analysis identified an overarching theme that the Workable Ranges Model provides a dynamic map for the mindful exploration of stability and stress. Three interrelated processes were evident: charting regulated and dysregulated states, embodied application in mindfulness practice, and orienting to and resourcing regulation and self-care. The themes from phase two shaped a broader meaning to both data sets. Three functions of the model as a map were identified and discussed. It worked: (i) as a method for teaching about healthy balance and stress; (ii) as a heuristic for self-exploration and developing insight; and (iii) as a guide for mindfulness-based self-regulation and self-care. Together, these aspects acted as aids to teaching and learning about mindfulness-based self-regulation. Theoretical and practical implications are discussed.
    • What can we do for nature? A systematic research approach to pro-nature conservation behaviours

      Richardson, Miles; Stupple, Edward J.N.; Sweet, Michael; Barbett, Lea (University of Derby, 2021-12)
      Nature is in trouble. The current levels of anthropogenic biodiversity loss have been classed by experts as a mass extinction. This is likely to have grave consequences for humanity. However, with humanity causing the biodiversity loss, it can also be fought by humanity, presuming action is taken. Research is needed on which actions can be taken by the wider public and how people can be encouraged to do so. There is a multitude of literature on general pro-environmental behaviours, however, conservation practitioners lament the lack of research on nature specific actions. This thesis set out to create a systematic research approach to those nature specific actions which were named pro-nature conservation behaviours. Based on research in pro-environmental behaviours, four steps to this research were set: (1) Defining and measuring the behaviour; (2) Understanding the antecedents of the behaviour; (3) Developing targeted interventions; (4) Evaluating the interventions. This thesis completed the first step and provided some first insights into the second step. Pro-nature conservation behaviours were defined based on both their ecological impact on nature and their goal orientation, meaning they need to objectively support nature conservation and subjectively be done by people with the aim to support nature conservation. An expert ranked list of possible behaviours was created, including small actions that one can take in their own garden as well as more politically driven actions, such as contacting local government about nature conservation issues. Then, using psychometric methods, a questionnaire scale measuring tool, the Pro-Nature Conservation Behaviour Scale (ProCoBS), was developed and validated. This resulted in a long and short form for adults, as well as a child version including only behaviours accessible to people under the ages of 16-18. The scale was found to have two subscales, one concerning behaviours in the garden and the other one civil actions. An overview of the adoption of pro-nature conservation behaviours in the public and influences of some demographic factors showed that while there is engagement, this could be improved and demographic variables impact behaviour. For example, women acted more often than men and people living rurally acted more often than people living in urban areas. Age also had an impact, interestingly showing different directions depending on the subscale. Finally, the influences of variables known from general behavioural research as well as research on pro-environmental behaviours on pro-nature conservation behaviours were examined. Based on the findings the efficiency of focusing on the so-called Value-Action gap was questioned, suggesting the Intention-Behaviour Gap to be more easily bridged. Further, it was shown that both an approach building on the Theory of Planned Behaviour, as well as an approach centring nature connectedness, could provide worthwhile insights into pro-nature conservation behaviours. Here, again, slight differences between the subscales were found. Connecting people to nature could be a key step in the efforts to protect biodiversity. Future research may profit from focusing not only on how to use nature connectedness to encourage pro-nature conservation behaviours but also how pro-nature conservation behaviours can improve nature connectedness.
    • An Investigation into Parental Understanding of Autism and the Development of an Individualised Autism Profiling Tool

      Bignell, Simon; Barnes, Chris; Lipka, Sigrid; Karousi, Alexandra (University of Derby, 2021-12)
      Raising a child with autism can be extremely challenging for parents and families due to the complex nature of autism and the wide variation in the type and severity of symptoms children experience. Several factors may influence parent perceptions about autism and their understanding of the child’s unique traits related to autism. To date, there is no research to identify the particular pattern of parental understanding of autism as related to their child’s individual strengths and challenges. Research into specific parent factors is critical to help inform intervention strategies that can meet the needs of children with autism and their families. The main aim of this research is to provide an investigation of the basic elements comprising parental understanding of their child’s presentation of autism and their pre-existing knowledge about the condition. In exploring this, an evidence-based tool, the ‘Individualised Autism Profiling’ (IAP) tool was developed in conjunction with key stakeholders and specialists in the field of autism. The first research objective was to determine whether there are differences between parents’ understanding of the general nature and characteristics of autism and the characteristics of their child with autism. The second research objective was to identify distinct parent profiles based on their child’s individual characteristics and unique needs. Findings from this research support the notion that parental understanding of autism in general and in relation to their child with autism might not be theoretically distinct constructs, and that parents of children with autism may recognize as common the characteristics of their child as related to all children with autism. Moreover, the present research provides novel evidence for the proposal of three distinct profiles of parental understanding of autism: a high, a moderate, and a poor level of autism understanding. These findings could lead to a better understanding of how parents understand their child’s potential and unique needs in the context of autism and would be important for informing decisions for intervention strategies to optimize child, parent, and family outcomes.
    • Investigating the relationship between implicit and explicit measures of optimism, and examining changes in them using positive psychology interventions.

      Sheffield, David; Maratos, Frances; Kirkman, Ann (University of Derby, 2021-06-21)
      Optimism has a multitude of benefits to individuals in the domains of physical health (Räikkönen & Chirag, 2019); it has also been associated with better performance, socially and academically (Solberg Nes, Evans, & Segerstrom, 2009), decreased stress and less likelihood to burnout (Chang, 2000), better mood, coping and stronger immunity in response to stress (Segerstorm, 1998), and increased problem solving (Chang, 1996). Currently, optimism has been defined in two main ways. Firstly, it has been defined as 'the global generalising tendency to believe that one will generally experience good versus bad outcomes in life' (Scheier & Carver, 1985; p.219). This suggests that optimists look on the bright side of life, whereas pessimists believe that if something can go wrong for them, it will. Secondly, optimism is conceptualised as a positive explanatory style; it concerns how they explain the event to themselves, either positive or negative. This optimistic or pessimistic thinking is reinforced daily through how we explain things to ourselves, relating to why good or bad things happen to us (Seligman, 2005). In the main, explicit measures have been used to measure optimism; however, explicit measures may be susceptible to several biases, such as social desirability. Implicit measures have been suggested to be able to overcome these biases (Greenwald, 1998). In this thesis, an implicit measure was created and assessed to overcome these biases. These implicit measures were compared to explicit measures to investigate how well they correlated. This thesis has three main aims; (a) to create an optimism implicit association test (IAT) to investigate the relationship between implicit and explicit measures of optimism. (b) to investigate the relationship between implicit and explicit measures of optimism, including associated changes when using positive psychology interventions. (c) to investigate if optimism is changeable over time. To address these aims, within the thesis, three studies and a systematic review were employed. Study 1 aimed to create a valid and reliable optimism implicit association task (IAT) and to also investigate the relationship between implicit and explicit measures of optimism. The study examined the relationship between implicit Visual Probe Task (VPT), IAT and explicit Life Orientation Test Revised (LOT-R). The findings in study 1 showed promising results for the reliability and validity of the IAT. However, no relationship was found between implicit and explicit optimism measures. Study 2 examined the factor structure of optimism, within both the optimism IAT and explicit questionnaire measures. The findings suggested that implicit and explicit optimism were separate factors and therefore, could be considered separate dimensions. A systematic review and meta-analysis explored optimism and positive psychology interventions in the workplace (using the PRISMA checklist). The systematic review revealed three studies that investigated randomised controlled trials (RCT) and whether positive psychology interventions (PPIs) increase optimism in the workplace. The meta-analysis found good homogeneity and a small to medium effect on optimism. This suggests that optimism in the workplace is malleable through PPIs. Study 3 used a pilot RCT to examine whether PPIs can change the implicit and explicit optimism. A working population were randomly assigned to kindness to self, kindness to others or control group. The findings suggest a preliminary effectiveness at increasing optimism. The overall conclusion from the three studies and systematic review suggested that optimism and pessimism are separate two-dimensional constructs. Additionally, the findings suggest that implicit and explicit measures are also separate constructs. Finally, the acts of kindness to self and others positive psychology interventions show potential to increase implicit and explicit optimism, and optimism is changeable over time.
    • How can children aged 8-12 years be involved in decision-making and consent processes in outpatient Child and Adolescent Mental Health Services (CAMHS)? An embedded case study.

      Forman, Dawn; Brannigan, Chris; Naylor, Bill; Cox, Ann Marie (University of Derby, 2021-06-17)
      Involving children in decision-making and consent processes in their own healthcare has long been a challenging area of clinical practice. The reasons for this are the challenges in assessing child development capabilities in decision-making, and the lack and ambiguity of guidance and frameworks that support this area of practice. This study addresses these challenges in relation to outpatient CAMHS and provides an in-depth examination of how children can consistently be involved in decision-making and consent processes. The study has triangulated children’s, parents’, and clinicians’ perspectives to provide a theoretical understanding of children’s involvement and how this can be used within clinical practice. The method used in this study has been an embedded case study design and the critical realist inquiry of retroduction. A variety of methods and analytical tools transcending the research paradigms have been used to elicit the relevant data. The study includes several literature reviews, a patient clinical record evaluation, a semi-structured questionnaire administered to clinicians, and four focus groups, two with children and two with parents. The findings are i) children can be involved in decision-making and consent processes; ii) children want to be involved in decision-making and consent processes; iii) The onus is on the adults supporting the child in the decision-making process to maximise the child’s involvement in the process and iv) the theories of prioritising, knowing and navigating are fundamental to understanding the decision-making process and provide an evidence base for this area of practice. This study provides practical solutions in translating the theory into practice. In conclusion, decision-making is a multifaceted process that needs time, resources, and skills to facilitate it properly. For the first time, children have been heard in how they want to be involved in decision-making and consent processes. A critical examination of how children can be involved in decision-making and consent processes has been undertaken. The development of the theories of prioritising, knowing, and navigating are critical to fully understanding and implementing this area of practice.
    • The Dark Side of Humanity Scale: A Reconstruction of the Dark Tetrad Constructs

      Harvey, Caroline; Baker, Ian; Howard, Chris; Katz, Louise F. (University of DerbyCollege of Health, Psychology and Social Care, 2021-05-07)
      A myriad of criticisms have been directed at the widely available scales which measure the Dark Tetrad (DT), constructs of Machiavellianism, psychopathy, narcissism and everyday sadism. These have included construct incongruence, unstable factor structures, sex and age variance. Sex and age are salient variables in research studies and as such, their reported variance was considered to be a weakness of the measures, which contributed to their instability. To ascertain whether this was indeed the case, an investigation of the widely available DT measures was conducted in study one (n=605). Through the use of Classical Test Theories, Exploratory Graph Analysis and Item Response Theory, the criticisms of past research were supported, including variance across age and sex. Mediated by the evidenced issues and in order to address them, the Dark Side of Humanity Scale (DSHS), was developed, which was the main aim of this thesis. The focus of the measure was to assesses the DT personality constructs as they manifest in the general population, whilst also being sex and age invariant. Using a diverse range of statistical methods and guided by theory, expert ratings and past research, where available, the development of the DSHS began in the second study (n=667). During analyses, a divergence from the widely available DT measures emerged, whereby primary psychopathy and Machiavellianism were unified. However, this corroborated past research which has discussed the two constructs as being parallel. It further afforded the DSHS with a shift away from the traditional DT conceptualisation. The resulting scale encompasses four factors. The first represents the successful psychopath, factor two addresses the grandiose form of entitlement, factor three taps into everyday sadism and includes sadistic fantasies, direct and vicarious psychological malevolence, whilst factor four pertains to narcissistic entitlement rage. Each factor is specific to the traits and behaviours of the construct they address. Study three reports on the convergent and discriminant validity of the DSHS (n=712), and test-retest validity (n = 413), for which temporal reliability as well as nomological validity was achieved. The unique contributions of this thesis are discussed in the final chapter. The DSHS provides an alternative approach to investigating the dark side of human nature in general population samples, whilst also being sex and age invariant.
    • Creating a student and patient focused research led environment in diagnostic radiography education

      Forman, Dawn; Hyde, Emma (University of DerbyHead of Diagnostic Imaging, College of Health, Psychology & Social Care, 2021-05-06)
      This critical appraisal explores my published works; how they have informed my development as researcher, diagnostic radiographer and teacher in Higher Education; and how they have changed practice at other institutions both nationally and internationally. Through my practice as a radiography educator and by undertaking research into diagnostic radiography practice, I have used a range of research methods to make a unique contribution to the knowledge base within the radiography profession. This new knowledge focuses on student radiographer’s experiences during their clinical placements and informed measures of patient centred care in diagnostic radiography. Through the research projects, I have influenced discussions about student placements at a national level and developed innovative new clinical placement opportunities. This has led to a secondment opportunity with Health Education England to lead a project on growing the Imaging Workforce in the Midlands. I have contributed to national and international debate about patient centred care in diagnostic radiography and developed theoretical models and audit tools to support patient centred approaches. In August 2020, I was awarded a prestigious National Teaching Fellowship by Advance HE, in recognition of the impact of my work and my research on radiography education within the UK. My research output now totals eight peer reviewed journal articles, one article in an industry magazine, one book chapter and one handbook to support Values Based Radiography education. These publications are helping to grow my research profile on ResearchGate, Scopus and Google Scholar. In addition, I have disseminated the findings of my research via 24 conference papers or posters. Contributions towards a new textbook about patient centred care, further journal articles and a Massive Open Online Course (MOOC) are currently in progress based on the findings of my largest research project, which sought to define informed measures of patient centred care in diagnostic radiography.
    • Bridging the Dementia Divide: the contribution of a Massive Open Online Course on Dementia to dementia care and pedagogy

      Robertshaw, David (University of Derby, 2021-05)
      Dementia is one of the most important global health issues of our time due to its impact on both individuals and society. This thesis spans a 6-year programme of research and scholarship focused on developing an open platform for people to develop an understanding of the symptoms, progression, and caring needs of living with dementia with the intention that it would change their attitudes and perceptions of dementia. The vehicle for this project was a massive open online course (MOOC), known as “Bridging the Dementia Divide” (BTDD). The research and findings from BTDD were analysed, evaluated, and disseminated through ten published works consisting of the BTDD MOOC itself which has been studied more than 10,000 times, a TED talk which has been viewed more than 1,800 times, seven articles published in peer-reviewed journals and one chapter. This body of work developed organically over time and involved an iterative methodological process. These works were driven by a pragmatic and reflexive approach to the work and research. This body of work has always had in mind the potential benefit to the end-user, service users, the public, professionals, patients, and people living with dementia. Because of this, specific aims were not set in the beginning but were developed iteratively over a period of five years. The initial aims and purposes of these works were to inform people about dementia and to make a difference to the lives of people living with dementia and their carers. The project then grew and developed into the development of the MOOC itself and resulted in the subsequent research surrounding it. The aims of the publications were developed in response to the developing research programme’s aims. The resulting aims of this thesis were: to conceptualise and implement a MOOC on dementia, to generate new knowledge pertaining to attitudes and perceptions and the lived experience of dementia within online fora; to evaluate the MOOC as a change intervention within the context of dementia and to discern the impact of dissemination of research findings for implementation in practice and pedagogy. This body of work was researched from a pragmatist paradigm. This critical appraisal used Rolfe’s (2001) reflective model of “what, so what, now what” to consider the published works themselves, their impact, and requirements for future research. Research originating from BTDD has contributed to dementia care by providing educational experiences, describing the experiences of integrated care from the perspectives of carers and family members with dementia, as well as identifying the roles and responsibilities people and organisations play. BTDD made a difference in participants’ attitudes towards and perceptions of dementia. The findings from BTDD have influenced University policy, practice, and programmes and as importantly the research and publications included in this thesis have influenced national and international research projects.
    • Exploration of contributing factors to mental health in workers and students

      Van Gordon, William; Sheffield, David; Kotera, Yasuhiro (University of Derby, 2021-04-08)
      Having worked in the field of human resources, my publications focused on mental health and neuro-linguistic programming (NLP). Poor mental health has been reported among workers and university students in the United Kingdom (UK). The costs of poor work mental health are estimated to be £87 billion annually in the UK. In particular, hospitality workers, who comprise 7% of the country’s workforce, are known to suffer from poor mental health. Likewise, more than a quarter of UK university students suffer from a mental health problem. Through a series of cross-sectional studies using correlation, regression, moderation and path analyses, I found that mental health shame was positively related with mental health problems, and self-compassion and intrinsic motivation were negatively related to both mental health shame and mental health problems in a variety of population groups that had not been explored before, including UK workers, UK students and Japanese workers. In my NLP research, I investigated the application of NLP-derived skills for career guidance and critically reviewed psychological outcomes of applying those skills in organisational settings, through a pre-post study, thematic analysis, and systematic review. Two skills, the Disney Strategy and Sponsorship, were regarded particularly useful by the small sample of registered career consultants in Japan investigated in Publication 1. My systematic review (Publication 8) concluded that while NLP may be effective for diverse psychological outcomes, there is a need for rigorous future research. Taken together, my findings suggest the wide applicability of the effects of self-compassion and intrinsic motivation on mental health, and the similarity of Sponsorship to the soothing system in the three emotion regulatory systems. The critical appraisal of my published works identified four areas that are caveats for understanding the findings and could benefit from further work: (a) Lack of consideration for established predictors, (b) Mental health variables being treated as a unitary construct, (c) Balanced discussion of positive and negative aspects of mental health, and (d) Lack of critical appraisal 6 of NLP. Future research should consider these critical insights to improve our understanding of mental health and NLP.
    • Individual differences and medication-mediation in chronic illness conditions: a mixed methods approach to the development of a novel, conceptual framework

      Sheffied, David; Owen, Deborah J (University of DerbyCollege of Health and Social Care, 2021-04)
      Chronic illness is prevalent; adherence to pharmaceutical therapy facilitates an optimal outcome and is the single most influential affect in the individual’s illness trajectory. Hence, a prerequisite of efficacy is that medication is taken as prescribed. Adherence levels are, however, sub-optimal, with rates to pharmacological interventions as low as 17%; this represents a significant challenge to the effectiveness of therapy, undermining the benefits of clinical care. The reasons for nonadherence are various and complex, incorporating demographic factors, such as age and gender, cognitive variables including forgetfulness, as well as illness and treatment concerns, such as disagreeable symptoms and side effects. An underexplored factor, however, is the influence of personality factors on health behaviour, even though individual differences have been noted as central in health psychology. The ambit of this thesis is to explore the determinants of, and barriers to, pharmacological adherence in chronic illness, with a particular emphasis on personality affects; the overarching aims of the research are to develop a taxonomical framework of adherence factors and, further, a conceptual model demonstrating various influences of medication-taking. Two literature reviews were undertaken to establish what is currently known in extant literature; the first review, an expansive historical timeline, encompassed an appraisal of published literature in order to secure an overall understanding of topics that have been considered in relation to the phenomenon of medication adherence, and revealed the foci of adherence studies over the past few decades. This historical timeline evidenced that the biomedical stance is habitually used by researchers at the exclusion of patient’s perspectives, and highlighted a gaping lacuna in terms of individual differences; furthermore, the review formed a novel basis on which to contextualise the second systematic literature review and meta-analysis, which honed in on personality and its causal affects on medication adherence in chronic illness conditions. To substantiate quantitative data attained from the reviews and to expound the core dimensions underlying medication adherence, phenomenological investigation was performed. Emergent themes of experiential notions of adherence, informed by interviews with thirty-one participants, were thematically analysed; motifs included challenges with self-management in chronic illness, coping with an alteration in the self and notions of ‘normality’, together with psychosocial negotiation of the illness itself. Prior to interviews participants also completed psychometric assessments in order to ascertain adherence rates (the Medication Adherence Rating scale) and identify influential personality traits (the Five Factor Model). Data were synthesised to construct a comprehensive taxonomical framework of the diverse determinants of adherence, which deepens our understanding, facilitates an entry-point into adherence research and has significant utility as a research-informed theoretical structure. Additionally, the novel IndEx-MediC conceptual model of adherence was developed, predicated on findings that medication-taking is a mediational process influenced temporally, experientially, and contextually, determined by individual and external factors. The model presents a novel description of patients’ experiences of adherence to pharmaceutical therapy in chronic illness and serves as a foundation to develop a predictive measure to identify individuals potentially at risk of nonadherence, from which tailored interventional strategies may be devised.
    • Advancing Health Professionals’ Knowledge of Liver Disease

      Mitchell, Kathryn; Forman, Dawn; Brannigan, Chris; Mortimore, Gerri (University of Derby, 2021-03)
      Over the last 50 years, mortality and morbidity from liver disease has increased and is a global health concern (Global Burden of Disease, 2020). In the United Kingdom, within this time frame, liver mortality has risen by 500% in the under 65-year age group (British Liver Trust, 2019). Treating and caring for patients with liver disease is complex, therefore it is imperative to educate health care professionals regarding the different types of liver conditions, the treatments and care required to support patients. The critical appraisal spans over 14 years of research and will examine 19 publications which details the impact of the author’s research on their academic journey, from a student nurse to the present day; underpinned by Benner’s (1984) five stage theoretical framework. This appraisal demonstrates how the impact of the author’s research, nursing practice and published papers is advancing health professionals’ knowledge of liver disease within national and international arenas. It additionally evidences how the research has improved standards of medical and nursing care for patients receiving treatment for liver disease and establish how, by listening and responding to patient experiences, guided the research and assisted in the development of educational resources. The research chronologically encompassed positivist, interpretivist, and latterly pragmatic paradigms and utilised both quantitative and qualitative research methodologies. The research generated new knowledge regarding patients’ lived experiences of haemochromatosis, generated data submitted to Parliament and highlighted the requirement for venesection guidelines. The principal findings of the research demonstrated that there was a disparity of care across the British Isles, for people undergoing therapeutic venesection for haemochromatosis. This prompted the development of the venesection guidelines to standardise practice. A further finding demonstrated that less than 27,000 people were being treated for genetic haemochromatosis when the numbers should be nearer to 400,000 indicating that the condition is underdiagnosed. A further qualitative study highlighted that many General Practitioners take years to diagnose the condition, and some were unaware of its existence. The author’s expertise and research reputation, as evidenced by the collection of published research, has been sought by the National Institute of Health and Care Excellence (NICE) for the development of national guidelines and quality standards. The contribution from the author was recognised by NICE by the conferment of the title, NICE Expert. Research findings were presented to Parliament via an All-Party Parliamentary Group in 2020, to highlight the condition, genetic haemochromatosis and to lobby for increased awareness. The Venesection Best Practice Guide received Royal College of Nursing endorsement and was published as and eBook which has been downloaded by many countries, evidencing worldwide dissemination. This project won the National Patient Safety Learning Award in 2018 and in addition, the co-authors have been awarded winners of Nurse of the Year, 2021 by the British Journal of Nursing. This clearly demonstrates how the author has advanced health professionals’ knowledge of liver disease by informing and influencing local, national, and international policy to improve or even transform lives for the better.
    • A Qualitative Exploration of Drug and Alcohol Using Parents’ Experiences in Drug/Alcohol Treatment when Social Services are Involved.

      Montague, Jane; Elander, James; Goddard, Kashmir (University of DerbyCollege of Health, Psychology and Social Care, 2021-02-05)
      This thesis is concerned with the lives of drug and alcohol using parents, who access treatment for their addiction. Parents who are drug and alcohol users may experience stigma, fear, shame, and denial around their misuse, which means that many fail or feel fearful to access any treatment for fear of official intervention. This thesis aims to explore the narratives of Class A drug users and alcohol users who access drug and alcohol treatment and who have been referred to Children’s Social Services when a Child Protection issue has been raised. Qualitative data was generated during the three studies. Semi-structured interviews took place during each study (1, 2 and 3). Study 2 allowed the use of photographs taken by participants to be examined. Study 3 allowed the use of a journal to capture the experience of the participants. Interpretative Phenomenological Analysis was applied to the verbatim transcripts. Key findings are presented as four superordinate themes in chapters 5, 6, 7 and 8. Each chapter focused on one of the four superordinate themes that were identified in the data analysis, which combined data from all three studies. ‘Risk and vulnerabilities’ in Chapter Five suggested that when these parents were teenagers’ drugs and alcohol were easily accessible, and there was trauma in their lives, which meant exposure to drug and alcohol use was a way of escape. Parents described addiction as a cycle they were continually on, and regardless of what they did the power of this cycle made it difficult to break free. This, for some, developed into committing a crime to fund their addiction. The theme of drug and alcohol use and parenting is discussed in Chapter Six. This chapter suggested that parents’ mental health was severely impacted as a result of their drug and alcohol use. This left the parents feeling stigmatised and experiencing a tainted identity. Parents expressed grief and trauma about their experience and how this impacted on family attachments and affected partner relationships. Parent’s emotional reaction to Social Services and Child Protection in Chapter Seven suggested a loss of control and negative emotions such as anxiety, anger feeling embarrassed, scared, guilt, and frustration when professionals became involved. Parents wanted professionals to understand addiction, and they hoped the professionals supporting them would be supportive to help them change. Recovery and change in Chapter Eight suggested coming to the point of realisation that they had no choice but to change their behaviour. There was also an understanding that their behaviour had impacted their children. Parents expressed the difficulty of treatment without proper effective interventions and, at times, relapse and how this was frowned upon. The subordinate themes linked to one another and some similar themes appeared in several chapters. Chapter Nine, the final chapter summaries the thesis as it provides a glimpse into the complex nature of being a drug/alcohol addicted parent. Key findings suggest a change in professional practice to meet the needs of the user and the wider family.
    • The needs of clients coming to counselling following an experience of second harm: A Q Methodology study

      Whiffin, Charlotte; Townend, Michael; Kenward, Linda (University of DerbyUniversity of Cumbria, 2021-02)
      Introduction Successive reports identified that psychological harm (second harm) can be caused to patients by poor responses of healthcare providers to initial errors or neglect. Aim To explore the needs of clients coming to counselling following experience of second harm. Method A Q methodology study involving ten participants UK wide was undertaken. Participants sorted 42 statements online constructed from a concourse comprising sources on experiences of second harm. Concourse sources focused on the deficits of interpersonal relationships, therefore statements focused on what participants needed from interpersonal relationships with counsellors moving towards recovery. Data analysis Factor Analysis via PQMethod was undertaken on the Q sort data. The interview data was used to elucidate the nuances of the Factors as viewpoints. Findings Two Factors were extracted from the Q sort data that demonstrated the viewpoints of participants: Viewpoint 1 – Needs that are both past and present focused: being understood. Viewpoint 2 – Needs that are both present and recovery focused: making me well. From these two viewpoints 11 perceived needs were identified. Nine were identified as generic needs within the counselling relationship; however, two were identified as specific to those attending counselling for second harm. Counselling needs specific to second harm were; the need for participants to not be blamed for what happened and, the need to have the counsellor understand the impact of the harm and the complaints and litigation system including issues of control, power, and autonomy. Conclusion Findings of this study revealed people who seek counselling following experiences of second harm have specific needs beyond those expected from a general counselling relationship. Furthermore this study was able to define second harm for the first time and offers this to the research and practice community in the hope it will advance the field by helping counsellors to understand the concept, nature, and impact of second harm in addition to the expected skill set for any counsellor supporting those who have experienced second harm. Further research is required to evaluate the impact of educating counsellors in second harm and further testing of the definition of second harm.
    • THE PERSONAL AND PROFESSIONAL EXPERIENCES OF COUNSELLORS AND PSYCHOTHERAPISTS WHO EMPLOY THE PRINCIPLES AND PRACTICES OF COMPASSION FOCUSED THERAPY: AN INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS

      Townend, Michael; Montague, Jane; Stoneley, Helen; Gilbert, Paul; Wood, Wendy (University of DerbyCollege Of Health and Social Care University of Derby, 2021)
      This research examined the personal and professional experiences of counsellors and psychotherapists who employ the principles and practices of Compassion Focused Therapy (CFT). The research was developed due to anecdotal accounts from counsellors and psychotherapists (and personal experience) that suggested that working with CFT significantly influenced their personal and professional lives. This research focused on a holistic understanding, examining how therapists made sense of CFT in their personal and professional life. The holistic focus is based on systemic theories. However, in this case, rather than looking at systems from a family therapy perspective, the focus here is on what happens in the therapy room is an interweaving of both the client/patient and therapists' experiences, including physiological, cognitive, emotional, organisational, and socio-political influences. Current research in counselling and psychotherapy is focused on patient/client outcomes; it is argued that understanding therapists is just as important as understanding the clients/patients since therapists are a significant part of the therapeutic intervention. Since CFT is a relatively recent psychotherapeutic intervention, the aim is for the research into therapists can develop at the same time as research into clients/patients. The research used Interpretative Phenomenological Analysis (IPA). The sample was 10 counsellors/psychotherapists who use the principles and practice of CFT in their personal and professional lives. The method of data collection was the diary/interview method. Thematic analysis was also used to analyse specific questions at the end of the diary and interview. Seven themes were discussed: Experience of using the principles and practices of CFT in professional life; Using CFT to engage with disempowerment, injustice, and abuse; blocks to compassion in clinical work; CBT CFT and other approaches; Experience of using the principles and practices of CFT in personal life; personal blocks to compassion and the importance of time as a block or support to compassion. This research found that psychotherapists' personal and professional experiences are complex and multi-dimensional. They include complex interactions and awareness that are internal to the therapist involving physiological, cognitive, and emotional responses that are ever-changing in response to environmental factors. Experiences also involve external interactions with patients/clients, supervisors, colleagues, other professionals, and the socio-political influences that shape personal and professional life. This research identifies several implications for practice, policy, education, and research. Time was a significant theme. The importance of sufficient time to reflect on practice, personal and professional development impacts the quality of service development and delivery. The importance of developing organisational and practice cultures of equity diversity and inclusion to facilitate the development of compassion was another significant implication. Concerning therapists’ education, explicit focus on the debates around integration and writing to enhance reflective practice. The implications for future research reflect the need to move away from methodological tribalism.
    • "I don't want to be touched all the time" - Street Harassment and the Indian Woman

      Holland, Fiona, Dr.; Williams, Sophie, Dr; Montague, Jane, Dr.; Khan, Sumana (University of DerbyCollege of Life & Natural Sciences, UoD, 2020-12-10)
      Street harassment is the gender-based sexual harassment of individuals in public spaces by strangers. Studies have shown that the majority of victims of street harassment are women and the perpetrators are men. Despite its serious implications on women’s quality of life and psychological well-being, street harassment remains an understudied area and has not been included in the wider ‘violence against women and girls’(VAWG) research and discourse. This research aimed to position street harassment as a distinct form of VAWG by exploring Indian women’s sense-making of their lived experiences of street harassment. The research was structured into two parts: Part 1 – The ‘Sociocultural Study’ implemented dispositive analysis of three recent Bollywood films of romantic genre to explore the construction of sociocultural discourses on Indian womanhood. Part 2 – The ‘Experiential Study’ explored the lived experiences of street harassment of adult Indian women by using Interpretative Phenomenological Analysis (IPA). The participants included four single women (aged 25-35) and four mothers (aged 35-50) to teenage daughters. The Sociocultural Study provided the cultural context for the Experiential Study. The findings of the Sociocultural Study indicated that the concept of womanhood is constructed by the Indian male gaze—the virginal sanskari (traditional) Indian woman is considered the symbol of Indian womanhood, whereas the “westernised” vamp is the morally corrupt temptress of men. These patriarchal constructions were rooted in deeply ingrained sexism, sexual objectification, and rape myth acceptance, proposed as the ‘triad’ of core mediators of street harassment by this research. The ‘triad’ featured significantly in the meaning-making of the participants in the Experiential study. The participants interpreted their experiences in themes of disempowerment, emotional isolation, loss of sense of agency, identity conflicts, and stress in family relationships. The findings aligned with UN’s definition of ‘violence against women’. Recommendations for future research include better theoretical developments to explain street harassment; investigation of potential long-term effects of street harassment in women such as post-traumatic stress disorder (PTSD); designing studies with more male participants to explore an ‘insider’ view into harassment; and finally, development of new standardised quantitative instruments to measure various aspects of street harassment.
    • Exploring Observational Pain Assessment Tools for Individuals with Moderate-to-Severe Dementia

      Ainslea, Cross; Dawn, Forman; Kreshnik, Hoti; Babicova, Ivana (University of DerbyCollege of Health, Psychology and Social Care (University of Derby), 2020-11-26)
      The global increase in the prevalence of dementia has provoked a multidisciplinary response from researchers, policymakers, educators and clinical sectors. There are many important aspects of care, which need to be considered when looking after an individual with dementia. One such aspect of care, and a fundamental human right, is appropriate pain treatment and management. Due to the progressive neurodegenerative nature of dementia, individuals in the moderate to severe stages of the condition are often unable to self-report their pain, therefore health professionals rely on the use of observational pain assessments. Unfortunately, pain continues to be under-recognised, underestimated and under-treated in people living with moderate-to-severe dementia. There is, therefore, a need to enhance observational pain assessment, to ensure that appropriate pain treatment and management is implemented. This thesis set out the following aim and objectives: Aim: To examine the psychometric properties, in terms of validity and reliability, of observational pain assessment tools for people living with moderate-to-severe dementia. Objective (a) to conduct a systematic review to further investigate the current state of observational pain assessment tools. Objective (b) to explore feasibility and use of observational pain assessment tools, specifically the Abbey Pain Scale and the PainChek®, in a UK care home setting. Objective (c) to validate and evaluate the psychometric properties of PainChek® in a UK care home. Objective (d) to investigate three case studies of individuals living with dementia who demonstrated atypical pain behaviours. The aim and objectives were accomplished by conducting four studies. The first study was a systematic review which examined the psychometric properties of observational pain assessment tools. The results from the seventeen studies which met criteria for inclusion indicated a highly heterogeneous, indicating that validity and reliability measures, such as inter-rater reliability or concurrent validity, were highly diverse across observational tools which were tested for psychometric qualities. The second study utilised exploratory qualitative methods to explore perceived feasibility of two observational pain assessment tools; Abbey Pain Scale and PainChek®. Transcripts from the semi-structured interviews were analysed using a thematic analysis. Four main themes were identified; strengths of the Abbey Pain Scale, limitations of the Abbey Pain Scale, strengths of PainChek®, limitations of PainChek® and critical factors of pain assessment. The third study focused on validating PainChek®; a semi-automated observational pain assessment tool in a UK care home. Twenty-two participants diagnosed with dementia and a painful condition were recruited. Over a period of sixteen weeks, psychometric properties in terms of validity and reliability of PainChek® were evaluated by direct comparison to the Abbey Pain Scale. Three hundred and two paired pain assessments were completed. The analysis of the data revealed excellent validity and reliability results, demonstrating that PainChek® would be a suitable tool to asses’ pain in people with dementia in UK care homes. The fourth and final study explored three case studies in depth. During the data collection in the previous study, three participants were consistently expressing atypical and unexpected pain behaviours. The investigation into the three individual case studies has highlighted the importance and growing need for increasing interprofessional education and learning, and a consideration of how uncommon expressions of pain could hinder the accuracy of pain assessment. The research conducted for this PhD thesis reiterated the on-going issue with under-recognition, underestimation and under-treatment of pain in people with dementia. The overall results collectively investigated and contributed findings towards the current knowledge of pain assessment in people with moderate to advanced dementia, by presenting an in-depth mixed-methods approach. In addition, the results from this thesis demonstrated excellent psychometric properties of PainChek® in a UK care home and explored the current limitations of pain assessment and offered possible solutions. To prevent poor treatment and management of pain in individuals with dementia, regular and accurate use of observational pain assessment tools is recommended. Finally, while feasibility and appropriateness of the use of the PainChek® were explored, further research focusing on implementation is needed to investigate the pragmatic and practical aspects of using an electronic device in care homes.
    • An investigation into the role of acceptance and related factors in quality of life among renal dialysis patients.

      Mitchell, Kathryn; Elander, James; Stewart, Paul; Stalker, Carol (University of DerbyCollege of Health, Psychology and Social Care, University of Derby, 2020-11-13)
      For patients with end stage renal disease, renal replacement therapy (RRT) is essential to a patient’s survival. Haemodialysis is one RRT, and a growing body of evidence has suggested that how patients relate to this treatment is associated with both clinical and psychological outcomes. Adjusting to illness is a complex process (Dennison, Moss-Morris, & Chalder, 2009; Moss-Morris, 2013; Walker, Jackson, & Littlejohn, 2004) and one factor identified as important in other chronic conditions is acceptance. Evidence supports that acceptance can be important in helping patients manage conditions that cannot be improved through medication or therapies (McCracken, 1998; Veehof, Oskam, Schreurs, & Bohlmeijer, 2011). Findings from studies across a range of chronic conditions (Brassington et al., 2016; Poppe, Crombez, Hanoulle, Vogelaers, & Petrovic, 2013; Van Damme, De Waegeneer, & Debruyne, 2016) suggest that more positive acceptance of illness facilitates improvements in patients overall quality of life (QoL). However, there is limited research addressing the role of acceptance of illness and the impact on dialysis patients. This thesis has evaluated the role of acceptance and associated psychological variables in haemodialysis patients to develop an understanding of the influence of acceptance and to enable the development of targeted acceptance-based interventions. This thesis aims to; gain an understanding of what acceptance means for dialysis patients; compare the influence of acceptance and associated psychological factors on patient outcomes, and examine the longitudinal relationships between acceptance and quality of life for dialysis patients. A mixed-methods approach was utilised and four methodologies were adopted; a systematic review evaluated the impact of acceptance on outcomes for patients with end-stage renal disease and how patients viewed acceptance in relation to these outcomes; cross-sectional studies compared the influence of acceptance, psychological and clinical variables on quality of life outcomes; a qualitative study explored patients experiences of accepting dialysis treatment, and a longitudinal study tested the impact of acceptance and psychological variables at 6 and 12 months post baseline. All participants were dialysis patients recruited from a single hospital site; a total of 102 participants were recruited. 98 were retained for analyses at baseline and 50 retained at 12 months. Ethical approval was obtained prior to the commencement of recruitment. The research generated several important findings. Firstly, it highlighted that acceptance in dialysis was complex, with qualitative findings indicating that acceptance of illness in dialysis patients related to themes of ‘accepting the necessity’, ‘accepting the functional aspects’, ‘acceptance from experience’ and ‘acceptance from support’. This resulted in the proposal of a conceptual model utilising acceptance mindset to address how patients reach acceptance and how they interpret their illness and treatment. Secondly, relationships between acceptance, psychological variables and QoL were identified; acceptance is a significant predictor of kidney disease QoL and physical QoL, with depression found to be a significant predictor for kidney disease QoL and mental QoL and was a significant mediator between acceptance and QoL. These findings demonstrate that acceptance is an important component of QoL in dialysis patients but also highlights the associations to other psychological variables. Theses associations in the cross-sectional study were confirmed longitudinally. Thirdly, tests of longitudinal associations demonstrated that although there were no significant changes in overall acceptance levels over time, group changes masked individual differences. The individual changes in acceptance were associated with changes in mental QoL and kidney disease QoL. Changes in acceptance rather than depression were predictive of mental QoL and kidney disease QoL at 6 months. At 12 months changes in acceptance and depression were important predictors of mental QoL and kidney disease QoL. The overall findings identified that acceptance of illness is an important aspect related to QoL for dialysis patients. Acceptance is a complex construct and relates to psychological factors, particularly depression. The qualitative analyses highlighted important areas related to acceptance and these were supported in the more complex analyses of QoL, these are areas that need considering in any future intervention developments. Although group acceptance did not change over time evidence at the individual level suggests that there may be benefit in targeting of interventions. Developing specific acceptance interventions targeted at dialysis patients may improve patients QoL and reduce the overall burden.
    • Developing a Cognitive-Behavioural Therapy Treatment Programme Designed to Promote Hopefulness and Self-Esteem in Mental Health Service Users Recently Diagnosed with a Psychotic Illness: A Pilot Study to Explore Service-Users’ Experiences of Accessibility, Engagement and Efficacy

      Townend, Michael; Strickland-Hodge, Barry; Pearson, Daniel James (University of DerbyLeicestershire Partnership NHS Trust, 2020-11)
      This study sits within a wider research agenda, the aim of which is to develop a novel psychological therapy programme designed to target hopelessness and compromised self-esteem in young people recently diagnosed with a psychotic illness. The aspiration is to develop a programme that is experienced as accessible and engaging and perceived to be of value. It is anticipated that that process will progress through several stages and a number of iterations. The primary objectives of this specific piece of research were to undertake a first piloting of the Therapy Programme, gather evaluative feedback from participant-service users, and fine-tune the approach. The secondary objective was to explore the perceived value of the programme with regard to ‘proof of concept’. The research design combined the methodological rigour of Interpretative Phenomenological Analysis with a mixed-methods focus on data, underpinned by the philosophical paradigm of critical realism. Quantitative data was collected through the completion of outcome measures pre, during and post-therapy. Qualitative data was gathered through the facilitation of semi-structured feedback interviews with participant-service-users shortly after the completion of each of their Therapy Programmes. Participants were followed-up at 2 years from the commencement of their therapy to ascertain the subsequent trajectory of their lives and to explore reflections on their experiences of the programme from a perspective of temporal distance. Eight Early Psychosis Service clients were recruited to receive the Therapy Programme. Three withdrew from the therapy. Another completed the Programme, but failed to complete all of the research requirements. One completer-participant experienced a psychotic relapse shortly before the end of therapy. The principal purposes of the research were the elicitation of critical reflections on the Therapy Programme and meaningful recommendations for its improvement. There was some evidence of reticence amongst participants regarding the expression of critical statements. Where more critical observations were expressed, they focussed primarily on the relative balance and chronological ordering of different elements. The consensus recommendation was for the ‘pure’ elements of the approach, including direct attention to the cognitive-constructs of hope and self-esteem, to proceed the consideration of more applied goals. There was a strong collective recommendation to allocate more attention to addressing unhelpful illness narratives. A Participant Handbook, written as a resource for those involved in the therapy, was positively received with regard to design. Participants, however, recommended significant change to the complexity of its content. Of the four completer-participants, three showed substantial improvements in reported hope, self-esteem and wellbeing over the period in which the therapy was delivered. Those gains were sustained at follow-up. The participant who experienced a psychotic relapse showed limited improvements on all measures at the end of the treatment period, but had progressed significantly at follow-up. In each case, reported scores on the outcome measures were supported by substantial success in negotiated life-goals. Participant feedback regarding the programme, post-therapy and at follow-up, was generally very positive, with all participants identifying causal connections between the therapy, achievement of therapy and life goals, and subsequent improved outcome scores. To accommodate a priority focus of qualitative data, participant numbers were small and there was no access to normative or comparative data for the service user population. The limitations of the sample size were compounded by a high rate of attrition. The delay to follow-up introduced additional confounding variables. As a consequence of the study-design, therefore, quantitative data can only be regarded as providing indicative evidence of reported improvements across the measures of wellbeing. It cannot be said to evidence a causal connection between therapy and identified improvements or to support statements regarding the efficacy of the approach. Finally, although participants were recruited explicitly to be collaborators in the evaluation and betterment of the Therapy Programme, reflections appeared to be somewhat biased towards a validation of the approach and critical evaluations, although present, were limited. The credibility of these observations is, further, undermined by the design-decision to have the therapist conduct the post-therapy feedback interviews. The primary objective of the research was to generate meaningful recommendations for the improvement of the Therapy Programme. That purpose was achieved. The secondary objective was to consider the programme with regard to ‘proof of concept’. Subject to the limitations detailed above, the level of improvement reported over the period in which the therapy was offered, together with the fact that those gains had not been lost at follow-up, tentatively supports an argument for further development of the programme.
    • Exploring the Conceptual Constructions of the Mobile Phone Within the Neoliberal Digital Age: A Thematic Analysis

      Howard, Chris; Hallam, Jenny; Montague, Jane; Smyth, Michael (University of DerbyPsychology, College of Life and Natural Sciences, University of Derby, 2020-10-27)
      This thesis is an investigation into the ways in which mobile phone users’ contextualised understanding of the mobile phone may have shaped their mobile phone practices and subjectivity within the cultural narratives of the neoliberal digital age in the UK. The proliferation of research literature focused on mobile phone practices has been dominated by mainstream psychology’s pathologised rationales for differences between mobile phone users’ practices. However, the distinction between normal and problematic practices are not clearly defined across studies. This thesis adopts a critical perspective to consider the socially integrated relationship between meaning, subjectivity and behaviour in order to inform the current rationales for differences between mobile phone users’ practices from an underrepresented perspective on the topic. The thesis is collection of four discrete but interconnected studies which progress from exploring the culturally accessible conceptualisation of the mobile phone presented by the mass media to the culturally contextualised understanding of the mobile phone by mobile phone users. Mass media data were collected from UK national newspaper articles about the mobile phone published between 1985 (first consumer handheld mobile phones in the UK) and 2019, to provide a wide historical context, and website-based advertising of mobile phones accessible to the UK population during 2019. Data was collected from mobile phone users through participant-generated reviews of their mobile phone by 164 self-selected mobile phone users and in-depth interviews with 20 mobile phone users positioned as at-risk problem users by the psychology literature. The data collected was analysed using an inductive thematic analysis informed by social constructionism. The analysis of the news media revealed that the conceptualisation of the mobile phone shifted from a business tool accessible by a wealthy few to a normal need of modern living for the masses which is integral to the user’s identity. It was argued that current cultural conceptualisations of the mobile phone were shaped by societal powers related to neoliberalism and regulation. The conceptualisations related to the advertisements promoted a normal, essential, desirable and continually developing contemporary tool of self-improvement, empowerment, independence, control, social connection and identity development. Mobile phone users’ conceptualisations related to the deep meaning that essential lifestyle enhancing activities had for them and positioned themselves as attached to their lifestyle and identity development that was accessible through their mobile phone practices which they positioned as culturally normal and essential to a modern lifestyle. For the users positioned as at-risk problem users, the mobile phone was an emotionally complex object which was related to emotional support and emotional tensions, in conflict at times. The relationship between the mass media’s conceptualisations of the mobile phone and mobile phone users’ contextualised understanding showed that cultural narratives, fashioned by societal powers, shaped users’ understanding and practices. It was concluded that mobile phone users were attached to the continual development of their lifestyle, identity and knowing that they experience through their mobile phone practices rather than attached to the device. Mobile phone practices are a symptom of neoliberal digital culture rather than a problematic symptom of the user. Future research must sustain the critical perspective to build upon the findings of this thesis and explore the identities of those who actively resist using mobile phones with consideration to their contextualised personal interests in order to further inform the distinction between normal and problematic mobile phone practices.