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Focusing on Citizenship Education (CE) and Education for Sustainable Development (ESD) within the Key Stage 3 (KS3) Learning for Life and Work (LLW) curriculum in Northern Ireland (NI), this research explores the extent to which 14-15 year old young people (YP) in NI exhibit features of 'sustainable citizenship' (SC) and how CE and other factors influence this. A literature review develops a new characterisation of SC as a pragmatic framework, characterising sustainable citizens (SCs) as those who think about how people interact within environmental, social, and economic aspects of the world and who are critical of how life is lived in order to change the systems that perpetuate unsustainable behaviour. Drawing on a children's rights-based approach, working with an advisory group of YP (n=11), this mixed-methods study included: a survey with YP (n=1136 ) across 26 schools; seven focus groups with YP (n=72); semi-structured teacher interviews (n=7). Statistical analysis indicated that Nature Relatedness (NR) and Competence for Civic Action (CCA) account for the majority of the variance explained for SC, with NR contributing most. Two demographic factors appear to influence SC: being female, which, in terms of explaining the variance for SC, was similar to that of CCA, and, by a lesser degree, attending a Voluntary Grammar school. Findings from thematic analysis suggest that whilst some YP in NI are thinking/acting as SCs, all YP face numerous barriers to SC, including: struggles concerning 'succeeding' in an unsustainable economic system; a lack of connectedness. Possible issues with the KS3 LLW curriculum, including the conflation of Employability and Citizenship and Employability being valued over sustainability, were revealed. In conclusion, the study suggests that to foster collective action towards a sustainable future, the curriculum requires underpinning by Education for Sustainable Citizenship, Ecological Responsibility and Human Rights, Communicative Space, and Outdoor Education and Play.

Objective: The focus on psychopathology in general, and posttraumatic stress disorder (PTSD) in particular, has been debated and critiqued recently in the context of refugee trauma. This mixed-methods study broadens the conceptualisation of refugee mental health in resettlement, and explores the relationship between the level of psychological distress (conceptualised as the rate of PTSD, depression and anxiety) and post-resettlement stressors and coping as determinants of refugee mental health. Method: Fifty war-affected Syrian civilians who arrived in the UK through the Vulnerable Person Resettlement Scheme (VPRS) and asylum route participated in individual interviews. The participants completed self-reported measures of PTSD, depression and anxiety, along with the Demands of Immigration Scale, and shared their post-resettlement experiences through semi-structured interviews. A range of statistical analyses are used to measure the association between psychological distress and post-resettlement stressors. Reflexive thematic analysis is applied to identify themes of post-resettlement experience and coping relevant to the main study questions. Results: Descriptive statistics using frequencies and percentage computations show that approximately 40% (M=30.96, SD = 16.30) of the participants scored above the cut-off point of 33 on the PTSD Checklist, which indicates a provisional diagnosis of PTSD. Approximately 57% (M=11.43, SD=8.84) of the participants scored 10 or above on PHQ-9 the cut-off point for moderate symptoms of depression. Approximately 40% (M=9.12, SD=4.50) of the participants scored 10 or above on GAD-7, the cut-off point for moderate symptoms of anxiety. A significant correlation is found between post-resettlement stressors and psychological distress. The reflexive thematic analysis reveals five interconnected themes as a model to explain key aspects of refugee mental health in resettlement and confirm the quantitative findings. Conclusions: Post-resettlement stressors have a significant impact on refugee mental health, reinforce feelings of uprootedness, and lower adaptation prospects. The study findings highlight the need for host countries to create opportunities for agency and autonomy which allow refugees to contribute to and transform local communities. Finally, the study advocates a culturally sensitive approach to improving refugee mental health, enabling them to initiate their own paths to recovery.

Preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes, which continue to have a substantial impact on morbidity and mortality. This mixed methods thesis comprises three studies intended to address key uncertainties of improving preconception health in the UK. The first study was an umbrella review that used the GRADE framework to assess the evidence certainty of 205 unique associations for preconception exposures contained in 53 systematic reviews. I identified high- and moderate-certainty evidence that maternal preconception folate supplementation, weight, interpregnancy weight change and physical inactivity, and advanced paternal age, are associated with adverse pregnancy, birth and postpartum outcomes. The second study was a cross-sectional survey of 835 women registered with primary care in the West of England, which assessed their knowledge, attitudes and views of preconception health and intervention methods. I identified a need to promote awareness of preconception risk factors and motivation for preconception health changes, particularly among younger and nulligravid women and women with lower incomes. Intervention methods involving communication from healthcare professionals, schools, family members, and digital media were reported to be acceptable. The third study involved in-depth interviews with 20 of the cross-sectional survey participants, purposively sampled using a maximum variation approach. A framework analysis of their views on interventions to improve preconception health highlighted a multitude of factors that can enhance the acceptability and appeal of these interventions. These included enabling discretion and access, seeking consent, ensuring sensitivity, including details of the 'why', 'how' and 'how much' of preconception recommendations, and the use of visual media and personalisation. In line with national policy recommendations, a need to deliver preventive interventions ahead of first pregnancy was highlighted. This thesis contributes to the growing literature on improving preconception health. Future research should seek to develop interventions informed by the findings of this research.

This thesis looks at cultural change that arises from globalisation processes such as migration, and technological advances (mainly in the form of the internet) in two societies, Mauritius, and the UK. We approach this using an interdisciplinary lens: we adopt the culture sensitive methodological approaches of indigenous psychology, combined with theoretical ideas from the fields of cultural evolution, and social, and cross-cultural psychology. Across our three studies, we look at cultural change in the form of changing identities and identity processes (Study 1), cultural learning and acculturation processes which underlie broader cultural change (Study 2), and how various dimensions of changing norms influence behaviour (Study 3). These three studies highlight the importance of 1) cultural sensitivity in how we approach different cultures, and 2) updating scientific theories as the world around us changes.

Suicide is the second leading cause of death among young people worldwide (World Health Organisation, 2014). People with care experience have an elevated risk of suicidal ideation and behaviour and dying by suicide compared to those without care experience (Evans et al., 2017). However, the existing empirical information on suicidal ideation among care-experienced people, particularly young adults leaving care in England and Germany, is scarce. An in-depth understanding of factors influencing the development and coping strategies is required to help inform suicide prevention strategies within the care systems tailored to young people in care and the transition to adulthood. Furthermore, it remains unclear whether the knowledge about this topic applies beyond national borders due to the lack of cross-national comparative studies about suicidal ideation among people with care experience. Therefore, this thesis addresses the following research questions: what is the occurrence of suicidal ideation among care-experienced young adults in England and Germany? Which factors do care-experienced young adults perceive as influencing suicidal ideation? This thesis applied a mixed-methods approach, consisting of a survey and semi-structured interviews with care-experienced adults from England and Germany, to answer these questions. Joiner's interpersonal-psychological theory of suicide (IPTS) informed the study, focusing on interpersonal factors influencing suicidal ideation. This study is the first that applied this suicide theory to people with care experience. This study shows that the occurrence of suicidal ideation among care-experienced people is complex. Many participants reported having experienced suicidal thoughts from a young age and during the transition from care to adulthood. The results underline the importance of belongingness and caring relationships for care-experienced people. This innovative thesis aims to deepen the understanding of suicidal ideation among care-experienced people in England and Germany. The findings highlight the necessity of holistic suicide prevention based on trauma-informed practices within the care system.

Background: Many people live with long-term conditions and subsequent difficulties with their mental health. Demand on psychological services is high, and initiatives need to address barriers to accessing these services. Group programmes use resources efficiently, but the relative effectiveness of different types of groups is unknown. This research adapted an evidenced-based acceptance and commitment therapy group intervention. It aimed to compare the feasibility, acceptability and preliminary effectiveness of this intervention, among specific-diagnosis and mixed-diagnosis groups. Methods A mixed methods pilot and feasibility study. Participants attended a specific-diagnosis or mixed-diagnosis group. The intervention comprised of 7, two-hour weekly sessions with an 8-week follow-up session. Outcomes included health-related quality of life, illness perceptions, depression, and anxiety, measured at baseline, post-intervention, and 8-week follow-up. Subsequently participants and health professionals (facilitators and referrers) attended qualitative interviews which explored their views on acceptability, informed by the Theoretical Framework of Acceptability. Results Both group conditions had similar improvements in psychological distress, illness perceptions and health-related quality of life, with significant improvements across time for anxiety, depression, energy, emotions, and general health. There was no overall differential effect of group, or a group by time interaction on any of the outcomes. Feasibility measures including retention (attended at least 3 sessions), true completion (attended all 8 sessions) and mean adherence rates were high and comparable across both group conditions. Acceptability was high across patient and health professional perspectives, with no marked difference between group conditions. Conclusions Pilot and feasibility testing revealed the intervention was feasible and acceptable in both group conditions. This preliminary data indicated a similar degree of improvement across group conditions. A randomised controlled trial and further comparative research is necessary to confirm tentative findings. This research indicates that services could flexibly plan their resources, based on patient need and capacity demands.

Aim: The aim of this study was to pragmatically investigate a vital element of bowel function, where emptying the rectum is difficult in women, usually because of obstructive defaecation, secondary to rectocele. Background: Rectal emptying difficulty in women is a sign of obstructive defaecation, which affects about one out of every ten women and can increase with age. Rectal emptying difficulty has a mostly unknown influence on women, and it is frequently a hidden issue. Women's self-management alternatives are underappreciated, as is the impact of such interventions on their quality of life. Despite the magnitude of the problem and its influence on women's lives and health care, non-surgical alternatives have received little attention. Methods: The research consisted of an exploratory phase of nine self-selecting women who had self-purchased the patient-centred device. This was followed by a mixed-method study, using an explanatory sequential approach with 35 female participants, recruited via secondary care outpatient clinics. The participants completed a composite questionnaire before and after an eight-week intervention using a patient-centred device, an alternative to using their fingers to help empty the rectum. The questionnaire comprised of a quality-of-life instrument (ICIQ-Vaginal Symptoms and Obstructed Defaecation Syndrome Questionnaires), bowel diary recordings and participant feedback on using the device. The majority of the same participants (n=26) subsequently took part in a semi-structured interview. Findings: The exploratory phase provided preliminary insight into self-initiated use of the patient-centred device, suggesting an improved quality of life and a reduction of symptoms. The questionnaire result from the mixed methods study identified that the patient-centred device helped participants reduce the need to use their fingers (z=-2.844; p=0.004) and offered the participants a better lifestyle. There was a significant reduction in difficulties to evacuate, digitation to evacuate, the feeling of incomplete evacuation, straining to evacuate and lifestyle alteration, all below the threshold of significance (P=0.05). Medication to evacuate, returning to the toilet to evacuate and time needed showed no difference. The sense of incomplete emptying before and after using the device was significant (z=-2.646; p=0.008) as was the feeling of being blocked, which improved following the use of the device (z=-3.317; p=0.001). Stool consistency did not change before or after using the device. Twenty-four participants (68.5%) completed the Patient Global Impression of Improvement question post-intervention. Overall, 16 participants (66.7%) reported that the device was better than not using it. Using framework analysis interview findings revealed six themes, knowledge, consequences, finding a solution, psychological impact, coping, and physical impact. The mixed-methods study showed that the patient-centred device was acceptable to participants. Conclusions: The research study has contributed to the existing body of knowledge on rectal emptying difficulty in women. Firstly, the effectiveness of a patient-centred device for women with rectal emptying difficulty to use as an alternative for using their fingers to help empty the rectum. Furthermore, it offers an additional conservative measure option within healthcare provision. Second, the participants' lived experiences can help healthcare professionals, such as women who report with a bowel problem, learn more about rectal emptying difficulty, which can improve quality of life and prompt access to care. The research has strengthened the feasibility for further investigation via a randomised controlled trial.

The REACT Study assesses the effectiveness of a community-based PA intervention designed to reduce the progression of mobility-related disability in older people (≥65 years). The aim of this thesis was to conduct a mixed-methods process evaluation of the REACT intervention to understand how it was implemented, the causal mechanisms involved and the impact of contextual variables that led to intervention outcomes. Systematic review methods were used to determine that there is low utilisation of process evaluations (53.6%) in PA trials targeting older adults and a lack of focus on intervention fidelity and qualitative process evaluation of mechanisms of impact. Multi-observer coding of audio recordings (n=25) of intervention sessions were used to assess the delivery fidelity of REACT BCTs. A modified Dreyfus Scale (score 0 to 5) was used to assess delivery fidelity, with competent delivery fidelity defined as a score of ≥3. Mean intervention delivery fidelity approached competence (2.5, SD=0.45), with variation between BCTs and intervention groups. Framework analysis of semi-structured interviews was used to explore participant experiences of the REACT intervention longitudinally at six-and-12-month interviews. Perceived benefits (physical, social, emotional and behavioural) moderated REACT attendance and PA outcomes (PA and/or exercise independent of REACT). Perceptions of autonomy, competence/self-efficacy and relatedness mediated both REACT attendance and PA outcomes. Enjoyment, a supportive facilitator and supportive group dynamics were key motivators of REACT attendance. Physical health, mental health and time were key barriers. Frail participants, scoring between 4-7 on the Short Physical Performance Battery (SPPB) experienced fewer perceived benefits and more barriers to REACT attendance and PA compared to pre-frail peers with SPPB scores between 8-12. There is a lack of process evaluation being conducted in PA trials targeting adults, which this thesis aimed to address. Improvements are needed to enhance delivery fidelity in future implementation of the REACT intervention. Exercise that is enjoyable and utilises social interaction to facilitate a shared identity around PA motivates participation. Process evaluations whilst vital for interpreting intervention outcomes raise pragmatic challenges that researchers need to navigate to successfully utilise this methodology.

In the UK alone, roughly 700 in every 100,000 individuals will sustain an acquired brain injury (ABI) annually, including non-progressive damage to the brain such as traumatic brain injury, stroke, anoxia, or pressure from a brain tumour. Roughly half of those with ABI will experience depression. Therapies for depression have variable efficacy in ABI, possibly due to high demands on cognitive capacities that may be impaired post-injury. Behavioural approaches to treating depression that place lesser demands on cognition, such as Behavioural Activation (BA) therapy, offer promise. BA theory posits that depression reduces energy levels and expectations of positive outcomes from activities, and increases avoidance, which exacerbates depression. This dissertation provides a test of BA theory by investigating novel predictors of mood and activity levels, and outlines two interventions aimed at increasing activity levels and improving mood, in adults with an ABI from a wide variety of recruitment sources. I utilise both quantitative (e.g., structural equation modelling and mixed-effects models) and qualitative (e.g., interpretive description, thematic analysis) methodology to harmonise the individual perspective of ABI and to identify common patterns in ABI samples. The first empirical chapter concerns how mood disorders, activation and avoidance relate to intolerance of uncertainty (IU), a set of negative beliefs about uncertainty and its implications, in ABI. I demonstrate that IU can be reliably assessed in ABI, and that despite changes in uncertainty due to COVID-19, IU remains a robust predictor of poor mental health, lower activity levels, and greater avoidance in ABI. When controlling for ABI symptoms, the inhibiting effects of uncertainty provided unique variance in anxiety disorders but not depression. Although not as strongly associated with decreases in activity level, higher IU was associated with increased avoidance and rumination. The second empirical chapter focuses on discrepancies in estimation of functional capabilities ("impaired self-awareness"), specifically whether an individual with ABI overestimates or underestimates their ability relative to a family member. Using assessment data from over 200 adults assessed in NHS ABI neurorehabilitation services, those who overestimate themselves tended to be less depressed and anxious compared to those who underestimate and accurately estimate themselves, and had more severe injuries. However, those who overestimate themselves did not fare worse in long-term participation outcomes. The third empirical chapter uses qualitative methodology to explore perspectives of individuals with an ABI on changes in activity levels, and their views on various BA components used to increase activity levels. Level of perceived effort, its potential emotional impact and relation to participant values, and whether the component was used at the "right time" post-ABI were central themes when attempting to increase activity level. An investigation of two 8-week group interventions, designed to increase activity levels and mood in ABI, is presented in the final empirical chapter. Changes linked with each group are compared to waitlist controls in a pilot feasibility randomised controlled trial. The first intervention, "traditional" BA, uses therapeutic strategies and directly encourages individuals to plan and engage in reinforcing activities beyond group sessions. The second intervention, "experiential" BA, encourages participants to engage in reinforcing activities during group sessions only. Both interventions were feasible and acceptable, with approximately 50% - 60% of participants demonstrating clinically meaningful improvements in activity levels. In exploratory analyses of efficacy, both interventions improved mood, but only "traditional" BA resulted in lower anxiety, reductions in the impact of the inhibiting effects of uncertainty, and improvements in motivation. Analysis of qualitative data indicated that "traditional" BA seems to challenge negative self-beliefs and enhance confidence through planning activities, while "experiential" BA provides a low-pressure environment to engage in reinforcing activities. This dissertation demonstrates that increasing activity levels to improve mood in adults with ABI is an easily scalable and potentially effective therapeutic target, in alignment with BA theory. These data point towards potential expansions of BA theory in ABI, in particular the role of uncertainty and impaired self-awareness to activity level and their contributions to mood. This thesis concludes by stating that in clinical research, a mixed-methods approach to the application of relevant theory and intervention design is essential.

The prescribing of injectable end-of-life anticipatory medications ahead of possible need has become established good practice in controlling distressing symptoms for patients dying in the community. The intervention aims to optimise timely symptom control, provide reassurance for patients and families and prevent crisis hospital admissions. However, in signifying the imminence of death, anticipatory medication carry great symbolic and emotional impact. Stakeholder perspectives, particularly those of patients and informal caregivers, have not been investigated in detail. This thesis examines the practice of prescribing and using anticipatory medications in the community in England and patient, informal caregiver and clinician perspectives of this care. My systematic literature review identified that anticipatory medication policy and practice is founded on an inadequate knowledge base. Current practice is based primarily on clinicians' beliefs that anticipatory medications offer reassurance to all, facilitate effective symptom control and prevent undesired hospital admissions. The views and experiences of patients, informal caregivers and general practitioners (GPs) have not been adequately investigated; neither has the clinical effectiveness, cost-effectiveness and safety of prescribing anticipatory medication. In the light of my review, I then investigated community anticipatory prescribing and administration practices and perspectives of care through three sequential studies in two English counties. I undertook interviews with GPs, examined documented care in deceased patients' clinical records, and conducted longitudinal interviews with patients, their informal caregivers and clinicians. Triangulation of these data revealed that prescribing practices reflected the structures and culture of community healthcare rather than being particularly person-centred. Discussion with patients and informal caregivers of the process of dying and the role of anticipatory medications in controlling symptoms was often vague, inadequate or even absent. Some patients and informal caregivers expressed ambivalence about the medicines and perceived that they might hasten death. The prescribing of standardised drugs and doses and of anticipatory syringe pumps, often weeks to months ahead of the patient's death, had unintended consequences for care experiences and patient safety. Although administered anticipatory medications were reported to have generally helped symptom control, some informal caregivers reported difficulties in persuading nurses to administer them to patients. Clinician and institutional preferences to put prescriptions in place at the earliest opportunity can be counterproductive and are unjustified. Anticipatory medications are a nuanced and complex intervention, which needs careful tailoring to the preferences and experience of patients and families and regular review as situations change. Nurses' decisions to administer medication should take into consideration informal caregiver insights into patient comfort, especially when patients can no longer communicate.

As Russel King wrote 'return is the great unwritten chapter of migration' (2000). Accordingly, very little is known about how returning migrants experience their return, especially in the context of a post-socialist Central European country. The thesis thus presents an inquiry into the lived experiences of high-skilled Hungarian returning migrants. As theoretical engagement with return has rather been fragmented and often marginal to migration theory, the thesis presents a novel Integrated Theoretical Framework, which draws on the insights of four key research areas: integration, re-integration, social networks and cultural identity. By combining the insights of the matrix of attachments, multi-dimensional re-embedding, social capital and support, and the Cultural Identity Model into a single framework, the thesis does not only address their individual shortcomings but enables a comprehensive analytical approach to understanding returnees' experiences as a multi-faceted process within the broader migration cycle. To do so, it takes a mixed-methods personal network approach, where it utilises personal network data and in-depth qualitative information from thirty-four returnees. As part of the data analysis, it combines Thematic Analysis, fuzzy-set Qualitative Comparative Analysis, and descriptive social network measures as well as multi-level modelling techniques. It finds that migrants' experiences vary greatly from highly positive experiences to ambivalent or even hugely negative experiences. The thesis demonstrates that these experiences can be conceived as returnees re-embedding process on five dimensions, including their living standards, social, cultural, professional and political re-embedding, and that their social re-embedding plays a particularly important role. Moreover, returnees' experiences are directly and positively linked to their social capital, which can be understood as the function of their positive and negative social ties, where negative ties have a disproportionately strong negative effect. As the multi-level social network analysis reveals, networks with several emotionally close ties to Hungarians who also reside in the country provide the most social support to returnees. Additionally, based on their network compositions, returnees demonstrate five distinctive network trajectories throughout their migration cycle: transnationalism, ethnic maintenance, ethnification, host country attachment, and dispersion. These trajectories are underlined by different integration patterns and cultural identity changes, leading to markedly different re-embedding processes, social capital and consequently return experiences.

This empirical mixed-methods research is an original work exploring Mexican primary school teachers' pedagogical adoption of technologies in close connection to contextual conditions. The study was developed and conducted in the context of the latest digital education policy in the country, which has a strong focus on learner-centred pedagogy given its roots in international standards for teaching and learning with technologies (UNESCO, 2011). Theoretically and methodologically, this research adopted a plural and pragmatic perspective that interrelatedly responded to the digital education policy concerns and the situated perspectives of practitioners. Theoretically, internationally dominant constructs of "best practice" for learner-centred pedagogy were interweaved with theories of pedagogy in context. Methodologically, the study integrated a sequential mixed-methods methodology composed of two phases. Firstly, two state-wide surveys (using items from IEA's ICILS and SITES questionnaires) were disseminated to primary school teachers (n=348) and headteachers (n=74) in Colima, Mexico. The instruments explored teachers' pedagogical practices with technologies and the contextual characteristics of the schools in which they worked. Secondly, a multiple case study collected 18 days of school observations, six days of classroom observations, eight interviews and various documents across two primary schools in Colima. This evidence provided details of the underlying processes and situated complexity of the pedagogical adoption of technologies. Findings regarding teachers' practices showed that their use of technology did not meet the expectations of the digital education policy in terms of frequency of use, kinds of technologies integrated into teaching and the development of digital skills on students. When comparing these findings with cross-national averages, Colima's teachers were found to underperform relative to these parameters. Nonetheless, qualitative evidence showed that despite not meeting policy expectations, teachers' adoption of technologies was driven substantially by learner-centred principles (i.e., Schweisfurth), providing engaging lessons that drew on students' interests and periodically opened spaces for their interventions. Findings related to the context suggested that the school infrastructural and cultural conditions profoundly influenced teachers' adoption of technologies. Concerning infrastructural conditions, survey results showed that schools had insufficient resources. When compared to cross-national data, Colima's schools were also significantly under-resourced. Regarding the school culture, evidence indicates that the school ethos was fundamental in shaping how the schools enacted the digital education policy. Schools' understanding of their purpose, the headteacher's leading role and the teachers' collaboration were crucial for the degree to which technologies were adopted for teaching. It was also found that the school's agency had not been thoroughly considered as part of the digital education policy. Similarly, tensions across design elements of the policy (such as the defined expectations and provision of resources to schools) were found to impact technology adoption for teaching negatively. By exploring this phenomenon through plural theoretical and methodological lenses that shed light on policy and practitioners' concerns, this thesis offers new perspectives to the study of technology adoption in Mexican schools and outlines initial recommendations to enhance future digital education policies and practitioners' experiences.

Background: Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer. While most children with ALL survive, pain experienced during treatment is difficult for the children and their family to endure. The aim of this programme of research was to investigate the experience of pain and its management during ALL from the perspective of the child, parents and clinicians. Methods: A mixed methods approach was used across two studies. In Study 1, perspectives of parents, nurses and doctors in a Danish sample were captured in 16 semi-structured interviews analysed using thematic analysis. In Study 2, six children completed daily diaries of pain ratings using a mobile application during the first three months of their treatment for ALL. The findings from interviews and pain diaries were triangulated through interpretation. Results: Full data from pain diaries were available in 57.8 % of the sample. In average across all registrations, children reported being in pain 54% (SD =28.77, range 0-100%) of the time. Mean pain intensity was 3.25 (SD=3.4, range 0-10), where 0 was no pain and 10 was the highest level of pain. Paracetamol was reported in 46% (SD= 29.48, range 0-95%) and morphine in 14% (SD= 9.67, range 0-26%) of registrations. Only one participant used other analgesics (tricyclic antidepressants). Non-pharmacological pain relief methods included distraction in 42% (SD= 35.49 range 5-100%), massage in 25% (SD= 34.47, range 2-100%) and a heating pad in 3% (SD= 3.81, range 0-9%) of registrations. Agreement between families and clinicians in symptom severity was more concordant for physical symptoms than for anxiety and emotional distress. There were no differences between mothers' and fathers' perspectives of their child's pain. Parental informational needs were high and family empowerment required individual tailoring. Parents associated opioids with severe illness, whereas non-pharmacological pain relief strategies gave a sense of control and normality. Parental anxiety and child's past pain experiences had a major influence on pain assessment and management. Conclusion: Pain trajectories in childhood ALL are unique individual experiences. The findings have implications for the need to place a greater emphasis on incorporating the child's voice and in developing broad relief strategies when managing ALL pain.

The present study aims to explore the extent that school and classroom climate are related to students' learning outcomes in mathematics. The study incorporates both academic and non-academic achievements in Indonesia. By using a mixed-method approach, the study also seeks explanations for the observed differences in school climate between schools, based on the schools' academic performance and types of school (religious vs non-religious schools). In the first phase, the author used a quantitative approach to examine the relationship between school and classroom climate with student mathematics assessment outcomes. The Indonesian TIMSS 2011 data of 5795 students, nested within 174 classrooms, and nested within 153 schools were analysed using three-level multilevel models (student, classroom, school). The results showed two school and classroom climate factors that had a significant positive effect on academic achievement, after controlling for student, teacher, and school characteristics: (1) student engagement in math lesson; and (2) school discipline. However, student safety had a significant negative relationship with academic achievement. On the other hand, equivalent analyses using student mathematics self-belief outcomes suggested five school climate factors of academic achievement: (1) student engagement with their school, (2) teacher safety, (3) teacher confidence in teaching math, (4) school physical resources, and (5) student safety. The other two factors that harmed academic achievement were: (1) teacher to teacher interaction, and (2) student engagement in mathematical lessons. However, these findings are tentative considering that the overall goodness of fit of the models was relatively weak (13-26 percent). In the second phase, the author employed a qualitative approach to examine whether the profile of the schools and classroom climate varied in schools that differed in terms of student academic performance and religious type. Four secondary schools were selected as illustrative cases. One high and one low academic performing school for each the general (non-religious school) and madrasah (religious school) were selected. Focus group interviews were conducted to four students and teachers. Individual interviews were conducted to respectively four headteachers and policymakers. The data was analysed using an analytical framework drawn from the literature. The study identified similarities and differences in school climate factors across the four sampled schools. The study highlights the value of using the effectiveness evaluation dimensions of the Dynamic Model of Educational Effectiveness (DMEE) proposed by Creemers and Kyriakides (2008) (frequency, focus, stage, quality, and differentiation) in exploring and evaluating school climate. By using the effectiveness evaluation dimensions, a richer explanation about the differences between school climates of the high and low performing schools was obtained. The qualitative analysis also supports the findings in phase one, particularly those differences in school climate between the high and low performing schools. The results also expanded the framework by including two emerging factors: education orientation and culture. Although the findings are tentative and exploratory, the research is original in particular. The study analyses and reports the relationship between school climate factors and broader student learning outcomes. The study also adopts a newly developed school effectiveness conceptual framework for Indonesia and other similar contexts. The study thus contributes to the international school effectiveness knowledge base.

Antibiotic resistance is a significant public health challenge arising through a more-than-human geography enrolling multiple species, microbes, institutions, and environments. Antibiotic resistance entangles human, animal, and environmental health(s) because the same antibiotics are utilised in human and veterinary medicine, and resistance to these antibiotics can cross species boundaries through shared environments. Minimal social scientific research has examined the experiences or rationales of pet-owners in relation to antibiotic use and antibiotic resistance, nor whether the experience of utilising veterinary care in addition to medical care has an influence on how pet-owners use antibiotics in the context of their own health. This thesis deploys mixed-methods to investigate the experiences of pet-owners when navigating multiple healthcare settings in the context of antibiotic use and antibiotic resistance and the extent to which pet-owners resemble petless members of the public in their knowledge and behaviour regarding antibiotics. Through the combination of quantitative and qualitative social research methods, this thesis argues that at the population level pet-owners and petless members of the public exhibit broadly similar levels of responsible behaviour regarding their own health. However, the experiences of accessing medical and veterinary care and following any subsequent treatment regimens are subject to inconsistent perceptions of health and illness across species borders and are productive of differing rationales for antibiotic-related behaviours in different species' care contexts. This significance of this thesis is that it highlights the complexity of antibiotic stewardship for pet-owners and the role that distinct perceptions of health and illness hold in pet-owners' navigation of veterinary care and antibiotic use. Animal and health geographers, already cognisant of ontological challenges relating to 'knowing' animals and perceiving health, are challenged by this thesis to pursue a deeper integration of these challenges to respond to significant contemporary public health challenges that are interspecies in character and consequence.

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.

This thesis aims to elucidate the complex and important ways in which community conservation areas in Kenya's Southern Maasailand interplay with resilience to drought. Using a social-ecological systems perspective and a resilience lens, this thesis makes use of data from quantitative and qualitative methods, including a household survey, semi-structured interviews, document analysis, and remote sensing to investigate two group ranches in Kenya's semi-arid South Rift, Olkiramatian and Shompole. These communities have chosen to establish conservation areas on a significant portion of their land, and they have experienced two severe droughts over the last decade. This thesis explores the historical context of livelihoods, droughts, and land tenure in Olkiramatian and Shompole, as well as the provenance of their conservation areas. Research findings show that the conservation areas were established in drought grazing refuges, and that these areas continue to be used in that way today. In examining processes of adaptive governance over recent droughts, this thesis also shows how the current constitution of natural resource governance institutions, and the ways in which they are given authority, have resulted in adaptive systems which are considered to be legitimate, participatory, and effective at mediating complexity and uncertainty. This thesis also revealed that although the social-ecological systems are changing, current land management systems appear to be maximising resources while maintaining local resilience for people, livestock, and wildlife. This research finds that although contestations exist, some of the benefits of conservation areas appear to be reaching poorer households, and that for most households, conservation areas did not make things worse during recent droughts. However, conflict with wildlife remains a significant cost. In collating these results, this thesis highlights that when there is strong local ownership, with effective governance which prioritises culturally and economically important livelihoods, conservation areas can be helpful in maintaining social-ecological resilience to drought.

Children with Autism spectrum disorder (ASD) and their caregivers can find sustaining their wellbeing to be highly demanding. Dance Movement Psychotherapy (DMP), with a holistic and non-verbal character, may present as a relevant intervention option for this group of children and their caregivers. This doctoral research study aimed to explore the contributions of DMP towards the wellbeing of children with ASD and their caregivers. The study was conducted in two phases using a mixed-methods approach. Phase I involved a systematic review of the available literature to identify, evaluate, and synthesise the outcomes of DMP towards the wellbeing of children with ASD. The findings of the review identified the potential of DMP to promote the wellbeing of children with ASD and highlighted the lack of evidence for its effectiveness and clarity on the therapeutic process. Phase I also involved the development of two DMP intervention protocols for children and caregivers based on the key findings of the systematic review along with theoretical foundations and clinical experiences of the therapist, supervisor and researcher. These protocols were piloted in Phase II of the study which investigated the effects of DMP on the emotional and social wellbeing of children with ASD and their caregivers using a randomised and controlled crossover convergent mixed-methods design. Fidelity assessments were also conducted that showed 75% and above adherence to each criterion, good agreement among the three raters (researcher, therapist and an external expert) and reflected that the protocols were implemented across groups consistently. Twenty-six children with ASD and thirty-seven caregivers participated in the study. Quantitative data were collected before and after DMP while the qualitative and arts-based data were collected during the intervention using a battery of methods. Social Communication Questionnaire (SCQ) and Strengths and Difficulties Questionnaire (SDQ) for children with ASD have shown statistical and clinical significant improvements in the wellbeing measures irrespective of their mode of communication. The qualitative strand for children described multi-layered and complex processes. Three main themes with 18 sub-themes were identified through the thematic analysis of qualitative data including a) individual transformation process; b) group transformation process; c) overall process and outcomes of DMP. A dance piece was created through the artistic inquiry process that identified six key moments of change during DMP sessions with children. Similarly, for caregivers both outcome measures used i.e. Parenting Stress Index-Short Form (PSI-SF) and Adult Wellbeing Scale (AWS) indicated clinically significant improvement after DMP and a statistically significant impact on post-intervention scores for AWS but not for PSI-SF. In addition, a significant association was found between pre-intervention scores, number of sessions attended with the post-intervention scores of both AWS and PSI-SF. Their engagement in the therapeutic intervention was significantly related to the post-intervention measures. The qualitative findings from caregivers involved six main themes and twenty sub-themes which revealed that participants experienced some helpful and unhelpful factors such as (beholding within and around; reflecting and reinforcing strengths; exchanging views; looking back and carrying forward; core benefits; challenges to engage in DMP) that influenced the process and outcomes of DMP. Four key moments of change were noticed through the artistic inquiry process which were woven into a dance piece. Due to many dropouts from the intervention groups of caregivers, a bidirectional association between wellbeing of children and caregivers was not explored through statistical analysis. Instead, two exploratory case vignettes were presented which highlighted the potential bidirectional influence of experiences of wellbeing. The limitations and appropriateness of the research methods implemented in this study for their use in a large RCT are discussed. Overall, the findings highlight the value of DMP for improving the lives of young vulnerable groups and their caregivers.

Current knowledge regarding Teacher Evaluation Systems (TES) as a suitable approach to quality education improvement suggests that the relationship between teacher monitoring and enhancement is far from straightforward. Yet, developing countries such as Mexico have uncritically employed variants of these reforms since the early 1990s to bring about change with regards to levels of quality teaching and learning. Although teachers and headteachers are in everyday contact with education policies, these actors are rarely consulted regarding TES development. Therefore, this exploratory research examined teachers’, headteachers’ and policymakers’ perspectives concerning the strengths, weaknesses, and unintended consequences of a new TES called the Mexican Teacher Evaluation (MTE). Since full implementation of MTE started in 2015, the availability and impact of Continuing Professional Development (CPD) on the teachers’ practice before and after MTE (i.e. the academic years 2014-2015 and 2016-2017) were investigated. This sequential mixed-methods research collected data via an online survey of primary teachers across Mexico using online teachers’ networks (n=367) and semi-structured interviews (n=13). Of the total participants, n=131 participated in MTE and provided an insight into the procedures of the new TES as well as opportunities for CPD after the evaluation. Descriptive and inferential statistical analyses of quantitative data and a thematic analysis approach of qualitative data were employed. The findings indicated that in 2014-2015, overall teacher participation was lower than previous records from a TALIS-Mexico report (Backhoff & Pérez-Morán, 2015). Nevertheless, most common CPD topics are like those in previous literature and were perceived impactful on the practice. Furthermore, a series of preparatory courses tailored to MTE emerged during 2014-2015. Concerning the strengths of MTE, the new TES was perceived as a better scheme for teacher hiring and promotion as compared with the former method where the teachers’ union held significant power. However, only half of the surveyed MTE participants highlighted the value and positive nature of feedback following assessments. Regarding the weaknesses, MTE lacks classroom observations, tailored CPD following the evaluations, and appropriate follow-up of Newly Qualified Teachers (NQT) and in-service teachers after the assessment. Regarding the unintended consequences, MTE might have negatively impacted the teachers’ wellbeing at various points of MTE implementation; however, the TES might have encouraged teachers to become involved in their preparation for the assessments. There is evidence that teachers focused on the summative aspects of the evaluation more than the developmental ones, although the rationales varied. This research concluded that TES in Mexico is not yet fit for purpose after both positive and negative aspects of new MTE policies were observed. Moreover, additional reforms to support educational quality improvement are required. The teachers’ self-perceived needs in terms of CPD, as well as standards that recognise professional development according to teaching experience, seem essential for success.

Assessing the language proficiency of second language (L2) learners and bilinguals is essential in second language acquisition (SLA) research; to control for language proficiency or to select participants into an SLA study (i.e., Gaillard, 2015; Drackert, 2016; Norris & Ortega, 2012; Tremblay, 2011). L2 proficiency testing is also important in educational programs to make decisions such as placing students into appropriate levels of language programs and screening students to identify those with limited language skills (i.e., Elder & von Randow, 2008; Norris, 2006, 2008). At present, there is an insufficient body of standardized and validated measurement instruments in SLA research (Norris & Ortega, 2012). Similarly, validating low-stakes screening and diagnostic tests has been underestimated in educational context despite their impact when they are published online open to hundreds of thousands of learners (i.e., Alderson et al, 2015; Schmidgall et al, 2017). To address these issues, this present research developed a Turkish C-test for adult L2 learners of Turkish and validated it by using Kane’s argument-based approach (2006) for two different uses: (1) SLA research purposes where researchers need to control the language proficiency of their research participants (study 1); (2) educational purposes as a screening test for the Turkish Proficiency Exam (TYS) used to admit Turkish L2 learners into Turkish-medium universities (study 2). Both validation studies adopted a mixed-methods approach in order to gain better insight into stakeholders’ perception of the uses of the Turkish C-test. For study 1, the Turkish C-test was administered to 85 Turkish L2 learners in the UK and USA along with a background questionnaire and feedback survey. This was augmented with a second survey administered to 10 SLA researchers, and interviews were conducted with five of these researchers. The Turkish C-test was found to discriminate between four different levels of Turkish L2 learners with an IRT separation reliability of .94. Furthermore, the internal consistency of the texts was high with a reliability value of .92, and texts functioned consistently across both UK and USA settings. Regarding stakeholders’ perceptions of the test, although they found the test practical, they were sceptical towards what it can measure and be used for. For study 2, the Turkish C-test was administered to 79 TYS candidates alongside a background questionnaire and feedback survey. Interviews were also conducted with 13 of these participants. This was augmented with a second survey administered to 34 instructors of Turkish, and interviews were conducted with two of these instructors. The Turkish C-test was found to moderately to strongly correlate with each TYS section (reading, writing, listening, oral) as well as TYS total score. It was also successful in placing 68% of the TYS candidates in the right TYS levels although it couldn’t discriminate between C1 and C2 levels. Qualitative data suggested that test takers and instructors were sceptical about the relevance of the Turkish C-test to the spoken sections of TYS despite the strong quantitative findings. Nevertheless, test takers reported that the C-test helped them understand their need to learn more and thus would be useful in exam preparation for TYS. Overall, the findings suggest that the Turkish C-test can predict success or failure in TYS and could therefore be used as a screening test. This can help TYS candidates save time, money, and energy. This dissertation is unique in showing the development stages of a Turkish C-test step by step with language specific factors. Through an argument-based approach to validation, it provided researchers and learners with a freely available Turkish C-test that can be effectively used for research and screening purposes on the condition that findings are replicated with a follow-up study. If future researchers or practitioners wanted to use a Turkish C-test for different populations or uses, they can follow the steps and guidance stated in this dissertation while developing their own C-tests.

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.

Identity formation during adolescence plays an essential role in seeking an answer to the question of “who am I”. This fundamental period of self-understanding is particularly challenging for ethnic minority youth from immigrant families as they negotiate between two divergent cultural worlds: their heritage culture and their society of settlement. Alongside this negotiation, second-generation immigrant youth can experience ethnic discrimination and additional challenges related to their acculturation. These experiences can be associated with a wide range of negative and positive mental health outcomes. In the UK context, researchers have examined distinct ethnic identities and acculturation processes, however, they have largely neglected the sizeable Turkish community. This is an important omission because Turkish minorities are one of the vulnerable ethnic groups who have possible cultural difficulties, social disadvantages and mental health problems in the UK. The present study addresses this lacuna in the literature by examining second-generation Turkish young people’s ethnic identity formation and mental health in England. The theoretical backbone of this research draws upon Umaña-Taylor et al.’s (2004, 2014) ethnic identity development model and Berry’s (1997, 2001, 2005) model of acculturation to examine ethnic identity formation and acculturation. Adopting a mixed-methods design, this thesis investigates the complex relationships between ethnic identity formation and mental health (using indicators of life satisfaction, self-esteem, depression and psychological well-being) among second-generation Turkish young people by considering their acculturation experiences and perceived ethnic discrimination in the context of England. To achieve this aim, self-report surveys (N=220) and semi-structured interviews (N=20) were conducted amongst 16-18-year olds. Structural equation modelling was used to analyse the quantitative data and thematic analysis was utilised to analyse the qualitative data. Survey results show that greater ethnic identification (having a meaningful and positive ethnic identity which is actively explored) is associated with positive mental health, and lower levels of assimilation and perceived ethnic discrimination partially mediating this relationship. However, these associations can be complexified when young people’s multiple social identities and acculturation experiences are considered. Qualitative results suggest that the complexity of social identities can be beneficial for ethnic identity development and acculturation processes when young people sense the multiplicity and complexity of these identities. Contextual (e.g. positive social relationships-particularly with parents, community support, diversity) and individual (e.g. blending different cultures, use of multiple languages and social identities, diversity awareness) factors are fundamental in making sense of multiple identities, developing a positive meaningful ethnic identity and different variants of integration. These findings have important implications for theory, research, policy and practice in second-generation youth growing up between cultures.

This thesis explores the overall question of "What is the influence of Caribbean students' technology usage, parental background and school type on their self-efficacy?" Different domains of self-efficacy are examined to explore how they might be uniquely affected by technology usage and adolescent student background. This includes entrepreneurial and social self-efficacy, which are underexplored amongst adolescents. Academic self-efficacy is also considered because though it is commonly explored globally, it remains underexplored in the Caribbean and in relation to technology usage. Technology usage (at school for schoolwork, at home for homework and social media time and connections) is explored because of its ubiquity in modern learning contexts, alongside the lack of research on its potential effect on the self-efficacy domains in this study. Parental background (mothers' education, fathers' education and wealth), school type and academic achievement are also explored because they have been shown in the global literature to be positively associated with several self-efficacy domains but remain underexplored in the Caribbean context. Exploring technology usage, student background and academic achievement together provides a detailed model of the pathways through which they interact and potentially affect self-efficacy. To explore these issues, a mixed-methods study was adopted, using a cross-sectional questionnaire involving 585 students, as well as semi-structured interviews with 34 teachers, students and a Ministry of Education official. Qualitative classroom and school observations were also done. Data were analysed using Structural equation modelling path analyses and Analyses of variance to establish models of relationships amongst variables. Qualitative data were analysed using thematic analysis to help explain the quantitative results. The results show various significant influences on self-efficacy. In terms of parental background, mothers' education positively influences all types of self-efficacy. Wealth influences social self-efficacy through increased time spent on social media, and entrepreneurial self-efficacy through increased social media connections. The thematic analyses suggest that a greater exposure to opportunities and ideas beyond their community may be one reason why students with more privileged parental backgrounds might have higher confidence. Technology usage also influences all types of self-efficacy. Academic self-efficacy is directly and positively associated with technology usage for homework, whilst social self-efficacy is positively and directly associated with the time spent on social media and the number of connections on social media. Entrepreneurial self-efficacy is directly and positively associated with the number of connections on social media. Computer use at school had no significant effect on any type of self-efficacy. The thematic analysis suggests that that lack of effect of computer use might be due to insufficient infrastructure and teacher professional development, reducing teachers' ability to competently facilitate technology use in classrooms. Finally, school 'prestige' positively influenced academic self-efficacy. The thematic analysis suggests that 'prestigious' schools had greater financial resources and lower levels of bureaucracy in implementing innovative pedagogy, which might facilitate the conditions for academic self-efficacy development. Finally, there were notable differences in the self-efficacy of boys and girls, with boys having higher. The thematic analyses suggest that the socialisation of meekness in girls and boldness in boys may be a reason. Ethnicity results also showed that African students had lower academic self-efficacy than their Indian counterparts, which the thematic analysis suggested could be because African boys are chastised by teachers at a seemingly greater rate. Notably though, African boys had the highest entrepreneurial self-efficacy. The conclusion brings together the results and identifies multiple areas for future research and policy development. Some key conclusions are that teacher professional development and infrastructure development are critical for technology use to be effective for developing student self-efficacy. Mothers' education also emerged as a key variable, which highlights that mothers should probably be a target for access to further education so that they are better equipped to support their children's confidence development. Schools could also explore having more celebrations of African culture to help African students feel more academically confident. Finally, the results of this thesis support the usefulness of domain-specific self-efficacy testing, as opposed to the testing of general self-efficacy, since clear differences were found in how each type of self-efficacy is influenced.

Behavior genetics argues intelligence and educational attainment are highly heritable (genetically influenced) and polygenic (influenced by many genes) traits. Researchers in this field have moved beyond identifying whether and how much genes influence the manifestation of a given outcome to trying to pinpoint the genetic markers that help predict them. In more recent years, behavior genetics research has attempted to cross-over into the field of education, looking to play a role in the construction of policy and the implementation of curriculum. This dissertation explores American teacher understandings of intelligence, race, and socioeconomic status in relation to genetics. The convergent parallel mixed-methods research design interprets findings from focus groups, interviews, and surveys through the notion of 'discriminate biopower'-a theoretical framework that combines intersectionality with biopower. Findings from this study suggest that US teachers believe children differ genetically and see genetics playing a role in a student's ability and race. Furthermore, teachers are open to learning more about the inclusion of genetics research in education policy. At the same time, however, teachers are wary of incorporating behavior genetics findings into education policy within a context where economic and racial segregation continue to dictate who gains access to resource and opportunities.

This thesis investigated knowledge about, and attitudes towards, concussion within the context of four-wheeled motorsport in the United Kingdom. Concussion in sport remains a concern globally. There is evidence to suggest incidence of the injury is high, and rising in motorsport. Despite facing similar challenges to other sports such as rugby or American football, there is a lack of motorsport-specific research. Expert opinion/consensus recommends the importance of increasing knowledge and awareness of concussion, and the need for concussion education programmes that lead to long-term improvements in knowledge as well as attitudes. Furthermore, understanding the context and needs within motorsport are essential to progress in this area. This research used an exploratory mixed-methods design comprised of three studies. First, a feasibility interview study (Study 1) was conducted with key stakeholders (medical personnel, drivers), which sought to understand the context of concussion within motorsport. This informed the need to assess knowledge and attitudes (Study 2) of both medical personnel and drivers, which was conducted using a quantitative online survey. Together, these studies formed the bases for developing, implementing and assessing the first evidence based motorsport-specific concussion education programme (Study 3), delivered in the form of a series of workshops for young drivers. Study 3 employed both quantitative and qualitative methods throughout the design. Findings indicated that concussion is a concern within motorsport and that medical personnel and drivers lack knowledge and awareness about key aspects of the injury. Education and training were the top priority areas for both stakeholder groups. A motorsport-specific education programme, which uniquely explored the potential role of Need for Cognition (NfC), leads to improved knowledge and awareness of concussion in drivers. Furthermore, whilst quantitative data provided limited support of improvements in attitude, qualitative findings did provide examples of improvements in attitude towards the injury. This research makes a substantial contribution towards understanding concussion in motorsport from a psychological and educational perspective. It also contributes to the improvement of concussion education programmes across sport.

Background: Phase IV cardiac rehabilitation (CR) improves outcomes and facilitates behaviour change following myocardial infarction. Although one-third of myocardial infarction (MI) patients in Scotland are under 65 years old, research is lacking in this age group. Aim: To explore the experiences, illness perceptions (Leventhal) and self-identity (Charmaz) of working age (18-65 year olds) individuals attending Phase IV cardiac rehabilitation, including around initiation and maintenance of lifestyle change and the role of spouses. Methods: 16 participants (14 male, 2 female) and 12 spouses (10 female, 2 male) completed nearly 23 hours of semi-structured interviews at the start and end of Phase IV cardiac rehabilitation in Fife and Dundee. Participants completed health behaviour and illness perceptions questionnaires at these time points and after 3 months. Data were integrated and analysed using framework analysis. Results: The MI conflicted with participants' self-identity. Fear and perceived consequences led to restrictive and protective control behaviour from both participants and spouses. CR aided participants goal of 'getting back to normal' - providing safety, monitoring and knowledge reduced fear, allowing return to pre-MI activities and behaviour, both healthy and unhealthy. Perceived cause, communication from health professionals, social influences all impacted health behaviour outcomes, which were varied. Although there were improvements in health behaviour at end of CR, these were not sustained at 3-month follow-up. Identity disruption, mood changes and medication side-effects persisted at 3-month follow-up. Psychological and longer-term support was lacking. Discussion: Cardiac rehabilitation is a time of transition, with experiences and outcomes varying between individuals. Participants and health professionals desired behaviour may conflict. Further research should explore long-term outcomes and opportunities for intervention and support in this group, as well as female attendance and gender. Using longitudinal mixed-methods, and theoretical models provides insight into processes over time but require careful data management and analysis.

Background: There are approximately 215,000 young carers in the UK, providing unpaid care such as housework, personal care and emotional support to family members. However, the real figure is estimated to be four times higher than this, as many remain hidden from official statistics. The care provided by young people may be long or short term, and when they have unmet needs arising from their caring role, this can impact on their health, well-being, education and transitions into adulthood. It is imperative, therefore, that young carers are triaged for support at an early stage, with ongoing monitoring to ensure they have the best opportunities to flourish. Aim: The aim of this doctoral study was to identify areas of burden experienced by young carers aged 11-18 and use their views and professionals' views to develop the Carers' Alert Thermometer for Young Carers (CAT-YC). The CAT-YC will act as a short screening tool to triage young carers to appropriate support, or a full assessment of needs, with the additional opportunity for ongoing monitoring of any unmet needs they may have. Methodology: A pragmatic, mixed-method, multi-phased, consensus approach utilising qualitative and quantitative data collected sequentially from a purposive sample of young carers and professionals via a focus group, interviews, a Delphi survey and consensus group meetings. Findings: Data from 26 young carers (n=17 individual interviews; n=9 focus group) were thematically analysed and developed into the first round of a 4 round Delphi survey. This was completed either online or at small group meetings by 96 participants in round 2 (n=68 professionals; n=28 young carers) and 110 participants in round 3 (n=74 professionals; n=36 young carers). In round 4, a further 19 members of an expert panel (n=11 young carers; n=8 professionals with a national or regional strategic role in young carer support) reviewed and ranked the final items for the CAT-YC. It was then piloted by three organisations working with young carers and a short evaluation of the pilot study (n=6 professionals; n=4 young carers) tested the readability and usability of the CAT-YC.

Background: Obesity treatment is a global priority. Current approaches to treating obesity have demonstrated good efficacy but the obesity epidemic continues to escalate. Holistic approaches which include a religious element are a promising intervention within obesity, as demonstrated by research conducted in the USA, but are yet to be explored in the UK. Methods: A mixed-methods feasibility trial with two embedded qualitative studies to investigate the feasibility and acceptability of a 3-month Christian, church-based, intuitive-eating programme. Results: A total of 18 participants were recruited, attendance during the programme peaked and troughed. It was feasible to recruit and train lay facilitators to deliver intervention sessions. Qualitative evidence exploring facilitators' experiences showed they were able to facilitate the sessions, but facilitating was not always easy. Facilitators experienced challenges associated with managing difficult group members, and the range of issues that can arise during group discussions. Qualitative evidence exploring participants' experiences showed the two novel components; Christian spirituality and intuitive eating took participants on a journey. None of the participants had ever thought of bringing God into their eating, but as participants started surrendering their struggles with food to God, their faith became an invaluable resource for their weight loss journey. Similarly, the intuitive eating component was initially difficult to understand. However, as participants learned to incorporate the principles of intuitive eating into their daily lives, the negative emotions associated with food were reduced. Post-intervention all participants felt ready to move forward into the next stage of their weight loss journey. 10 Significant improvements were observed in mental well-being, anxiety, depression, quality-of-life, pain/discomfort uncontrolled-eating, emotional-eating, cognitivere strained-eating, intuitive-eating and BMI post-intervention. By 6-month followup there was a return to baseline levels for weight, BMI, energy intake, and a partial reversal in uncontrolled eating, emotional eating, cognitive restrained eating, anxiety, depression, mental well-being and spiritual well-being. However, improvements in intuitive eating were fully sustained at this time point and total fat, saturated fat and sugar intake had reduced further. Conclusion: It was feasible to recruit, deliver and evaluate Taste & See in a UK church, with lay volunteers. The intervention was acceptable to both facilitators and participants and qualitative evidence showed good engagement with the content. The clinical outcomes were positive but a larger RCT is needed to demonstrate efficacy.

The aim of this study is to exploit the gap in entrepreneurship literature by using mixed methods to advance our theoretical and empirical understanding of the role played by the family in developing the entrepreneurial intentions (EI) of Indian youth. This is of specific relevance from an Indian point of view since family in India is considered the cornerstone of its culture, and is considered to be responsible for passing on values and beliefs that are socially acceptable. The study combines an enthnographic study of six families in Delhi with a survey of 1,123 complete responses from final year undergraduates. The ethnographic study advances our knowledge of Ajzen's Theory of Planned Behaviour by identifying four elements of family which influence EI: (i) support and encouragement from grandparents, (ii) support and encouragement from parents, (iii) experience and experimentation with entrepreneurship, and (iv) image of entrepreneurship. Informed by the results of the ethnographic study, structural equation modelling (SEM) was used to formally test the direct relationships between the four elements of family and EI. The study finds strong relationships between Support and Encouragement – Parents to EI and also Experience and Experimentation to EI. The SEM also investigates the mediating role of: (i) Perceived Behavioural Control (PBC), (ii) Personal Attitudes (PA) and (iii) Subjective Norms (SN) between EI and the four elements of family influence. The study has been successful in establishing the crucial role played by an individual's family in the development of their intentions towards entrepreneurship. The researcher hopes that this understanding along with the help of appropriate structural interventions can help to motivate the present young generation who have entrepreneurial aspirations but are constantly challenged and influenced by societal and familial pressures.

This thesis examines pre-service teachers' multicultural competence and the factors influencing its development, taking Greece as a case study. Multicultural competence is a concept used frequently to describe teachers' knowledge, attitudes and skills related to making educational experiences relevant to all students while also taking into consideration their diverse backgrounds. Despite featuring highly in academic literature and policy agendas worldwide, pre-service teachers' multicultural competence and the factors influencing it are to-date rarely examined. Bringing together literature from multicultural competence, multicultural teacher training and geographies of education and learning, this thesis contributes to an increased understanding of the concept and its main drivers. This study uses an innovative mixed-methods approach to capture more holistically the complex concept of multicultural competence and the factors influencing it, utilising the construction of a statistical model and path analysis with focus group discussions. The empirical dataset comprises 356 questionnaires completed by final-year undergraduate students of Primary Education from three departments in Greece and 6 focus group discussions with students recruited (out of the same pool of participants), conducted equally across the three departments, in which questionnaires were administered. Thus, this study contributes to geographies of education and learning by bringing together a direct engagement with young people, making them the subject of educational research, with an exploration of the influence of wider processes of formal and informal educational spaces on their learning. The study's findings show that, although based crudely on the quantitative scalar measurements, Greek pre-service teachers' multicultural competence scores are relatively high, their narratives present a more complex reality, revealing misconceptions around its practical manifestations and a general lack in multicultural teaching knowledge and skills with a social justice orientation. Moreover, the study traces webs of causal connections between multicultural competence and pre-service teachers' sociocultural positionalities, experiences of international mobilities, multicultural encounters as well as experiences of both formal and informal curricula across diverse spaces of learning. In doing so, the study reveals the importance of thinking relationally about the spatialisation of multicultural competence and offers invaluable insights to the academic literature and policy debates around the best ways to prepare multiculturally competent educators.

Pulse oximeters are low-cost, easy to use, and effective at detecting hypoxemia (low blood oxygen levels), a common complication of bronchiolitis, asthma, and pneumonia, the leading infectious cause of death in children worldwide. However, pulse oximeters are often unavailable in lowincome settings, and if available, often underused, yet little research investigates why. In this thesis, I examine pulse oximeter implementation in low-income settings, focusing on Kenyan hospitals as a case study, and using a mixed-methods approach. I conducted a systematic literature review, examining how pulse oximeter use with children at admission to hospital impacts health outcomes; I then conducted quantitative analyses of 28,000 children admitted to seven Kenyan hospitals to determine with which children pulse oximeters are used, and pulse oximetry's impact on treatment provision; these analyses informed the qualitative research component, for which I conducted interviews with 30 healthcare workers (HCWs) and staff in 14 Kenyan hospitals and employed theoretical frameworks to determine how HCWs decide whether to use pulse oximeters, and the barriers to pulse oximetry. I found that pulse oximeter use varies substantially between and within Kenyan hospitals over time. After adjusting for case-mix and signs of illness severity, HCWs were most likely to use pulse oximeters with children with a very high respiratory rate, indrawing and/or who were not alert; children who obtained a pulse oximeter reading were more likely to be prescribed oxygen than if a pulse oximeter was not used; and children with a reading below 90% were more likely to be prescribed oxygen than those with higher readings, suggesting that HCW decision-making is influenced by international and national guidelines. However, HCWs sometimes cannot use pulse oximeters when they intend to, because of insufficient pulse oximeter availability, largely due to inefficient and confusing procurement processes and repair delays. Furthermore, HCWs sometimes use pulse oximeters incorrectly or misinterpret their results, because of insufficient training. Pulse oximeter promotion programme planners can use the recommendations I provide to effectively target barriers to pulse oximeter uptake in low-income settings. Increased pulse oximetry implementation could enable early detection of hypoxemia, improving accurate diagnosis, and supporting prompt, effective treatment, which could help reduce mortality in children needing oxygen, in line with Sustainable Development Goal 3.

With the expansion of online communities, extant research in multiple disciplines has attempted to investigate its adoption and use among individuals. However, the biggest challenge encountered by managers of these communities is supplying knowledge, particularly, the willingness to share knowledge among the members. It is extremely important to maintain committed members in terms of active participation. Yet their level of participation might vary based on some social, behavioral and environmental factors that eventually affect their intentions on whether to participate actively or not, in fact some users choose to discontinue participating totally in the community. Cancers figure among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer related deaths in 2012. The number of new cases is expected to rise by about 70% over the next 2 decades. Among men, the 5 most common sites of cancer diagnosed in 2012 were lung, prostate, colorectal, stomach, and liver cancer. According to the world cancer report, among women the 5 most common sites diagnosed were breast, colorectal, lung, cervix, and stomach cancer. For this reason, there is an ever-increasing need to establish communities to offer empathic support to patients. Though peer support groups have been known to offer adequate support to patients with cancer and are considered to be an important complement to the formal health care system, however, practical barriers such as time, mobility and geography limit their use, this is where the online communities serve an advantage, as they have the potential to overcome barriers posed by regular offline communities. To achieve its objectives, this study mainly adopts the Social cognitive theory and two components of the social influence theory. According to the SCT, user behaviour is influenced by two factors: personal cognition and environment. Social influence model postulates that individual behaviour in a community can be affected by the social environment and three factors constitute this, they are compliance, identification and internalization. The study aims to provide insights on how and why patients diagnosed with cancer (and their relatives) seek social support using the Internet and social media. In particular, we seek to understand the motivation for joining these groups and the values derived from the community for the users both active and non-active.

Background: Presymptomatic genetic testing should always involve a considered choice. Young adults are at a key life stage as they may be developing a career, forming partnerships and potentially becoming parents. Presymptomatic testing may therefore affect the future lives of consultands significantly when testing is undertaken in early adulthood. Aim: To explore presymptomatic testing for hereditary cancer in consultands aged 18-30 years with particular reference to psychosocial impact, the decision-making process and the consequent counselling needs. Methods: A mixed-methods sequential exploratory design was used, comprising a systematic review, a qualitative study and a quantitative study. Results of all phases were used to build a theoretical model regarding the process of presymptomatic testing in young adults. Findings: The systematic review indicated that many participants grew-up with little or no information concerning their genetic risk. The experience of genetic counselling was either reported as an opportunity for discussing problems or associated with feelings of disempowerment. Parents appeared to have exerted pressure on their children during the decision-making process. However, as a result of the qualitative study, the influence of other people and the decision-making process prior to counselling were identified as key factors. Further results from the quantitative phase underlined that parents felt they had control over the decisions their children made, while the majority of the young adults reported the request for the genetic test as their own decision. A new theoretical model of decision making and impact on young adults was built to synthesise the overarching experience of participants in this research project. Conclusion: Counselling approaches to this population may require modification both for young adults and their parents. Young adults may benefit from a multi-step approach to presymptomatic testing. Parents need to be more informed that genetic counselling is a forum where information can be obtained and young adults can talk about the testing decision, regardless of whether they want to be tested or not. The traditional ‘wait until they come to us’ approach by health services may be failing to meet the educational and emotional needs of this population.

The purpose of this mixed-methods research is to determine the effectiveness of the Kingdom Marketing (KM) intervention for improving Israeli SME marketing knowledge among managers and employees of Israeli small and medium-sized business. The secondary objective of the study was to portray the process of change in participating organisations. The newly developed KM intervention programme was designed to enhance Israeli SMEs’ marketing knowledge and marketing strategy, imparting new marketing skills and allowing SMEs to operate with better marketing knowledge. The intervention uses a metaphoric story-line approach to teach participants in mediator-led sessions to understand and use important marketing concepts, such as the difference between sales and marketing. Although the intervention has been used in business settings, it has not yet been empirically validated using rigorous methods. This study was conducted using a mixed methods paradigm with an embedded experimental design. Five Israeli based SMEs were recruited to take part in the training programme. The research consisted of three phases. In Phase 1, I administered a preintervention evaluation to measure five variables: awareness of marketing processes, mistaken marketing attitudes, incorrect marketing process beliefs, organisational marketing skills, and marketing need awareness. Participants were also interviewed during Phase 1. In Phase 2, I administered the KM intervention and collected qualitative data in the form of daily open-ended feedback and a researcher diary. In Phase 3, I administered a postintervention evaluation to assess change in the five quantitative variables, and I conducted a second round of interviews. The findings indicated that the KM intervention programme (a) increased awareness of marketing processes, (b) reduced mistaken marketing attitudes, (c) reduced incorrect marketing process believes, and (d) increased marketing need awareness. However, the intervention had no significant effect on organisational marketing skills. Qualitative analysis confirmed that, although the KM intervention empowered participants with marketing knowledge and skills, it did not result in broad organisational changes. I conclude that the KM intervention programme is valid and worthy of wider use for promoting the survival of SME businesses through marketing knowledge and skill improvement. However, the intervention should be used in conjunction with internal efforts to translate increased knowledge into lasting organisational change.

Energy conservation can mitigate significant issues such as climate change and fuel poverty, yet the determinants of this behaviour are poorly understood. It is important to understand the antecedents of energy conservation in order to effectively stimulate this behaviour in society. Traditional models have focused on normative and intentional processes to explain environmental behaviour, but have proven largely unsuccessful for predicting energy use. Considering that day-to-day energy behaviour is likely to be habitual and context dependent, models such as the Comprehensive Action Determination Model (CADM, Klöckner & Blöbaum, 2010), which have integrated these factors with more traditional antecedents of behaviour, may better account for people’s actions. The early research in this thesis tests the application of this model to energy saving behaviour using a mixed-methods approach. Findings show that such a model is suitable to account for the drivers of energy behaviour, particularly because of the important role of habits and situational influences on this behaviour. Although this model can successfully predict daily energy behaviours that involve the routine curtailment of household energy use, one-off energy efficiency investment behaviours are unlikely to be determined by the variables considered by the CADM. That is, these behaviours may be more dependent on people’s understanding of the energy consumption in their household, or their energy literacy. Therefore, the second part of this thesis investigates the cognitive processes that inform conscious energy judgements to explore the antecedents of this energy literacy. The studies in this thesis uncover an unprecedented variety of energy judgement heuristics in this decision-making process, and these heuristics are further investigated, again using various methods. This thesis concludes that, to maximally facilitate energy conservation, the habitual and situational antecedents of energy saving behaviour, as captured in such frameworks as the CADM, need to be considered alongside the cognitive processes that shape people’s energy literacy when designing effective energy conservation interventions that target both routine and non-routine actions.

This study focused on stress and resilience among teachers in 15 urban secondary schools serving areas of multiple and complex disadvantage in the Greater Manchester and Merseyside regions of England (UK). It utilised the mixed-methods approach to gather and analyse the data. This consisted of a questionnaire survey of 150 teachers and interviews of 20 teachers. It examined person characteristics of teachers in these schools; key stress risks in the schools; coping strategies employed by these teachers and their protective factors. The main quantitative analysis methodologies used in the study were descriptive analysis; factor analysis and regression analysis. Qualitative findings were analysed using thematic analysis and teacher pen portrait and school case study presentations. Integrative analysis of quantitative and qualitative findings was then conducted in the discussion of main findings. This study found that the teachers’ major force characteristics were self-efficacy; persistence; personal attitudes towards one’s job; personality and temperament and commitment to the job. Their main resource characteristic was experience while their major demand characteristic was their professional role. These teachers were also exposed to person, proximal processes, context and time risks. There were risks associated with force and demand person characteristics. The main process risks were within their interactions with pupils, parents, colleagues and senior management. There were also context risks in their microsystem, mesosystem, exosystem and macrosystem. There were also time risks across the microtime, mesotime and macrotime. To cope, teachers in this sample utilised both direct-action and palliative coping strategies. Results also indicated that these teachers’ protective factors were in their resource and force characteristics; proximal processes; context and time.

The student experience is a unique journey of challenge and opportunity, for which their success, subjective well-being (SWB) and psychological health are key elements. In three related investigations, this mixed-methods research programme examined the effects of Time-Perspective (TP: An individual’s psychological relationship with time) and Character-Strengths (CS: 24-positive traits associated with good character) on these outcomes. Investigation 1 involved developing a Likert-type scale to measure students’ success in areas they felt were important to the construct. Qualitative content analysis identified that HE students and staff collectively defined success as a multifaceted construct, consisting of numerous academic, non-academic and social aspects. These informed the development of a reliable and valid questionnaire for measuring success perceptions in seven of these areas. This was used in the following investigation to assess a range of outcome variables pertaining to student success. Investigation 2 was a longitudinal study assessing the effects of TP and CS on the success, good/poor psychological health and SWB of Year-1 HE students. In line with previous research, excessive or insufficient use of certain TP orientations was associated with, and could predict multiple positive and negative outcomes. For example, Future and Past-Positive orientations were predictive of academic success, perceived student success and SWB. Student psychological problems were associated with a bias towards Past-Negative and Present-Fatalist orientations. Additionally, a new formula for calculating a continuous Balanced Time Perspective (BTP) variable was devised and tested. High levels of BTP were associated with many positive aspects of the HE experience. Strengths were mainly associated with SWB and perceptions of success. However, Hope and Self-Regulation were inversely related with depression, anxiety, stress and negative-affect. Investigation 3 was a follow-up interview study with six student participants, who presented interesting profiles in Investigation 2. They talked about their experiences of psychological ill-health/well-being and student success in relation to TP and CS. Five super-ordinate themes were identified, including ‘Living with negative past experiences’, ‘A balancing act’ and ‘Using my strengths’. Psychological difficulties represent an escalating problem in HE, and student success and SWB are important outcomes. Both TP and CS offer additional understandings of these areas, adding value in academic, practical and theoretical contexts. This research has indicated that interventions focused on TP modification (i.e. developing a BTP) and strength development, may potentially offer preventative mental-illness strategies for susceptible students and enhance their success and SWB.

In this thesis, applying an innovative postmodern equal-weight/sequential QUAN→PHEN Mixed-Methods Phenomenological Research ('MMPR') approach to study an Olympics' impact within its two-cluster socio-demographic footprint forms its main contribution to knowledge. Facilitating between-methods triangulation is a novel eclectic pragmatic approach that is used to capture the richness of thematic data flowing from in-depth, open-ended interviews with most - 62 in all - senior Hoteliers spread evenly between distinct urban Metro-Vancouver and rural alpine-Whistler, whilst concurrently capitalizing on the availability of a unique BC Stats proprietary micro-municipal-level secondary data source, i.e., British Columbia's 'Additional Hotel Room Tax' ('AHRT'). Typically, traditional mono-method-positivist neo-classical economic syntheses are used to quantify an Olympic Games' ex-ante or ex-post impact. This study's findings confirm that such syntheses attempts, at the micro-municipal level, lead to inevitable dead-ends. At a sub-national level of micro-granularity, using available economic models is an impossible task due to the insurmountable practical problem of complete lack of, or paucity, of data. When applied to assess mega-events, such modelling is shown to lack credibility; models are insufficiently comprehensive or its users consciously engage in 'shenanigans' by force-fitting input/output to produce pre-ordained outcomes for political expedience and meeting agency interests. The 'MMPR' approach acknowledges and respects the established and 'current-thinking' paradigmatic epistemological and ontological perspectives. 'Hotel Activity', measured via 'AHRT', is substituted as a 'Proxy' for 'Tourism' following empirically establishing these three variables as highly correlated. Prevalent academic findings of negative impacts from Winter Olympics are not borne out. Phenomenological issues of 'illusory correlations' and 'data saturation' are addressed.

Digital inequalities continue to concern researchers across highly technologised countries. In recent years, however, most research on digital inequalities has focused on distinguishing different patterns of Internet use rather than examining Internet non-users. The few quantitative studies of non-use and reasons for non-use often stay on a descriptive level, while qualitative studies mostly investigate subpopulations, such as those living in specific neighbourhoods. Although there are a number of studies of digital inequalities among young people and the elderly, a systematic literature search finds no research focusing on middle-aged individuals, who might face specific problems with being offline, as they are of working age and more likely than other age groups to have children living in the household. On the basis of a mixed-methods research design that compares non-users in Great Britain and Sweden, the overarching research question for this study sheds light on the mechanisms contributing to Internet non-use, as it examines the socio-economic backgrounds, attitudes, perceptions, and everyday life experiences of non-users with a focus on 25 to 55 year-olds. It applies advanced statistical analyses of secondary nationally representative survey data as well as in-depth analysis of qualitative interviews with 10 middle-aged non-users from each country. The analysis of these combined data shows that while socio-economic variables still play an important role in influencing who is on- and offline, general attitudes towards technologies are even more influential. The study finds that there is a lack of life-fit (Selwyn 2006) of ICTs for a number of non-users and a potentially negative impact of warm experts (Bakardjeva 2005) who have previously been regarded as a positive influence. Moreover, vulnerable groups (e.g. immigrants) are facing more substantial problems, such as issues with literacy and language, which need to be tackled first. The deliberation of similarities and differences between Britain and Sweden against the backdrop of policy interventions and cultural values shows that being offline is not problematic for all Internet non-users; some of them thrive in highly technologised societies. The conclusion offers proposals for both future research and policy interventions for those, currently offline mainly due to socio-economic reasons, who would like to go online in the future.

This study examined impact of national culture on human resource management (HRM) functioning in present-day Pakistan.

When walking is difficult to attain or maintain, the ability to mobilise independently with the use of wheelchair equipment is often a positive and joyful experience for families of children who have a paediatric neuromuscular condition. Despite its benefits and often inevitable need, parents of children with a neuromuscular condition commonly respond to wheelchair recommendation with hesitance, and the emotional impact can be immense yet often hidden and unsupported. Wheelchair provision may be delayed, posing risks to the child’s safety, function, and development. This thesis aims to understand parents’ perceptions of wheelchair recommendation, address their unmet information and support needs, and respond to these needs through user-informed development and evaluation of a tailored psycho-educational resource. A scoping review of qualitative and quantitative studies was systematically synthesised and critically appraised existing evidence, identified research gaps, and informed thesis design. The review of 10 studies identified themes such as the value parents place on walking, the grief and gradual adjustment that occurs when a wheelchair is recommended, and the need for tailored supports. It also confirmed that parents’ perceptions of wheelchair recommendation have not yet been explored for paediatric neuromuscular conditions. My first original qualitative study assessed the views and experiences of parents whose child had a confirmed diagnosis of a neuromuscular condition and been recommended a manual or power wheelchair. Interviews were conducted with 21 parents (13 mothers, 8 fathers) and a phenomenological approach was used to analyse the data. Common emotional responses included grief, loss and denial, which affected acceptance of wheelchair recommendation. Challenges navigating the unfamiliar, complex and multifaceted process of wheelchair prescription were also highlighted as a barrier to wheelchair engagement. Facilitators included integration of psychosocial care into multidisciplinary clinical management and tailored education to enable parents to engage in shared decision-making with healthcare professionals. A subsequent qualitative study involved interviews with 21 neurologists and allied health professionals from Australia and the USA who had paediatric neuromuscular condition experience working within government and private sectors. A phenomenological approach was used to analyse the data and findings were consistent across countries and health sectors. Health professionals’ perceptions of emotional responses to wheelchair recommendations were congruent with those reported by parents. The lack of psychosocial resources and need for tailored education for families, funding bodies and wheelchair suppliers was also highlighted. These two studies informed the development of a psycho-educational booklet regarding the transition to wheelchair use for paediatric neuromuscular condition s. The booklet was developed by a multidisciplinary team and graphic designers, comprising 11 chapters and piloted with 10 parents whose child had a neuromuscular condition and was recommended wheelchair use. The feedback provided informed modifications to the booklet and survey items. The aim of the booklet was to address common emotional responses and concerns of parents and provide tailored information regarding wheelchair equipment options and the prescription process. The updated booklet was evaluated by mixed methods research among 27 parents (21 mothers, 6 fathers) and 9 healthcare professionals. All parents felt that the booklet addressed their emotional and information needs and facilitated engagement in the wheelchair prescription process. Written feedback reinforced that the booklet normalised parents’ feelings and was a useful reference for discussions between families and healthcare professionals. Quantitative thresholds for acceptability, usefulness and emotional impact were set a priori and all were met. All parents and healthcare professionals endorsed provision of the booklet to parents, preferably at the time of wheelchair recommendation. In conclusion, studies undertaken in this thesis have established that the provision of timely wheelchair equipment to facilitate independent mobility for children with a neuromuscular condition requires collaboration, education and engagement between healthcare professionals and families, and the integration of psychological care and social support. Importantly user-informed development and evaluation of a psychoeducational booklet suggests its potential use an effective resource for addressing parents’ needs and empowering shared decision making with healthcare professionals. Clinical implications of this thesis include booklet implementation within Australian paediatric neuromuscular clinics, adaptation to culturally and linguistically diverse populations, and education for stakeholders such as community therapists, funding bodies and equipment suppliers. Future directions for research include prospective examination of booklet use in clinical practice and development of a child-centred booklet.

Coach behaviors impact several essential athlete factors such as the quality of athlete motivation and psychological functioning and yet, many youth coaches remain untrained in motivation and athlete-centered principles. This study’s aim was to explore the efficacy of a need-supportive intervention on youth hockey coaches’ attitudes toward, and reported use of, need-supportive and/or need-thwarting approaches. Participants included 25 youth hockey coaches randomly assigned to an intervention or delayed control condition. Grounded in Self-Determination Theory, the intervention included four sessions within which coaches learned how to adopt need-supportive coaching strategies and reduce need-thwarting tactics. A mixed-methods approach guided the evaluation of the program’s effectiveness via an integration of pre- and post-test measures of coaches’ self-reported coaching style and written reflections. At post-test, intervention participants showed significant improvements in self-reported autonomy-supportive coaching and significant reductions in controlling and chaotic coaching behaviors when compared with the delayed control group. Coaches reported how program enhancers, barriers, and their implementation efforts contributed to the overall training experience. Overall, the findings indicate that the present intervention approach may be suitable for training other youth sport coaches to adopt need-supportive behaviors and reduce need-thwarting tactics which can enhance youth sport experiences.

The Black middle class presents sociologists with unique opportunities to understand social mobility. Critical race theory (CRT) is an essential tool in Black class studies because it helps to identify ways that meritocratic discourses mask inequity and oversimplify the process of social mobility. Changes in the sociopolitical and racial landscape between the 1960s Civil Rights movement and the death of George Floyd in 2020 necessitate innovative studies of success and social equity ideologies in the Black population. This study is an integrated mixed-methodological analysis of core Black middle-class people living in Atlanta, Georgia. The research questions are: 1) What are the success narratives of Atlanta’s core Black middle class, that is, how do members account for ‘success,’ however it is defined?; 2) What are the values and motivations that shape how this class conceives or understands success and how do these relate to various cultural practices? ; 3) If distinct success ideologies can be delineated, how does each relate to equity and social justice concerns?; and 4) What role, if any, has education played in the success narratives and values of this class? Data were collected from sixteen participants via concept mapping and semi-structured phenomenological interviews. During concept mapping, participants brainstormed ideas, organized those ideas conceptually, and indicated values related to success, education, and social justice. Five people from the concept-mapping group were recruited to provide 90-minute phenomenological interviews to contextualize concept map findings. Data from concept mapping was analyzed using multidimensional scaling and cluster analysis; two coding phases were conducted to analyze interviews. This inquiry is significant because it centered Black experiential knowledge to construct a conceptual framework of success and social equity values of an understudied demographic. The study can inform education policymakers and social justice reformers about education, social equity, and success priorities from a seemingly privileged population; complicating meritocratic notions. In addition, it illustrates the utility of an integrated mixed-method research design in conducting sociological studies. Finally, the study is an example of honoring scholar and familial ancestors to continue the work of racial uplift.

When curious, we admit we do not know. With the contemporary workplace emerging through increased complexity, leaders are compelled to shift mindsets and practices from more traditional methods to those more in service to the uncertainty of the day. The purpose of this mixed-methods study was to generate an integrated theoretical framework for curious leadership, a validated scale for its measurement, and practical methods for engaging differently in the context and practice of leading. Drawing from the literature review of relational leadership, adaptive leadership, complexity leadership, growth mindsets, and curious behavior, and from my practice, 12 sub-constructs were identified as possible scale components of curious leader behavior. A mixed-methods approach was taken with three differently composed focus groups who reviewed the 12 sub-constructs and honed them to four based on their intersections in Phase 1 of the study. In Phase 2, a survey was thereby developed identifying 66 items for further subsequent appraisal. A finalized survey was undertaken with 274 respondents. From principal and confirmatory factor analysis, four sub-scales were eventually identified: Encourage Emergence, Enable Openness, Engage Experiments, and Honor Humanness resulting in the development of the Gick Curious Leader Capacity Scale. The scale's application and future implications for research and practice are discussed. This dissertation is available in open access at AURA, https://aura.antioch.edu/, and OhioLINK ETD Center, https://etd.ohiolink.edu.

This dissertation investigates the political causes and consequences of cultural censorship. One of the central arguments of this project is that cultural censorship is often a response to citizen demand. Using a mixed methods approach, this dissertation explores the demand for censorship and benefits a regime receives from censoring citizens in an effort to understand the calculus of cultural censorship. This project focuses on the Americas and looks at censorship in both democracies and autocracies across time. Leveraging high quality archival data, a survey experiment, and regional datasets, this project aims to understand the rationale behind cultural censorship and finds that both democracies and autocracies benefit from imposing limits to the freedom of expression. Additionally, preliminary findings suggest that citizens do not consume the media they are demanding be censored and are instead seeking censorship to protect third persons in an imperfect information environment. The experimental portion of this project tests this relationship of who wants censorship of what and why further and suggests that those with conservative ideologies are more likely to demand censorship to protect minors while liberals are more concerned about censoring hateful themes. The research I have completed for this project also finds that citizens in censored settings display lower levels of interpersonal trust and higher levels of institutional trust. Not only do these findings tell us something about how cultural censorship affects citizens and artists politically, but indicates that regimes, both democratic and authoritarian, are incentivized to fulfill citizen-demanded censorship in the interest of political survival.

Changes to the way work is performed over the past several decades due to economic recessions, unstable job markets, and global turmoil facilitated by COVID-19 call for research into the way today’s young adults idealize, evaluate, and select careers. Informed by the theory of vocational anticipatory socialization, this study surveyed university students through a series of open- and closed-ended questions to investigate how they think about “making a living”. This project also explores the career frameworks young adults use to evaluate potential careers, compares them to the ability, enjoyment, and goal frameworks identified by Jahn and Myers (2014), and takes a step towards validating a career frameworks scale. Content analysis of open-ended responses indicate that compensation, work-life balance, making a difference in society, company or workplace culture, stability, and continuous learning opportunity are common motivating factors in career or job selection. Content analysis also identified ability, enjoyment, goal-identity, and goal-lifestyle frameworks informing young adults’ career pursuits, which differed in form and frequency from Jahn and Myers (2014) original work. Confirmatory factor analysis did not confirm predicted components, but exploratory factor analysis revealed emergent factors. Several theoretical and practical implications are discussed as well as limitations and suggestions for future research.

Researchers have identified an academic insufficiency in investigating leadership during in-extremis situations both by emphasis and through difficulty in researching real-time events. These situations can and do commonly occur in settings involving the military and domestic safety forces such as police, fire, and emergency medical teams (EMS). This research has defined in-extremis circumstances as when the participants, whether civilians caught up in the circumstances, first responders to emergency incidents, or military personnel involved in combat situations are vulnerable to incurring significant injuries up to and including death. In plainer words, when people’s lives are on the line and the decisions and actions performed during the event could greatly impact the outcome.This research utilized a mixed-methods design gathering online quantitative data from 401 fire officers (grouped into Exemplars and General Fire Officers) and qualitative data from a Delphi panel of Exemplars only. A purpose of this mixed-methods study was to investigate how career fire officers who were identified by their fire departments as exemplars in field command reported they make critical decisions during in-extremis moments and to explore whether there are commonalities in their leadership approaches. This was attained through a Delphi panel composed of 14 Exemplar fire officers. Three rounds of semi-structured interviews were conducted that attempted to reach consensus among the Delphi panel members. In addition, the Rational-Experiential Inventory-40 (REI-40) was offered online to 17 career fire department officers to help evaluate their tendencies towards rational/analytical and experiential/intuitive thinking.Results from the online REI-40 survey and findings from the Delphi interviews revealed that the Exemplars rely upon their experience and intuition to a greater extent and rely less upon written procedures than did their General Fire Officer counterparts. The Delphi panel interviews indicated that personal experience was essential in developing their skill and faith in making improvised decisions based upon situational awareness of the emergency scene. The Delphi panel reached consensus and stated their ability to ‘think outside the box’ and develop unique best-case solutions was a requirement to achieving a higher level of expertise and success.

Researchers have been investigating the cyberbullying phenomenon since the early 21st century. There is a substantial body of cyberbullying studies focused on text-based formats. However, studies revealed that visual-based social media platforms are more powerful than text-based platforms in affecting people’s emotions, causing significant psychological impact. Young adults ages 18-29 use visual-based social media heavily in their daily lives; therefore, visual cyberbullying on various sites has become a critical issue for this generation. Yet, the majority of existing cyberbullying studies focused on age groups under 18. The studies that did investigate this phenomenon among young adults focused mainly on text-based types of cyberbullying. Few studies have investigated visual-based cyberbullying of the adult population. Thus, this dissertation study explored university students’ perspectives of visual-based cyberbullying, with a specific focus on Instagram, because of its popularity. A Holistic Theoretical Framework was proposed to guide the study. This framework is grounded in the Social Ecological Model and the Cognitive-Affective-Behavioral frameworks. This study applied a mixed-method approach to collect data using four techniques: surveys, interviews, visual narrative inquiry, and scans of policy documents. Findings reported in this study have disclosed the nature of visual-based cyberbullying on Instagram as experienced by university students, revealed students’ perspectives of visual-based cyberbullying, unveiled the visual elements from actual incidents narrated by students, generated a novel definition of visual cyberbullying, and illuminated the gap between current university policies and real-world practices regarding the visual-based cyberbullying issue. This study contributes to the cyberbullying theoretical foundation, especially in exploring visual cyberbullying from cognitive, affective, and behavioral perspectives. Furthermore, the study collected visual cyberbullying cases that were crafted and narrated by study participants who witnessed cyberbullying incidents in real life. Future studies and practitioners may benefit from this study by applying the visual cases participants created to inform the design of research instruments and literacy educational materials. In addition, policymakers in higher education may learn from this study about the need to address cyberbullying more effectively in policy documents targeting undergraduate students. This study may also serve as a reference for the definition and examples of visual cyberbullying.

Teacher attrition is a problem currently afflicting classrooms around the world. Emotional exhaustion and teacher self-efficacy have been demonstrated to be factors in attrition. This study assesses the efficacy of potential tools for use in evaluating emotional exhaustion and self-efficacy before problems arise and to guide professional development in efficacious directions. This parallel-convergent mixed-methods study performed quantitative regression analyses on the joined effects of emotional exhaustion and self-efficacy to assess their potential mediating role between teachers’ job stressors and considerations of leaving the job. The existence of mediation was demonstrated. Qualitative thematic analysis of transcripts from six interviews with current teachers was conducted. Two themes, difficulties with administration and workload, emerged. Integration of the QUANT and QUAL data streams revealed that neither, by itself, generates a complete picture of the teacher experience. Researchers conducting similar studies should consider the use of a mixed-methods approach for a more comprehensive analysis.