Risky sexual behaviours are prevalent among low Socio Economic Status (SES) female teenagers, and earlier sexual initiation is associated with unplanned pregnancies and sexually transmitted infections. Large systematic reviews have found an extensive list of predictors of risky sexual behaviours, but it is not clear which of these are highly important to low SES female teenagers and if sexual health intervention programs are currently meeting teenagers’ sexual health needs. This thesis sets out specifically to address this issue, by investigating the predictors and developing a brief online sexual health intervention program for low SES female teenagers. Two research questions were explored using a mixed-methods approach across five studies. The research aimed to gain sexual health professionals and teenagers qualitative views on the predictors of risky sexual behaviours, and then confirm these predictors quantitatively with a large number of female teenagers. Teenagers views of existing online sexual health intervention programs were then explored leading to the development of a brief online self-affirmation and sexual health intervention program. Self-esteem was found to be an important predictor of risky sexual behaviours both by sexual health professionals and low SES female teenagers. It was also clear that teenagers did not currently have access to reliable sexual health information. Therefore, a brief online self-affirmation intervention, aimed at increasing self-esteem, paired with reliable sexual health information was developed. It was found that the self-affirmation intervention significantly increased self-esteem for the self-affirmed group compared to the non-affirmed group. In addition, the self-affirmed group had significantly higher intentions to have safe sex post intervention and at a one week follow up, compared to the non-affirmed group. Therefore, low-cost brief online self-esteem and sexual health interventions can be effective in increasing intentions to have safe sex for low SES female teenagers. The theoretical and practical implications of these results are discussed together with suggestions for future research.

Despite regulatory requirements for occupational therapists (OTs) to appraise the effectiveness of their service, there is little empirical evidence to suggest that they do so. This relativist research addresses the need to understand the phenomenon of effective occupational therapy with children and young people (CYP) with complex mental health needs/learning disabilities, in the lived experience of OTs. Assuming an interpretivist epistemological perspective, a Heideggerian (1962) interpretive phenomenological methodology guided a reflexive relational approach (Finlay and Evans, 2009) to in-depth interviews carried out with eight OTs working in specialist CYP services. Using threefold analytical methods: thematic (Van Manen, 1997a), metaphorical (Ricoeur and Thompson, 1981) and Lifeworld (Ashworth, 2003), results were contextualised using an occupational perspective of health (Wilcock and Hocking, 2015). Effective occupational therapy with young people identified issues of occupational injustice and was child centred. It supported the development of a sense of occupational being through having an authentic relationship and time and space during therapy. Opportunities to improve health through occupational doing were created through micro grading of activity-based interventions. Utilising their expertise in grading the environment enabled OTs to facilitate young people to set and reach personally meaningful goals to become the experts in themselves and develop a sense of self-hood. Consequently, outcome measurement toolkits were designed to capture patient and clinician reported experience and outcome measures. Such tools may enable occupational therapists to provide assurance that they are addressing issues of effectiveness as part of their statutory and ethical obligations, planned next stages are to pilot their use with clinicians and children. An important contribution of this study is that it supports the necessary bridging of the areas of paediatric, physical OT and MH/LD specialist OT, to enhance effective holistic occupational therapy.

Increased life expectancy for people with intellectual disabilities (ID) has meant that more adults with ID are living with ageing parent-carers. Incapacity or death of the parent can lead to crisis-care management, compounding the trauma of loss for the person with ID. Existing literature has tended to focus on experiences of younger families and is limited in relation to older families with ID. The aim of this thesis was firstly, to review the literature regarding the psychological impact of life-long parental caregiving and secondly, to develop a grounded theory of the experiences and perceptions of the future for older families with ID. A literature review regarding the psychological impact of life-long caregiving included 14 studies being identified and critically reviewed. Findings revealed that parents experience satisfaction as well as stress in their caregiving roles. Despite profound fears and anxieties regarding the future care of their son/daughter, the review highlighted that most parents do not make future plans. However, there is still scope for further research investigating the perceptions of the future and barriers to planning for older families with ID. A grounded theory was co-constructed with nine older parents and three individuals with ID. ‘Tolerating uncertainty’ was found to be the core process in participants’ attempts to manage anxieties about the future. This research study provides a unique contribution to knowledge because it includes the perspective of both the older-parent and the person with ID, often an omission in the literature. It further adds to the growing evidence base of exploring the needs of older families with ID in order for interventions to be tailored accordingly. In the final chapter the process and findings of both the literature review and research study are reflected upon. The reflexivity of the researcher is also examined. The personal experience of conducting the research was both challenging and rewarding. It is important that the voices of these often marginalised groups are heard so that services can support these families in planning for the future and thus avoiding crisis-care management and increased trauma for the person with ID when their parent is no longer able to care.

The psychiatric diagnosis of Borderline Personality Disorder (BPD) leads to service users experiencing stigmatising and disempowering attitudes from professional mental health staff. To date, a nursing theory has not been developed to understand mental health nurses’ personal and professional constructions towards service users with this diagnosis. The development of such theory may enable improved service user engagement, collaboration and recovery for this group of individuals. This study answered the questions of determining the nature of mental health nurses’ beliefs towards service users with a diagnosis of BPD and how these beliefs affect their therapeutic relationships with this service user group. An ethnographic approach was used in this study. Data was collected using a combination of observation of the patient assessment and allocation meeting within a community mental health team; and ethnographic interviews with named nurses for service users with a diagnosis of Borderline Personality Disorder. A reflective journal was also kept by the lead researcher. N-Vivo Version 7 was used to aid data analysis and this involved examining the scripts for repetitive patterns or sequences including descriptions, figures of speech, metaphors etc. in order to illuminate differences between different practices and contexts. Findings from the study elicited a model of how CPNs construct BPD categorisations and a potential pathway to alienation is described together with recommendations for the development of CMHTs and CPNs when working with BPD. Development of reflexive practice can be a vehicle for developing alternative constructions of BPD and recovery informed practice can reduce stigmatising practices experienced by service users with BPD.