Search

Dependent adults (i.e. eighteen-year-old or older who need or receives assistance due to a reduction in mental capacity or physical capability) can experience oral health problems. Whilst the reasons behind these problems are complex, evidence suggests that caregivers' limited knowledge about oral health and care may play a role. Oral health measurement instruments could provide one means by which to help caregivers establishing appropriate oral care plans for dependent adults and, thus, preventing or managing these problems. This project aimed to investigate oral health assessment measures for oral care planning of dependent adults through three separate studies. A qualitative evidence synthesis was undertaken to establish an empirical conceptual model of oral health in dependent adults. It showed that oral health in dependent adults is a dynamic and multidimensional construct that consists of four domains: the intactness and cleanliness of oral structures; oral pain and discomfort; oral functions; and noticeable oral health aspects. A systematic review was undertaken to critically appraise published oral health measurement instruments for dependent adults. It revealed many instruments have been proposed, but none of these instruments has been adequately and comprehensively tested to establish strong evidence in relation to their measurement properties, feasibility and interpretability. Finally, a qualitative interview study was undertaken to explore healthcare service providers' perspectives on barriers and implementation issues in relation to measuring oral health in dependent adults. The consistent theme was that the implementation of oral health measurement instruments may not be easy due to multiple potential barriers. These barriers therefore need to be considered during implementation, including those related to instruments, service providers, dependent adults and implementation environment. The findings in this thesis support a recommendation that multiple perspectives need to be considered when designing and evaluating oral health measurement instruments used to guide oral care planning for dependent adults. By doing this, these instruments are more likely to meet different stakeholders' needs and, thus, can be successfully implemented.

This study is motivated by Twitter's growing popularity as a space where Saudi men and women discuss issues pertaining to their lives without being stigmatised in an otherwise gender-segregated society. It aims to shed light on the multiple perspectives adopted by them to reveal an existing tension between tradition and modernity in SA (Yamani, 2000). Adopting an eclectic qualitative method, I draw from Critical Discourse Analysis (CDA) tools to analyse the constellation of discourses that are related to gender and the discursive strategies used as resources for stance taking in a corpus of 1000 unique text-based tweets derived from two selected topical hashtags collected in June, 2015. These two hashtags mark the public reaction to a) newly-announced travel controls for Saudi women and b) statistics about the percentages of unmarried Saudi women. in. The data provides evidence that voices of difference, protest, and dissent regarding women's rights and their social role are in a dialogic relation with dominant conservative discourses. The analysis reveals that hashtag contributors mainly engage in the evaluation of gendered discourses, epitomised by a predominant Discourse of Patriarchy, and a Discourse of Gender Equality and Human Rights. A Discourse of Patriarchy manifests in two mutually-supporting discourses: a discourse of dominance that privileges men and gives them control over women, and a discourse about the subordination of women. The Discourse of Gender Equality discusses women's retrieval of their full citizenship status, without the need for guardianship, and an equal social respect for their life choices, including those related to marriage and mobility. While drawing on these discourses, contributors position themselves on a spectrum of conservative (anti-change) and progressive (pro-change) stances. By way of critiquing them, and sometimes, constructing new democratic social worldviews, the contributors show signs of engaging in a form of linguistic intervention to promote social change. Invocations of these discourses were manipulated for the macro-functions of perpetuating, undermining, or transforming existing discriminatory practices against women. Within these macro-strategies, other meso-discursive strategies were employed, namely referential and predicational strategies, assimilation and differentiation, legitimation and delegitimation, intensification and mitigation, and humour. These meso-strategies were fulfilled drawing on linguistic and semantic means including sarcasm, laughter, mock suggestions, comparison, metaphors, etc. I argue that the identified patterns found in the Twitter data reflect as well as facilitate (on the discursive level) an ongoing gradual social change in the Saudi society since the unheard can now be heard and the dominant social practices involving women are being presented for public deliberation. In addition to contributing to the Arabic literature on discourse and gender, this study engages in an act of historicising these changes in SA and provides an assessment of the transformative potential of Twitter.