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Background: Diabetes is a serious condition affecting the UK South Asian (SA) population. Beliefs amongst a number of factors have been reported to impede on self-management behaviours. Social networks (SN) are known to be an important source of support for diabetes management. Yet little is known about how much and what types of diabetes 'work' is undertaken and the impact of SN in shaping beliefs about diabetes. The aim of this study was to explore and gain knowledge about the association between illness beliefs and SN in British SA adults with diabetes. Methods: A mixed methods approach was used. Firstly, a systematic review was conducted to assess the feasibility of using standardised questionnaires to measure diabetes-related beliefs in this target population. Secondly, using a cross-sectional design, a Postal Health Survey (PHS) explored illness beliefs (Brief Illness Perception Questionnaire-BIPQ) and health outcomes (health status, self-efficacy, normalisation and self-care) in a sample of (N=67) recruited using random, purposive and snowball sampling. A Social Network Survey Interview (SNSI) with (N=37) (who completed the PNS), identified SN in each participant's network using concentric circles, and closed- questions on the amount of 'work' done by the network. A topic guide, specific to the aims of the Qualitative Study (QS) was embedded within the SNSI to explore the social, cultural and religious context related to diabetes management. Participants who completed the SNSI also completed the QS. Data was collected during 2010 and 2011. Results: Five studies meeting the review criteria were identified from the systematic review. The results supported the need to measure illness beliefs using standardised questionnaires. Certainsocialnetworkcharacteristics:sizeofthesupportnetwork, number of supportive females, practical and emotional work was related to diabetes- related beliefs. After multivariate analysis, emotional work remained a significant predictor of concern and emotional distress related to diabetes. The qualitative study identified six themes: fatalism, normalising diabetes, social networks, alternative food therapies, and travel back home to the East and religion related to beliefs and management practices. The QS also complemented and extended some of the findings of the cross-sectional study, related to social networks and fatalism beliefs. Conclusion: This study provides a unique contribution to the research on diabetes management in British SA, using a mixed methods approach. It has addressed the gap in knowledge with regards to illness beliefs about diabetes in British SA, as measured by five dimensions of the CS-SRM (Leventhal et al, 1980) and described the importance of the social context, particularly the family in being at the forefront of 'work' related to diabetes management. Future studies need to establish utility of the BIPQ in the UK South Asians to ensure it is appropriateness to the experience of diabetes in SA. Policy guidelines on diabetes may need to move beyond the notion of 'self' to include support and education for the SN, with a recognition of the impact of cultural and religious beliefs on diabetes management.

Objectives: This thesis aims to explore evidence for the effectiveness of cognitive behavioural therapy (CBT) for non-cardiac chest pain (NCCP). Design: The systematic review aimed to evaluate evidence for CBT as an effective intervention for anxiety in the NCCP population. Study one describes the chest pain characteristics, illness beliefs and prevalence of anxiety in a NCCP sample in a cross-sectional design. Study two explores the acceptability and clinical effectiveness of a CBT-based self-help intervention for NCCP patients, using a between subjects, repeated measures design. Methods: A systematic review was completed via a comprehensive literature search for comparative studies examining CBT-based interventions for NCCP including a measure of anxiety. In the empirical study, participants completed measures of anxiety, illness beliefs and indices of chest pain (self-reported frequency, severity and impact on activities) at baseline. Comparisons between illness beliefs and anxiety were undertaken using descriptive statistics and Pearson correlations. Participants were randomised to receive a CBT-based self-help intervention booklet or treatment as usual, with questionnaires re-administered at three-month follow-up. ANOVAs were used to evaluate whether the intervention led to improvements in anxiety levels, or increased belief in participants’ personal control of symptoms. Results: Ten studies met inclusion criteria for the systematic review, with four studies showing evidence regarding the effectiveness of CBT for anxiety. Approximately two thirds of the thesis research sample reported on-going pain following clinic attendance, for the majority this was ‘very mild’ or ‘mild’ pain. Almost half (47%) reported experiencing clinically significant anxiety. Stress was the most common causal attribution advocated by the sample to explain their chest pain. Anxiety scores were significantly associated with psychological attribution scores, but not with personal control or illness coherence beliefs. In study two, 87 participants completed the study and ITT analyses were completed on 119. There were no significant differences between the groups in terms of reduced anxiety or self-reported belief in personal control of symptoms. The intervention booklet was evaluated largely positively by those who reported reading it. Conclusions: CBT-based self-help appears an acceptable intervention for those diagnosed with NCCP. Further research is needed to identify those who are most likely to benefit from such self-help intervention.

Patients’ beliefs about their illness are known to influence their experiences of illness, its psychological impact, their health behaviours, and overall health outcomes. Research into illness beliefs has typically involved written or oral methods, yet recent studies have suggested that patients’ beliefs about their illness may be embodied in visual form, in their mental images of the disease. Beliefs embedded in mental images may not be captured via traditional modes of assessment, and thus far the possible significance of this kind of ‘visual knowledge’, has been largely overlooked. Studies using visual methods to explore patients’ mental images suggest this is a viable and useful approach which may provide additional insights into their illness beliefs. Research of this kind is in its infancy however, and there are several fundamental questions concerning the existence and nature of mental images, how best to access such images, and their relationship to illness beliefs, which are as yet unanswered. This thesis employed qualitative methods to address these issues and explore the significance of mental images within the context of head and neck cancer. It consists of three empirical phases – a methodological pilot study, a qualitative meta-synthesis, and a longitudinal study. The findings indicate that many patients do generate a mental image of their cancer, and this is significant in terms of their understanding of both the disease and its treatments. Images appear to enhance patients’ comprehension of what is going on inside their bodies, and may both reflect and influence illness beliefs. In this thesis these findings are considered with reference to the methodological issues intrinsic to researching mental images, and the implications for future research and clinical practice.

This thesis is a descriptive study of health care in the Inuit settlement of Gjoa Haven, N.W.T. The purpose of the research was primarily to describe and analyse the interactional networks of health and illness related behaviour that are associated with the Nursing Station. The cultural and organizational background of the administrators and nurses who provide medical services to Inuit are described, as are the attitudes and beliefs held by Inuit about illness and about the health care delivery system.<p>The thesis examines the acculturation of Inuit beliefs and practices related to illness throughout the contact period and focuses particularly on the changing role of the Inuit healer, the anqatquq or shaman. Various influences such as epidemic diseases, missionary activity, and changing economic orientations that have contributed to Inuit dependency patterns and changed beliefs about illness, its causes and cures, are detailed.<p>Theoretically, the thesis is partly a study of the replacement of a traditional medical system by the cosmopolitan medical system and the gradual attenuation of the traditional curer's role. It is also an examination of the manner in which the conflict resulting from differences in attitudes between administrators, nurses and Inuit, affects the delivery and utilization of health services in Gjoa Haven. It demonstrates that where problems occur they are as much a result of conflict between administrators and nurses, as they are due to conflict between nurses and Inuit.<p>The substantive portion of the thesis examines specific domains of interaction such. as health education, agency coordination and native participation and points out areas where failure occurs in each of these arenas. Recommendations are included that suggest strategies for improving the effectiveness of health care delivery and ultimately the health levels of the Inuit population.

This thesis is a descriptive study of health care in the Inuit settlement of Gjoa Haven, N.W.T. The purpose of the research was primarily to describe and analyse the interactional networks of health and illness related behaviour that are associated with the Nursing Station. The cultural and organizational background of the administrators and nurses who provide medical services to Inuit are described, as are the attitudes and beliefs held by Inuit about illness and about the health care delivery system.<p>The thesis examines the acculturation of Inuit beliefs and practices related to illness throughout the contact period and focuses particularly on the changing role of the Inuit healer, the anqatquq or shaman. Various influences such as epidemic diseases, missionary activity, and changing economic orientations that have contributed to Inuit dependency patterns and changed beliefs about illness, its causes and cures, are detailed.<p>Theoretically, the thesis is partly a study of the replacement of a traditional medical system by the cosmopolitan medical system and the gradual attenuation of the traditional curer's role. It is also an examination of the manner in which the conflict resulting from differences in attitudes between administrators, nurses and Inuit, affects the delivery and utilization of health services in Gjoa Haven. It demonstrates that where problems occur they are as much a result of conflict between administrators and nurses, as they are due to conflict between nurses and Inuit.<p>The substantive portion of the thesis examines specific domains of interaction such. as health education, agency coordination and native participation and points out areas where failure occurs in each of these arenas. Recommendations are included that suggest strategies for improving the effectiveness of health care delivery and ultimately the health levels of the Inuit population.

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