Statutory wheelchair provision in England and Wales has been equipment led since its inception in 1990. However, users are reported to be dissatisfied with the service and a reorganisation of provision is underway that purports, in accordance with recent Government advice (DOH, 2012), to make the wheelchair user central to the supply process. However, little is known about wheelchair users perspectives of the equipment that they use to inform this process.

There has been considerable debate over the optimum age of introduction of solid foods in infants and particularly its association with nutrient and iron adequacy for growth and development as well as its impact on eating behaviours, such as feeding difficulties, dietary variety and food preferences. Since infants and toddlers are at a higher risk of developing iron deficiency anaemia, a non-invasive method of measuring haemoglobin could be a useful tool in identifying low haemoglobin levels early and prevent further deterioration of iron status. Since the adoption of the World Health Organisation (WHO) recommendations for exclusive breastfeeding for 6 months, there has been limited data in the UK about how the new guidelines have affected the growth, eating behaviours, dietary intake and iron status. This thesis aimed to address these gaps in the literature in 3 studies: the Brighton’s Breast-fed Babies Study, the Haemospect® Validation Study and the GO-CHILD Study.

Traditionally, creative activities have been used in occupational therapy practice as an intervention with people who have a mental illness. Recent research has explored engagement in creative activities with people living with disabilities, mental illness, retired people and people with cognitive impairment. The findings centred on positive emotions, increase in self-confidence and respite from worrying thoughts. Anecdotal evidence from local occupational therapy practitioners and arts organisations suggested that people in remission of mental illness seemed to use creative activities in their daily lives as a way to keep well, but deeper understanding was missing about this. The first aim of this study was to gain a deeper understanding of the phenomenon of voluntary participation in creative activities by people in remission of mental illness. The second aim was to explore and provide evidence of any relationship between well-being and creative activities as it was perceived by the participants. The research utilised a hermeneutic phenomenological approach. Qualitative data were collected through interviews with participants, transcribed verbatim and analysed within the hermeneutic tradition. Ten participants volunteered and were recruited by mental health NHS staff in central England. All participants had a diagnosis of a mental illness but were in remission from between six months and seven years at the time of the interviews. The data were analysed via my own interpretation of Cohen, Kahn and Steeves’ (2000) approach to hermeneutic phenomenological data analysis. The findings revealed that for all participants, engagement in their chosen creative activity evoked enjoyment and was of particular personal significance and meaning. Their subjective experiences highlighted the possible therapeutic potential of creative occupation, in particular, temporary mental relief from self-referential thoughts through deep immersion into the creative process. Deep engagement in creative occupation encompassed different types of optimal experience and might have a soothing effect on the Default Mode Network. The deliberate engagement in creative activities supports Wilcock’s theory of the use of occupation for self-restoration and keeping healthy. Additionally, the real contact with people and places facilitated a more active lifestyle which impacted also positively on the participants’ sense of well-being. The findings of the study are discussed from an occupational science perspective to extend our understanding of the solitary and group nature and effects of participation in creative activities.

The success of Highly Active Anti-Retroviral Therapy (HAART) requires a high rate of adherence to a complex regimen. Even small variations in adherence compromise treatment efficacy and can lead to viral resistance. Low levels of adherence to HAART continue to pose a major barrier to the success of these treatments. Studies investigating adherence to HAART have focused on practical barriers, yet studies in other illness groups suggest that patients' perceptions of their illness and treatment have a strong influence. This thesis is concerned with furthering our understanding of non-adherence to HAART. It begins with a review of HIV and its treatment. A critical review of the literature was conducted using systematic techniques. This identifies outstanding questions relating to the antecedents of adherence to HAART. The aim of this investigation was primarily to test the Self-Regulatory Model (SRM) and extensions to it to incorporate treatment perceptions (perceptions of personal necessity for HAART and concerns about adverse effects) in predicting adherence to HAART.

Due to the problems associated with local antimicrobial delivery to the oral cavity, such as poor retention times, the use ofbioadhesive polymers within oral healthcare products may significantly improve therapeutic efficacy. In the current study, bioadhesive antimicrobial-polymer complexes were investigated as a formulation strategy to improve the substantivity of antimicrobial compounds within the oral cavity.

Strain differences have previously been observed in the anxiolytic effect of the Angiotensin Type I receptor (AT1 R) antagonist losartan in mice. Structural variation in key binding sites, AT1 receptor binding, AT1 expression, the effect of a microsatellite in the promoter region of the gene and the influence of angiotensin receptor associated protein (ATRAP) were investigated for association with this observed behavioural variation.

β-Carboline derivatives display a wide range of interesting biological activities from intercalation to enzyme inhibition and anticancer to psychological activity. β- Carboline compounds are frequently isolated from natural products in the β- carbolinium form and thus contain a bridgehead quaternary nitrogen.

Soybeans have been in the human diet since the first millennium BC. They contain three major types of isoflavone, genistein, daidzein and glycitein. All three have been shown to have a powerful antioxidant effect and bind to oestrogen receptor beta with high specificity. It has been demonstrated that dietary soybeans favourably impact bone health in postmenopausal women by lowering the incidence of osteoporosis. The literature shows that genistein supplementation reduces marrow stromal cell (MSC) differentiation to an adipocytic pathway and may favourably stimulate osteogenesis. More recently soybean biomaterials (SB) have been developed which contain significant levels of isoflavones and have shown bone regeneration potential in vivo.

The purpose of this study was to explore personal accounts of acute non-specific low back pain experiences to gain insights and extend knowledge for physiotherapy practice and research. At present, knowledge of acute low back pain and understandings of the transition from acute to chronic low back problems largely derives from experimental research and population-generated findings developed from self-report questionnaires. Despite extensive research, there remains a limited ability to prevent the transition from acute low back pain problems to chronic pain and long term disability in many individuals. A qualitative study of personal accounts of acute low back pain experiences was undertaken using a theoretical perspective drawn from narrative research and discourse analysis. The approach incorporated narrative theory and perspectives from social constructionism, post-structuralism and theory of language. Nineteen participants with acute non-specific low back pain problems (< 6 weeks) were followed through to recovery or to three months with persisting problems, considered as the transition to `chronicity'. Data was generated through repeated interviews and written personal accounts involving a reflective timeline and a seven day open-format diary. Data analysis applied a narrative-discursive approach, and in particular a combined micro-interactional and macro-social approach drawn from discursive psychology. The nature of personal accounts of acute low back pain experiences has been shown to be significantly more complex than previously described within physiotherapy or low back pain literature. As personal circumstances were characterised so as to be appreciated as a significant problem, the accounts were constructed with qualities to support the credibility of the information. The accounts were also shaped to manage impressions of personal character, moral integrity, and personal accountability. In addition, considerations provided by the broader and situated social context, social relations and the unfolding interaction influenced the nature of the accounts. Finally, time was also an integral feature to the nature of the accounts, as a changing social context, an entity of personal and social significance and for its use as a resource for conveying meanings. This complexity has important implications for the interpretation of accounts and for the kind of knowledge assumed possible. Understanding the complexity also supports a more informed approach to the generation, interpretation and use of personal accounts as a form of information within practice and research contexts. The value of the methodology used in this study and the incorporation of theory and understandings from other disciplines for extending knowledge for physiotherapy practice is also discussed. 2

Changes in health and social care present exciting opportunities for occupational therapists to expand their practice into innovative settings. To prepare graduates for these opportunities, placement experiences must reflect current trends in practice. Role-emerging placements are increasingly being used to help students develop the skills, knowledge and attributes needed to become the therapists of tomorrow. Whilst the literature on role-emerging placements is increasing, studies have tended to be general placement evaluations, with limited studies exploring students' experiences in detail. No studies have explored the influence of role-emerging placements on graduates' professional practice and identity. This study adopted a phenomenological design to gain a deeper understanding of how occupational therapy students experience and ascribe meaning to role-emerging placements and the ways in which such placements influence their professional practice and identity once qualified. In-depth initial interviews were carried out with five MSc pre-registration occupational therapy students within one month of having undertaken a role-emerging placement. Follow-up interviews were carried out six months after the students had graduated and gained employment. Interviews were audio taped, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Key findings reveal that the role-emerging placements acted as a strong catalyst for the students' ontological development. Through engaging in challenging and autonomous learning experiences, they developed deeper insights of who they were becoming as professionals. This led to a professional identity that was of their own making. Having to continually reflect on and verbalise the core essence and contribution of occupational therapy, students developed clarity of understanding about the uniqueness of the profession. This is an important finding in light of the historical difficulty occupational therapists have had articulating their unique role and professional identity. Once qualified, participants had mixed experiences concerning the extent to which they were able to sustain this identity and enact practice in a way that was meaningful to them. A significant finding was the difficulty that graduates experienced working in NHS settings where the nature of occupational therapy practice restricted their ability to work in a way that was congruent with the professional way of being that they had developed during their placement. Consideration therefore needs to be given to the nature of occupational therapy practice in traditional settings. Recommendation is made for role-emerging placements to be made compulsory for all occupational therapy students to assist them in their ontological development and prepare them more effectively for practice. Further research into the long-term influence of such placements, in particular on graduates' practice and identity, is required.