Reversal theory (Apter, 1982) is a psychological theory of motivation, emotion, and personality that purports to explain human behaviour as well as experience. In 1999 Svebak proposed a triangular relationship between metamotivational dominance, sport preference and biological composition among elite athletes using a reversal theory framework. Svebak’s proposition would suggest that when three of these components match (e.g., telic dominant individual with slow-twitch muscle fibre predominance who participates in endurance activities), they have a higher probability of success, and of optimizing the joy of participating. However, this proposition has only been examined in elite athletes (Braathen & Svebak, 1990). The purpose of the present research was to examine whether components of Svebak’s triangular relationship could be demonstrated in the general population and to examine the relationships between dominance, state and physical performance. A series of four studies were conducted with subjects purposely sampled and allocated to telic and paratelic groups from a pool of individuals who initially completed the Paratelic Dominance Scale (PDS; Cook & Gerkovich, 1993). Subjects who scored higher than one standard deviation above the mean were classified as the paratelic dominant (PD), while those who scored lower than one standard deviation below the mean were classified as the telic dominant (TD) (Gerkovich, Cook, Hoffman, & O’Connell, 1998). Age, sex, preferred sports/exercise activity and frequency of exercise per week were recorded for each subject. In each study, state was manipulated via video stimuli into telic and paratelic in a crossover design before completing an exercise task, the subjects continued to watch the video stimuli for the duration of the exercise. Manipulation checks indicated that the video stimulus was successful in changing state. The Telic State Measure (TSM; Svebak & Murgatroyd, 1985) and Tension and Effort Stress Inventory (TESI; Svebak, 1993) were completed during each of the studies. The exercise performed in each study varied with 5 s isometric leg extension used in Study 1; 100 repetition isokinetic leg extensions in Study 2; 30 s Wingate test in Study 3 and ramped peak test in Study 4. Exercise preference in all four studies indicated that telic dominant individuals preferred endurance exercise activities, while paratelic dominant individuals preferred explosive exercise activities, supporting previous research (Cogan & Brown, 1999; Kerr, 1991; Kerr & Svebak, 1989; Svebak & Kerr, 1989). Physiological responses (EMG and HR for Studies 1 and 2; HRV and HR for Studies 3 and 4) showed mixed results. For the Study 1, EMG was employed to examine if either state or dominance influenced neural activation during isometric leg contraction, however no significant differences were found. Study 2, muscle tension was examined using EMG gradients during isokinetic leg exercise with results indicating dominance determining EMG gradients rather than state (gradients present in telic dominant individuals). HRV has never been investigated previously in relation to reversal theory. In both Studies 3 and 4 the majority of HRV components decreased after exercise as a result of vagal withdrawal. When examining metamotivational dominance/state and HRV variables, changes showed no statistical significance in both studies, but responses in HRV variables were observed in relation to differences between metamotivational dominance/state suggesting a need for further studies. Heart rate was measured in all four studies and results were consistent with telic dominant individuals having a lower resting heart rate. No significant differences were found between metamotivational dominance in relation to performance. However, across all four studies there was a tendency for paratelic dominant individuals to perform better during explosive/power activities while telic dominant individuals performed better during endurance activities, both groups tended to perform better in their preferred state. There was a strong tendency for telic dominant individuals to report higher levels of stress than the paratelic dominant individuals regardless of the state condition. State effects were observed for some of somatic emotions (i.e., excitement, relaxation, boredom and anxiety), while other emotions showed time effects due to the results of exercise in all four studies. Generally, both telic and paratelic dominant individuals were more excited and less bored at post-exercise; and telic dominant individuals were more anxious throughout the course of experiment. The present research has made contributions to reversal theory research by supporting previous findings in exercise preference and resting heart rates, and presenting new data on changes in stress and emotions in telic/paratelic state conditions during exercise. Furthermore, muscle tension, as indicated by EMG gradients, has been observed relative to state and HRV has been measured for the first time in relation to reversal theory, indicating possible links between HRV and metamotivational dominance/state. Methodological issues such as state manipulation and dominant group selection have contributed to the reversal theory research. The data provide some support for Svebak’s proposed triangular relationships among general populations.

This study sets out to make a meaningful and useful contribution to the discussion surrounding the treatment of heroin addiction in the Republic of Ireland. The exploration describes the experiences of service users who are receiving methadone treatment in general practice in Dublin and provides recommendations for practice. A Husserlian phenomenological approach drawing on the psychological research methods of Colazzi informed this study. This qualitative descriptive genre was coupled with the genre of reflexive methodology and utilised the techniques of bracketing interviews and polyvocality. The study took place in nine urban general practices in Dublin city. Twenty five service users were interviewed indepth. The data were analyzed using the methodology espoused by Collazzi (1978). Four themes emerged from the data: Service users’ experience of attending general practice for methadone maintenance; The significance of methadone for the service user; Service users’ understanding of the Methadone Treatment Protocol and The experience of addiction and it’s effect on families. Service users’ accounts traced the historical steps that influenced the introduction of the MTP. Their depictions of their experience of treatment shed light on the process of care in general practice and how clinical guidelines have been interpreted and developed locally. The study identified what it is that affects the delivery of methadone treatment from the users’ perspective. It provides insight into the harm reduction policy of methadone maintenance and highlights how, from the service users’ own experience, the implementation is falling short. The data identify that the delivery of methadone treatment requires a sustained policy review, informed by a clinical perspective on all issues related to regulations, practice guidelines, and treatment resourcing. The recommendations suggest that to be truly effective, strategies which recognize the importance of user involvement need to be addressed.

This research attempts to investigate two fundamental questions<i>: what factors are driving the move towards the increasing use of medical devices in the home environment, and more importantly, what the challenges are to product developers who want to design and deliver medical devices for the home-use marketplace.</i> In addition to describing the current healthcare system in relation to the objectives posed above, the research identifies <i>fourteen major driving factors</i> behind the increasing use of medical devices in the home environment and ranks them into high, medium and low categories according to their prominence. The research also recognizes <i>a number of key issues and challenges</i> to product developers in designing and delivering home-use medical devices. These issues are grouped into ten <i>core issues</i> which are then integrated into a model that conforms to the different stages of the product life cycle of a medical device. The core issues are related to business, technology, the design and development process, regulation, manufacture, point of provision, use, support, liability and disposal of home-use medical devices. Finally based on the understanding of the issues and challenges, a <i>design tool</i> is formulated. The tool is a diagram, based on the idea of Gough’s design tool for packaging, that presents all the challenges and issues in a succinct form and allows product developers to assess whether they have considered the issues, and if so, to what extent. This tool also gives an opportunity to product developers to make comparison between their different products. Compiling and developing the results of this research into a form more suitable for professional use form, such as a quick-reference workbook, evaluating its usefulness and effectiveness to product developers through <i>case studies methods</i>, and disseminating it to a broader audience has been proposed as future work.

Patient safety is as an increasingly active field of research and policy in the UK and around the world. The prevailing academic model for understanding the cause of patient safety incidents considers failures in cognitive and system aspects of care to playa role, with an emphasis on system factors in preventing harm. General practitioners (GPs) are the first port of call for a wide range of undifferentiated medical, psychological and social problems, presented by patients with whom they may form lasting relationships. The priorities and processes of care in general practice are consequently less clearly defined, more individualised and more strongly influenced by the people involved than in the hospital settings where the existing model was developed. Research in general practice has thus far been conducted from a professional standpoint, using doctors' reports to detect and understand safety incidents. Patients may bring a valuable new perspective to understanding the nature, incidence and cause of adverse events in general practice, allowing the existing model to be refined. This study aimed to provide a detailed description and analysis of patients' perspective on episodes of care they regarded as regrettable. A qualitative approach was used, conducting in-depth interviews with 34 patients whose healthcare experiences made them likely to be good key informants regarding patient safety issues in general practice. An adaptive theorising approach was used, to allow grounded insights arising from the empirical data to be interpreted in the light of, and to add to the development of, theories about the causation of adverse events. The results showed respondents' evaluations of GPs' medical performance to be contingent on their expectations, prior experiences and the doctor-patient relationship. They understood the quality and safety of GPs' care to be determined by their knowledge, skills and an attitude of professional commitment, using this understanding to inform the attribution of responsibility or blame for their experiences of care. This approach differed from the prevailing academic model in that it focussed on errors more than adverse outcomes, placed a strong emphasis on the importance of personal and relational factors in error causation and paid relatively little attention to the role of system factors. It identified diagnostic error as a significant issue in general practice, highlighting the dependence of technical aspects of care upon the GP's personal and interpersonal performance. Having sufficient professional commitment to choose to perform well was seen as a prerequisite for the safe application of knowledge and skills. Even where little or no physical harm was sustained, errors attributed to a failing in professional commitment could result in Significant psychological distress, loss of trust, and changes in future help-seeking behaviour. Interpersonal aspects of care and personal factors in GP performance appear to be key influences on safety in this context. This has implications for the focus of safety improvement efforts, which may need to take more account of the role of the individual professional, alongside issues of human factors and system design. A renewed emphasis is recommended on traditional values of altruistic professionalism and personal responsibility. Patients may make good partners in improving safety, provided it is acknowledged that their perspective is subject to socially patterned biases, and that they are sometimes hesitant to challenge medical authority.

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Patterns of distribution and cause of child burrs and scalds in Bradford, and a comparative study of several towns in the Indian subcontinent, based on hospital records and interviews. The aim was to look for patterns associated with socioeconomic status, stress, and changing technology. A twopronged approach was used, with statistical analysis of hospital records, and a collection of interviews. In Bradford over 1500 cases from the casualty register were analysed spatially, an age corrected rate calculated on a ward basis, and correlated with a range of socio-economic indices. A linear step-wise regression and factor analysis were carried out using prepared computer programs in order to study factor interaction. Analysis of the most frequent time, day month and age at which accidents occur was carried out, and a regression between monthly temperature and accidents calculated. From the 77 interviews the most common agents of injury can be identified, and some background factors commonly involved. The hazard observation picture in the questionnaire produced some results of relevance to prevention. The comparative study in South Asia was based on analysis of 3 sources of data: 4 burns units; hospital records and interviews (parallel to the work in Bradford) in Rajkot; and interviews with school-children in Mirpur, a source area for immigrants to Bradford. Spatial analysis along the lines of that in Bradford was not possible, but there is some spatial description. Temporal patterns, family background and agents of injury are analysed. The thesis includes a comprehensive literature survey, with brief abstracts of all material included.

Action learning is increasingly being adopted by NHS organisations as a way of providing leadership and organisational development for staff, including senior clinicians. The benefit of action learning is that it allows work-based learning to take place with the intention of improving patient care and developing a strategic direction for individual services. Through this approach, senior clinicians will increase their selfawareness and be sensitive to the cultures within their organisation and ensure that their actions are responsive to these and not consider their actions in isolation. The research had an organisational project to consider how a salaried primary dental care service had to change in order to meet the needs of the local population in a changing NHS environment and a personal project of a journey of learning, development and change. The thesis analysed the development of the Community Dental Service from the School Dental Service to the recent developments of salaried personal dental services, including dental access centres. Moreover, it looked at how market forces and shortages in the dental workforce have influenced national policies and how these in turn have affected salaried dental services. Using my work within the Community Dental Service, I described the personal, service and organisational problems facing a clinical director. With the involvement of an action learning set, I explained how possible solutions to these problems were identified, action implemented to address them, their effects monitored and evaluated and to reflect upon the learning from these actions. The key achievements have been on a personal, professional and organisational level. I have developed as a clinical leader of a NHS service. Through the knowledge and understanding I have gained, I have matured as a manager and have been able to identify a strategy within my organisation and have implemented this for the benefit of the staff, patients and PCT. This in turn gave me personal confidence both in my work life as Clinical Director and in my life outside my work. The clinical service I lead still needs to improve, but this will always be the case. This thesis has been an opportunity for me to undertake a postgraduate qualification within a full time position in the NHS. The benefit has been the pragmatic learning which has occurred within my workplace, the learning set and through my academic studies. In summary, this process of enquiry has brought together theory, professional practice and organisational development. It is recommended that action learning is an appropriate methodology for enabling change to take place in the NHS. Action learning has been demonstrated to be a valuable approach for continuing professional development. It should be explored further within dentistry and in the wider area of health care, incorporating it into clinical leadership training programmes. 10

This study aimed to explore the experienceso f living with multiple sclerosisi n terms of quality of life, independencea nd satisfactionw ith health, social care and voluntary services, from a community psychological perspective. The research was undertaken in a Northern Locality of England. It was a qualitative study with elements of action research. Participants included 21 people affected by multiple sclerosis, seven family members and six health and social care practitioners. The research used a range of different methods to collect data about the experiences of living with multiple sclerosis, from different perspectives, within a pragmatic paradigm. All participants completed a short quality of life questionnaire (WHOQOL-BREF) and participated in face to face interviews. These data were enriched by a focus group, a multi disciplinary conference, field observations and two meetings with the Minister of Care. Questionnaire data were analysed descriptively and thematic analysis applied to interview, focus group and observational data. Data revealed the diverse experiences of living with multiple sclerosis. Most participants affected by multiple sclerosis reported higher satisfaction with their quality of life than their health; and in many cases, the participants most physically affected seems to be the most independent. Relatives and practitioners perceived people affected by multiple sclerosis to be less satisfied than they did themselves. Local health and social care services were seen to be reactive rather than proactively promoting independence and enhancing quality of life. The local Multiple Sclerosis Society restricted itself to social activities. People affected by multiple sclerosis revealed barriers within the local community and gaps in existing service provision. Questionnaire data were deemed to be very superficial and a case was made for enrichment through the collection of qualitative information. A new model to promote interdependence while enhancing quality of life of people living with multiple sclerosis was presented and the role of the scholar activist was discussed.