The aim of this thesis is to understand the important components of a set of sustainable interventions to prevent obesity at the community level by using realistic evaluation, which draws on the philosophy of critical realism. From the application of a structured set of criteria based on critical realism, three interventions emerged, which were selected as the case studies of my thesis: the ‘Healthy Weight Communities’ project in Scotland, the ‘Bewegung als Investition in Gesundheit’ (Movement as Investment for Health) project in Germany, and the ‘Walking for Health’ project in England. Based on the key concepts of critical realism an interview topic guide was developed, which was tested by the help of the pilot project ‘Paideiatrofi’ in Greece. Key personnel involved in the organisation of each of the three selected interventions were identified and qualitative research and data analysis was carried out. The framework of critical realism and the application of the key concepts of realistic evaluation: ‘generative mechanisms’, ‘context’ and ‘outcomes’, enabled the disentangling of which mechanisms from each case study, were most related to outcomes and under which contexts. A number of common themes emerged from the analysis of the three interventions. Reflecting on these common themes, I connected them to a set of more abstract categories associated with the social structure, the human agency and the emergent outcomes with their distinguished properties. Critical realism and realistic evaluation provided a conceptual guide which allowed me to explain how the effects of the interventions were produced by the interplay between structural conditions and people as agents. The study of the contextual factors and of the generative mechanisms that enabled or constrained the production of certain outcomes, constituted a novel approach to explain how and why the selected interventions worked to prevent obesity.

The main focus of this thesis has been an investigation into the lives of men who have experienced some form of mental health problem. It has been suggested that mental illness may not be the most helpful way of conceptualising these experiences, as it presupposes the validity of the medical model of explanations and meanings. Instead it has been proposed that the term 'emotional distress' allows for the embodied nature of the experiences, and distances them from medical definitions. The key sociological concept used in the thesis is that of biographical disruption, a notion used by Bury (1982) in the context of chronic illness, and one of the aims of the research has been to establish the usefulness of this concept to research on experiences of emotional distress. The chosen methodology in achieving this aim is that of life-history narratives, which have been used in the study to illustrate the ways in which emotional distress emerges from and impacts upon the lives of individuals. Eight men provided life-history narratives, and these were supplemented by published (auto)biographical accounts, and by my own experiences as a mental health service user. As men were identified as the focus for the research, an investigation into the role of masculinity as a factor which mediates these expenences was also undertaken. Thus, the contribution that the study makes to sociological knowledge is to extend the concepts which have been applied to chronic illness, into the field of emotional health, with a particular focus on biography, on the role of masculinity, and on embodiment and emotions. It also contributes to an understanding of emotional distress, an experience which is often hidden form view. The thesis concludes that all of these sociological ideas are indeed valuable in the search for meaning in the experience of emotional distress.

This thesis has been concerned with how everyday social interactions facilitate personal change in the lives of therapeutic community (TC) client members. TCs are planned social environments that aim to provide a safe setting whereby troubling relational patterns can be explored through confronting past trauma and dysfunctional interpersonal dynamics. All aspects of community life, particularly everyday social encounters, such as smoking breaks and meal times, are potentially therapeutic. Whilst there are have been numerous studies focusing on treatment effectiveness and clinical outcomes, there have been relatively few studies that explore how interactions during these potentially therapeutic informal periods facilitate personal change. Thus, everyday social encounters are not only underrepresented in the literature in terms of mechanisms of personal change, they remain poorly understood in practice. Therefore, this research specifically investigates how everyday interactions support personal change by: examining the mechanisms of interaction rituals outside of structured therapy; questioning the function of peer-to-peer interactions; exploring how social interactions reflect TC values; studying the influence of power and social control that may exist; and looking to understand client members’ definitions of change. The study used a narrative ethnographic approach within two adult-democratic TCs, one residential and one a day community, for individuals with a diagnosis of personality disorder. Specific methods of data collection included over 700-hours of participant observation, in-depth interviews with clients and staff members and document analysis. Drawing on Interaction Ritual (IR) theory, this study explores the role of emotions, feelings of inclusion and how power is used during everyday interactions. One of the key findings is that transforming negative emotions into positive long-term feeling occurs through the process of inclusion and solidarity. Crucially, community members will tolerate high levels of negative emotions if they feel included in the TC. Both communities had an overall rhythm to community life that provided the emotional tone and pace of each day. Importantly, solidarity and emotional rhythmic entrainment, the process by which individuals become in synch with one another, were crucial for establishing and maintaining inclusion and producing positive change outcomes. Where solidarity and entrainment are broken, communities will invoke restoration rituals to establish connection with the entire community in order continue working towards positive change. Additionally, interaction rituals highlight dynamics of power, authority, and social control within communities, particularly between client members. Several clients reported increased feelings of confidence and tolerance towards themselves and others as a result of participating in community life. There are two main contributions of this research for IR theory and TCs. Firstly, IR theory has not been applied widely to the field of mental health. The thesis suggests clarifying the use of emotions to include an analysis of how negative emotions are sustained in successful interaction rituals. Secondly, for TCs, this research highlights the significance of times spent outside of structured therapy. Exploring personal transformations through the lens of interactions, rather than individuals, provides a multi-layered explanation of how change occurs.

A major challenge of the 21st century for the health-care professionals is to provide care for the ever-expanding population of people with renal-failure. Patient numbers are rising and specialist nurses, who are the pivotal factor in haemodialysis units, are becoming increasingly scarce. In this context it has become essential to understand the dynamics and functioning of haemodialysis units. The aim of this research project is to increase understanding of the lives of patients and carers by uncovering the culture of haemodialysis units. Ethnography, from the naturalistic paradigm, is a holistic study of culture, developed out of classical philosophy. This study examines the entire social world of the dialysis unit. It describes the ethnographic journey made over twenty-four months' research in two different dialysis units. The participants were amongst patients and carers from these two units. The fieldwork, which facilitated data collection, was based on a participatory process of observation, interviews and participant feedback. These data were analysed into domains and themes using Spradley's Research development sequence (1980) and the reflexive process. Through the theme-based analysis used during the research and writing of this ethnographic study an emergent theory of partnership in care became apparent. Such a theory contributes to our understanding of the culture of the dialysis unit. Uncovering the culture of dialysis units will not prevent the increase in numbers of people needing Renal Replacement Therapy. It does, however, shed light on the condition of living with renal failure and the nature of partnerships developed in the haemodialysis unit. It is these partnerships between people, machines and the environment that sets the dialysis unit apart in the hospital, giving it its own particular culture. Partnership means shared care where patients and carers work towards mutual goals. The realisation of these common goals leads towards the overall objective of better treatment outcomes.