There are many 'voluntary sector' led attempts which use personal computers to facilitate improved participation of disabled people in social and economic life ('digital inclusion'). However, the organisation and longer-term outcomes of such projects have tended to remain under-researched. The thesis adopts a long-term focus on the challenges and workarounds that characterise successful or failed attempts by disabled people (typically using off-the- shelf applications for affordability and support reasons) to ensure meaningful connections. Much of the research on 'digital inclusion' projects of this kind tends to be conducted through questionnaires, and often suffers from a 'box-ticking' approach to issues such as 'installation' and 'ICT use' that tends to leave open questions regarding how any challenges were actually resolved (or not) in practice. Furthermore, an often extensive reliance on on- line interviews and questionnaires inevitably leaves non-users unaccounted for. Similarly, research often tends to adopt short-term approaches which overemphasise lCTs' "potential to improve disabled people's lot" (Sheldon, 2004) and thus fail to give a clear picture of what form (the hoped for) 'digital inclusion' did take in practice. Such research therefore tends to focus on end states (before/after) at the expense of questions of processes and practices. This, the thesis argues, is a critical omission since voluntary organisations which are the most common channel for digital inclusion schemes (Social Exclusion Unit, 2005) are unlikely to possess optimal equipment or support. What is often missing in this literature therefore, are accounts of how disabled people and their helpers "muddle through" the technical, support and other challenges they face. Drawing on qualitative research undertaken with a UK non-profit organisation, the thesis focuses on the ways in which disabled people are able (or not) to make use of information technology in their homes, and the challenges, workarounds that are involved in their successful or failed attempts at becoming 'connected'. The general contribution the thesis makes is to the ongoing debate within social science concerned with the role of technologies in social life. Through a focus on disabled people it offers a novel way of entering into this debate which serves to unpack the often taken for granted nature of the role the body plays (in this case, the impaired body) in the organising of 'social' and 'material' (sociomaterial) relations.

This research engages with critical realism to reassess the meaning of the dwelling for physically disabled individuals. Much of the existing literature on experiences of the dwelling for physically disabled individuals has explored functional design issues. In doing so a homogenous view of the meaning of the dwelling has been presented, one that has largely neglected the influences of both agency and physiology. To remedy this neglect this research seeks to explore the possibility for difference in the meaning of the dwelling and in doing so move beyond the explanations presented in the past. Drawing on the data generated through life history interviews with nineteen individuals with a wide range of physically disabilities, this thesis explores the range of events that can affect the meaning of the dwelling for physically disabled individuals. Moreover, by developing a critical understanding of critical realism, over the course of the thesis an analytical framework will be developed; a framework that can help explain the experiences of the nineteen participants in a non-reductionist fashion. Principally, this framework will highlight the impossibility of reducing experiences to just one cause and assert the need to recognise that a combination of structures, mechanisms and events co-determine the meaning of the dwelling. By taking an epistemological position influenced by critical realism it becomes possible to acknowledge experiential diversity in the form of: episodic issues; type of impairment; biographical accomplishment; emotional attachments; impact of care services etc. without disregarding all important issues of design or homogenising experiences. In doing so this research not only makes a contribution to the meaning of the home literature, but to disability and housing studies in general.

Sexuality is an area in which people with learning disability are disabled by social attitudes. Stereotypical views about the sexuality of people with learning disability range from asexuality, implying that they have no erotic or romantic inclinations, to hyper-sexuality which reinforces institutionalized sex segregation through the process of social exclusion. In Malta all these influences contribute to hinder the rights and the quality of life of people with learning disability. The theory of the social model of disability underpins the research aims, while reflecting discourses of equality and rights. The research aims at giving a better understanding of the sexual lives of people with learning disability in a Maltese context, whilst eliciting the opinions and beliefs of people with learning disability themselves, their parents and their service providers. Qualitative data, collected from people with learning disability, their I' parents and service providers is interpreted using phenomenological analysis. A sex education intervention pilot project is also run as part of the research, being informed by the findings of the same research. Findings identify ideologies, highlight missing structures and illustrate feasible future strategies. They reveal a lack of community support and emphasise the need of platforms where people with learning disability can form and maintain friendships and relationships. The dearth of any adequate form of sex education currently available for people with learning disability across Malta as well as the lacuna in policies related to sexuality, and particularly referring to the sexuality of people with learning disability is also uncovered. Recommendations reflecting findings from the main research study and the pilot project mainly target the necessity of sex education, policies and procedures surrounding sexuality in the context of people with learning disability in services across the islands.

In recent decades the rapid growth in the numbers of the very old, those aged 85 years and above, has made them the fastest growing age group of most populations worldwide. Nevertheless we know little about their health and disability, the latter being a particularly important aspect of quality of life for individuals but also more widely as a major determinant for residential care. This thesis uses a unique study, the Newcastle 85+ Study, a longitudinal, population based cohort study of people born in 1921 and aged 85 years at first interview in 2006, to explore the disablement process in very late life through three substantive sub-studies. In the first sub-study I explore how disability unfolds through the order of loss in basic and instrumental activities of daily living, ADLs, these being the building blocks of disability. ADLs were lost in a specific order, activities requiring long distance mobility and balance (for example shopping) being lost first and those requiring upper body strength (e.g. dressing, feeding) last and with little difference between men and women. The second sub-study examines the impact of specific diseases on disability onset and finds that arthritis, diabetes and cognitive impairment were similarly disabling for men and women, cardiac disease was more disabling in women, and cardiovascular disease and respiratory disease disabling for women only. The final sub-study uses novel statistical techniques to uncover patterns of disability from age 85 to 90. Four distinct trajectories of disability were found for both sexes, with a disability-free trajectory being identified in men but not women, and all other trajectories showing increasing levels of disability. These sub-studies are discussed in the light of other literature, the extent to which they explain the greater disability yet survival of women (the disability-survival paradox), and the implications for the future.

This is a narrative account of a cohesive programme of research carried out between 2010 and 2016, which resulted in ten peer-reviewed, published papers that provide an empirical basis for my thesis. The impetus for this academic exploration was provided by my personal experience of acquired sight loss, where my medical and functional needs were prioritised but my emotional needs were overlooked. The first study I undertook confirmed that people experienced negative emotional effects attributable to acquired sight loss. Subsequent studies explored the experience of social exclusion in health and education for blind and partially sighted people. Difficulties were evident across the lifespan, starting with undiagnosed refractive errors in childhood, moving to perceptions of inclusion in high school and on to experiences of exclusion in health care and engagement with leisure activities in adulthood. These papers offer a context for understanding the social and emotional effects of sight loss. Two supporting papers examined how inclusion in healthcare might be increased through nurse education and how accessible games might aid inclusion in entertainment. The thesis as a whole focuses on the development of Counselling for Sight Loss, a pluralistic practice framework for responding holistically to the emotional effects of sight loss, which are compounded by social exclusion. My theoretical model explaining the transition from sight to blindness provided a theoretical context for the thesis, advocating that different people benefit from different types of emotional support at different times in their sight loss journey. This has implications for the nature and timing of emotional support offered to blind and partially sighted people. Counselling for Sight Loss is based around a menu of therapeutic tasks, identified from analysis of systematic case study data in which clients identified helpful aspects of their therapy. These tasks provide an empirical basis for working therapeutically with clients who have visual impairment and will act as a foundation for the development of training materials. The findings of my most recent study have highlighted the need for a national framework for the provision of emotional support services for blind and partially sighted people within the United Kingdom. Currently, emotional support and counselling services are being delivered by staff with varying degrees of relevant training, including those with none. My research has contributed to the development of quality standards and training, based on my Counselling for Sight Loss data, to benefit UK service delivery. Thus my thesis represents a systematic commitment to using research to generate real-world solutions to a real-world problem: designing and delivering effective emotional support and counselling for adults with sight loss in the United Kingdom.

The aim of my work was to explore the meaning of sexual well-being for physically disabled people and to use the knowledge gathered to inform social work practice with adults. It uses a practice project and research to achieve this aim. The well- being principle in the Care Act 2014 makes this a topical subject for social work practice with adults in England. The study uses theoretical concepts such as humanisation of care services to develop an understanding of well-being focused practice. The thesis comprises four elements: (i) a literature review; (ii) a research study; (iii) a practice development project; and (iv) a narrative which is interwoven throughout, highlighting points of reflexive decision making. A phenomenological approach was used to collect data through a series of unstructured interviews with six physically disabled participants. The findings revealed that disabled people experience discrimination regarding sexual expression, and this has a negative impact on their well-being. Insights gained from the research led to a practice project based on regard for sexual well-being, enabling social work practitioners, and other professionals, to confidently and knowledgeably explore sexual well-being with service users who wish to do so. Making the insights from this research useful to practice requires overcoming barriers to practitioner engagement with learning and research, and I develop a learning tool and practitioner research network as potential ways of addressing these barriers. I end this thesis with a narrative review of my work, identifying both potential contributions to knowledge and potential limitations.

Development discourse and practice have generally ignored, even silenced, people with disabilities. In response, this thesis draws on the case of Burkina Faso to bring geographies of development and disability into dialogue with postcolonial theory, which seeks to recuperate the voices of the marginalised and oppressed. It adopts a mixed ethnographic methods approach, including participatory techniques and interviews, in order to understand the lived experiences of disabled people in Burkina Faso. The thesis first examines the general context of Burkina Faso and the different aspects of Burkinabe life and society in which disabled people’s lives unfold. These aspects are interlinked with the perceptions of disability in Burkina Faso, both in how society perceives disability and in how disabled people view themselves. These perceptions, which are explored subsequently, affect the lived experiences of disabled people, which are often not taken into account by development practitioners who intervene in disabled people’s lives using western models and ideologies. Furthermore, development interventions influence the creation and functioning of grassroots disabled people’s organisations, and here the thesis looks at the challenges these organisations face with regard to their heavy dependence on external partners as well as the lack of ‘organisational spirit’. Finally, the thesis examines disabled people’s perceptions of development and the emphasis on economic independence as an essential element in a disabled person’s life to challenge the predominant perception of disabled people as a burden. It highlights the significance of opening up spaces in which disabled people’s voices can be heard, using techniques such as participatory video, and the significance of having these voices heard by development practitioners. The findings indicate that there is a need to theorise disability from Global South perspectives, as well as to facilitate development through an engagement with the voices and agency of disabled people.

Background: A good transition from child to adult services remains a challenge for young disabled people (14-25) due to multiple organisations and professionals involved. Delineating what should happen is described in transition protocols/pathways, yet there is little evidence of their effectiveness, especially for young people for whom such protocols/pathways are intended to support. Aims and objectives: The aim was to understand the transition process, the contextual relationships, and the external and internal mechanisms facilitated by the intervention of a Transition Key Worker and how they may help create opportunities to achieve good outcomes for young people moving into adulthood. Methods: A Realist framework, as advocated by Pawson and Tilley, utilised an underpinning programme theory to unpick how protocols/pathways work to better manage the transition process and to evaluate how 14 sites implemented transition key working. A stakeholder workshop commenced the realist process to develop the mid-range theory and to identify what works, how it works and in what circumstances for young people. Thematic analysis was used to analyse 61 stakeholder interviews. I drew upon my ‘insider’ perspectives and reflexivity, which was a novel feature. Main Findings: Parents’ poor experiences of ‘pre-transitional’ support hindered preparation for their child’s future and determined their ability to think positively and let go of the past, which was not found in the literature or identified by Transition Key Workers. However, young people were not majorly concerned about the future. The mid-range theory areas of structuring the transition process, having support, planning well to make active decisions, with parents being ready for change within a robust governance and accountability framework were key indicators which determined what makes a successful transition. Transition Key Workers were regarded as an essential facilitator of the process. How to plan effectively and in detail with young people from was absent. Conclusion: The findings contribute by providing major insights into understanding what stakeholders considered to be the key elements of achieving successful transition. Determining a successful transition is individual and young people should not be coerced to fit into imposed systems, which limit their aspirations. The linear description of the transition process in current protocols/pathways does not fully represent the complexities where multiple organisations are involved. There is a need to set out in guidance how to plan with young people. The development of a new mid-range theory provides a significant contribution to inform practice in supporting young people to plan well for their futures.

Background: Despite positive attitudes amongst support staff towards sexuality, adults with learning disabilities report being dissatisfied with the support they receive. This research aimed to explore how support workers understood their role in supporting the sexuality of people with learning disabilities. Method: Six support workers from supported living services completed interviews and vignettes exploring their role. Data was analysed using interpretive phenomenological analysis. Results: Three themes emerged which were understood as suggesting that support workers’ held both complex and conflicting affective associations to their role supporting sexuality. This was interpreted as creating an ambivalence that resulted in them distancing themselves from having an active role in supporting sexuality. Conclusion: This study concluded that support workers may inadvertently express an understanding of their role that may be consistent with negative and limiting discourses about the sexuality of people with learning disabilities. This study reiterates the need for sexuality training.

In the aftermath of the First World War, hearing loss gained a new prominence in public consciousness because of the mass ‘deafening’ of soldiers. For the British Post Office, this meant that the amplified telephones they had designed for the trenches could be appropriated into civilian use as their new ‘telephone service for the deaf’. This thesis traces the development of this telephone service to explore how such technology has interrelated with the social construction of hearing loss. Answering what motivations underpinned the development of the amplified telephone has necessitated studying the history of technology alongside science and technology studies and disability history. This fusion of approaches provides a creative analysis of amplified telephony to give greater insight into the impact of communication assistive technologies. This thesis demonstrates that a historical understanding of technology designed for the disabled can reveal the agency and experiences of disabled individuals to show their interactions with technology as a reciprocal relationship instead of an imposed one. My thesis offers a way to do this by combining a social constructionist approach with elements of disability history to reveal the contribution of disabled users to amplified telephony. An aspect of prosthetic production that has previously not been emphasised, this shows the rich connections between technology and creativity in the disabled context. Indeed, the development of the amplified telephone was heavily influenced by its users, as so called ‘deaf subscribers’ made their voices heard in order to influence the telephone’s form, frequency and cost. By drawing on the socio-technical approach that questions how users matter, this thesis will foreground the individual experiences of users to shed light on how the telephone was used as a prosthetic, and emphasise the forgotten contribution of users to the development of amplified telephony.