The thesis explores priority setting in the National Health Service. It focuses on the changing way in which rationing issues are dealt with in the wake of the Health Service reforms and the separation of function between purchasing and providing health care. It examines how managers within sample District Health Authorities justify their priority-setting agenda. Two connected themes are also analysed. One is how health needs assessment and the call for a 'primary care led NHS' presage a more dominant role for Public Health medicine in informing purchasing. Secondly, how evidence based medicine together with the use of clinical protocols/guidelines, measurement of outcomes and the use of clinical/medical audit, become factors in the decision making process. Theoretically, the thesis attempts to demonstrate a practical use for the Foucauldian concept of 'governmentality' as a framework with which to analyse contemporary changes in health policy. The principal concern is the role experts play within the problematisation of government associated with liberalism. This includes their role within the institutions and technologies of governance that reflect the notion that the strength of the liberal state is derived from securing the well being of the population. In turn this reflects the self-critical dynamic within liberal problematisations of defining the legitimate boundaries of government responsibility in a society made up of autonomous individuals. The PhD is based on semi-structured interviews (32 in total), conducted with the Chief Executives and principal directors of six English District Health Authorities, together with the Chief Officers of their associated CHCs. The District Health Authorities were selected - after a general review of Health Authority Purchasing Plans for 1996/97 - from those Authorities that acknowledged the rationing debate in their purchasing intentions and represented a cross-section of gainers and losers with respect to the new funding formula.

Laboratory diagnosis of tuberculosis is often difficult and time consuming. This study has evaluated some new strategies for improved isolation and detection of Mycobacterium tuberculosis in clinical specimens. This work was conducted over several years examining samples from the a high tuberculosis prevalence population in Jeddah, Saudi Arabia and in the low tuberculosis prevalence setting in Queensland, Australia. Commercial nucleic acid amplification technologies were evaluated and compared with in-house real-time quantitative PCR strategies for both pulmonary and extrapulmonary specimens and for paraffin embedded tissue samples. The study examined strategies for the detection of multidrug resistance strains through the use of Lipa assay to detect mutations in the rpoB gene. Variable numbers of tandem DNA repeat (VNTR) typing was applied to samples from Saudi Arabia and Queensland, Australia to assess their discriminatory power and to demonstrate the diversity and uniqueness of strains of M. tuberculosis in distinct geographical regions. A combination of VNTR typing targeting six ETR loci and an additional three polymorphic MIRU loci was applied to a strains of MTB to enhance discrimination of strains. The results demonstrated that culture remains the "gold standard" for diagnosis and that a liquid culture system is essential for timely isolation of mycobacteria. Direct nucleic acid techniques are valuable diagnostic tools in samples where AFBs can be demonstrated but have markedly reduced sensitivity in AFB smear negative MTB culture positive samples. A combination of VNTR and MIRU typing provides excellent discrimination of strains of Mycobacterium tuberculosis. This stable typing strategy relies on PCR which allows for real-time epidemiology of transmission to be monitored.

The purpose of this study was threefold; to examine the unique challenges faced among young breast cancer survivors’ self-concepts; to explore the identity reformulation process as they adjust to a new lifestyle after completing medical treatment; and to identify women’s creative problem solving solution used to mitigate any long-term distress and discontinuity between past, current and ideal selves. In-person semi-structured interviews were conducted with 10 young breast cancer survivors (aged 32-45). The results indicated that exploring women’s narratives through the identity reformulation process created an alternative approach to the four prescribed quality of life domains used to understand survivors’ overall wellbeing. The results also identified three shared domains of social location (gender, youth and health status) that intersected in women’s identity reformulation process. These findings have implications for psychosocial oncology literature, as well as clinical practice for mental health practitioners. Limitations and recommendations for areas of future research were discussed.

Poverty reduction and conservation can seem contradictory as integrated goals. Despite mixed results over the past several decades, both goals are increasingly being sought out together in practice. Using a case study of an integrated conservation and development project in the Azua province of the Dominican Republic, this thesis examines the definitions and measurement of poverty and wellbeing within integrated conservation and development initiatives. It asks whether the inclusion of subjective ideas and participatory approaches may present new opportunities to better integrate poverty measurements within natural resource initiatives. Four focus groups and 250 questionnaires formed the core methods for data collection. The study reveals wellbeing as a concept was better able to capture the multi-faceted nature of capabilities poverty. Wellbeing often engages with the themes of vulnerability and inequity and includes politically-sensitive considerations instead of concepts that are about assets or consumption, ideas based in the outdated income-poverty perspective. Locally developed indicators were best able to reveal nuances related to context that universal poverty indicators would miss or misrepresent. The results also found that the way poverty, wellbeing, problems and solutions are conceptually framed and defined can be highly relevant. Using asset-based concepts and metrics would lead to economic development goals whereas rights-based ideas would promote very different objectives and methods. The comprehensive identification and targeting of stakeholders was found to be a necessary focus in determining the priorities. Participatory processes, especially with a commitment to power devolution, can help ensure that an array of local ideas are accounted for, and contribute to, a nuanced understanding of complex phenomena. Overall, subscribing to a rights-based approach that targets the means (opportunities) of development and not the ends (assets) can facilitate the needed shift towards the new poverty paradigm, in both concept and practice. A more successful integration between poverty reduction and conservation will require such a shift.

The purpose of this research project has been to gain a deeper awareness of the practice of Cultural Awareness Training and to develop resources that will support other practitioners in the field. My hope in undertaking this project is to make the wider community more aware of what it means to be Aboriginal, at a time when jail is replacing initiation for many young Indigenous people. I want to engender a greater understanding about social, cultural and political issues in the Aboriginal community, by building bridges of awareness between Indigenous and Western cultures. My research question is: How does my approach to Cultural Awareness Training deal with uninformed and racist attitudes towards Aboriginal people in ways that effect positive, constructive change? In the documentation of my professional practice, I have examined critical incidents that have shaped my responses to uninformed and racially stereotyped attitudes within an educational context. This includes stories of overt racism in the classroom experience. In undertaking critical reflection about my professional practice as a Cultural Awareness Trainer, I have aimed to provide insights, as well as practical resources, to support the professional practice of others in this field.

Research Doctorate - Doctor of Philosophy (PhD) / This thesis draws on diverse documentary sources and ethnographic research to look at the importance of place and ethos in the constitution of historical processes and contemporary cultural practices concerned with health and healing. Through an analysis of the interrelationships of morbidity, conceptual frameworks, behaviour, morality, therapeutic modalities, and socioeconomic and religious transformation, the thesis elucidates how people in Ponorogo deal with illness and misfortune in their quest for wellbeing. The regency of Ponorogo is located in the southwest corner of the province of East Java. Its most identifiable symbol is the barong tiger mask which is the main character in Reog Ponorogo performances. An exploration of the area’s extensive archaeological, historical and narrative resources reveals the ongoing dialogue with wider Java, and how the celebration of strength and physical prowess in the performance of reog enacts a distinctive rural ethos and local identity. Reog, therefore, lends itself to de Certeau’s everyday practices of arts of “operating” and “practice”. Strength and stamina are important for the livelihoods of people in Ponorogo, the majority of whom depend on physical labour. A somatic culture and skilful aesthetic inform the search for wellbeing and the use of therapeutic resources. In rural Java biomedical services predominantly dispense pharmaceuticals. Their reputation for fast relief, together with the coincidence of patterns of morbidity, constrained economic resources, problems of access, and the historical and contemporary use of other therapeutic agents forms a local ecology of care in which the use of pharmaceuticals has been incorporated into existing regimens of prevention, protection, cure and maintenance. This local ecology also includes folk practitioners who offer a diverse range of services which are encompassed by the dynamic concept of slamet (wellbeing). While socioeconomic change has enabled them to take advantage of changing aspirations, the moral framework of religious transformation has meant that practitioners have had to modify their services to maintain their legitimacy. In contemporary Ponorogo topography plays a significant role in the exacerbation of socioeconomic difference and health inequalities. The latter part of the thesis focuses on the dry limestone highlands of the regency’s borders. Lack of infrastructure, difficult terrain, and resource-poor environments characterise the chronic poverty of these regions. Ecology and the realities of living in small, geographically-isolated communities contribute to a distinctive ethos which places emphasis on social harmony and conflict avoidance. Extended analysis of a community killing of suspected sorcerers not only illustrates the multidimensional and contextual understanding of wellbeing, but also articulates with the increasing importance placed on the morality of folk practitioners in contemporary Java. The final chapter revisits and integrates the main themes of the thesis in a concluding discussion of lowland and highland contrasts and connections, and how the dynamic concept of slamet is able to adapt to and incorporate change.

Previous research has shown that humankind is not becoming happier, and that in fact symptoms of depression continue to rise, despite the belief of many that happiness is the ultimate purpose of human life. The purpose of this study was to investigate whether happiness can be taught through an intervention programme aimed at increasing levels of subjective wellbeing as measured by scales of self-reported happiness and depression. Participants attending a course based on research into Positive Psychology that included the practice of multiple validated interventions made up the experimental group (N=33), and participants in other community education courses made up the control group (N=41). A pre-intervention, post-intervention and follow-up design was used, with participants completing sets of questionnaires designed to test levels of happiness and depression, and additional questionnaires capturing demographic information and signature character strengths. The results of this study suggested that the intervention had a positive effect on increasing happiness and reducing symptoms of depression. The non-randomised groups resulted in a more depressed experimental than control group prior to the intervention. Generally speaking, it was not true that any subgroup benefited more from the intervention than others, nor were happier or more depressed than others. This study appears to support earlier research that found that subjective wellbeing could be increased through education and volitional behaviour. Implications for the findings are discussed in relation to group education and therapeutic intervention both for increasing happiness as well as reducing symptoms of depression.

Doctor of Philosophy (PhD) / Although the field of coaching psychology has witnessed some theoretical and empirical advances in recent years, this has yet to translate into a commonly accepted theoretical and empirical foundation for coaching practice. Rather, coaching practice has run well ahead of related theory and research, and resulted in the establishment of an industry that lacks firm foundations. This doctoral dissertation reports on a series of reviews and empirical studies designed to further the development of evidence-based coaching practice (EBCP). A review of the relevant literature revealed that the development of solid evidence-based foundations is critical if coaching is to realise its promise and potential. As events surrounding the decline of the human potential movement (HPM) in the 1960s and 1970s indicate, the absence of theoretically-based rationales and solid research support may be a reliable predictor of decline for particular treatment modalities. Whilst the development of EBCP has important implications for the formal preparation of coaches, pedagogical recommendations to industry educators are difficult whilst the characteristics of the coaching industry remain hidden. In order to develop the profile of the Australian coaching industry, a survey was conducted of 148 practicing coaches. The results of this study revealed the presence of a diverse local industry. Despite the existence of a small core of highly experienced practitioners, the majority of coaches appeared to have little coaching experience and greatly varied skills and experience. Interestingly, only 20% of respondents reported any formal training in psychology or the other helping professions. Given recent data that suggests mental health issues may sometimes be encountered in coaching (Green, Oades, & Grant, 2006; Spence & Grant, in press), it is concluded that the majority of coaches lack the skills and knowledge to identify and deal effectively with such eventualities. As the development of an informed strategy for dealing with mental health issues would move the practice of coaching onto a more professional footing, it is recommended that coaches receive basic training in the identification and appropriate referral of such issues. Much of the work presented in this dissertation is based on the presupposition that client outcomes can be optimised through the use of EBCP. However, as this assumption has yet to be empirically tested, a total of 63 participants took part in a 10-week life coaching program. The results showed that when life coaching was conducted by coaches trained in cognitive-behavioural solution-focused (CB-SF) coaching methods (i.e. professional coaching), as opposed to untrained peers (i.e. peer coaching), participants were more engaged in coaching and reported significantly greater goal attainment, goal commitment and environmental mastery. Effective goal-directed self-regulation requires that individuals remain focused on their goals overtime, whilst managing a steady stream of disturbances that can destabilise goal directed effort. In this regard, the construct of mindfulness has much conceptual relevance. Mindfulness reflects the unique human capacity for directing conscious awareness via the controlled deployment of attention. After an extensive review of the scholarly literature, three alternative conceptualisations are presented (i.e. Eastern religious, socio-cognitive and cognitive-attentional perspectives), accompanied by a description of the mindfulness skills training practices associated with each. A total of 72 participants then took part in a study to assess the impact of three mindfulness training (MT) programs on mindfulness, goal-directed self-regulation, mental health and wellbeing. The results revealed that all the MT programs were effective in significantly increasing mindfulness and a variety of mental health and wellbeing indicators. Importantly, MT was also found to significantly increase goal attainment; suggesting that MT may be a valuable addition to EBCP. Goal attainment is a key dependent variable in coaching research. However, the measurement of goal attainment has yet to receive much attention in the coaching literature. As most empirical coaching studies have reported findings based on measures that rely exclusively on subjective measures of performance (measures that are susceptible to several forms of distortion and bias), some key issues relating to the measurement of goal attainment are reviewed and explored in detail. From this review, goal attainment scaling (GAS) is identified as a potentially useful methodology with which both researchers and practitioners can document and evaluate coaching outcomes. The final study pulls together the threads from work presented to that point, and integrates them into a practice framework for coaching. A total of 42 participants took part in this study, which investigated the efficacy of using MT and CB-SF coaching to facilitate the attainment of health goals. The results showed that the delivery of MT prior to (rather than after) CB-SF coaching was more effective in facilitating these outcomes. This suggests MT may be important in coaching for helping people prepare for change.

The purpose of this study is to find out what effect and meaning the youths’ describe that  music has for their wellbeing. The idea is to examine how students studying music at the esthetic program describe that they perceive that practicing music and listening to different types of music affect their wellbeing, with focus on psychosomatic and psychic symptoms. The point is also to examine why the youths think that music can affect their feelings and wellbeing and why they perceive that music is important to them. The study is qualitative and starts from a life world phenomenological perspective. Music is regarded as a phenomenon in this study. The study’s data was collected through a survey which was performed at three different gymnasiums in southern Sweden. The result presents that music listening and music practicing can reduce many of the youths’ psychosomatic and psychic symptoms – mainly by music affecting the youths’ feelings in different ways, making them feel good, creating fellowship and acting as an escape route from reality. Two types of music that can make the youths feel better is calm music and happy music. It also appears that music can increase psychic and psychosomatic symptoms in a way that different types of music can increase symptoms such as anxiety, worry, sleep difficulties and stress. Music described as sad is a type of music that is mentioned making these symptoms worse. The music is important for the youths in different ways. Examples given are that it’s a part of them as individuals, that it works as a support and that it can affect their wellbeing and feelings. The result also presents why the youths think that music can­­­ affect their wellbeing and feelings. The primary point that emerges is that they describe that there is a connection between humans, memories and feelings; that music can affect and amplify peoples’ feelings and memories. In the discussion it appears that music could be used in order to decrease the youths’ psychosomatic and psychic symptoms.

Previous research into the psychological impact of miscarriage has taken a pathogenic approach, with limited research examining the factors that relate to enhanced psychological wellbeing. As a result, it is difficult to understand what predicts lower anxiety, depression and higher wellbeing. In order to address such gaps this study employed mixed methods, using a salutogenic perspective to investigate the effects of miscarriage on women's psychological wellbeing and to identify factors related to enhanced psychological wellbeing over time.