Aims: This study explores how training in Motivational Interviewing (MI) is experienced and given meaning by 23 multi-disciplinary health professionals. It uses a qualitative interpretative thematic analysis, aiming to identify key elements in the process of learning and applying MI consultation skills in their clinical practice. Setting/method: The health professionals were recruited from two MI training programmes in Scotland, they worked in either cardiac rehabilitation or substance abuse settings. The time elapsed since training workshops for each participant varied between 4 months and three years. Data were collected electronically via E-mail and participants completed either an open-ended questionnaire or a reflective diary. Results: The data obtained via these data collection methods was rich and informative and it revealed several key experiences and factors for successfully learning and applying MI. MI training is an emotional experience before, during and after workshops. Learning MI is challenging, and a shift in professional identity with clinicians feeling temporarily deskilled is a common experience. Practice with real clients, supervision and other reflective practices, facilitate and are crucial for learning effective MI skills, and developing competency can take years. MI is also seen as powerful and concerns about sensitive disclosure may arise, that may inhibit practicing MI skills. Clinicians also find it challenging to adjust to new ways of thinking and behaving, and often revert to the more traditional authoritarian expert approach they are used to. When clinicians become more competent and skills are consolidated, they experience an increased sense of professionalism and confidence in their ability to facilitate clients in making informed choices about their health and about illness management. They also experience less stress and dissatisfaction with resistant clients. Several additional facilitators and barriers are discussed. Conclusion: The study raises implications for MI training theory and practice and adult learning theories. The findings suggest that learning MI is emotionally demanding and tiring, and that building MI competency requires a considerable amount of time and resource. This needs to be taken into account, when planning and implementing MI training programmes if these are to succeed in embedding MI culture in health services.

Aim: Small and medium sized enterprises have notable difficulties in engaging with health and safety activity and experience proportionally higher levels of accidents than larger businesses. SMEs have also been described as problematic to access for research and intervention purposes. The aim of this research was to investigate the role of psychosocial factors in health and safety behaviour among small or medium sized enterprises (SMEs). Methodology: The research employed a mixed method design over two phases of study. In the first phase, fifty semi-structured telephone interviews were used to derive behaviours that the SMEs considered relevant to their type of business. In addition, the SMEs provided views on the rationale for, perceived effectiveness and facilitators of health and safety behaviour they had undertaken. In the second phase, a questionnaire survey was conducted using key SME health and safety behaviours and health and safety-related attitudes derived from the telephone interviews and key theoretical construct domains. Three hundred and thirteen SMEs completed questionnaires distributed at trade shows in Scotland and England. Results: Overall, the level of health & safety activity undertaken by SMEs was reported to be low (with 59% spending one hour or less in a typical week according to questionnaire responses, the figure was 60% for the telephone interviews). Smaller businesses notably the micro business, spent significantly less time on health and safety activity compared with larger organisations. Those spending approximately one day per week or more on health and safety activity were found to be the largest SMEs in the sample. Hierarchical regressions performed on the survey data highlighted five key predictors of health and safety activity. These were positive and negative beliefs regarding resources, relationships with suppliers, and decision making by middle and junior level staff. It is notable that after taking into account the influence of the size of the company, these factors remained of significant importance. This suggests that the influence of these factors persist despite previous findings related to the size of the SME. Results also suggest that beliefs associated with the consequences of health & safety behaviour tend to lead to increased activity. Further, organisational design was found to mediate this effect. Conclusion: Interventions designed to increase health and safety in SMEs would be advised to take into account the psychosocial influences on health and safety behaviour, in particular those highlighted in this study, as these may have implications for uptake and sustainability of any new initiatives requiring such activity.

Background Having a child with autism places significant demands on parents. Few interventions address parental understanding of the meaning behind child behaviour, and the relationship this has with parental stress. Parent-mediated interventions focus on behaviour exhibited by the child and ignore parental stress. This study assesses the impact of a psycho-educational intervention, which assists parents to derive meaning from their child’s behaviour. Aims The overall aim was to investigate if an intervention targeted exclusively at parents would: • Reduce parent stress associated with Child Characteristics • Reduce parent stress associated with Parenting Characteristics • Facilitate changes in parental coping styles Methods A quantitative approach was adopted to evaluate the impact of the intervention. Measures of parental stress (Parenting Stress Index) and parental coping (Ways of Coping, Revised) were taken at three time intervals; prior to, at a mid-point, and at the end of the intervention. Results Questionnaires were completed by 71 parents and the results were computed using a repeated measures analysis of variance (ANOVA). There was a statistically significant change within the parent and child domains of the Parenting Stress Index (p. 0.0005), with parents showing less stress associated with interpretations of their child’s behaviour, and significant changes in their use of problem-focussed coping. Conclusion Parent-mediated interventions that target parent characteristics associated with child behaviour, are inexpensive and have significant benefit. However, we require further research to explore the relationship between stress and coping variables in parents of children with autism to inform the future direction of intervention.

Background: Internationally, high levels of stress and Psychological Distress have been identified in university employees. There have been calls to investigate stress over time and to include measures of coping and personality. This study provides the first longitudinal assessment of stress and Psychological Distress and examines the role of personality and coping in university employees during campus relocation Method: All 500 employees in Queen Margaret University were invited to complete standardised measures assessing Psychological Distress and sources of stress (HSE Indicator Tool) before (N = 143) and after relocation (N = 116). Participants also completed measures assessing Job Satisfaction, Personality, Coping and additional demographic information. Findings: High levels of Psychological Distress were identified before relocation (42%) and at 6 months (38%). Academic staff had a higher prevalence of Distress following relocation. Matched pair analyses (N = 48) showed the majority of stress sources remained stable from T1 to T2 with one significant decrease in reported levels of Control. Stressors explained 31.8% of the variance in Psychological Distress even when the effects of pre-specified variables (Neuroticism, Coping and age) were controlled. Employees with higher levels of Neuroticism and Emotion focused coping had significantly higher levels of Psychological Distress. Discussion and conclusions: Psychological Distress was higher than in population norms and other occupational groups. The primary stressors were identified and targets (based on national benchmarks) suggested. On-going monitoring and actions aimed at reducing stress and improving Psychological Distress are warranted. This is one of the first studies to assess the relationship between the management standards (indicated by the HSE Indicator tool) and stress outcome, and to use a matched participant design to assess change in the management standards. That the Management standards predict Psychological Distress lends support to the use of the management standards approach.

Background: Endometriosis is a common, yet enigmatic chronic gynaecological condition, with an unknown aetiology and no cure, affecting approximately 6-10% of females of a reproductive age. Symptoms include heavy menstrual bleeding, pelvic pain, fatigue and infertility which has a negative impact on daily living. Clinical research aiming to establish the cause of the condition and to develop treatments is ongoing; however, there is a lack of research investigating what it is like to live with the disease. Aim: The aim of the study was to examine the experiences of women with a surgical diagnosis of endometriosis. Methods: Semi structured interviews were carried out with 13 women. Interviews were transcribed verbatim and data analysed using Interpretative Phenomenological Analysis (IPA). Analysis revealed five key themes: making sense, impact on daily life, identity, taking back control and legitimisation. Results: Women reflected upon the journey they travelled in trying to make sense of their symptoms. Diagnosis enabled a fuller understanding of their condition and facilitated increased knowledge and support. The condition impacted on all aspects of daily life and psychological outcomes to the point where women felt controlled by the disease. Identity and sense of self was challenged through changes in their ability to fulfil expected social roles, with women trying to maintain their past identities by minimising the reality of their symptoms. A variety of coping skills were employed to take back control over their lives. Finally, normalisation of symptoms by medical professionals, family members and lay public reduced the legitimacy of the condition and made self-management difficult. viii Conclusion: There is a general lack of knowledge, acceptance and support for women with endometriosis. Qualitative studies such as this one add the contextual information required to understand what it means to live with endometriosis. However, improving the quality of life of women with this debilitating condition requires further understanding of their lived experiences.

Lung transplant can improve both quality and quantity of life for a person with Cystic Fibrosis (CF) at end stage respiratory disease. However, life post transplant can be challenging both medically and psychologically due to the need to adjust to a significantly changed health status, as well as understand and manage the side effects and medical complications of transplant. This study questioned, whether from a service perspective, the support needs of adults with CF changes with transplant and how a specialist CF centre should accommodate this. In order to do this, a more detailed understanding of the experiences of a post transplant group was sought utilising qualitative methodology. Eleven participants or sixty-five percent of adults with CF post transplant who attend one of Scotland’s largest specialist CF centres participated in semi-structured interviews. Framework analysis was chosen as the method of analysis due to its relevance in a health care setting. A framework was generated consisting of four broad areas of post transplant adjustment: Recovering; Adjusting and realising; Redefining and pursuing and; Managing the issues of post transplant life. Each area has activities and key factors which provide more information about post transplant adjustment life as well as factors that may account for individual differences. In general, and in the absence of medical complications, participants adjusted to transplant with the support of partners, families and local CF and transplant services. They did not indicate the need for dedicated post transplant services in their local CF centre, but found communications between service providers to be inefficient. When faced with medical complications especially rejection, participants reported needing more psychosocial support. Recommendations include an increased awareness of the processes of psychosocial adjustment post transplant for health professionals, psychological intervention at times of crisis and more efficient communication between transplant and local CF services.

Modern science is well established as the institution through which knowledge is legitimated, facts are produced, and credibility is assigned. Operating within the prevailing capitalist socio-political order, science is also controlled by the wealthy elite, whose resources are required for its production, evaluation, and implementation. Beyond disproportionately serving powerful interests, however, science enables the most privileged groups within society to embolden certain understandings of the world and marginalize others, to shape public perceptions, behaviors, and norms, and thus to reinforce the existing social systems and institutions that support their own dominance. Building on critical scholarship that addresses inequality by problematizing the structures and practices that reproduce power, this thesis examines the prominent and politically opposed positions of the oil industry and mainstream environmentalists in the U.S. policy debate over whether to permit petroleum development in Alaska’s Arctic National Wildlife Refuge (ANWR). Specifically, through Critical Discourse Analysis (CDA), I explore how these two ‘mid-stream’ scientific actors, which have effectively appropriated the wider ‘for’ and ‘against’ drilling campaigns respectively, each engage with the generation as well as dissemination of technical knowledge in order to substantiate their arguments and enhance the authority of their claims. The analysis presented here demonstrates that the hegemonic framing of the ANWR conflict, which I describe in terms of Materialism as Morality, reifies scientific expertise whilst burying values beneath assumptions of objectivity and neutrality. It also allows incongruent truth claims to eclipse the many legitimate but competing perspectives, priorities, investments, ideologies, risks, and ethical dilemmas that lie at the heart of the ANWR drilling debate. Moreover, this framing is implicit in the perpetuation of systemic social and environmental injustice. Ultimately, my research argues for a transformative politics that engages all stakeholders in the negotiation of competing interests, the discussion of social values, and the production of scientific knowledge; and above all, which recognizes the interconnectivity of all three.

This study considers the health benefits that may be experienced by patients and staff in a medium secure forensic setting when singing in a choir. It also investigates how shared participation in choral experiences might influence the relationships between patients and staff. In addition, framed within the context of Community Music Therapy1 (Pavlicevic and Ansdell 2004; Stige et al. 2010; Stige and Aarø 2012), this study explores how – and to what extent – the researcher’s identity as a music therapist may be altered as a result of including a community-based approach to his work in addition to a clinically-oriented model. The investigation was undertaken throughout a six-month period in which weekly rehearsals comprising up to eight patients and six members of staff were held; a short performance was arranged at the culmination of the project. Whilst studies exploring the use of choral singing in music therapy for people with chronic mental illness have been undertaken (Eyre 2011), there would appear to be a dearth of literature specifically investigating the potential benefits of this intervention with patients in a medium secure forensic setting. A qualitative methodological stance was adopted. Data were collected and analysed using Participatory Action Research (Stige 2005a; Elefant 2010) and key principles of grounded theory (Glaser and Strauss 1967). Findings suggest that people may experience overall feelings of wellbeing such as enjoyment, warm-heartedness, excitement and fun as well as an increased awareness of posture and breathing. A sense of belonging, hope and contributing to a group may similarly be felt. In addition, opportunities for learning are provided and a sense of empathy towards others may be fostered. The results also suggest that shared participation in choral experiences can positively influence the relationships between patients and staff through feelings of benevolence for each other, a removal of boundaries and a deeper realisation of being a person in one’s own right. Finally, results indicate that the researcher’s identity as a music therapist is altered through the inclusion of a more didactic approach, a conscious working towards musical outcomes and a heightened sensitivity regarding the needs and abilities of service-providers as well as service-users.

Background: Smoking cigarettes is a well-documented cause of ill-health. Cigarette smoking among people with diabetes increases the risk of developing long-term complications. Although smoking cessation is considered important for all, it is especially significant for people with diabetes and is recommended throughout the literature. Few studies have investigated the impact of a smoking cessation intervention tailored to the needs of people with Type 2 diabetes. This study attempts to address this. Aims: The overall aim was to assess the impact of a smoking cessation psychological intervention for people with Type 2 diabetes and whether the intervention had a positive impact on their glycated haemoglobin levels. Methodology: Design: This was a quantitative longitudinal smoking cessation psychological intervention with no control group. Participants: Participants were 31 adult patients (n=14 males, n=17 females) with Type 2 diabetes who regularly smoked cigarettes. Primary Outcome Measures: Using a minimum data set and validated scales, glycated haemoglobin (HbA1c) and carbon monoxide (CO) levels were recorded and the Perceived Control of Diabetes Scale (PCDS) and Smoking Locus of Control Scale (SLoCS) administered to investigate changes in participants perceptions of their diabetes and smoking behavioural control across the subscales. Secondary Outcome Measures: Readiness to stop smoking (likes, dislikes, motivation and confidence), concerns relating to smoking, awareness of smoking cessation products and services and knowledge of health risks associated with smoking and diabetes were measured for comparison. Participant weight (kg) was also measured as a precaution. Procedure: Participants were recruited in Falkirk Royal Infirmary at their annual diabetes review. Measures were recorded at baseline immediately prior to the health intervention. This was repeated at 12-month follow-up. Data Analysis: Data were analysed at T1 and T2 with SPSS 17 using withinfactors repeated measures ANOVA. Results: Positive effects post-intervention were found for: HbA1c (p < 0.0005) and CO (p < 0.0005) levels, PCDS (p < 0.0005) and SLoC (p < 0.0005) Internality subscales and for dislikes (p < 0.003), motivation (p < 0.0005), confidence (p < 0.0005) and knowledge of associated health risks (p < 0.0005). No participants stopped smoking during this study. Conclusion: The results demonstrate a positive impact on health behaviour change showing an increase in the likelihood that participants will take greater control of their glycated haemoglobin levels and smoking behaviours and will be more motivated and confident to do so. With no control group the design does not control for all factors that may have contributed to these changes.

Background: Sleep disturbance, including insomnia disorder, is common among patients with chronic health conditions, and is associated with psychological difficulties and impaired health-related quality of life (HRQoL). Less is known about whether a similar relationship exists in individuals with chronic health conditions who do not have a clinical diagnosis of sleep disturbance (NCSD). Recent evidence suggests that Cognitive Behavioural Therapy (CBT) in the form of self-help (SH) is an effective treatment for individuals with chronic health conditions and has the advantage of low cost and ease of access. Any form of sleep disturbance may be perceived as problematic for individuals with chronic health conditions. This study aims to: a) examine whether the NCSD population with chronic health conditions at baseline have poor sleep quality, insomnia symptoms, high levels of psychological distress (anxiety, depression and stress), sleep-related dysfunctional beliefs and impaired HRQoL, and b) assess the effectiveness of the CBT-SH booklet. Method: Participants were recruited from outpatient clinics and received a 6-week CBT-SH booklet for sleep-related problems. Outcome measures included evaluations of subjective sleep quality and the severity of insomnia symptoms, psychological distress (anxiety, depression and stress) sleep-related dysfunctional beliefs and HRQoL. Measures were completed before and after the intervention. Results: Forty-nine participants (44 females) completed the study. Prior to the intervention, 46 participants reported poor sleep quality and 47 participants reported clinical or subthreshold insomnia. Mean scores for the measures of psychological distress indicated moderate levels of anxiety, depression and stress and sleep-related dysfunctional beliefs respectively. HRQoL was also impaired. Following the CBT intervention, participants showed significant improvements in sleep outcomes, sleeprelated dysfunctional and stress levels. No significant differences were found in HRQoL depression and anxiety outcomes. Conclusion: A brief CBT-SH booklet for sleep-related problems is effective for patients with chronic health conditions and NCSD in clinical settings.