As the ageing population continues to grow, health and social care services face increasing demands. Technology based interventions such as telecare offer a potential solution to meet this increase in a cost effective manner. However, there is a concern that such technologies may lead to increased social isolation. Traditional approaches towards resolving social isolation typically involve the provision of activities designed to provide social interaction. In this thesis, we investigate a novel persuasion based approach to address social isolation. To this end, we conducted a modelling study to discover effective persuasive strategies for encouraging social interaction and how to apply them. From the results of this study, we identified, defined and categorised effective persuasive strategies, grounded in theories of persuasion and behavioural change and developed a strategy selection heuristic for applying them. We investigated the perceived effectiveness of both the strategies and strategy selection heuristic and discovered conceptual differences between selecting the most suitable strategy for older adults and a wider audience. Finally, we investigated the actual effectiveness of the strategies with an observational study involving formal carers and older adults. Our results can be combined to create a persuasive virtual agent aimed to tackling social isolation amongst older adults.

Purpose The aim of the systematic review and meta-analysis was to determine the magnitude and strength of the loneliness-psychosis relationship, and to synthesise current evidence. The aim of the empirical investigation was to establish whether, in older people, loneliness may increase proneness to auditory hallucinations and perceiving visual human-like features in ambiguous stimuli. Methods For the meta-analysis a search of electronic databases was conducted (PsychINFO, MEDLINE, EMBASE and Web of Science). Studies were included if they reported usable data relating to the association between loneliness and psychotic symptoms. A random effects meta-analysis was used to compute a pooled estimate of the correlation, together with 95% Confidence Intervals (CI). Study quality and outcome quality were systematically assessed using adapted versions of the Agency for Healthcare Research and Quality (AHRQ) tool and GRADE approach, respectively. For the empirical study, a parallel group experimental design with random allocation to experimental conditions was employed. Participants (62 healthy adults aged 65 and above) were assigned to one of the two conditions – the experimental condition or a control condition. A loneliness induction procedure was employed in the experimental condition whereas participants in the control condition completed a neutral task. A logistic regression was conducted to evaluate performance on auditory and visual tasks across the groups and an odds ratio was calculated. Results Thirteen studies were included in the meta-analysis, providing data from 15,647 participants. A moderate association between psychosis and loneliness was observed (k=13, N=15,647, r=0.32, 95% CI 0.20, 0.44; I2 97.56%; moderate quality evidence). Whether loneliness was assessed by single-item or a more comprehensive measure had no moderating effect on the estimate. The experimental study revealed that participants in the neutral condition were significantly less likely to hear words in ambiguous stimuli than those in the experimental condition (OR = 0.70, 95% CI 0.51 – 0.94, p < 0.05). Exploratory analysis revealed that higher scores on the state loneliness measure were associated with an increase in the likelihood of hearing words (OR=1.17, 95% CI 1.01-1.35, p = 0.03). No effect of loneliness induction was found on perceiving human-like features in ambiguous visual stimuli. Conclusions The meta-analysis confirmed a significant positive relationship between loneliness and psychosis, while the experimental study suggested that loneliness may have a causal role in the development of subclinical auditory experiences in older people. Further studies examining whether loneliness is involved in proneness to other psychotic experiences would be beneficial.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Registered nurses in residential aged care work with older people who have complex care needs. Besides providing direct care, these nurses have a wide range of responsibilities which include supervising staff and attending to the smooth running of the care facility. This grounded theory study using dimensional analysis was aimed at answering the question: How do registered nurses organise their work? Indepth interviews were conducted with 10 registered nurses who worked in a range of positions in aged care facilities. Theoretical sampling and constant comparative analysis was used to guide both ongoing data collectiona and data analysis. Categories were examined for their relationships and dimensions to arrive at a substantive grounded theory which I have named 'shifting focus'. Individual and institutional philosophies of care were core elements in the registered nurses' focus of work. There was a relationship between staffing adequacy, individual and institutional philosophies of care, and the focus of registered nurse work. These relationships created conditions where the registered nurse would focus on ensuring the delivery of individualised resident care or focus on getting through the routine of care. The relationship between staffing adequacy, philosophies of care and the registered nurses' focus of work remained consistent when staffing adequacy changed. In instances of decreased staffing adequacy, the participants' focus shifted to either maintaining individualised care or focusing on safety. When the registered nurse aimed to change the philosophy of care, an increase in staffing adequacy enabled some aspects of cultural change to commence. The relationships between residents, family and staff were significant contrasting elements within an individualised philosophy of care, and an institutional philosophy of care. In the former, relationships were valued and developed. In the latter, they were benevolent, functional or conflicted. The significance of this study is that it reveals how registered nurses and management personnel in aged care facilities, can create conditions where the relationships between residents, their families and staff, are valued and developed to result in positive care outcomes. It is recommended that future research be conducted to examine the resources required to maintain an individualised approach to the nursing care of residents in aged care facilities.

Thesis (Ph. D.)--University of Hong Kong, 2007. / Also available online.

Thesis (B.Sc)--University of Hong Kong, 2004. / Includes bibliographical references (p. 103-107)

Thesis (M.Soc.Sc.)--University of Hong Kong, 2006. / Title from title page (viewed Apr. 23, 2007) Includes bibliographical references (p. 39-51).

Thesis (Ph. D.)--University of Hong Kong, 2007. / Title proper from title frame. Also available in printed format.

Thesis (B.Psy.Sc.(Hons.)) - University of Queensland, 2006. / Includes bibliography.