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This thesis explores how general groups of people think about predictive genetic testing. Psychological research into individual decision-making prior to the consulting room is scarce, with our knowledge of the types of factors that influence the decision to request this service barely investigated. The research presented undertakes this task by identifying salient factors influential in the contemplation of this new health choice. The research then examines how these factors impact on genetic-testing decision-making processes and intentions in more detail. The aim is to increase scientific understanding of early decision-making in this area, by exploring the motivations of individuals who intend to request this service and also the decision-making of those individuals who will never be seen at a genetic clinic. The thesis is comprised of four studies. The first study uses an exploratory qualitative methodology, gathering focus group data to discover how groups of people who have not directly experienced predictive genetic testing think about this service. The findings suggest that people are primarily concerned with their perceived control over genetic testing decision-making processes and their risk of genetic diseases. The second and third studies use repeated measures experimental designs to manipulate perceived control (self- efficacy) over genetic-testing decisions and perceptions of disease risk. The findings revealed a complex relationship between self-efficacy in these domains, global self- efficacy, perceptions of risk and intention to undergo testing. Study two showed that when specific efficacy in these domains was experimentally decreased global perceptions of self-efficacy also reduced, alongside the desire to maintain control over these domains. Study three showed that a lack of intention to undergo genetic testing was predicted by perceptions of high disease risk, high levels of health-specific self-efficacy and the importance of this efficacy - but not levels of general self-efficacy. Additionally the results from the third study revealed that intention to undergo testing was higher when people were given no information about the genetic inheritability of a disease, indicating that that as a disease becomes 'geneticized' both control over that disease and general control may become eroded. The final study again uses a qualitative methodology, using interview data from individuals at high and low risk of disease to further examine the role of risk and self- efficacy in genetic testing decision-making, and to identify which areas of self-efficacy have most impact on intentions. The study also examines how people make sense of their 'genetic risk', how they conceptualise self-efficacy within this domain, and how they perceive these two concepts to be related. Findings from the last study suggest that levels of general self-efficacy may be relevant to decision-making when the individual's confidence is extremely high, in that the person feels confident to cope with the test result regardless of any possibility of cure or prevention. Attitudes and intentions towards genetic testing also appeared to be strongly determined by levels of disease-risk anxiety, with the attraction of testing appearing to wane when the emotional consequences of genetic testing were reflected upon. To conclude, these findings suggest that a lack of perceived control over genetic testing decision-making and disease risk has wide-reaching consequences in negatively impacting on overall perceptions of competence and well-being. The findings also suggest that for people at extremely high risk of disease, who feel both in control of any potential symptoms and value this control, genetic testing is unattractive, in robbing them of the potential for control in the future. Diseases perceived as being genetic were largely viewed as immutable and uncontrollable. On deeper reflection, decision-making in this area was often perceived as anxiety provoking and conceptualised by ambivalent and complex thinking.

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This thesis explores and examines the history of Aboriginal child welfare policy in Western Australia. This historical scheme allowed thousands of Aboriginal children to be separated from their families. The policy of separating Aboriginal children from their families to be raised in the 'white way' was underpinned by an intrusive legislative scheme that made the Chief Protector of Aborigines or the Commissioner of Native Affairs the legal guardian of all Aboriginal children whether they had living parents or not. However, the statutes, Aboriginal specific or mainstream, remained relatively silent on the content of the guardianship duties, thus the need to turn to the common law to identify these duties. Overlaying these duties is the best interest of the child principle. Unfortunately, according to testimonies and some corroborating official documents, it appears that in many instances the State guardians failed to comply with their guardianship duties. This raises issues of State accountability and responsibility and legal liability. However the court system has failed to provide redress for the separated Aborigines. It is argued that the courts could provide redress by holding the guardianship relationship as a sub-category of the fiduciary relationship requiring protection of the non-economic personal interests of the separated Aboriginal children. It is acknowledged though, that the protection of noneconomic interest is foreign to Australian fiduciary jurisprudence. It is furthered acknowledged that the separated Aboriginal children face other legal hurdles. The lack of judicial redress means a political solution is required in response to the demands for justice by the separated Aboriginal children. It is argued that the examination of the guardianship relationship and breaches of guardianship duties provides added political force to the case for awarding reparations to the separated Aboriginal children.

This thesis explores the implications of individual caseload practice for midwives. Over the past fifty years childbirth in England has become predominantly hospital oriented, with midwives forced to meet the needs of the institution rather than those of childbearing women. In 1994, a change in government policy for the maternity services attempted to address the dissatisfaction felt by mothers and midwives. The model for caseload midwifery was developed from their recommendations. Midwifery retains an ideology of independent practice yet the reality of working in a subservient position to obstetricians and controlled by the dictates of an institution have been seen in some studies to have undermined midwives' practice. However, their willingness and ability to work in a more independent manner was questioned. This study explored the implementation of caseload midwifery within a highly medicalised inner-city NHS maternity service. Working in partnership, within small groups, each midwife carried a caseload of 40 women per year. No longer based in the conventional hospital or community services, the midwives worked where and when appropriate, to meet the needs of their women. The research was undertaken over 46 months using an ethnographic approach and a variety of data collection methods. The prolonged study period facilitated an understanding of the development of caseload practice from its implementation into an established service. This thesis explores the adaptations the midwives needed to make on moving from conventional practice into caseload practice. Comparison of the difference services offers an understanding of the ways in which organisational features can influence the practice and meaning of midwifery. The control over and uses of time emerged as an important theme in this regard. Of particular note was the high level of job satisfaction expressed by the caseload midwives and their consideration that this model enabled them to practice "real midwifery", phenomena which are explored within the thesis. In working 'with' women, it is argued, the midwives developed a form of authority that had not been facilitated with the conventional services, and which contributed towards a new form of professionalism for the midwives. Although considered by many to be independent and 'isolationist', the strengths of caseload practice were seen to be in the context of group and inter-professional relationships, and the relationships midwives formed with mothers and their families as their work became re-embedded in the society in which childbirth occurred and had its meaning.

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Objectives: To use the theory of plannedb ehaviourt o explore factors associatedw ith performing skin care behaviours and the occurrence of pressure sores in people with spinal cord injury. Design: A within-group cross-sectional design was used to assess 59 people with spinal cord injury living in the community. A sample returned a repeat assessment allowing a longitudinal examination of the relationship between intention and actual behaviour. Methods: A measure was developed in accordance with the theory of planned behaviour guidelines through interviews with people with spinal cord injury. Measures of mood and knowledge of skin-care behaviours were also included. Results: The theory of planned behaviour components, mood and knowledge of skincare behaviours were helpful in predicting intention, skin care behaviour and occurrence of pressure sores. Demographic and disease factors also helped to identify people at increased risk of performing less skin-care behaviour or developing a pressure sore. Overall, past behaviour and indirect perceived control and past behaviour and age were particularly important predictors of pressure relief and skin checking intention respectively. Conclusions: Psychosocial factors, including the theory of planned behaviour components, were useful in understanding adherence to skin care behaviours and the occurrence of pressure sores. Overall the combination of past behaviour and indirect perceived control, and past behaviour and age were particularly important predictors of pressure relief intention and skin checking intention respectively. The clinical and theoretical implications of these findings are considered and suggestions for future research are outlined.

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