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Section A: Presents a narrative literature review using a quality appraisal framework to evaluate the quality of studies exploring the experiences of people with chronic pain attending pain management programmes. Chronic pain and pain management programmes are discussed. The review presents three broad categories that summarise the qualitative findings: interrelational group experience; introspective experience; and self-management skills. The clinical implications include encouraging discussions in the pain management programmes to foster these group processes. The research implications include exploring experiences of attending pain management programmes for specific disease conditions (e.g. sickle cell disease). Section B: Presents a grounded theory study exploring the therapeutic mechanisms that are perceived in sickle cell pain management programmes. A model hypothesises that the processes of learning about pain, the sharing and relating within the group of participants may have contributed to the development of a more positive sickle cell identity through acceptance and making changes. Participants who attended non-specific pain management programmes highlighted the importance of the facilitators’ knowledge in relation to sickle cell. The model contributes to understanding how people with sickle cell disease can be supported in managing their pain, and relevant clinical and research implications are considered.

This thesis investigates the overlooked role of family and/or private carers in infection prevention and control (IPC) practices and examines the underlying factors and implications associated with their involvement in patient care across Bangladesh, Indonesia, and South Korea. Despite their involvement in patient care, family carers have not received sufficient attention in the IPC guidance and practices. Whilst family carers’ presence with patients and their involvement in care activities are considered cultural and social norms, to date, there has been limited exploration of the types of patient care activities and the potential risk of healthcare-associated infections (HAIs) associated with their in-depth involvement. Current efforts to reduce the risk and burden of HAIs have primarily focused on healthcare workers, who are the main care providers in Western hospital settings, thereby neglecting the potential contribution of family carers to infection transmission and prevention efforts, as suggested by evidence from outbreaks like MERS and COVID-19. Therefore, this thesis aims to advance knowledge by investigating patient care arrangements, the role of family carers in care provision, and their significance in IPC practices and guidance. Using a multi-methods approach, this thesis conducted three studies across the selected countries, namely Bangladesh, Indonesia, and South Korea. These countries were chosen because they can highlight cultural elements in care provision that transcend socioeconomic status and due to the availability of local researchers who can immerse themselves in the natural environment for in-depth insights. The first study involved a review of current IPC policies and guidelines in these countries to assess whether the roles of family members in care provision were adequately addressed to ensure safe patient care. The second study utilised a patient self-reported diary over a 5-day period to assess the patient care environment, including family and private carers, IPC communication during patients’ admission, and the details of family/private carers’ involvement and IPC practice. The final study employed a qualitative approach to explore the experiences and perspectives of patients, family carers and healthcare workers regarding family carers’ involvement in care provision, care activities, caregiver guidance and training, and IPC practices. This study also examined factors influencing patients and their family carers’ adherence to recommended IPC measures and comprehensively explored IPC employment in the context. This study highlighted how deeply ingrained cultural values influenced healthcare arrangements and the delivery of care practices. The study identified substantial gaps between actual practice and IPC policies/guidelines, revealing a lack of alignment with the care provided by family carers and the cultural influences shaping the healthcare arrangements. This study also identified key barriers affecting the adherence of patients and their family members with IPC recommendations and highlighted diverse perspectives on IPC empowerment. Furthermore, it uncovered the challenges faced by patients, family members, and healthcare workers in achieving IPC empowerment. Based on the findings, this thesis suggests that policies and guidelines should acknowledge the cultural influences on patient care arrangements. It recommends the development of culturally acceptable and responsive IPC strategies tailored to specific contexts. These strategies should embrace the involvement of family members and private carers to ensure the safety of both patients and their family members throughout the caregiving journey.