Background: In recent decades, improvements in medical treatment, public health, technology and education have resulted in people living much longer. This includes people with learning disabilities, the fastest growing sector being the over-70s, and those who are women. There have been a limited number of studies exploring ageing in the population of people with learning disabilities, and very few of these have studied ageing from the perspectives of women. Aim: To develop a contemporary perspective of the lived experiences of older women with learning disabilities. Objectives - To identify how women with learning disabilities construct the experience of ageing, through the lens of an asset theoretical framework - To examine how older women with learning disabilities experience the wider cultural and socio-political influences, and how these impact on their lives - To utilise a narrative approach that integrates stories and photo elicitation to facilitate a more in-depth understanding of their experiences - To indicate how a refined model could be developed to improve policy and practice in the provision of services for older women with learning disabilities An inclusive methodology is central to this thesis, with an expert reference group of four women with learning disabilities working in partnership with the researcher. The expert reference group ensure that this work is grounded in everyday experience, providing both support and challenge. Ten women over 55 with mild or moderate learning disabilities were purposively invited to take part. Narrative methods integrated with photograph elicitation captured their lived experiences, facilitating a more in-depth 3 understanding of their experiences of ageing. In methodological terms this offered a number of strengths in helping the women to engage with the research process and provided a visual reference that promoted a more inclusive and flexible approach to capturing the lived experiences of older women with learning disabilities. Findings The findings identify how a group of older women construct their experiences of ageing. The equanimity and positive outlook on life is interpreted and understood through developing and understanding their protective health assets. A central theme is the importance of friendships and relationships, providing a buffer during adverse times and helping the women to feel supported and valued by their local community. Conclusion In its contribution to service development and knowledge, this thesis provides a contemporary perspective of the lived experience of women with learning disabilities as they age. Furthermore, mapping the narrated assets of these women introduces a new and alternative model for representing individual experiences that challenge the mainstream perspective that has been central to UK policy and practice during the 21st century. This thesis has begun to address a gap between policy and the reality of the lived experience, and presents an alternative asset-based relationship framework (Fig 30 p. 248) that has the potential to guide and shape future learning disability practices. Finally, this appears to be the first study to apply an asset theoretical framework to underpin research with women who have learning disabilities, offering an alternative perspective that challenges social care policy and professionally-defined integration and social inclusion indicators.

Ungdomars försämrade psykiska hälsa är ett stort folkhälsoproblem bland ungdomar i Sverige. Forskning visar att ungdomars sociala kapital kan ses som en hälsotillgång samt att skyddsfaktorer, som familj och vänner, har betydelse för den psykiska hälsan. Distriktsköterskor i elevhälsan har en viktig roll i att arbeta med individens friskfaktorer för att främja den psykiska hälsan. Syftet med studien var att beskriva om det finns ett samband mellan psykisk hälsa och socialt kapital, såsom socialt nätverk, social förmåga och känsla av tillhörighet bland flickor och pojkar i åldern 14-16 år. Tvärsnittsstudien genomfördes i en mindre stad i sydvästra Sverige. Total deltog 461 stycken ungdomar i åldrarna 14-16 år. Data om den självskattade psykiska hälsan och uppfattningen om socialt nätverk, den sociala förmågan och känslan av tillhörighet samlades in med hjälp av mätinstrumentet Minneapolis Manchester Life of Quality (MMQL). Både flickor och pojkar skattade psykisk hälsa och socialt kapital högt. Det fanns inget tydligt samband mellan psykisk hälsa och socialt kapital i form av socialt nätverk, social förmåga och känsla av tillhörighet. Socialt kapital skulle kunna belysas som en hälsotillgång av distriktssköterskan i det hälsofrämjande arbetet. Det behövs fler longitudinella studier för att få mer kunskap om effekten av socialt kapital på psykisk hälsa, samt vilken roll sociala medier har i ungdomars sociala kapital. / The increasing mental health issues among adolescent in Sweden is a major public health issue. Research shows that the social capital of young people can be seen as a health source, and that protection factors, such as family and friends, have an impact on mental health . District nurses in school health service have an important role in their work with individual's health factor to promote the mental health. The aim of this study was to describe whether there is a relationship between mental health and social capital, as social network, social ability and sense of belonging among girls and boys aged 14-16 years. The cross-sectional study was performed in a smaller town in southwest of Sweden. A sample of 461 adolescents aged 14-16 years participated. Data for the self-rated mental health and the perception of social network, social ability and sense of belonging were collected from the instrument Minneapolis Manchester Quality of Life (MMQL). Both girls and boys rated their mental health and social capital high. There was no clear connection between mental health and social capital, in forms of social network, social ability and sense of belonging. Social capital could be highlighted as a health addiction by the district nurse in health promotion. More longitudinal studies are needed to gain more knowledge about the effect of social capital on mental health, as well as the role of social media in youth social capital.

Este trabalho se propõe analisar a relação entre o investimento em saúde e desenvolvimento dos estados brasileiros - medido pelo Índice de Desenvolvimento Humano- (IDH) mediante a utilização da tecnologia de produção denominada FDH (Free Disposal Hull - Fronteira com livre descarte de recursos). Para os estados não eficientes, serão identificados os percentuais de alteração dos insumos necessários para que estados sejam eficientes. Na seqüência, são selecionados os estados eficientes e com baixo índice de desenvolvimento, para serem utilizados pelos governos estadual e federal como prioridade em uma política de desenvolvimento para o Estado brasileiro, uma vez que, esses estados, por serem eficientes, com o aumento de investimento em ativos de saúde, aumentarão seu índice de desenvolvimento. Em suma, tem-se que os resultados permitirão algumas considerações sobre a eficiência em alocação de recursos nos diferentes ativos de saúde, possibilitando auxiliar a tomada de decisão do gestor público, no que diz respeito à alocação dos recursos disponíveis para área da saúde. / In this work it has attempted to appraise, quantitatively, the efficiency levels of the brazilians states. It is analyzed the relationship between output (development) and inputs (Health Assets) by constructing nonparametric efficiency frontiers. The technique of efficiency analysis were used to determine this frontier is the FDH approach. For the not efficient states, the percentages of alteration of inputs will be identified (Health Assets) necessary so that states are efficient. In the sequence, the efficient states and with low index of development will be selected, to be used for the state and federal governments as priority in one politics of Brazil development, a time that, these states, for being efficient, with the increase of investment in health asset, will increase its index of development. The results will be provided useful insights into the assessment of the administrative efficiency Health Assets.

Este trabalho se propõe analisar a relação entre o investimento em saúde e desenvolvimento dos estados brasileiros - medido pelo Índice de Desenvolvimento Humano- (IDH) mediante a utilização da tecnologia de produção denominada FDH (Free Disposal Hull - Fronteira com livre descarte de recursos). Para os estados não eficientes, serão identificados os percentuais de alteração dos insumos necessários para que estados sejam eficientes. Na seqüência, são selecionados os estados eficientes e com baixo índice de desenvolvimento, para serem utilizados pelos governos estadual e federal como prioridade em uma política de desenvolvimento para o Estado brasileiro, uma vez que, esses estados, por serem eficientes, com o aumento de investimento em ativos de saúde, aumentarão seu índice de desenvolvimento. Em suma, tem-se que os resultados permitirão algumas considerações sobre a eficiência em alocação de recursos nos diferentes ativos de saúde, possibilitando auxiliar a tomada de decisão do gestor público, no que diz respeito à alocação dos recursos disponíveis para área da saúde. / In this work it has attempted to appraise, quantitatively, the efficiency levels of the brazilians states. It is analyzed the relationship between output (development) and inputs (Health Assets) by constructing nonparametric efficiency frontiers. The technique of efficiency analysis were used to determine this frontier is the FDH approach. For the not efficient states, the percentages of alteration of inputs will be identified (Health Assets) necessary so that states are efficient. In the sequence, the efficient states and with low index of development will be selected, to be used for the state and federal governments as priority in one politics of Brazil development, a time that, these states, for being efficient, with the increase of investment in health asset, will increase its index of development. The results will be provided useful insights into the assessment of the administrative efficiency Health Assets.

Public health policy and practice principally acknowledge a needs-based approach when developing, implementing, and evaluating community health programs. This needs-based perspective receives criticism because it focuses too heavily on what is missing or wrong with communities as opposed to building on their strengths. As a result, community members are perceived as passive recipients, which is disempowering, and ultimately risks creating unsustainable and ineffective programs. In recent years, there has been a growing interest in achieving a balance between the needs-based approach and the asset-based approach, which accentuates positive capabilities. While the amount of literature discussing the benefits of this latter perspective has grown substantially, accompanying evaluation required to sustain continued investment has been limited. Compared to needs-based research, there is less literature on asset-based evaluation. Emphasis on such research could contribute to the progression of evaluation methodologies and theories, ultimately encouraging their use. The purpose of this study is to apply an existing public health evaluation framework – the RE-AIM model (Glasgow, Vogt, and Boles, 1999) – to asset-based community health interventions and to examine the utility of such an evaluation structure across a variety of asset-based health projects. A multiple case study design facilitated comparison of the applicability of the RE-AIM model dimensions – Reach, Effectiveness, Adoption, Implementation, and Maintenance across three cases in the East London borough of Tower Hamlets, United Kingdom. These included the Local Links Asset-mapping project, the Healthy Early Years Project, and the Good Moves project. The RE-AIM framework is additionally guided by principles of the Realist Evaluation approach (Pawson and Tilley, 1997). This research study contributes to asset-based research by providing a guideline and conceptual framework to support asset-based intervention evaluation theory and practice.