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This thesis reports a study of presented discourse in popular science narratives of discovery in English. It focuses on the fictionalizing role of presented discourse. The thesis proposes minor adjustments to the existing models of presented discourse analysis, dividing discourse presentation into Public Discourse (speech/writing) and Private Discourse (thought). After exploring the forms and functions of discourse presentation in the narratives, the thesis concludes that Private Discourse prefers the forms commonly associated with non-fiction while assigning to them the functions most often observed in fiction. All the forms of discourse presentation in the narratives contain dramatizing properties, yet Public Discourse possesses the highest degree of dramatization. Private Discourse in the narratives possesses communicative properties generally assigned to speech/writing presentation exclusively. Private Discourse is more likely to communicate scientific hypotheses than reveal the inner worlds of actants. The thesis concludes with an examination of presented discourse outside the narratives of discovery. This analysis confirms the phenomena observed in the narratives and reveals a unique feature of presented discourse outside the narratives-the fictionalized reader-a fictional actant created using discourse presentation. The findings of the thesis present a strong argument in favour of fictionality in popular science.

Management of long term conditions is seen as one of the greatest challenges facing the English National Health Service currently (House of Commons Select Committee, 2014). One of the proposed solutions for this growing crisis is to support patients to manage their conditions themselves, thereby reducing hospital visits and lowering costs to the NHS overall (NHS England, 2013). Self-management necessarily involves the patient having some level of knowledge regarding their condition. In addition, there is a commitment within healthcare for patients to be involved in decision making regarding their healthcare needs with the mantra "no decision about me without me" (Department of Health, 2010) as well as development of the 'expert patient' agenda within healthcare (NHS Choices, 2014). In order for knowledge to be shared between health care professionals, patients and carers, knowledge boundaries must be managed within the process of knowledge sharing. This ethnographic study takes as it starting point, literature concerned with knowledge boundaries specifically, but highlights how current understanding of these boundaries is limited in some ways. In particular, issues of power and choice within the management of knowledge boundaries are inadequately explored within this body of literature which limits its applicability to contexts such as healthcare, in which power dynamics are endemic. In addition, the concepts of identity and expertise are implicated in issues of power and therefore this study seeks to explore the relationships between power, identity, expertise and knowledge in order to better understand the nature of knowledge boundaries and the dynamics of their management. This study found that issues of power were fundamentally implicated in knowledge sharing and the management of knowledge boundaries. Knowledge boundaries were found to be not only sites of struggle over knowledge, but also sites of struggle for control more generally. Whilst knowledge and power have long been associated, this study found that this relationship was complex and greater knowledge did not necessarily confer greater power on the social actor. Despite being evident in the rhetoric of healthcare, as a basis for power, expertise was redundant as more embedded social discourses remained prevalent. It is proposed that bases of social power are hierarchical in some respects as power based on one foundation can be rendered ineffective if faced with opposing power exerted by another social actor based on an alternative and more efficacious basis. This study emphasises the pervasive nature of embedded power dynamics within healthcare which concurrently facilitate conventional knowledge sharing processes and impede the development of new processes which would encourage the increased involvement of patients.

This thesis reports on the longitudinal study of consonant production in fifteen typically-developing monolingual children living in the south-east of England acquiring non-rhotic accents of British English. The data relate to the consonant patterns found in spontaneous speech production as recorded in individual diaries kept by caregivers. The study follows two lines of enquiry. Firstly, the speech data are analysed to chart the emergence of English consonants in relation to phonemic targets. Separate analysis of the production of initial and final singletons and cluster consonants is undertaken. This reveals word-position asymmetries in the production of consonants and consonant classes, and identifies the classes and the contexts in which consonants are most avoided. Secondly, the speech data are analysed further for evidence of word-position bias in the use of the simplification processes identified in O'Neal (1998) as features of two discrete phonological profiles. Children who demonstrate tendencies towards either of these profiles in their patterns of consonant deletion, fronting, stopping and reduplication are identified, and their profiles compared and contrasted with those of other monolingual English-learning children.

This thesis examines the phonetic, phonological, and social aspects of pre-aspiration in English spoken in Aberystwyth, mid Wales. Pre-aspiration refers to a period of voiceless (primarily) glottal friction occurring in the sequences of sonorants and phonetically voiceless obstruents (e.g. in mat [mahts] or mass [mahs]). Chapter 1 summarises the objectives of this thesis and where the thesis is positioned with respect to our current knowledge of the phenomenon and the relevant theoretical issues. Chapter 2 introduces the data used to address these objectives. Pre-aspiration is usually considered as consisting of a voiced glottal component, or breathiness, and a voiceless glottal component, or voiceless pre-aspiration, and these are treated as a single unit in a number of analyses (Helgason 2003; Helgason & Ringen 2008; Karlsson & Svantesson 2011; Morris 2010; Ringen & van Dommelen 2013; Stevens & Hajek 2004b, 2004c; Stevens 2010, 2011). Chapter 3 shows that this is not adequate because distinguishing the two enables us to discover patterns that would remain obscured otherwise – such as breathiness being a possible precursor to pre-aspiration. This is demonstrated through the segmental and prosodic conditioning of pre-aspiration and breathiness. Chapter 4 shows that although pre-aspiration is not an obligatory feature of Aberystwyth English (in the sense that it would occur in 100% of time where it can), it nevertheless forms two clear categories sensitive to phonological rather than phonetic vowel height. However, phonological vowel height on its own cannot explain these two categories and interacts with a number of other conditioning factors. Whilst Chapter 3 investigates the relationship between pre-aspiration and breathiness, Chapter 5 looks into that of pre-aspiration and glottalisation and demonstrates that the two can occur in the same environment, which enlightens the debates related to the historical connections between pre-aspiration and glottalisation in particular (e.g. Kortland 1988). It furthermore reveals that although it is not known why they are co-occurring for some speakers and mutually exclusive or allophonic for others, their relationship is conditioned prosodically and not segmentally. Chapter 6 illustrates that pre-aspiration is an acoustic correlate of the fortis-lenis contrast in plosives in production at least equally well as breathiness, voicing, release duration, or the duration of the preceding vowel, and better than voiceless closure duration, glottalisation, or f0 before or after the plosive in question in the word-medial (cotter [khɒhtsə] ~ codder [khɒdə]) and the word-final positions (cot ~ cod). It is therefore at least as important as the other four correlates. Chapter 7 finds that pre-aspiration also exhibits social conditioning. Females pre-aspirate more frequently than males, which is often found in pre-aspiration studies, but this difference disappears as the age decreases. Furthermore, the frequency of breathiness, and the duration of pre-aspiration and breathiness are not conditioned by gender. However, all four variables are affected by age. Pre-aspiration thus seems to be undergoing an advancing sound change according to Labov’s Principle II (2001: 292) and breathiness seems to be its precursor. Chapter 8 summarises the results and outlines questions for further research.

Public participation is an increasingly prominent policy in the United Kingdom and elsewhere. This thesis locates one example of participation within wider debates about the constitution of contemporary society, changing welfare-state governance, and the challenges of operationalizing such initiatives. It relates the particularities of this case to practical, policy and theoretical questions. The thesis begins by considering the rise of participation in historical context, relating its aims to social-theoretical commentaries on late-modern society. This framework informs an examination of rationales for participation, an analysis of policy discourses on public involvement in health, and consideration of the challenges of making participation happen. The remainder of the thesis presents the results of an empirical study of one example of participation: service-user involvement in a programme of pilot cancer-genetics services, managed by the third-sector organization Macmillan Cancer Support. Using interview, observational and documentary data collected over a three-year period, it offers a longitudinal perspective on the practice of involvement, drawing on various actors’ perspectives. Considered over five empirical chapters are competing rationales for involvement put forward by different groups of actors, the micro-processes of involvement, and the varied outcomes of negotiations across the seven pilots studied. In reconciling the theoretical and policy literatures with empirical findings, the thesis highlights certain tensions. Policy-level ambiguities permit the coexistence of multiple discourses about the purpose of involvement, the identity of those involved, and the influence it should command, resulting in conflict as participation is put into practice. Policies designed to avoid directiveness and facilitate local discretion create dilemmas for those charged with implementation, especially third-sector organizations whose intermediary role means they must reconcile divergent views of diverse stakeholders in participation practice. The result is a situation where pragmatic negotiations take precedence over any theoretical or normative vision for participation in determining its remit, scope and influence.

Background: A large proportion of ill-health is preventable (Signorelli 1993). A goal for health promoters is to provide information about health risks with the aim of persuading individuals to modify their behaviour. Previous research suggests that the readability of many health promotion materials is too low for effective comprehension. Evidence suggests that much of the health information available is written at a level that is too difficult for the target populations (e.g. Dollahite et al. 1996, Meade & Byrd 1989, Greenfield et al. 2005). Whilst this work is useful in identifying barriers to accessibility to health information, there has been little research that systematically explores the concept of usability within the context of health information. Objectives: The first objective of the thesis was to examine whether the concepts of usability and usefulness as outlined in the Technology Acceptance Model (Davis 1993) can be applied to the domain of health promotion and used to predict intentions to follow the advice given in health promotion leaflets. Second, the studies sought to make distinctions between subjective and objective usability and to explore the factors underlying subjective ratings of the usability of health information. Further, the thesis sought to demonstrate that both objective and subjective usability would influence the persuasive effect of health promotion materials. Finally, using theory from dual-processing models of persuasion (e.g. Elaboration Likelihood Model. Petty and Cacioppo 1986) it was predicted that when usability of leaflets was high, participants would be more likely to make judgements about their intentions to follow the advice given in the leaflets based on peripheral clues such as frame (Tversky and Kahneman 1981, Rothman and Salovey 1997, Levin et al. 1998). Methodology: 5 empirical studies examined the research questions. The first study consisted of two samples from working populations (n=441), and explored manual handling and use of hearing protection. Participants evaluated existing health and safety leaflets in relations to their usability and usefulness, and rated their intentions to follow the advice in the leaflets. The second study, also conducted on a working population (n=97), used experimentally manipulated leaflets on safe manual handling to test the hypothesis that framing effects would be found when usability of leaflets was high. The third study used a student sample (n=127) to explore factors that influence subjective usability. The study used experimentally manipulated leaflets about safe alcohol consumption to examine whether the concept of subjective usability is a function of reader characteristics (psychological constructs, mood, past exposure to the health problem) and leaflet characteristics (frame, objective reading ease). The fourth study used a student sample (n=238) to test the effect of objective reading ease on recall, in order to test for differences in processing of two experimentally manipulated leaflets about safe alcohol consumption. It was predicted that easy leaflets would be processed at a more shallow level than difficult leaflets. The fifth study, also conducted on a student sample using experimentally manipulated safe alcohol leaflets (n= 135), used pre and post testing to further explore the effects of usability on framing effects, and to test for a moderating role of prior knowledge on the effect of usability on intentions. Results: The studies showed that readers distinguish two separate components to health information leaflets: usability and usefulness. Subjective perceptions of usability and perceived usefulness predicted intentions to follow the advice given in the leaflets. Objective usability (reading ease) influenced the persuasive effect of the leaflets, with easy leaflets being more persuasive than difficult leaflets. Perceived usefulness partially mediated the relationship between subjective usability and intentions. Objective reading ease affected recall, with easy leaflets resulting in higher levels of both accurate and false recall of the information in the leaflets. Prior knowledge moderated the relationship between usability and intentions. Those with low prior knowledge were more persuaded when usability was high. Usability influenced the effect of frame on intentions. Framing effects were only found where usability was high. Where framing effects were found, negative frame was more persuasive than positive frame, offering support for Levin et al.'s (1998) typology of framing effects. Conclusions: Results from the studies show that the concepts of usability and usefulness, formalised in models of technology acceptance (TAM), can be applied to health information and used to predict intentions to follow health promotion recommendations. A distinction can be made between subjective and objective usability, and both of these can influence persuasion. Using theory from dual-processing models of persuasion, usability of health information leaflets can influence the effect of frame on intentions to follow the health promotion advice.

Aim This thesis explores the seeking of help from a General Practitioner in the event of psychological distress. The study explores help-seeking, lay understanding around mental health, and the relationship between the two. Background Help-seeking has been shown to vary according to different demographic factors, and is not necessarily correlated with need. Frequently, those who need help most do not seek it, whilst those with low need are more likely to enter care; help-seeking is complex, and there is value in understanding more about current patterns. Lay knowledge is perceived as playing a crucial role in help-seeking, providing rationale for examining the two alongside each other. Method Qualitative interviews were used to explore the stories of people who have recently sought help, alongside interviews from a group of ‘lay’ participants who discuss distress, help-seeking and mental health more generally. 20 interviews were carried out, analysed using a combination of thematic analysis and the process of analytic induction. Findings The thesis sheds light on the limited role of lay knowledge; its role is most evident when considering hypothetical help-seeking. For recent help-seekers, journeys towards care were mediated by factors pertaining to their wider lives; help-seeking was intimately related to their context. Help-seeking is the outcome of a complex interplay of factors and the study sheds light on aspects of individuals’ stories that render distress more or less likely to enter Primary Care. The process of medicalisation is illuminated, for example, individuals receiving care for physical health problems are particularly prone to their distress being medicalised. Findings lend support to a contextually-rooted approach to understanding help-seeking. Expectations of – and preferences for – care are explored, evidencing a need for General Practitioners to consider referral to self-help and/or support groups within the community; individuals may not necessarily be seeking a medicalised response.

This thesis argues that health policy practices on access to medication in Cameroon have been shaped by global health partnerships (GHPs), with the result that the capacity of the state has been undermined and the national health system fragmented, with no resultant reduction in the incidence and burden of malaria and HIV I AIDS. GHPs have played an increasing part in relation to access to medication in a number of developing countries in Africa, defined in terms of potential and actual access to pharmaceuticals and healthcare services. GHPs are supposed to provide a better policy response to the practical problem of access to medication by combining the expertise of UN agencies, the pharmaceutical industry, international civil society organizations, national government and local groups to formulate and implement country-specific policies. Ostensibly, they are able to bridge the gap between medical technology and the public health needs of poor societies. Neither of these claims can be substantiated. Theoretical approaches to models, embodied knowledge and social constructionism are used to provide a conceptual framework to study the role of GHPs on access to medication. GHPs are conceptualised as 'models' that occupy the intermediate position between theory and policy practices, within which are found three major narratives, based on public health, economistic and human rights approaches to the issue of access to medication. These narratives became embodied within GHPs, and are analysed to show how they shape different elements of policy practices. The operation of GHPs within a 'transcalar network', this 'social space' in which global-national-local linkages are formed and interactions take place is also examined. Global and national (country-specific) perspectives on the emergence of the GHP as a facilitator of access to medication are identified, and the role of GHPs in determining national health policy and local delivery practices for achieving access to medication for the poor and most vulnerable population is investigated. Two programmes in Cameroon are used as case studies: 1) National Malaria Programme created on Roll Back Malaria partnership guidelines and 2) National HIV/AIDS Programme created on Accelerating Access Initiative and Equitable Access Initiative guidelines respectively. The empirical evidence from this thesis supports a critical evaluation. GHPs emphasise specific medical intervention programmes, and are effective only in this narrow technical sense. Even though their efforts have not reduced the incidence and burden of malaria and HIV I AIDS, they have legitimised the direct intervention of international agencies, private corporations and civil society organizations at the local level. The GHPs' pursuit of 'quick results' has fragmented the national health system and undermined the role of the state. This thesis suggests that the key to reducing disease burden and improving public health is a strengthened national health system, one that the current GHP model does not offer. Developed to address the supposed failure of African states to ensure access to medication, GHPs have further marginalised the role of the Cameroon state, thereby reducing its capacity to protect and advance the health of its citizens.