Background: Evidence from population-level studies demonstrates that adolescent sexual health outcomes are associated with social exclusion, and that certain groups, including young people looked after by local authorities often experience poorer sexual health outcomes. The poorer sexual health outcomes observed for looked after young people has led to the Scottish Government recommending that looked after young people be prioritised for the delivery of sexual health and relationships education, and that residential carers, foster carers and social workers should play a key role in the delivery of sexual health and relationships information to looked after young people. This recommendation builds on existing policy initiatives that have emphasised that parents should be routinely talking to their children about sexual health and relationships. Despite a growing research interest in the health of looked after young people, there is currently little known about how sexual health and relationships discussions are undertaken within the care setting. This is because much of the research that has been published to date has focussed upon identifying barriers to communication rather than establishing how communications are shaped by the characteristics of carers, looked after children and the wider context of the care system. In this thesis I hope to address this research gap by exploring what factors shape communications about sexual health and relationships within the care setting, and examining the extent to which connectedness, monitoring and supervision — parenting factors identified as promoting positive sexual health outcomes for adolescents within the wider literature — mediate these discussions. Methods: 54 in-depth qualitative interviews were conducted with looked after young people (aged 14-18), care leavers (aged 16-23), residential workers, foster carers and social workers in one local authority in Scotland between August and December 2011. Data were analysed thematically, with data collected from corporate parents and looked after young people used to compare and contrast experiences of talking about sexual health within the care setting. Findings: The results presented in this study demonstrate that there has been a perceived shift in attitudes towards talking to looked after young people about their sexual health, and that residential carers, foster carers and social workers believe that talking to young people about sexual health and relationships should be a core responsibility of the corporate parent. Despite this, the results of this study demonstrate that talking to young people about sexual health and relationship is a subject that is fraught with tensions, with many of the corporate parents interviewed expressing difficulties reconciling their own views about the appropriateness of talking to young people about sexual behaviours with their professional responsibility to inform and protect looked after young people from risk. Looking specifically at how communications about sexual health and relationships were undertaken within the care setting, the results of this study show that talking to young people in care about sexual health and relationships is mediated by the impact or pre-care and care histories, in particular maltreatment and poor attachment security, upon young people’s understandings of relationships and their ability to trust other people and seek out help and support. Whilst corporate parents emphasised the need for training to help them identify strategies for talking to young people about sexual health and relationships, the results of this study show that corporate parents are already undertaking sexual health and relationships work that is tailored to the age and stage of the child, and is balanced by the provision of monitoring and supervision to minimise risk. Conclusions: The results of this thesis show that discussions about sexual health and relationships need to be underpinned by a trusting relationship between corporate parents and looked after children. As such, an emphasis needs to be placed upon improving young people’s ability to trust other people. Improving permanency for young people in the care system, in conjunction with the development of attachment based sexual health practices, may result in the promotion of positive outcomes for looked after young people. Future policies and training relating to the provision of sexual health and relationships education within the care system should reflect this fact.

Tidigare studier har visat att pappor upplever att de känner sig utanför i kontakten med barnavårdscentralen. En av barnhälsovårdens uppgifter är att ge stöd och råd till föräldrar, för att främja barns utveckling. Pappor som inte är delaktiga, kan leda till otrygg anknytning mellan barnet och föräldern, vilket kan påverka barnets fortsatta utveckling. Syftet med studien var att undersöka distriktssköterskors upplevelser av pappors delaktighet i samband med kontakt med barnavårdscentralen. Studien hade en kvalitativ ansats. Individuella semistrukturerade intervjuer gjordes med tolv distriktssköterskor som arbetade på olika barnavårdscentraler i södra Sverige. Intervjuerna analyserades med en kvalitativ innehållsanalys. I resultatet framkom tre kategorier: Möjligheter att vara närvarande, pappans känslor kan påverka delaktigheten och pappor som är aktiva på BVC (barnavårdscentralen). Resultatet visade att distriktssköterskorna upplevde att papporna inte var särskilt delaktiga i kontakten med barnavårdscentralen, vilket ofta berodde på att pappan arbetade. Distriktssköterskorna upplevde att papporna kunde känna sig bortglömda, när fokus främst var på mamman och barnet. Distriktssköterskorna upplevde att papporna hade andra frågor och var intresserade av andra ämnen än mammorna. Majoriteten av distriktssköterskorna upplevde att pappornas delaktighet i kontakten med barnavårdscentralen ökade, och att det delvis berodde på att distriktssköterskan själv hade ändrat inställning till pappors delaktighet och därmed mer aktivt bjöd in papporna nuförtiden. / Previous studies has shown that fathers feel left out of the contact with the child health centre. One of the assignments of the child health services is that of giving support and advice to parents, in order to promote the development of the child. When the father is not involved it can lead to insecure attachment, and also affect the development of the child in a negative way. The aim of this study was to describe district nurses experience of fathers participation in contact with the child health centre. A qualitative approach was used. Individual semi-structured interviews were conducted with twelve district nurses working in child health centres. The interviews were analysed with a qualitative content analysis. Analysis of the interviews resulted in three categories: The ability of being present, fathers feelings could affect the participation, fathers who are active in the child health centre. The result of this study showed that the district nurses experienced that fathers could feel forgotten, when the main focus was of the mother and child. The district nurses experienced that fathers had different questions and were interested in other subjects than the mothers. The majority of the district nurses experienced that fathers participation in the contact with the child health centres increased, in part of the district nurses change of attitudes towards fathers participation, leading to more active invitation of the fathers.

Section A provides an overview of the role of family caregivers of individuals with chronic illness, and describes key conceptualisations and theories posited in the caregiver literature. This is followed by an overview of research conducted with caregivers of children with chronic kidney disease (CKD), a summary of the limitations of this research, and suggestions for future research. Section B Despite a recognised need to monitor caregiver burden in caregivers of children with CKD, there is no measurement tool currently available to meet this aim. The present research documents the development of a measure of caregiver burden specific to family caregivers of children with CKD. Methods: Interviews were conducted with 16 caregivers of children with CKD and 10 healthcare professionals in order to generate measure items. A provisional version of the measure was developed and piloted with 18 caregivers of children with CKD and five healthcare professionals. Results: An initial pool of 97 items was generated from the content of interviews, which was reduced to 60 items following review for item redundancy. A piloting exercise provided preliminary evidence for the usability, readability, and relevance of measure items; adaptations further to piloting resulted in the 51-item ‘Paediatric Renal Caregiver Burden Scale’ (PR-CBS). Conclusions: It is hoped that the PR-CBS will serve to identify areas of need amongst caregivers of children with CKD, and in turn improve outcomes for this caregiver population and children with CKD. Section C is a critical appraisal of the conducted research study, and includes an overview of research abilities acquired during its completion, reflections on how the research may have been conducted differently, implications for future clinical practice, and ideas for future research.

SYFTE: Syftet var att undersöka kvinnors erfarenheter av amning under barnets fyra första månader när de deltagit i amningsförberedande kurs under graviditeten.  BAKGRUND: Amning ger hälsovinster för barnet genom att minska risker att drabbas av olika sjukdomar. För att lyckas med amning önskar kvinnorna stöd från omgivningen samtidigt som egna copingstrategierna har avgörande betydelse. Tidigare studier belyser utvecklingsbehov av amningsutbildningar. DESIGN: Retrospektiv tvärsnittsstudie där svaren på öppna frågor bearbetats med hjälp av kvalitativ innehållsanalys METOD: Trehundratre kvinnor svarade på amningshjälpens enkätundersökning september, 2012- mars, 2014. Alla kvinnor hade deltagit i amningskurs som erbjudits på 32 orter i Sverige. Data analyserade med kvalitativ innehållsanalys med induktiv ansats. RESULTAT: Resultatet presenteras som två teman och fyra subteman med tillhörande kategorier. Första temat ”stärkt självkänsla när amning fungerar, trots amningsproblem som behöver hanteras” med subteman ”Känna stolthet över fungerande amning” och ”lösa övergående amningsproblem” beskrev kvinnornas erfarenheter av fungerande amningar. Andra temat ”Förlorad självkänsla när amning är en ständig kamp” med subteman ”Kämpa med amning trots amningsproblem som fortsätter, vilket leder till avveckling” och ”Uppleva krossade förväntningar” som visade kvinnornas erfarenheter av misslyckade amningar. KONKLUSION: Flertalet kvinnor var hjälpa av att ha deltagit i en amningsförberedande kurs under graviditeten. Återkommande amningsproblem sänker kvinnans självbild och upplevelse av misslyckande. Barnsjuksköterskor som arbetar på barnavårdscentralerna har en viktig betydelse för kvinnor som behöver extra stöd med sin amning. Resurser bör satsas för att personal på barnavårdscentralerna ska ha uppdaterad amningskunskap och god förmåga att stödja vid amningsproblem.   NYCKELORD: Amning, Amningsutbildning, Self-efficacy, Barnsjuksköterska, Stöd, Barnavårdscentralen / BACKGROUND: Breastfeeding provides health benefits for children. In order tosucceed with breastfeeding, women need support from family and healthcareprofessionals, but their own coping strategies are crucial. Earlier studies highlight theneed for further development of breastfeeding education.DESIGN: A retrospective cross-sectional study with qualitative approach using openquestions to process the answers.METHOD: Between September 2012 and March 2014, 303 women responded toAmningshjälpen’s survey. All women had participated in breastfeeding education.The data was analysed with qualitative content analysis with an inductive approach.RESULTS: The result is presented as two themes and four subthemes withassociated categories. The first theme, “Strengthened self-esteem when breastfeedingworks, despite problems during breastfeeding”, with subthemes “Feeling pride fromsucceeding with breastfeeding” and “Solving breastfeeding problems”, described theexperiences of women who succeeded with breastfeeding. The second theme, “Lostself-esteem when breastfeeding is a constant struggle” with subthemes “Strugglingwith breastfeeding, leading to decommissioning” and “Experiencing crushedexpectations” described the experiences of women who were unsuccessful withbreastfeeding.CONCLUSION: Participating in the breastfeeding education helped many women.Recurrent breastfeeding problems lower the woman’s self-esteem. Nurses have animportant role in supporting women who breastfeed. Resources should be put intomaking sure that pediatric nurses’ education in breastfeeding is up to date, and thatthey have the ability to support women with breastfeeding problems

Background: In 2015, Swaziland had a tuberculosis (TB) prevalence of 733 per 100 000 population and HIV prevalence of 27.5%. Baylor College of Medicine Children’s Foundation Swaziland (BCMCFSD) reported 83% prevalence of malnutrition amongst children in 2014. No study has described the association between malnutrition and childhood TB in Swaziland. Purpose: To examine the association between malnutrition and diagnosed drug susceptible tuberculosis (TB) amongst children aged zero to fifteen years old in Swaziland. Method: The Mixed Method approach was used to conduct the study. A total of 306 children’s electronic records were extracted, then 12 children’s caregivers interviewed. Extracted data were cleaned and exported to an excel database, then analysed using STATA version 14 by a statistician. Qualitative data were analysed using NVIVO version 11 post the analysis of the quantitative data. Triangulation of quantitative and qualitative results was conducted to obtain a comprehensive picture of the study. Validity, reliability, trustworthiness and adherence to ethical considerations were maintained. Results: History of previous TB treatment, HIV status and age were strongly associated with poor TB outcome (<0.001) and severe malnutrition (<0.002). Sex, regions and TB type were statistically insignificant. Nutritional situation at home and nutritional support from the health care facility, emerged as themes. Conclusion: TB and Malnutrition are significant predictors of children mortality, thus the children caregivers need consistent health education and support. / Health Studies / M. P. H

ABSTRACT Aim: To assess the overall quality of child health services provided at primary health care facilities in the Johannesburg metropolitan area. Objectives: Primary Objective To evaluate the quality of clinical care provided by health care workers caring for children; including an assessment of the treatment of common childhood illnesses, counselling and health promotion. Secondary Objectives 1. To assess the quality of well baby services such as immunisation, growth promotion and developmental monitoring. 2. To assess the availability of drug supplies and equipment. 3. To assess the quality of record keeping. 4. To describe the infrastructure available at health facilities and the availability of services provided to children, including appropriate referral services. Design: This was a cross-sectional, observational study over a two-month period conducted at 16 primary health care facilities in the Johannesburg Metropolitan area; four community health centres (CHC) and 12 primary health care (PHC) clinics. A researcher-developed structured checklist, based on national guidelines and protocols was utilised. Results: A total of 141 sick child and 149 well child visits were observed. Caregivers experienced long waiting hours (mean [SD] of 135±72 minutes). Many routine examination procedures were poorly performed, with an appropriate diagnosis established in only 77% of consultations. Almost half of the children (46%) received antibiotics; their use was unwarranted in one-third of instances. Health promotion activities (such as growth monitoring) were consistently ignored during sick child visits. The mother or sick child’s HIV status was seldom considered or investigated. At least a third of children requiring cotrimoxazole prophylaxis were not prescribed the antibiotic. Growth promotion and nutritional counselling at well child visits was generally inadequate with not one of 11 children requiring food supplementation receiving it. The majority of facilities were adequately equipped and well-stocked with drugs. A lack of capacity to manage children with chronic conditions (such as asthma), mental health problems and disabilities exists. Conclusion: The poor quality of care offered to children in the richest city in Africa is a sad indictment of the inability of health service providers in the city to meaningfully address children’s health needs. Nothing short of a deliberate and radical overhaul in the way that health care is organised for children, with clearly defined and monitored standard clinical practice routines, is likely to significantly change the status quo.

Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent, yet controversial diagnosis affecting children and young people. This study aims to inform educational practice and challenge the negative outcomes associated with ADHD by exploring the lived experience of young people and their teachers. I use Interpretative Phenomenological Analysis (IPA) making use of a paired design to explore how student-teacher dyads within a mainstream secondary school conceptualise and experience ADHD. Findings suggest participants’ conceptualisations of ADHD and associated treatment (e.g. medication) were widely varied and influenced by their personal experiences. Consequently, I advocate a bio-psycho-social understanding of the condition as beneficial for both students and teachers. Students experienced stigma and isolation but benefitted from positive relationships with teachers. Teachers found it difficult to assess the need for a different approach when teaching students with ADHD, but also recognised positive relationships as factors to enable student’s success. This study offers a unique contribution to the substantive topic, and original application of a multi-perspective IPA design. Implications for professional practice are discussed and I invite further research to build upon the current findings by addressing the experience of female students with ADHD, wider samples of secondary school teachers, and further multi-perspective designs.

My research takes a social work perspective to investigate the concept of the child with ‘additional needs'. This concept arose out of the Labour Government's programme ‘Every Child Matters' (HM Government, 2003) which proposed that children's needs for support should be picked up at an earlier point by an integrated Children's Services consisting of social care, health and education. This would stop them from ‘falling through the net' of services. A focus on ‘additional needs' should mean that children in distress are helped at an early stage before problems became critical, improving the ‘well-being' of children and their families. The research has traced the cases of twelve children with ‘additional needs' through their contacts with Children's Services, using an interactionist methodology to interrogate the meaning-making between respondents. Further, following Hacking (2004), a Foucauldian approach to discourse allowed me investigate the discourses which shape formal diagnosis and categorization. Focusing on the ways that the child is positioned and perceived has allowed me to address the question of whose ‘need' is prioritized when the child enters the professional gaze. In doing so it has examined the role of formal and informal labels in constructing the child, the emotional content that goes into creating the ‘meaning-labels' of the child, and the ways that failures in knowing about the child affect the ways that a child becomes pictured. It concludes that in the shifting practices that make up Children's Services, the child with additional needs can become lost in the complex interaction between adult needs and emotions. The informal ‘meaning-labels' which arise out of this complexity often identify the child as carrying a ‘spoiled identity'. This can be carried through into practice with the child, including the processes of formal diagnosis and categorization. Adult emotions need to be managed better if children are to get fitting and timely help to allow them to thrive.

Researchers have linked physical activity (PA) with positive health outcomes. Unfortunately, PA in young people continues to be reported as a concern with many not achieving the recommended guidelines. Further, participation in childhood and adolescence is positively associated with PA into adulthood, highlighting the importance of PA habits in young people for lifelong participation. Gender, socio- economic status (SES), and motivation have all been shown to be important factors that influence participation, and as such are a focus of this thesis. Mixed methods research was adopted to ‘investigate the nature of PA in young people within a Scottish context' including quantitative (study one) and qualitative (studies two and three) methodologies. The initial motivation for study one emerged through my personal interest in understanding the nature of young people's participation in structured club activities and the role SES, gender and motivation play in a Scottish context. Sport is often used as a proxy for PA and as such, young people's participation is frequently reported on sports club based activities. On reflection, this focus on ‘weekly club activity sessions,' rather than a more broad, valid, and reliable measure of PA, limited the application of the findings. Nevertheless, the findings and reflection on the methods used in study one informed the direction of the thesis moving forward. More specifically, SES was found to be the strongest predictor of club activity participation, with those from higher SES taking part in more club activity sessions than those from lower SES. No significant gender differences in participation were found. While SES was the sole predictor of school club activities, perceived competence and intrinsic motivation were also important predictors of participation in out-of-school club activities. The regression models predicted between 5% and 27% of the variance in club participation, highlighting the multi-factorial nature of the influencers of participation. In order to understand the nature of PA more broadly in young people from lower SES within a Scottish context and to investigate the complexity of participation influencers, a qualitative methodology was used. Study two investigated low SES Scottish youths' PA experiences across key development stages (i.e., childhood, adolescence and newly identified early adulthood, study two). Results suggested that young people from low SES participate in a high variety of unstructured PA throughout their lives, which is under reported in the literature. Participation in structured sport based activities in childhood, particularly those in which a young person forms a sport ‘identity,' influences future adherence, but also engagement and enjoyment of school physical education (PE). For many young people, particularly those from less affluent backgrounds, school PE may be the only opportunity for them to participate in structured PA. While some young people embraced school PE, others perceived PE a threatening, so leading them to avoid or drop out altogether. Findings showed that in addition to previous experience, the nature of the PE climate also influenced participation as young people entered early adulthood. As well as shedding light on the broad nature of young people's PA from low SES backgrounds, the findings from study two highlighted the role that schools (e.g., through PE) have in influencing young people's PA and associated attitudes. Study three aimed to investigate young people's PA, motivational influences, and the role of schools from the perspective of qualified Scottish PE teachers, knowledgeable on policy issues and active in the development of future teachers. The main findings from study three showed that family influences (mostly parents) and SES were key towards the formation of young people's attitudes and behaviours towards PA, particularly in sports. Those young people with parents not showing any interest in PA were more likely to be inactive compared to those youngsters with active parents. Young people from lower SES backgrounds were less likely to participate in sports activities, thus preventing them from gaining the necessary experiences (and competencies) needed to successfully take part in many school PE activities. Also, this study found that secondary school PE is perceived by many pupils as threatening which subsequently led many to avoid PE altogether. Many young people are not achieving the curriculum expected health and well-being benefits through school PE. The results also highlighted the huge challenge and role conflict that is apparent for PE teachers in schools, which is a barrier to effective promotion of PA and positive attitudes in a range of young people. This thesis supports the contention that SES is an important factor in young people's PA. While those from lower SES were shown to participate in less structured sport club activity than those from higher SES, evidence emerged suggesting that young people from lower SES participate in a variety of unstructured PA which is underreported in the literature. The complexities of PA participation were also apparent where previous experience, parents and school PE were found to have important roles, which either facilitated or debilitated motivation, and participation. This thesis also highlighted that there are serious challenges in delivering an effective PE experience to pupils with a wide range of ability and backgrounds. These challenges were exacerbated by the vagueness of policy guidance (e.g., within Scotland's curriculum for excellence), the pressures of certification, and the mostly sport dominated culture of PE. Implications for policy and practice in relation to the motivational climate of PEemerged. Recommendations for future research and practice in this area are discussed.

Volume I is divided into two papers. The first is a literature review that explored the emotional experience of professionals who work with victims of domestic violence. Twelve papers are evaluated and the evidence of negative and positive effects is presented. The second is a qualitative study with young people, their mothers and their grandmothers which explored resilience after domestic violence. Data was analysed using Interpretative Phenomenological Analysis. Four themes regarding the memories of domestic violence, newfound stability, acceptance and strength and continued and re-scripted attachments were found. Volume II consists of five reports. The first describes the assessment of a 13-year-old boy with low self-esteem. His needs and strengths are formulated from two approaches: cognitive-behavioural and systemic. The next discusses a behavioural intervention and single case experimental design for a 15-year-old male presenting with challenging behaviours. The third paper outlines a Person Centred Care training program for staff working with older adults. The fourth is a case study of two siblings in local authority care. To consider care-plans, a formulation is informed by the complex trauma literature. The final report was an oral presentation of an admission assessment of a young woman in a high secure hospital.