A mix of qualitative research instruments is used to investigate networking at the national health sector level, the primary care level, the regional of NHS Wales, and at the local level within four local health groups across one health authority area. Findings from the study provide original theoretic and empirical exploration of the contextual issues driving reform in health care and the salient factors impacting upon network relations.

This ethnography examines how Accident and Emergency (A&E) operates as both threshold and gatekeeper. The study draws upon field work undertaken in the accident and emergency department of a major UK teaching hospital. Focussing on patients' and staffs' everyday practices and interactions, the study shows how, and in what moments, medical, administrative and cultural classifications are drawn upon to legitimate and contest different interests. The exploration of categorisation and classification practices is important, not only for a better understanding of A&E as a site in which access to important life chances are negotiated, but also for understanding more about the relations between medicine and socio-cultural classification, and the consequences for those enrolled in their re-making. A&E is shown to be an important sociological site in which forms of knowledge, moral values and relations of power are produced. The thesis situates itself between a body of sociological research that focuses on medical practices as socially constructed, and that pays attention to how medicine re-produces socio-cultural classification, and a set of literatures that account for medicine as particular forms of knowledge. Building on an emergent tradition of research that extends and moves beyond this division, the thesis adopts a particular view of medical knowledge practice that is performative, existent in and through social relations, not only the social relations that occur between people and between people and materials, but also the relations that occur with other modes of ordering such as those produced through clinical governance guidelines. The thesis shows how staff continually perform 'real' emergency medicine. 'Real' emergency medicine is shown to be produced in a number of different ways. It is often accounted for as purely clinical, and as a knowledge practice that relies upon a specific form of medical perception and clinical practice. However, in their accounts of those persons presenting at A&E who fall beyond the boundaries of the purely clinical, members help to accomplish what the 'real' is not. In other moments 'real' emergency medicine includes the organisation and rationing of resources through medical staffs' managing of clinical expertise. Finally, during processes of patient assessments 'real' emergency medicine can be accomplished through patient's own performance of good citizenship as they negotiate their access to health services. Thus, in developing 'accessing' as its central trope, the study shows how A&E as a critical site, is one in which medicine emerges as deeply implicated in mundane practices of social inclusion and exclusion.

This thesis presents a qualitative case study of successful fostering in Wales. The study examines the social worlds of ten foster families from across Wales and undertakes an in-depth analysis of what helps to promote success in fostering. The families occupy three differing contexts comprising local authority fostering, independent agency fostering and local authority fostering but receiving specialist support from a voluntary agency. The study has aimed to involve all the participants within the foster family: the carers, the foster children, the birth children and, where appropriate, adult birth children who no longer live at home but continue to provide support and care to the foster family. The thesis addresses key issues such as the motivation to foster, and the every day world of caring, food, the body, space and time, and children. The data are discussed in relation to a number of theoretical and conceptual frameworks, including critical engagements with relationality, intimacy and the sociology of the family. I have attempted to reflect faithfully the agency and the voice of children who participated in this research. In so doing, I have particularly focused on the nature of care in the context of the embodied encounter with the physical and emotional world and to reveal this world from their perspective, and from the adults and significant others who provide foster care. Throughout this thesis I refer to children and young people interchangeably. I do this to avoid repetition. However, where age-relevant distinctions need to be made, I make clear my categorisation of child or young person.

In the light of public concern about underage alcohol consumption, and increasing use of sport sponsorship to promote alcohol brands, this research investigates interrelationships between teenagers' drinking intentions, involvement in sport, and responses to sponsorship. A Theory of Reasoned Action - based model is proposed, which predicts alcohol use intentions from attitudes toward alcohol, subjective norms, sporting involvement, and awareness of, knowledge of, and response to sponsorship. Data was gathered from 14-15 year olds in five Cardiff schools. Results showed significant gender differences, with boys more involved in sport and more knowledgeable about sponsorship. As expected, positive attitudes toward alcohol consumption, and more favourable subjective norms, predicted higher likelihoods of alcohol use. Boys heavily involved in sport were significantly more likely to drink than those less involved, and believed that at age 18 they would drink more, and get drunk more often. Involvement in sport strengthened the influence of positive attitudes toward alcohol. Girls' results were less significant, but suggested that involvement in sport was linked to lower alcohol consumption. Additional sponsorship-related effects were comparatively small. For boys, awareness and knowledge of sponsorship tended to enhance the effect of sporting involvement, while decreasing the influence of parents and teachers. For girls, there was little evidence of any consistent sponsorship-related effect. Previous studies have shown normalisation of involvement with alcohol to occur in the mid-teens. This work suggests that for boys, sporting involvement encourages this normalisation, with attention to sponsorship playing a significant but lesser part. Thus legislation restricting sport sponsorship by alcohol brands would have little effect, unless part of a coordinated effort to weaken traditional links between sport and alcohol. Such cultural change would require not only commitment from many parties, but also recognition among the wider community of its desirability.

This thesis examines the lives of a group of welfare-reliant single mothers, the &ldquo;Lifeline Girls&rdquo; living in the upper reaches of the South Wales Valleys as they participate in a community education project (&ldquo;Lifeline&rdquo;) tasked with raising them out of poverty. The project is situated within the local social and economic structure and the broader institutional context of market and state. In this way, the research conceives of the linkages between a local site of investigation and the external forces that permeate it. This is achieved through a multi-method, ethnographic approach that charts the everyday interactions of the women involved in Lifeline with the labour market and the pervasive mechanisms of street-level welfare governance. In this the recent restructuring of the welfare state is of particular interest, <italic> firstly</italic> through the dispersal of welfare governance to new sites of practice in the field of community development and specifically here to &ldquo;Lifeline&rdquo;; and <italic>secondly</italic> through the extension of the moral imperative of employment to those traditionally assumed to be outside of the labour market. The &ldquo;Lifeline Girls&rdquo; were key targets of this restructuring and the ways in which it repositioned this group of young women within new symbolic and material constraints and opportunities is the focus of this research. As such the study examines welfare restructuring, from its rhetorical imaginings to the situated action and meaning masking found in one site of its practice. The account established the ways in which the &ldquo;Lifeline Girls&rdquo; were subject to both coercive and therapeutic pressures associated with very different forms of welfare practice. Here, &ldquo;Lifeline&rdquo; itself emerges as a &lsquo;space of contestation&rsquo; but one that is inevitably flawed.

The social and economic impact of medication-related problems (MRPs) of cardiovascular drugs has been under-reported in the community setting. Cardiovascular patients on multiple drug therapy do not know whether side-effects they experience are medication-related or due to their condition. The aim of this study was therefore to develop a system to detect medication side-effects of cardiovascular drugs and their impact on patients' social and economic well-being. The problem was overcome by developing a Socioeconomic Impact Profile (SEIP) questionnaire in which patients were asked if they experienced medication side-effects and what impact these MRPs have on their ability to work, socialise or use healthcare services. The Socioeconomic Impact Profile (SEIP) consisted of 19 items in three domains. Each item was scored from 1 to 5 (1=all of the time, 2=most of the time, 3=some of the time, 4=a little of the time, 5=never). Higher scores indicated better socioeconomic well-being. Psychometric evaluation of the SEIP was carried out in 348 patients with cardiovascular disease (mean age=58.8, median=58.5, age range=37-84, male 175, female=173) recruited from five pharmacies across South West England and South Wales. The SEIP was generally acceptable to most patients with a mean completion time of 5.7 minutes. A high level of agreement among expert panel members on all items of the SEIP was achieved during content validation (Kappa coefficient "k"= 0.85). Factor analysis was used to identify redundant items and also provide initial evidence of construct validity. Evidence supporting internal consistency reliability was excellent (Cronbach's a =0.77-0.95). To further examine the reliability of the SEIP, test-retest reliability was carried out in 92 patients with cardiovascular disease 50 (42.3%) males mean age=57.7 median=57.0 range=39-78 from five community pharmacies in South Wales and the reliability coefficient was high (rs= 0.91-0.93). Evidence supporting the validity of the SEIP was also shown in 96 patients 49 (51.0%) males mean age=63.1 median=63.0 age rangesss39-84 with a cardiovascular condition from the community pharmacy setting. Convergent validity was demonstrated as SEIP patient scores showed moderate to good correlation with the patient MIDAS (Myocardial Infarction Dimensional Assessment Scale) scores. Divergent validity was established as the Short Form-12 health survey (SF-12) overall score demonstrated weak to moderate correlation with the SEIP scores. This study has established the practicality, reliability and validity of the SEIP as a promising socioeconomic related tool, especially in cardiovascular patients with medication-related problems in the community setting. Future work needs to focus on promoting use of the SEIP as part of the new community pharmacy initiatives in the UK for evaluation of treatment outcomes in patients with medication-related side-effects.

No description available.

The aim of this study is to explore the discussion and management of diagnosis and non-diagnosis (which occurs when a genetic diagnosis of the client's problems cannot be made) in the genetic counselling setting. Two aspects of this setting are key to the identification of these analytic themes: the relatively high frequency of diagnostic uncertainty, and the process of genetic counselling as an intertextual chain of communicative events. To explore the way in which diagnosis and non-diagnosis are managed in interaction I supplement my analysis of the spoken clinic with a description of the written communication that provides a record of that talk: medical notes and the client's follow-up letter. Within diagnosis and non-diagnosis, I explore a series of sub-themes including; the use of evidence (from professional and client perspectives), uncertainty, normality and temporality. These themes are explored by focusing on a range of interactional strategies including reported speech, contrast and hedging. The data for this research consists of audio-recordings of 18 genetic counselling sessions, covering a variety of genetic conditions and symptoms, for clients at different stages of establishing a diagnosis. Copies of the accompanying medical notes and follow-up letters are also collected. This thesis suggests that clients within genetic counselling are able to actively participate in talk about diagnosis. I suggest that talk about diagnosis can serve to acknowledge and manage the clients' everyday experiences of their personal situation. However, in the giving of non-diagnosis the need to establish a diagnostic label is foregrounded, and everyday experiences are invoked to promote this need, or manage the non-diagnosis. Finally, I see non-diagnosis in the genetic counselling setting as a flexible concept that can be regarded as a continuum with differing degrees of uncertainty. The clinic interaction allows participants to negotiate their position along this continuum.

Findings show differences in implementation that arise from the degree of closeness of sub-systems related to patient contact. The importance of middle managers on improvement implementation emerges. The impact of Professionals and senior managers is greater at the extreme of performance.

The empirical basis is a focus upon three substantive areas: IB claimants' routes on to IB; experiences of compulsory Work Focussed Interviews with Jobcentre Plus Advisors; and experiences of the Condition Management Programme in each of these areas will be covered within a chapter. A review of selected literature occurs before presenting the original findings alongside existing research. The discussion returns to the issues of policy intention, policy implementation and claimant engagement.