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Using attachment theory as the theoretical framework and social-cognitive, observational and self-report methods of data collection, this thesis addressed important questions peliaining to attachment and care giving in young adulthood. This research is part of the growing field of adult attachment research from a social and personality psychology perspective. It has addressed a relatively new theme in adult attachment research: individual differences in caregiving toward romantic partners and peers. This thesis addressed three main research questions. The first addressed the affect of romantic care giving on emotional well-being and evaluations of the self and romantic relationship. Romantic caregiving lead to temporary changes in the selfesteem and relationship dissatisfaction of young adult support-seekers. These changes were moderated by support-seekers' attachment orientation and perceived distress. The second focus addressed the way in which experiences of receiving care from attachment figures in childhood (i.e., mother and father) and young adulthood (romantic partner and peer) shaped young adults' caregiving ability. Results revealed that the way in which care is received from attachment figures shapes the way in which care is provided. Specific patterns of influence were found: same-sex parent and identification, opposite-sex parent and matching of features between the attachments (e.g., nature of dyad). The third focus addressed Collins and Read's (1994) propositions regarding the structural features of working models of attachment and caregiving. Model strength and model elaboration as an indicator of model strength were operationalised and hierarchical regressions were used to examine the way in which structural features moderate relationship-specific influences on adult caregiving. Findings are discussed in terms of their support for social-cognitive perspectives on attachment theory, their relevance for informing clinical and therapeutic interventions, the intergenerational continuity of care giving patterns and the importance of romantic care giving from an evolutionary perspective.

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La naissance est marquée par le paradoxe d’une forte médicalisation et d’un désinvestissement hospitalier de la période postnatale. Les dispositifs d’accompagnement au retour à domicile ne constituent pas une démédicalisation mais plutôt un transfert de l’hôpital vers le réseau social des familles et les professionnels de la santé. Le suivi médical à domicile doit permettre la poursuite d’une surveillance des familles. A l’issue de ce travail, il apparaît d’une part que les dispositifs étudiés ne sont pas complètement appliqués selon les recommandations, parfois au détriment de certaines familles, et d’autre part, qu’ils ne sont pas adaptés à l’ensemble des personnes rencontrées à Roubaix. Les usages des familles face à ces propositions sont divers. La place des professionnels à domicile est variable selon les contacts préétablis. Certaines familles s’approprient les services proposés et en tirent bénéfice, d’autres les perçoivent comme un contrôle et s’en défient. Cette organisation est source de difficultés puisque les critères d’éligibilité sont essentiellement médicaux. Des familles ne recourent pas systématiquement aux dispositifs institutionnels qui pourraient les préparer au retour précoce, cherchant parfois à se mettre à distance du système ou privilégiant leur expérience. A distance, les mères et leur famille, selon leur niveau socio-économique, leur expérience de la maternité ou leur parcours de formation favorisent les savoirs professionnels ou profanes. L’organisation à domicile est dépendante de l’investissement du conjoint et de l’entourage, peu repéré par les professionnels, et peut alors être l’occasion d’une fragilisation de la situation personnelle et familiale. / Contemporary, birth is marked by a paradox: it is both widelymedicalized and underinvested by hospital during the postnatal period. The existing schemes for caring at home cannot be seen as a demedicalization process, but rather as a transfer from hospital to social network families and health professionals. The medical follow-up at home is meant to enable the monitoring of families. This thesis shows that the recommendations of these schemes are not fully applied, sometimes to the families’ disadvantage. Furthermore, the schemes are not adjusted to all the people, we have interviewed in Roubaix. Families’ uses of these schemes are diverse, and the investment and role of the professionals depends on formerly established contacts. Whereas some families take over the proposed assistance and profit from it, others families perceive them as control and distrust. This organization can create some difficulties as eligibility requirements are mainly medicals. Moreover, some families do not systematically take up institutional schemes which could prepare them to an early return after delivery, in order to stay away from this system or to opt for their own experience. According to their socio-economic status, their maternity’s experience or their educational background, mothers and their family do not favour the same knowledge (professionals or non-expert). Eventually, home organization depends on the partner, relatives and friends’ investment, which is barely noticed by professionals and can cause personal and familial breakdown.

Existing home care technology tends to be pre-programmed systems limited to one or two interaction modalities. This can make them inaccessible to people with sensory impairments and unable to cope with a dynamic and heterogeneous environment such as the home. This thesis presents research that considers how home care technology can be improved through employing multiple visual, aural, tactile and even olfactory interaction methods. A wide range of modalities were tested to gather a better insight into their properties and merits. That information was used to design and construct Dyna-Cue, a prototype multimodal reminder system. Dyna-Cue was designed to use multiple modalities and to switch between them in real time to maintain higher levels of effectiveness and acceptability. The Dyna-Cue prototype was evaluated against other models of reminder delivery and was shown to be an effective and appropriate tool that can help people to manage their time and activities.

Public work programs (PWPs) gained increasing recognition among governments and international development agencies for their contributions towards women’s empowerment, combining aspects of (1) job creation, (2) skills development, (3) income generation, (4) service provision, and (5) credit from social protection into a single scheme. Of particular interest to the PWP community, consisting of development agencies, government agencies, donors, policy makers, community-based organisations, planners and evaluators, is the extent to which a social care agenda increases the gender responsiveness of PWPs in the Global South. I seek to investigate the above issue through examining the unique case of South Africa’s home community-based care (HCBC) programme, a social care service implemented as part of South Africa’s Expanded Public Works Programme (EPWP). South Africa’s EPWP is a pioneer in (and to date one of very few cases) adopting a social service dimension through the HCBC and Early Childhood Development (ECD) interventions. In this study, I question the impact of HCBC on community caregivers’ (mostly females) empowerment. Triangulating a systematic review of the literature against findings from my semi-structured interviews collected in Cape Town, South Africa, and background data from government reports, I evaluate the extent to which HCBC achieved its five action areas targeting women’s empowerment, in particular increased (1) access to employment opportunities, (2) employability, (3) income generation which promotes poverty alleviation, (4) community participation, and (5) access to service provision. My findings show the HCBC’s capacity to promote women’s economic and political empowerment to be constrained, albeit providing a partial route to socio-psychological empowerment through increasing women’s visibility and social recognition within the community and women’s self-esteem.

In 1998 World Health Organisation Europe outlined a vision of a new community-based nurse called the Family Health Nurse (FHN) who would help individuals, families and communities to cope with illness and to improve their health. Scotland was the first European country to develop this idea through policy, education and practice. The two phase national pilot project (2001-2006) primarily involved remote and rural regions. Despite its vanguard position, Scottish family health nursing has been subject to little in-depth critical analysis. This thesis addresses this deficit by analysing why and how family health nursing developed in Scotland. The research methods used are: critical review of textual sources; empirical research into policy, education and practice; and critical review and application of relevant theoretical perspectives to enable interpretation. Grounded primarily in constructivism, this approach builds explanation of the development of family health nursing in Scotland as a phenomenon in contemporary nursing history. This explanation highlights the importance of key factors and processes, particularly: agency at policy formulation level; use of the piloting mechanism to mediate knowledge production, containment and expansion; tensions between generalism and specialism as manifest within the promulgated FHN concept, the educational programme, and the FHN role as it was variously enacted in practice; related difficulty in engaging substantially with families; and the strong influence of local context on the nature and scope of FHN role development, especially in terms of situated power and embedded culture of place. The explanation is summarised as a synoptic story. A new integrative, explanatory model of the development of family health nursing in Scotland is also posited. This knowledge is then examined in relation to contemporary community nursing and primary care in order to understand influence and implications. This highlights the importance of the development of family health nursing in shaping the new Community Health Nurse (CHN) role which emerged from the Review of Nursing in the Community in Scotland 2006. The new explanatory model constructed within the thesis is then applied in its more generic MAPPED format (Model for Analysing Policy to Practice Executive Developments) to analyse the new policy formulation advancing the CHN role and to anticipate key developmental factors and processes. On this basis, the thesis argues that the MAPPED model is potentially valuable for the analysis of developments that require purview from policy through to practice. The thesis concludes by summarising its contributions to understandings of community nursing policy, practice, research and theory, and makes a number of related recommendations.

The term 'hard to reach' first appeared in the Health Visiting Review (Lowe 2007). This review claimed that the health visiting service was able and experienced in reaching the 'hard to reach'. Yet there was a dearth of health visiting literature on what this concept meant and how it was interpreted in practice. A wide literature review was undertaken which examined government child health policies on reducing health inequalities and how the targeting of services to meet the needs of 'vulnerable', 'disadvantaged' or 'hard to reach' families had developed. The literature review identified how the concept of risk in relation to child health promotion had been defined and redefined since the 1970s. The latest shift involved the identification of 'new social risks' and the promotion of early intervention to prevent social exclusion and health inequalities. At the time of the study's inception, health visiting was a service both in decline and under threat. In contrast, the development of new early intervention programmes such as Sure Start (National Evaluation of Sure Start 2005), On Track (Doherty et al. 2003) and intensive home visiting (Barlow et al. 2005) also led to the critical examination of the concept of 'hard to reach'. In response to the lack of information on the concept of 'hard to reach' in health visiting, I set out to examine critically how Health Visitors (HVs) working in a disadvantaged area conceptualised and operationalised the concept of 'hard to reach'. This qualitative ethnographic case study (Yin 2003), by using research methods of focus groups, participant observation of a Well-Baby Clinic and interviews, gathered perceptions and experiences of HVs and service users. Thematic analysis was guided by Gee's (2005) method of critical discourse analysis and revealed how the term was contested by HV practitioners. It was considered a broad term that in practice could be applied widely and negatively as a label for non-engaging service users; yet themes emerged which also demonstrated how HVs related to and constructed the concept in their day-to-day practices of client engagement. The findings were categorised and a typology was developed in relation to the reach of health visiting within a predominantly deficit model of health. The typology consists of four types, all of which relate to the 'reach' of the health visiting service at the interpersonal level. The first type, the 'easy to reach' client, highlights the diversity of clients: not all clients living within a disadvantaged area were 'hard to reach'. This category also identifies how some clients living within this disadvantaged area developed relationships with HVs. Including the type 'easy to reach' within the typology acknowledges the diversity of clients living within an area of disadvantage, and also the facilitators in HV/Client relationships. The second type identified was the 'emotionally hard to reach' client, and identifies characteristics of clients who had a tentative relationship with the health visiting service. Working with 'emotionally hard to reach' clients involved negotiation and the building of trust at each encounter. The third type, 'physically hard to reach', developed following the identification of a range of barriers that reduced access to vulnerable clients. The fourth type, 'hard to reach services', arose from the findings - and this type relates to barriers created by the organisation of the health visiting service in a disadvantaged area. The typology highlights the importance of both clients' and HVs' engagement in the development of working relationships. It recognises the organisational structures and discourses that act as barriers and facilitators to client engagement. It recommends that health visiting should take the opportunity offered in the Health Visitor Implementation Plan (DH 2011) to develop a health visiting service underpinned with a strengths-based model of public health.

The aim of this study was to analyse the role of the registered nurse in the management of pro re nata (PRN) medication in a care home (nursing) for older people. Studying PRN medication provides insights into the role of the nurse in care homes (nursing) who act as assessor, decision maker and evaluator in residents' care. It also provides a lens by which to explore how residents and their carers interact and participate in day-to-day care decisions about residents' health. The case study draws on ethnography. It is a multi-method study, using documentary and medication reviews, observations and interviews to answer the research questions. Thirty-four residents were recruited to the study and 60 care home staff. Findings showed that 88.2% of residents (n=30) were prescribed PRN medication and that all residents were on a minimum of 1 and a maximum of 7 medication. During each 28-day MAR sheet period between 35 and 44 PRN prescriptions were written. They contributed 12.7% of all medication prescribed, accounting for between 1.2 and 1.5 medication per resident. Nurses were found to administer PRN medication, but a finding of this study was that this activity could be delegated to carers who were identifying resident needs. There was some evidence of resident engagement but this was often a three-way process between resident, GP and family or resident, carer and nurse. A percentage of medication that could have been PRN were routinely prescribed. Observations also identified that nurses would decide not to administer routine medication in certain circumstances and that this was directly related to their assessment of the resident. The process of medication management was dominated by the regulations and governance processes of the care home. Observations and interviews found that care home staff recognised and affirmed residents' pain but did not take action for analgesia to be administered. They were familiar with the use of pain assessment tools for older people living with dementia and had received training in dementia care. Many of the staff were also able to interpret signs and symptoms of a resident's distress. Nevertheless, their preoccupation with meeting internal and external regulator standards was a barrier to addressing residents' needs. This is the first study that has looked at an aspect of medication management to understand how nurses and care home staff work for and with residents to moderate and address their health care needs. It suggests that additional training in aspects of medication management and resident assessment may not be able to address deeper seated issues of autonomy and how the nursing role is understood and enacted in care home settings.