Understanding the philosophy of a different culture and integrating this understanding into the provision of pharmaceutical care is challenging and complex. This thesis argues the importance for community pharmacists to acknowledge that culture, religion, family and community dynamics can impact on patients' health, health seeking behaviour and medicines adherence. The perceptions of members of the South Asian population, general practitioners, and community pharmacists about how these factors are viewed in relation to community pharmacy services were explored in this study. It was conducted in Leicester City, which has a South Asian minority ethnic population of more than 25%. Participants' views of the role of extended community pharmacy services in the wider government agenda were explored. South Asians attitudes to healthcare, self care and the management of minor ailments were discussed. A qualitative methodology approach was adopted, which used constructivist and interpretive principles. Data collection for the study was conducted in two phases. In Phase 1, one to one semi-structured interviews were conducted separately with six local GPs and five community pharmacists from both 'white' (European) and South Asian backgrounds. In Phase 2, six gender specific focus groups were convened comprising of fifty five participants in total from the Sikh, Moslem and Hindu communities. Bi-lingual community workers were used in this study which allowed a more 'sensitive' exploration of the sociological aspects of health seeking behaviour and the impact of 'cultural' influences on medicines adherence. The need for 'cultural competence' of community pharmacists is discussed as one of the major contributions to the evidence base for pharmacy practice. Such initiatives would require pharmacists to acquire more effective consultation skills in the first instance. South Asians expressed views that community pharmacists need to be more knowledgeable, responsive and flexible in their professional practice by assessing their pharmaceutical needs and being aware of particular cultural sensitivities when planning their services in line with the new pharmaceutical contract. More specifically, South Asian participants illustrated the need for community pharmacists and their staff to be more 'culturally knowledgeable' about the communities in which they practice. It is argued that the provision of a more culturally sensitive and pro-active service is needed to develop a better patient-practitioner professional relationship that promotes trust. South Asians illustrated how certain behavioural, religious and cultural beliefs impact on medicines adherence, such as compliance issues whilst on holiday to their homeland, the impact of religious pilgrimage and fasts. Many South Asian participants had limited understanding about 'generic' medicines and considered these to be 'inferior' or 'less effective' than 'branded' medication. Participants' views of 'sharing' of medicines and medicines waste were also illustrated. Factors such as 'stress', 'fate' and 'karma' and their impact on health of the participants were discussed. Many of these factors could not be solely attributable to a South Asian 'culture'. However, the findings illustrate a need for a Medicines Use Review (MUR) service to include more 'targeted' exploration of medicines adherence and medicines optimisation for this population. The findings also highlighted why South Asians rarely consult the community pharmacist about sensitive or stigmatised issues such as depression, and how some conditions and symptoms were perceived to have negative impact on the 'social acceptance' of South Asian individuals within their own communities. South Asians suggested that community pharmacists needed to be more pro-active and 'responsive' to their pharmaceutical needs and respect confidentiality through use of private consultation areas for routine counselling, health promotion and medicines information. All participants endorsed a need for more 'professional' recognition of the pharmacist not only as an autonomous health care professional, but as one integral to providing NHS services relating to medicines and public health. The findings illustrated a lack of professional collaboration between community pharmacists and GPs, confounded by community pharmacists being 'subordinate' to GPs and portraying more of a 'shopkeeper' image. South Asians were well informed about the lack of shared medical records and relied heavily on a doctor's definitive 'diagnosis' for somatic symptoms related common ailments. South Asians pro-actively engaged with 'community action' based approaches in health education and health promotion, and an opportunity for community pharmacists to become more involved with social initiatives was inferred from the findings. Candid and animated discussions explored their understanding of exercise as part of weight management and their interpretation of effects of the use of herbal products, alternative practitioners and the importance of collaboration with religious and community leaders in promoting medicines adherence. Participants desired alternative communication methods other than leaflets (translated or otherwise), including the use of audio-visual means and use of media. Communication difficulties were still prevalent, and trained interpreters were rarely used. By embracing some of these challenges, community pharmacists could enhance the value of their services and provide a more meaningful, 'culturally' competent and responsive services based on the needs of their local populations and nurture a better trusting and professional relationship with their service users and healthcare colleagues.

Les groupes ethniques minoritaires sont parmi les secteurs de la société qui sont menacés en permanence par des risques plus élevés de catastrophes. Le fondement d'un tel constat est les impacts négatifs disproportionnés de catastrophes passées. Il est de ce fait nécessaire d'intégrer tous les groupes ethniques en particuliers les minorités dans la réduction des risques de catastrophe (RRC). Pourtant, la communauté scientifique a peu étudié le rôle de l’ethnicité dans la vulnérabilité et la capacité des populations exposées à divers aléas. Ainsi les praticiens sur le terrain et les organisations non-gouvernementales (ONG), ne possèdent pas de méthodes et d’outils appropriés pour intégrer les minorités ethniques dans la RRC. En plus, des exemples de méthodologies et de politiques visant à rendre cet objectif opérationnel et institutionnalisés sont également limités. Cette étude vise à répondre à ces lacunes, en prenant l’exemple des communautés multiethniques autour de Mont Kanlaon situé sur l'île de Negros aux Philippines. La zone d'étude se caractérise par une grande diversité ethnique composé d'au moins trois grands groupes ethniques (Ilonggos, Cebuanos et Bukidnons). Les résultats de cette étude suggèrent que cette mosaïque constitue une dimension importante de la RRC puisque chaque groupe ethnique possède ses propres formes de vulnérabilité et de capacité face aux aléas volcaniques et d’autres origines. Ces minorités ethniques sont parmi les secteurs les plus vulnérables de la société philippine en raison de leur statut marginalisés. En outre, les résultats de cette étude suggèrent que chaque groupe ethnique possède des capacités issues en grande partie de ressources locales qui sont utiles aux fins de la RRC. / The ethnic minority groups are among the sectors of the society who are permanently threatened by higher risk of disasters. The basis of such claim is the disproportionate negative impacts of both major and minor disasters. There is thus a pressing need to integrate ethnic minority groups in disaster risk reduction (DRR). However, within the scientific community, there are limited studies in the current literature of disaster that investigated the role of ethnicity in shaping the vulnerability and capacity of the ethnic groups. The authorities, non-government organizations (NGOs), and researchers have limited defined methods and tools to make such as objective operational in the field. Finally, plans, actions and policies to make such objective institutionalized are also limited. This study aimed to fulfill those gaps. The study has adapted an integrated DRR framework and a methodology that follows the ideals and principles of Community-Based Disaster Risk Reduction (CBDRR). The present study focuses on the multiethnic communities surrounding Mt. Kanlaon located in the island of Negros, Philippines. The study area is characterized by a great ethnic diversity composed of at least three major ethnic groups (Ilonggos, Cebuanos, and Bukidnons). The results of the study suggest that this ethnic mosaic constituted a major dimension of DRR because each ethnic group portrays different vulnerabilities and capacities in the face of volcanic hazards and other natural hazards. These ethnic minorities are among the most vulnerable sectors of the Philippine society due to their marginalized and minority status. In addition, the results of this study also suggest that each ethnic group possesses capacities derived from local resources that are useful for the purpose of DRR.

Rationale: This study was conducted to help improve mental health care for Black and Minority Ethnic (BME) clients as previous research carried out in non-western countries has suggested that western-developed psychotherapies often need to be culturally adapted to become more effective in treating this client group. The aim of this study was to explore how CBT therapists deliver manualised CBT with BME clients and if they make any adaptations, how and to what extent are they implemented. Method: Interpretative Phenomenological Analysis (IPA) guided the conduct and analysis of one-to-one, semi-structured interviews with six CBT therapists working in an Improving Access to Psychological Therapies (IAPT) service. The inclusion criteria for participants was accreditation with the BABCP, completion of an IAPT programme CBT diploma and to be currently working in an IAPT service, at least two years experience as a CBT therapist and at least four cases of completed therapy with BME clients. Findings: Four master themes emerged (1) CBT is based on western principles, (2) The complex nature of CBT, (3) Changing practice of manualised CBT and (4) The influence of therapist factors. Conclusion: The participants experienced many issues in their practice of manualised CBT with BME clients which led them to make changes including adaptations to manualised CBT. They described their current practice as being integrative as they incorporated therapeutic approaches other than pure manualised CBT, making them more flexible and adaptable. The adaptations involved altering the cognitive and behavioural interventions to better suit the individual needs of the client. The adaptations took into account the client’s culture, religion, language, psychological mindedness, acculturation to their host country, education and age. The participants’ confidence in CBT and their self-identity as therapists also influenced their overall practice of therapy. Recommendations for practice are discussed in relation to therapeutic practice, training of therapists, supervision and policy makers.

Aim: The existing evidence-base indicates that the experience of being a Black and Minority Ethnic (BME) trainee clinical psychologist is under-researched. The aim of the current study was to capture the broader training experiences of BME trainee clinical psychologists. The impact of potential personal and professional experiences that may arise for BME trainee clinical psychologists may be important for course tutors and clinical supervisors to explore with them in relation to personal and professional development. Thus, it is hoped that the findings of the current study will raise an increased awareness within the clinical psychology training courses, of their needs, perspectives and experiences. Method: A qualitative approach was adopted for this study. Semi-structured interviews were conducted with nine BME trainee clinical psychologists. The accounts were analysed using IPA, which attempts to illuminate the lived experience of a phenomenon for small samples of individuals. Results: The analytic procedure highlighted five main themes which emerged from participants’ accounts: The hardship of not being White, The challenge of negotiating multiple identities, Challenges and dilemmas of highlighting race and culture issues, The versatility that comes with being a BME trainee and Finding connections and safe places. Implications: Current initiatives to attract more applicants from BME groups need to be considered in the context of wider structural experiences of power and difference in relation to race, ethnicity and culture that operate in the training arena. Courses need to explicitly state their commitment to supporting trainees from BME groups with regards to their experiences of difference. Emphasis should be placed on personal and professional development of all trainees and needs to include work on privilege, social disadvantage, and racism. Programmes should also undertake a commitment to training course staff and supervisors in relation to race issues in the context of training.

本論文在結構上，除去「緒論」與「結論」外，「本論」共分成五章。第一章「三大英雄史詩的產生及其內容」，第二章「三大英雄史詩的情節類型」，第三章「三大英雄史詩生存的社會背景」，第四章「三大英雄史詩的流傳」，第五章「從比較文學看三大英雄史詩」。 　　第一章，是對「三大英雄史詩」作一個整體性的論述。英雄史詩與民族的關係不但非常密切，而且能成為該民族文學的活水源頭與象徵，變成後期文學攫取養分的精神寶庫。本論文以中國少數民族文學裡最具代表性的「三大英雄史詩」《格薩爾》、《江格爾》、《瑪納斯》為對象，它們比諸世界上其他民族的英雄史詩雖然內容相同（歌頌英雄的戰績），但是在類型上卻有很大的不同（已定型或仍在繼續生長）。了解「三大英雄史詩」的形成、發展、茁壯、消退，將會讓我們更清楚「英雄史詩」在民族文學史以至於世界文學史上的重要地位。 　　對英雄史詩的整體了解之後，我們進入英雄史詩的內部結構。「三大英雄史詩」作品內容都有大同小異的情節，經過比較和分析，可以找出相對固定的情節，也就是所謂的「情節板塊」。本論文大膽使用「板塊」這個概念，整理出《格薩爾》板塊13個、《江格爾》板塊10個、《瑪納斯》板塊20個。由於英雄史詩的情節大多是相對固定的「板塊」構成。歌手按一定的情節模式構造的「板塊」，以不同的方式連接拼綴起來，加上藝術的加工和個人的即興發揮，一個個完整的故事便千姿百態地呈現出來。因此只要掌握「情節板塊」，不管史詩故事如何的離奇怪異，都可以輕易指出它的故事結構。本論文第二章利用「板塊」來分析比較「三大英雄史詩」，這應該是「三大英雄史詩」結構分析的研究裡較為突出並呈現整貌的一坎。 　　透過英雄史詩作品的結構掌握到英雄史詩的內部之後，第三章是探討英雄史詩的生存的社會環境。宗教與娛樂的社會功能，是英雄史詩能夠廣泛流傳的重要條件，透過了解這兩項重要的條件，我們才能進一步知道英雄史詩能夠生存的背景環境。 第四章「三大英雄史詩」的流傳，本論文從四個方面下手，即「三大英雄史詩」的演唱環境、說唱藝人的傳承、書面版本的傳播、以及「三大英雄史詩」的跨族流傳現象。整章完全環繞「流傳」這個主題，從各種不同的面向，討論「三大英雄史詩」的傳播過程。因為藝人傳承在過去是比較被忽略的，而「三大英雄史詩」的版本也過於繁瑣散亂，無法理出頭緒，所以本章較費心力是在整理藝人傳承的發展以及書面版本的匯整。 　　本論文對「三大英雄史詩」的了解是先從外在大環境的分析開始，然後深入史詩內部結構剖析，再回到「三大英雄史詩」的生存環境，探討史詩的社會功能而明自「三大英雄史詩」的流傳現象。最後一章則從比較文學的角度來探討，「三大英雄史詩」的地位與影響力。 　　對「中國少數民族文學」而言，精華之所在是「民間文學」，而「民間文學」燦爛耀眼的地方在「史詩」，史詩則以「三大英雄史詩」聞名。反過來說，研究「三大英雄史詩」正是採擷到史詩的粹精。

In the face of globalisation, one of the challenges for Christians ministering to asylum seekers and refugees in the United Kingdom is the question of integrating Christian asylum seekers and refugees into the Christian community. British churches and para-church organisations that are involved in refugee ministry have to decide whether they want to support the formation of independent refugee churches or the integration of refugees and asylum seekers into local indigenous churches. This thesis examines these options from a missiological perspective. Two social research projects form the heart of this study. One compares the life and ministry of two mature minority ethnic churches, the other investigates the integration process at a British church that has been involved in refugee ministry for almost a decade. Contrary to the widespread view that the establishment of homogeneous churches is crucial for the mission of the church in postmodern British society, the findings of this research suggest that the integration of asylum seekers and refugees into indigenous British churches is the better option. They further demonstrate that it is not the mono-ethnic refugee church but the multi-ethnic church which makes the greater contribution to the integration of Christian asylum seekers and refugees and to the missio Dei in Britain. In a multi-ethnic church, asylum seekers and refugees serve as role models to British Christians and especially as effective agents of mission. These research findings also show that the integration of asylum seekers and refugees is promoted through the congregation within the congregation model and an incarnational approach to mission. However, they equally indicate that various stumbling blocks can hinder the integration process. These include a low ecclesiology, a conversionist approach to mission, a lack of awareness of globalisation, and a reactive leadership style and church culture. / Christian Spirituality, Church History and Missiology / D. Th ((Missiology)Christian Spirituality, Church History and Missiology)

In the face of globalisation, one of the challenges for Christians ministering to asylum seekers and refugees in the United Kingdom is the question of integrating Christian asylum seekers and refugees into the Christian community. British churches and para-church organisations that are involved in refugee ministry have to decide whether they want to support the formation of independent refugee churches or the integration of refugees and asylum seekers into local indigenous churches. This thesis examines these options from a missiological perspective. Two social research projects form the heart of this study. One compares the life and ministry of two mature minority ethnic churches, the other investigates the integration process at a British church that has been involved in refugee ministry for almost a decade. Contrary to the widespread view that the establishment of homogeneous churches is crucial for the mission of the church in postmodern British society, the findings of this research suggest that the integration of asylum seekers and refugees into indigenous British churches is the better option. They further demonstrate that it is not the mono-ethnic refugee church but the multi-ethnic church which makes the greater contribution to the integration of Christian asylum seekers and refugees and to the missio Dei in Britain. In a multi-ethnic church, asylum seekers and refugees serve as role models to British Christians and especially as effective agents of mission. These research findings also show that the integration of asylum seekers and refugees is promoted through the congregation within the congregation model and an incarnational approach to mission. However, they equally indicate that various stumbling blocks can hinder the integration process. These include a low ecclesiology, a conversionist approach to mission, a lack of awareness of globalisation, and a reactive leadership style and church culture. / Christian Spirituality, Church History and Missiology / D. Th ((Missiology)Christian Spirituality, Church History and Missiology)

The unprecedented turbulence and uncertainty experienced in global economic and financial markets because of the 'credit crunch' has had a damaging impact on consumer confidence. Trust and credibility have been eroded as many customers feel let down by the banks suggesting the need for banks to rebuild constructive dialogue and long-term, meaningful relationships with their customers again. Though financial service, in this case, is considered a utilitarian service, based on the fact that money is needed to support people‘s daily activities, the present state of financial service has suggested the need for banks to appeal to consumers‘ emotions with the aim of improving their reputation. Also, the competition within the industry also could suggest the need to adopt an emotionally appealing advertisement strategy as emotions are known to play an influential role in building robust brand preference. This study builds on the communication theory, meaning transfer theory and consumer involvement theory, to understand the messages the banks are sending out and to elicit consumers‘ emotional reaction. One thousand, two hundred and seventy-four UK bank advertisements in nine national newspapers were content-analysed to identify the emotional appeals presented by the banks. The perception of these appeals and their associated meanings were sought through semi-structured interviews with 33 participants in London and Luton. The results of the analysis indicated that UK Banks are utilising emotional appeal in their advertisements to reach out to the consumers to convince them to upgrade their account, to open an additional account or switch their account. The most predominantly used appeals were relief and relaxation followed by excitement and happiness or satisfaction with the bank, and finally, security and adventure. However, variations were found in different financial products that employed emotional appeals. It was found that high-involvement products such as mortgages and loans used fewer emotional appeals. Both bank groups - high street banks, including the big four (Barclays, HSBC, Lloyds and RBS) and non-high street banks, such as the new entrants, supermarket brands, and online banks were using emotional appeals. However, it is acknowledged that the communication strategies between these banks could be different as the non-high street banks are more likely to repeat and publish the same messages across many newspapers, instead of publishing different emotionally appealing advertisements. Though consumers acknowledged these emotional appeals in the advertisements, they were more concerned about their relationship with the banks as they don‘t rely on advertisements to make a financial decision. Rather, recommendations from families, friends and associates and also branch location are more important when deciding on which bank to choose. The lack of congruency between financial services and emotional appeals in advertisements is also observed as customers are more likely to be persuaded by rational appeals however this study has not completely ruled out emotional appeals in bank advertisements as the use of both types of appeals is recommended. The study provides important theoretical and managerial contributions to understanding how the consumers understand meaning-embedded advertisements produced by the banks. Managers will be able to consider the implications of advertisements in enhancing their brand equity and building relationships with customers in anticipation that, by word of the mouth and established relationship, their bank‘s reputation will be enhanced. Limitations of the study and opportunities for future research are identified.