This work is aimed at understanding and unifying information on epidemiological modelling methods and how those methods relate to public policy addressing human health, specifically in the context of infectious disease prevention, pandemic planning, and health behaviour change. This thesis employs multiple qualitative and quantitative methods, and presents as a manuscript of several individual, data-driven projects that are combined in a narrative arc. The first chapter introduces the scope and complexity of this interdisciplinary undertaking, describing several topical intersections of importance. The second chapter begins the presentation of original data, and describes in detail two exercises in computational epidemiological modelling pertinent to pandemic influenza planning and policy, and progresses in the next chapter to present additional original data on how the confidence of the public in modelling methodology may have an effect on their planned health behaviour change as recommended in public health policy. The thesis narrative continues in the final data-driven chapter to describe how health policymakers use modelling methods and scientific evidence to inform and construct health policies for the prevention of infectious diseases, and concludes with a narrative chapter that evaluates the breadth of this data and recommends strategies for the optimal use of modelling methodologies when informing public health policy in applied public health scenarios.

CD4+ T cells play a key role in orchestrating adaptive immunity. Their activation requires antigen presentation via MHC II proteins on antigen presenting cells (APC). Exosomes are membrane vesicles released by various cell types including APCs. APC-derived exosomes are MHC class II-positive and can induce CD4+ T cell responses. MHC II delivery to the cell surface and/or exosomes might be influenced by tetraspanins, a family of transmembrane proteins. We have prepared exosomes derived from Epstein-Barr virus (EBV)-infected human B lymphoblastoid cell lines (LCLs) and shown by Western blotting and immunoelectron microscopy that they contain MHC class II and tetraspanins including CD63, CD81 and CD82. Such LCLs as well as LCL-derived exosomes can mediate immunologically specific recognition by MHC class II matched EBV antigen-specific CD4+ T cell clones when directly added to the T cells. Using shRNA, we have decreased CD63 expression in LCLs and had been studying the effect of such downregulation on LCL as well as LCL-derived exosome mediated antigen presentation. Despite an unaltered level of MHC II, CD63low LCLs showed to be hyperstimulatory. In spite of a similar depletion of CD63 in exosomes derived from CD63low LCLs, the CD4+ T cell stimulation by these exosomes was unaltered. In search for the mechanism of this phenomenon we found a higher level of exosome secretion by CD63low LCLs. We speculate that CD63 may influence T cell stimulation by exosome trafficking as well as exosome release.

This thesis reports from a telecare evaluation in a Norwegian municipality (2012-2016). The project was established to provide domestic results from a hitherto new field in the country to underpin future policy. This evaluation includes pre- and post-implementation data collection, which has been scarce in telecare. The methodological approach was realist evaluation that seeks to explore how telecare works, for whom, why and in which circumstances – or why it does not work. The research aimed to explore the hypothesis elicited from national policy documents: ‘If telecare is used, then people are enabled to remain safe in their own home for longer’. Various methods were used to gather data from multiple stakeholders as they have different knowledge about how the implementation developed. The methods in this evaluation included literature reviews, observations, and sequential interviews with users and relatives in addition to sequential focus groups with frontline staff. Realist evaluation was particularly suitable in demonstrating how and why telecare is useful to some users but not to others. Telecare had to match users’ abilities and needs for them to benefit from it. Telecare operates in a dynamic context, and therefore requires adjustment according to the user’s current situation, taking into account changes as they occur. This appears to have been often underestimated. Telecare holds a different position from other devices and technologies in people’s everyday life, which also needs to be acknowledged. Correct assessment is significant for users to obtain the intended effect from telecare. When telecare is correctly adjusted to users, it increases safety, which is essential for enabling older people to remain living at home. Several challenges in establishing telecare projects are identified and alternative ways to understand multi-disciplinary partnerships are suggested. By using realist evaluation the findings are nuanced and point to elements that are significant for achieving the intended outcomes.

There is a dearth of smoking research involving young children despite the knowledge that the developmental proocess begins in early childhood. This paucity hinders the development of effective smoking prevention strategies, which need to be based on an accurate understanding of the perspectives of the target group. Therefore basic research is required, to discover where primary school children are at in their thinking about smoking before any potent anti-smoking initiatives can be devised. Such an endeavour however, is exacerbated by the lack of appropriate methods of data collection for this particular age group. The aim of this research study was to explore the perspectives that Liverpool primary schoolchildren in their early years (four to eight years of age) have about smoking by examining the beliefs, knowledge, perceptions and behavioural intentions that inform their attitudes about the habit and subsequently, to assess any changes in these factors over time. This work not only provides the understanding and insight fumdamental to the development of proactive health promotion programmes aimed at tackling the increasing prevalence of smoking among local children but also the empirical evidence needed to fill the significant gap in the existing literature on smoking as well. To achieve these aims ,a multi-method, child-centred participatory approach was used. This between-methods traingulation included questionnaires The Draw and Write Technique, semi-structured interviews and focus group interviews. For the cross-sectional study, a representative sample of primary schoolchildren in their early years from wards of varying socio-economic status participated. All were involved in the quantitative method and a subsample partook in the qualitative methods. For the longitudinal study, the same research design was used to track one birth cohort - the children from Reception for a period of three years to document any changes in perspective over time. The research findings from both studies demonstrated that the children in this investigation had considerable understanding about the nature of tobacco smoke, had as yet to take up the habit and generally expressed little intention to smoke in the future. Their perspectives were predominantly negative, very stable and relatively homogenous. They were grounded in a broad knowledge base that was primarily influenced by cognitive development and socio-cultural experiences. They acknowledged the importance of the family and perceived parents to be both preventers and promoters of the habit. The children also harboured some misconceptions, believing that the health implications from smoking were far greater for children than adults. This belief has cultivated a widespread notion that smoking is an intrinsic part of adulthood. The study findings have substantive implications for the development of proactive smoking interventions in primary schools. The results suggest that any prevention strategy devised must be implemented as early as possible in the school curriculum, that it should be developmental in nature and more than knowledge- based. A grass roots approach, one that fosters empowerment tbrough the active involvement of the children in both the development and implementation of the strategy, in collaboration with the school, the home and the community is recommended, as this work has confirmed that children in their early years can be reliable and valid participants in the research process.

Global statistics indicate that currently 35 million people are living with HIV of which 4, 634 are living in Scotland (out of a total population of 5 295 00) and the figure for Zimbabwe is estimated at 1, 400 000 (out of a total population of 14 149648). In this thesis, I have suggested a framework that goes beyond a limited analysis of the complexity of understanding the HIV/AIDS origins, its evolution and prevalence beyond the epidemiological mapping. The approach allows for the development of a more rational, inclusive, broader and sustainable HIV/AIDS Education (Wood 2014, Wood and Rolleri 2014). This approach is not only emancipatory but also empowers (Freire 2000, Freire 2004) both those affected and infected by the HIV/AIDS epidemic. I have chosen both Scotland and Zimbabwe as each of them has dealt with the epidemic in different ways. Scotland has had significant success in combating HIV/AIDS through various initiatives. Zimbabwe on the other hand, is an example of a developing country in sub-Saharan Africa with one of the highest levels of HIV/AIDS infected and affected people in the world (UNAIDS Country Report 2014). I used ‘selected’ documentary analysis that is, looking at selected documents that contain the major policy responses to the HIV/AIDS epidemic. I also conducted interviews with key informants using semi-structured interview questions and then analysed the resultant data using a range of heuristic tools. The main findings of this research included how a number of conspiracy theories were constructed in order to explain the origins and the evolution of HIV/AIDS. Examples of these conspiracy theories included the homosexual link to HIV/AIDS,witchcraft and biological warfare among others. Other issues discussed focused on conspiracy as the construction of otherness, moralising the epidemic, assessing the impact of culture, religion and politics on the epidemic as well as the implications of these issues on Sex Education. The thesis concluded with suggesting a framework for developing a transformative approach to HIV/AIDS and Sex Education.

Revised and extended version of the author's doctoral thesis. / Includes bibliographical references and index.