Introduction: There is little evidence of the use of guided self-help as an intervention for people with intellectual disability. The Self-Assessment and INTervention, is a guided self-help tool designed specifically for this group. There are three linked studies within this thesis that aim to; [1] develop a guided self help intervention [2] test its reliability and validity and [3] pilot it in practice using a single case experimental design. Method: The SAINT was developed using Delphi methodology and focus groups and has demonstrated good reliability and validity. The pilot was conducted in two parts; part 1 had 15 recruits to test the intervention, whilst part 2 (which aimed to replicate the findings over an extended period) had three recruits, including two from part 1. A Nurse visited each participant weekly to facilitate the intervention. Results: Reliability testing was completed on 59 participants. The SAINT showed significant correlation at the p <0.001 levels, (2-tailed) with the GDS-LD (r = 0.619), GAS-ID (Worries) (r = 0.496), with test-retest correlation (N=25), 0.881 at the p < 0.01 level (2-tailed) and a Cronbach Alpha score of = 0.828 suggesting good internal consistency and reliability. From part 1 twelve out of fifteen people completed the intervention, of these nine (75%) demonstrated a decreased symptom scores in both, of the intervention phases for depression and three (25%) for anxiety. In part 2, both participants from part one replicated positive results; as did the new participant. For all cases anxiety improved in both intervention phases N=3 (100%), as did depression in n=2, (66.6%). Those with a history of affective disorders (n=8) showed the most consistent improvement. Summary: The SAINT has shown itself as a potentially viable and valid treatment option. It has shown a decrease in mean symptom scores for the majority of participants; which more importantly were replicated over an extended period in part 2 of the pilot for two participants.

Culture appears to be an important influence on attitudes towards people with intellectual disabilities (e.g., Fatimilehin & Nadirshaw, 1994). The author aimed to identify and review all relevant studies. This review highlights the complexity of conclusions drawn from cross-cultural attitudinal research and emphasises that social inclusion is a western concept that is not necessarily applicable to non-western cultures. Suggestions for future research are made, including the importance of investigating attitudes in multicultural societies. This is particularly relevant in the UK, which is culturally diverse, whilst employing a western conceptualisation of intellectual disabilities.

This thesis describes the effects of globalisation on the modern Korean house form. It is argued that house form is determined by complex socio-cultural interactions and has evolved across cultures as, for example, the bungalow. The research methods included a pilot study, a survey of Korean inhabitants and interviews of specialists. The pilot study was conducted in five different areas with 33 Korean respondents who were living abroad. The inhabitants' survey involved 131 respondents who were living in Korea, using questionnaires and interviews. The specialists' interviews involved 32 specialists in historical and contemporary house form in Korea. The major findings from these studies are: 1) Korean people understand globalisation as a process of interaction with other countries which has introduced new forms of transport, communication, technology and ideas. 2) Korean house form has been changed by internal developments and external influences through processes of modernisation and globalisation. Western influences especially affect cultural and social values in Korea whilst the demands of Korean people are for comfortable and high quality modem living. Government housing policy focuses on design and building standards and `ecology friendly' housing. 3) There has been a process of change for Korean house form. It first gradually and then speedily changed over time under more and more western and global influences. This process can be seen in different new developments in housing types such as Gae- Ryang Han-Ok, Mun-Wha house and Yeong-Dan house in the beginning of interaction with other countries for modernisation before the 1950s, apartment and quasi-houses in the 1960s, and Jeonwon-chutaek (rural style house), wooden house, luxury villas, Office-tel (office with residential facilities), one room apartment, Jusang boghab apartment (mixed with commercial and residential areas), Silver Town house (complex for elderly people) and 3 Sae-dae Dong-geo apartment (3 generations living together)in recent years. 4) There are several outcomes of changes as follows: i) Domestic living patterns have been changed. Families are smaller and it has become more usual for people to live alone. People pursue individual rather than communal family activities, and there is more concern for personal hygiene. Overall, people are interested in gaining higher standards of living. ii) Interior design has changed, reflecting altered living patterns. Families now have separate rooms to accommodate individual interests. Toilets and bathrooms are situated indoors, and there are often multiple bathrooms. Although parents' and children's spaces are still separated, as is the tradition, the separatenessh as been redesigned to fit in with western house forms. iii) House types have changed as mentioned in above 3. These are greatly influenced by global designs and are built to accommodate the new living patterns. The changes in house form in South Korea are very similar to changes in house form across the world in the process of globalisation. This is seen as a result of the high technology information age, which provides the ideas and blueprints for house form, coupled with rapid industrialisation in Korea, which has provided a growing economy to finance domestic modernisation. 111

The thesis explores the spiritual experience of people with profound and complex intellectual disabilities with a Christian theological framework. It critiques recent intellectual disability theology and, in particular, the use of qualitative research methods in the context of this discrete group of people, arguing that these empirical approaches are neither viable nor necessary in an exploration of the experience of people who cannot access the linguistic or cognitive process inherently required to participate in such research projects It presents the case that a richer and more fruitful source of information about the spiritual experience of people with profound and complex intellectual disabilities can be found in the broader Christian faith tradition of systematic, biblical, philosophical and mystical theology.

In this thesis I take up a DeleuzoGuattarian methodology of assemblage analysis. I use this methodology to map how the problem of sexuality is produced within the specific material context of a service for adults labelled as having intellectual disabilities. The primary method of data collection was in-depth narrative interviews with a strategic sample of service providers and male service users. Service users were invited to share opinions on, and to tell stories about, attending a service and attempting to lead a sexual life (broadly defined). Meanwhile, service providers were invited to share opinions on, and to tell stories about, working within a service and working \vith male service users around issues pertaining to sexuality (broadly defined). This process led to the collection of a large volume of opinions and a huge number of stories, told from a variety of perspectives, about the treatment of sexuality within the service. The data was analyzed using a bespoke meth9d of assemblage analysis. Two intricately interconnected themes were recognized as central to the problematization of sexuality: firstly, intense sexual surveillance; and, secondly, widespread fears regarding sexual abuse. These themes were analyzed as assemblages leading to the production of two maps. The first explores how sexual surveillance works in a post-institutional community based service. The second elucidates how fears and suspicion of sexual abuse are continually produced within the service, despite a lack of accounts detailing non-consensual acts.

No description available.

No description available.

The mainstreaming agenda championed in government documentation such as Valuing People (2001) and Valuing People Now (2007) is based on principles of choice, empowerment and inclusion, and is prolific throughout Learning Disability policy and practice. Service users are encouraged to access mainstream health care services and consequently much recent research on the health and health care of people with learning disabilities has been based within mainstream health services. The current study proposes to address this gap in the literature and explore the impact of the mainstreaming agenda on the management of the health and health care of people with learning disabilities. Three focus groups were carried out with care and support staff, who work with people with learning disabilities. One further focus group was carried out with a group of people with learning disabilities. Vignettes were used as a talking tool to encourage conversation and semi structured interview protocols were followed. The groups were transcribed verbatim and analysed using thematic analysis. The following key themes emerged from the staff focus groups: Roles and responsibilities, Empowerment: support versus independence, Assumptions and beliefs about learning disabilities. Themes of Understanding of health and illness and Responsibility for health emerged from the service user group, which whilst being distinct themes were clearly related to what was discussed within the staff focus group. This was usefully conceptualised in an over-arching thematic thread described as 'the constructed lives of people with a learning disability'. This thread highlighted the interconnectivity of the lives of people with learning disabilities and the people who support them. A misunderstanding by staff of key concepts from policy and organisational rhetoric, used throughout learning disability services, such as empowerment, choice and control, impacted upon the way staff interacted with service users and consequently affected the way service users understood and experienced health and health care themselves. The mainstreaming agenda, whilst being based on solid principles, which should serve to benefit people with learning disabilities, is actually based on principles that staff in the current study struggled to truly understand and implement effectively. This should be considered when examining service development and innovation within Learning Disability Services, in particular in relation to care and support staff who may consider supporting the health and health care of people with learning disabilities as being outside of their substantive role. Further research is needed to explore the differing understanding and application of concepts such as choice and empowerment and if further discrepancies identified, training developed to support staff to effectively understand and apply these concepts in practice.

Parents of children born with risks for intellectual disability (ID) report emotional upheaval and greater support needs compared to those raising a typically developing child. Exploring these parents’ needs and experiences is critical for the provision of early intervention and/or paediatric services that benefit the whole family. Consequently, this study aimed to explore the experiences and needs of Maltese parents of young children born with biological risks for ID, during the first five years of life. It adopted a cross-sectional qualitative design, using Interpretative Phenomenological Analysis (Smith et al., 2009). Four groups of parents, (N=37) depending on their children’s age (0;6, 2;0, 3;6 and 5;0 years) were interviewed using a semi-structured interview guide. Six super-ordinate themes were identified: ‘experiencing is true understanding’, ‘family functioning’, ‘info-emotional cycle’, ‘micro-system sociological framework’, ‘service-needs-resource cycle’ and ‘experiential challenges’. Socio-cultural influences have affected parents’ interpretations of their experiences and needs. Moreover, parents reported that raising an ‘at risk’ child had an impact on their daily life as a family, as a couple and on their individual lifeworld. Maltese parents felt that their needs were not given their due importance by policymakers and professionals. This warrants the incorporation of parents’ needs, together with the needs perceived for their child, in the provision of early intervention and/or paediatric services in Malta. This study also identified parents’ experiential differences as the child grow, highlighting the need for regular re-evaluation of parents’ needs. Recommendations for changes in Maltese family policy, service provision and education of professionals were proposed to reduce parents’ stresses.

People with intellectual disabilities (ID), and in particular adolescents, are at increased risk of suffering from poorer health than people without ID. This vulnerable group are at particular risk of becoming obese and developing type 2 diabetes which can lead to cardiovascular disease, stroke and death. An established mediating factor to lessen the likelihood of becoming obese and its associated risks is through participating in regular physical activity.