• 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.
    • Assessment and training in breast cancer detection.

      Cowley, Helen Claire.; University of Derby (1999)
    • Creative ageing: participation, connection & flourishing. A mixed-methods research study exploring experiences of participatory arts engagement in later life through a systematic review of literature and focus groups with older people

      Bradfield, E. (University of Derby, 2020)
      Background: A rapidly increasing ageing population has significant consequences for the demography, health and wellbeing of our society. Participatory arts programmes and activities can contribute to health promotion in later life, by providing community-based, non-clinical opportunities for meaningful engagement and interaction. To date, academic research studies have mainly focused on people living with dementia and have investigated the benefits of therapeutic and / or musical interventions. However, little research has been conducted with healthy older people participating in other arts’ domains such as the visual arts or been approached through a creative ageing lens. Creative ageing is an inherently interdisciplinary field of enquiry, which sits at the intersection of arts and health and social gerontology and places emphasis on the role of creative engagement in enhancing personal growth, creativity and building social connections in later life. Aims: This thesis uses a mixed-methods approach to explore experiences of participatory arts engagement in later life through a study of literature and focus-group conversations. The study considers existing theory within social gerontology, arts and health and the creative ageing movement in a conceptual review, providing the context that underpins the thesis. A mixed-methods systematic review is conducted to examine the published evidence on the effect of participatory arts on wellbeing, quality of life and cognitive function and to explore distinctions between engagement in different arts domains and levels of participation. A two stage focus group study aims to investigate whether themes developed from the review resonate with older people’s own subjective experiences of participatory arts engagement and to explore barriers to participation in the arts in later life. Methods: The study employs a multi-stance approach to data collection and analysis, through a mixed-methods methodology which draws on the traditions of pragmatism and phenomenography. First, a conceptual review explores key concepts in social gerontology, definitions of arts and health and approaches to ageing, including the burgeoning field of creative ageing, providing the theoretical context for the thesis. Next, a mixed-methods systematic review is conducted to identify relevant qualitative, quantitative and mixed-methods studies of the effect of participatory arts engagement in later life and older people’s subjective experiences of engagement. Quantitative results from studies in the review are analysed through an exploratory meta-analysis of the topic of subjective wellbeing and through narrative analysis, categorised by wellbeing and cognitive function domains for clarity. To employ creative methods in the analysis, as this is a study about arts engagement, qualitative findings are analysed using thematic and I-poem analysis, which places emphasis on the older people’s voice. The qualitative and quantitative analyses are then integrated to provide a combined evidence synthesis of experiences and effects of participatory arts engagement in later life. A two-stage focus group study is then carried out to explore whether the themes developed from the review resonated with participants’ own subjective experiences of participatory arts engagement and to explore barriers to participation. The first stage of the study involves three focus group sessions with groups of older people, which took place at three locations in Cambridge. Themes from the review were used as the stimulus for conversation and provide the structure for analysis. The findings are further scrutinised using Seligman’s (2011) PERMA model of wellbeing (Positive emotion, Engagement, Relationships, Meaning and Achievement) as a framework, focusing on the elements of wellbeing which contribute to a meaningful life. Stage two of the study examines barriers to participation with a more socioeconomically diverse sample of older people. This stage involves two additional focus groups which were held in Peterborough and Wisbech. Findings are re-analysed in light of the second study and identifies both barriers and facilitators to participation in the arts. Systematic reviews play an integral role in the production of research knowledge. However, review reports often remain in academia, without the findings being shared with relevant stakeholders. By further examining the systematic review findings through focus group interviews with older people, this thesis may help to close the gap between research and practice. Additionally, enabling groups of older people to discuss the findings meant that the study could be contextualised in contemporary group settings, increasing the quality and relevance of the review and reflecting participants’ voice. Concepts developed during the analysis are discussed in the final chapter and presented in a conceptual framework of creative ageing. Findings: The mixed-methods systematic review identified 33 relevant studies which investigated the effects of participation in dance, visual arts, creative writing and theatre on wellbeing, quality of life and / or cognitive function for healthy older people. Quantitative analysis produced as part of the systematic review process showed statistically significant improvements to some aspects of wellbeing following engagement in dance and visual arts activities, and enhanced cognitive function in the domains of general intellectual ability and attention after participation in different art forms. The exploratory meta-analysis showed an overall combined effect size of g=0.18 indicating the effect of dance on enhanced subjective wellbeing. Qualitative findings were developed into five themes: making and creating; connections and communities; identity; the ‘feel good’ factor; and body, mind & soul. Additionally, I-poem analysis revealed an association between positive emotion and participation in dance and a poem titled ‘I feel happy when I’m dancing’ was produced as a creative output. Findings from the review were shared in a two-stage focus group study. In the first stage of the focus group study, three supplementary themes were developed to those identified above: engagement as ritual; emotion and engagement; and ikigai. In stage two, an iteration of the theme of engagement as ritual was developed into spiritual resonance: engagement as ritual, along with a further theme around transitions of ageing. These themes elucidate the role of the arts and cultural engagement in supporting people to remain active and involved in their communities in later life and which may provide a ‘reason for being’. The study also allowed a connection to be made between the ritual of engagement in the arts and the sense of belonging felt by bringing people together creatively, in addition to the potentially detrimental effect of non-participation on subjective wellbeing. Transitions of ageing provides evidence for the role of creative engagement in challenging perceptions of ageing and enabling opportunities to explore a new sense of self in later life. In the second stage of the focus study, barriers to participation were categorised as: infrastructure, situational and dispositional barriers, as well as factors which might facilitate participation, classified as: intra-personal, inter-personal and external factors. Infrastructure barriers emphasised the need for accessible transport links which enable older people to access arts and cultural activities, particularly in more rural areas. Personal circumstances including finance and relationship status were highlighted as situational barriers preventing participation, while dispositional factors including low levels of selfefficacy and literacy may inhibit engagement. Findings also explicated factors which may provide solutions that improve access and inclusivity for older people wishing to participate in the arts, including offering taster sessions, befriending schemes and reducing financial and access restrictions. Finally, a conceptual model was developed which highlighted three key interwoven concepts of creative ageing: participation, connection and flourishing. Conclusions: This thesis substantiates existing evidence on the potential role of creative engagement in enhancing quality of life, promoting social connectedness and thus reducing loneliness in later life. It also contributes to the mixed-methods’ paradigm discourse through its innovative use of a creative method within the systematic review and the multiple-stance approach to the thesis. The study contributes new knowledge by establishing a meaningful association between creative ageing and human flourishing and provides evidence for the need for more accessible community-based arts activities which encourage older people to participate and develop positive connections. Factors which might inhibit or encourage participation should be considered in the design of creative programmes to ensure that they are accessible and inclusive to a diverse range of older people. In conclusion, creative engagement may contribute to developing more resilient, creative and healthier communities within which our ageing population are enabled to flourish. With an established evidence base on the benefits of participating in the performing arts, including dance for promoting subjective wellbeing, there is now an opportunity for us to expand our perceptions and understanding of creativity in later life through further research which embraces a broader definition of creative ageing.
    • The design and feasibility of a work-focused relational group-CBT treatment programme to enhance job retention in employed service-users with moderate-severe recurrent depression.

      Townend, Michael; Strickland-Hodge, Barry; Walker, Nicola (University of DerbyHealth and Social Care, 2020-10-15)
      Background: Employees with moderate-severe recurrent depression are at risk of losing their jobs. A search of the literature revealed that most psychotherapeutic interventions are not work-focused, and there are none that have been specifically designed to enhance job retention in employed service-users of UK Community Mental Health Teams. A subsequent update of the research evidence using the same literature search strategy plus another search with more stringent inclusion criteria found several studies of work-focused psychotherapeutic interventions. However, but there is still a gap in terms of work-focused psychotherapeutic interventions specifically designed for employees with more severe mental health problems. Methods: The Medical Research Council guidance for the development and evaluation of complex interventions was used throughout this study. Firstly, an effectiveness review of relevant psychotherapeutic interventions revealed several over-arching principles which appeared to underpin their effects such as using a care pathway incorporating multi-disciplinary teamwork, guideline concordance, informed clinical decision-making, tracking of progress, and the use of outreach to encourage clients to complete treatment. Secondly, a stakeholder consultation was undertaken during the planning period, and realist analysis of the focus group data identified six plausible mechanisms of change which allowed for modification of the new intervention design and refinement of the programme theory. Thirdly, piloting involved a small feasibility study using a quasi-experimental pre-post design with eight participants which generated both quantitative and qualitative data regarding clinical and work outcomes. Fourthly, a further stakeholder consultation was undertaken during the reviewing period to consider re-design of the new intervention in terms of improving acceptability and accessibility. Finally, a process of mixed methods data integration was used to make recommendations for further implementation and evaluation in a definitive trial. Results: Six provisional Context-Intervention-Mechanism-Outcome (CIMO) configurations were developed into a programme theory. Overall, implementation and evaluation of the new intervention were feasible although problems were encountered in recruiting sufficient numbers for randomisation, and with collecting follow up data. It was also expensive to provide compared to CBT programmes in primary and secondary mental healthcare services. Outcomes suggest the new intervention is a promising treatment for moderate-severe recurrent depression for some women and may help them in maintaining their employment. Acceptability could be improved by making the new intervention more interesting and stimulating, with a focus on coping over the long-term. Accessibility could be improved by making the new intervention more understandable, delivering it at the worksite, and making it peer-led. Conclusions: Job retention for employed service-users may be enhanced if the tertiary individual level Treatment Programme is re-designed as a primary organisational level Training (and staff support) Programme informed by group-CBT.
    • 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.
    • The Enosis Method: An Alternative Mixed Method to Analyse Qualitative Information

      Fakis, Apostolos (University of DerbyUniversity Hospitals of Derby and Burton NHS Foundation TrustDerby Clinical Trials Support Unit, 2020-06-24)
    • An evaluation of a specialist service model for treating Body Dysmorphic Disorder (BDD): application of the National Institute for Health and Clinical Excellence Guidelines for BDD (NICE, 2006).

      Stalmeisters, Dzintra; Townend, Michael; Govender, ANUSHA (University of Derby, 2020-02)
      Body dysmorphic disorder (BDD) is still poorly recognised with a dearth of research into treatment. This is the only known study to date to evaluate the implementation of the National Institute for Health and Clinical Excellence (NICE) guidelines recommended treatment for BDD in clinical practice as well as providing qualitative data of both patients and clinicians (NICE, 2006). The study aims to evaluate current recommended treatments for Body Dysmorphic Disorder utilised in a specialist service for BDD. In addition the study elicits the experiences of patients receiving treatment and the clinicians providing the treatment. This provides a basis to assess if refinements are to be made to treatment protocols for BDD in this specialist service. A mixed methods approach was employed with quantitative data from patients treated for BDD collated from the Trust’s database and examined with intention to treat analysis. Thematic Analysis (TA) was used to analyse data from semi-structured interviews conducted with clinical staff and patients to elicit their experiences of respectively providing and receiving treatment. The clinical data indicated impairment in patients’ functioning plus high risks and substance misuse. Treatment outcomes of NICE recommended CBT and medication (Selective Serotonergic Reuptake Inhibitors and augmentation) produced significant improvements in BDD symptoms in patients with severe symptoms at baseline. Patients also showed significant improvements in depression and overall functioning. However despite improvements symptoms were not completely eliminated and one group treated by the service (Level 6 outpatients) showed minimal to no improvement on all symptom measures. Both clinician and patient participants expressed dissatisfaction with the lack of sufficient knowledge and expertise for treating BDD. Both groups also placed high value on the therapeutic relationship. However clinicians interviewed indicated a higher dissatisfaction with current treatment options for BDD than patients. The experiences of patients provided a different perspective to the findings in the quantitative phase. Their view of improvements was based on their functioning and overall quality of life. Clinicians’ perspectives provided insight into other options for treatment which are lacking and could provide substantial support for current recommendations. Given the evidence base for recommended treatments is still limited, it is essential to include qualitative data in evaluating effectiveness of treatment and in developing services that respond to patient needs and choice.
    • An exploration of the role of visual arts projects for refugee well-being

      Hogan, Susan; Sheffield, David; Phillips, Katherine (University of Derby, 2020-03-14)
      Art therapy and other art-for-health initiatives are part of UK health and social care policy, as well as international humanitarian services for people fleeing persecution. There are currently unprecedented numbers of refugees and high levels of mental distress have been identified in this population. The non-verbal and symbolic potential for expression within art-making may provide a unique form of beneficial initiative. Through a critical realist perspective this thesis adds to the body of knowledge about art-based projects for refugee well-being. A mixed-methods systematic review was conducted in 2018. The quantitative data (k=2) showed that group art therapy is an effective intervention for reducing symptoms of mental distress in refugee children. The qualitative synthesis (k=24) presents a way to conceptualise the kinds of outcomes people experience from different modes of art-based engagement. Themes were developed through the qualitative data synthesis, including Beautifully handmade, Seeing with fresh eyes, Honour the past: forget the past, Telling the story and Being part of the world and Learning and working together. Accordingly, an interplay of creative, personal and social elements is proposed to occur is such activities. While different art-based approaches are identified: art therapy, facilitated art-making and independent art practice, these are shown to engender similar human experiences. This thesis builds on previous research on the use of colouring books for well-being. A mixed-methods randomised controlled study demonstrates their efficacy as a selfsustained well-being activity over one week. This study compared the effect of colouring pre-drawn mandala patterns with free-form drawing and a control group. The study included 69 university students and staff. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the Depression Anxiety and Stress Scale (DASS) were used. A large and significant effect size was found for WEMWBS and a dose response was demonstrated in the colouring condition. A feasibility project was then run at a refugee drop-in centre, where colouring books and colouring pages were provided on a weekly basis for seven weeks. While colouring books have been provided to refugees previously, this thesis demonstrates the potential well-being value of such provision, and the likely uptake of colouring books by this population. Data are presented from four refugees and four staff members. Accordingly, this thesis shows that colouring books are acceptable to refugees. Thematic analysis and qualitative content analysis were used to explore the qualitative data from both primary research studies. Colouring was found to be a relaxing activity by participants in both studies. Participants valued both the process of colouring and the final product. Both reflection and distraction are presented as potential mechanisms involved in improving well-being through colouring. Some participants found the colouring evoked memories, some used the process to express emotions and others found the colouring gave them a welcome diversion from other thoughts. Colouring at the refugee centres also provided an impetus for inter-personal relationships, such as colouring with friends. Art-based approaches are explored as a range of useful and acceptable interventions to improve the well-being of refugees. Consideration is given to the variety of contextual factors that influence the creative and relational elements that are considered central to these interventions. Art-based projects operate within complex social and political systems. Identifying cultural norms and exploring power dynamics can contribute to the understanding and development of initiatives seeking to improve individual well-being, and effect wider collective social and political change.
    • 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.
    • 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.
    • 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.
    • 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.
    • “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.
    • "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.
    • 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.
    • 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.  
    • A living inquiry: activating and integrating the multiple identities of dramatherapist, researcher, artist and teacher

      Forman, Dawn; Mitchell, Kathryn; Bird, Drew (University of Derby, 2019-05-31)
      The critical narrative explores published and creative works as a performer and how this has informed the author’s development as researcher, artist, dramatherapist and teacher in Higher Education. Through clinical work as a dramatherapist in different settings and practice as a dramatherapy educator the author explores the integrating of therapy and teaching approaches such as meaning making, deep learning and student-centred learning. The research is a living inquiry that is an unfolding of the researcher’s experience and deepening of understanding over a fourteen-year period as a clinician and teacher. The author examines the encounter and interrelationship dynamic between the performer and audience; therapist and client; teacher and student; and researcher and research participant as a means for co-construction and co-creation of meaning, knowledge and raising awareness. The author explores the importance of a research approach that is congruent with a dramatherapy and teacher identity emphasising non-verbal exploration, the senses, the imagination and play as a means for deepening understanding of dramatherapy and teaching practice. Through the creative works of a solo performer the author explores how engagement as an artist informs and strengthens their identity as a dramatherapist, researcher and teacher. Different research methodologies including heuristic inquiry, autoethnography and a/r/tography are considered for their suitability for a living inquiry that addresses the multiplicity of roles.