People with intellectual disabilities are increasingly being diagnosed with cancer due, in part, to increases in life expectancy for this population. Despite the growing number of people with cancer and intellectual disabilities, the cancer-related experiences of people with intellectual disabilities are under-researched. Person-centred approaches to research are needed to better understand the needs and psychosocial outcomes of people with cancer and intellectual disabilities. This thesis aims to better understand the cancer-related experiences of people with intellectual disabilities, and the impact on the people who support them. The thesis comprises four related studies: (1) a systematic review of psychosocial experiences of cancer in people with intellectual disabilities; (2) a qualitative study of cancer experiences in people with intellectual disabilities using thematic analysis informed by grounded theory; (3) a survey of UK oncology nurses' attitudes and care perceptions towards people with intellectual disabilities; and (4) a feasibility study of an intervention to improve healthcare professionals' perceptions of communicating with people with cancer and intellectual disabilities. Five themes emerged from the ten papers included in the systematic review: delayed diagnosis; information, communication, and understanding; negative psychological consequences; negative physical consequences; and social support. Six of the ten papers included data from the same ethnographic study of 13 people, highlighting a paucity of empirical research regarding the psychosocial cancer experiences of people with intellectual disabilities. The qualitative study indicated that people with intellectual disabilities were often excluded from conversations about their diagnosis, treatment, and ongoing care, and expressed confusion and anxiety about their cancer. Attempts to protect them from distress inhibited communication, but where additional support was offered, participants engaged more meaningfully in their experience and this should, therefore, be encouraged. In the qualitative study, oncology nurses were reported to be important figures in the care of patients with intellectual disabilities. The survey of oncology nurses highlighted that caring for cancer patients with intellectual disabilities may intensify their already difficult role; however, previous experience may ameliorate negative consequences. This sample identified their need for training about communicating with people with intellectual disabilities. The first three studies informed the development of a novel, brief, online, video-based intervention for healthcare professionals working with people with intellectual disabilities and cancer. The feasibility trial of this intervention indicated that there were problems with recruitment, high attrition, and intervention adherence. These problems were, most likely due to participants finding the content and delivery method to be unacceptable. It is clear that the intervention is not feasible in its current format, and that further theoretical and modelling work is needed before the intervention is feasibility tested again ahead of a definitive trial. This body of work has demonstrated that people with intellectual disabilities and cancer face multiple barriers to accessing cancer care, including informative and understandable communication with healthcare professionals. With appropriate support, psychological and physical outcomes can be improved for people with intellectual disabilities and cancer, but caring for people with cancer and intellectual disabilities can be challenging for paid and informal carers, and oncology staff. Difficulties with communication are bi-directional, and improving communication might be an appropriate first step to improving cancer experiences for this population, but developing effective interventions presents numerous feasibility challenges.

ABSTRACT This study explores the post-treatment psychosocial experiences of female adult cancer patients. In particular, this study aims at identifying common themes in the nature of their experiences. This research was exploratory in nature and took place within the context of the qualitative paradigm. The focus group method was utilised in collecting data. The six participants were white Christian females between the ages of 50 and 62 who had completed treatment (either chemotherapy, radiation or both) not more than four months prior to the study. Data were analysed by means of categorical content analysis. Four out of the six participants reported relief as well as mixed emotions after discovering they had survived cancer. A major finding of this research was that all of the participants were experiencing anxiety that the cancer might recur. Five out of the six participants reported ample support from their partners and other family members. The entire group of participants admitted that their genuine friends remained supportive throughout treatment, while some friends avoided them when they had cancer, but were willing to continue the friendship after treatment. This impacted negatively on their friendship. The entire group mentioned negative social experiences due to the stigma attached to having cancer. It was also found that the participants preferred spending time with people who have insight into the meaning of life. All of the participants agreed that without their relationship with God and the social support structure including churches and acquaintances at church, they would not be able to get through their experiences during and after treatment. The entire group mentioned the experience of a greater appreciation for life after having completed treatment and survived cancer. It is evident that the experiences of cancer survivors in the South African context necessitate further research and that an understanding of these experiences plays a crucial role in the development of successful interventions for survivors, their families and the wider social community in regard to cancer.

Aims: Life satisfaction and self-efficacy are psychosocial experiences that appear to profoundly influence the rehabilitation of a stroke patient. However, relevant studies have been mostly carried out on Western stroke survivors, with limited reports on stroke experience in the Middle East. Reviewed literature suggests a positive correlation between religious faith and health outcome, however studies investigating relationships among religious faith, self-efficacy and other psychosocial variables in stroke patients are limited. The aims of this study were therefore to (1) explore stroke experience and factors associated with life satisfaction post-stroke in Kuwait, (2) to investigate the relationships between self-efficacy, life satisfaction and religious faith in female stroke patients living in Kuwait, and (3) to identify cultural influences on stroke survivors in Kuwait from the health professionals‘ point of view. Method: The study was carried out in these four phases. 1) Phase 1:- Exploring stroke experience in patients in Kuwait with semi-structured interviews 2) Phase 2:- Client-Centred Adaptation of a Self-Efficacy measure for stroke patients living in Kuwait 3) Phase 3:- Assessing quantitative relationships between the three variables (self-efficacy, life satisfaction and religious faith) with questionnaires 4) Phase 4:- Exploring perceptions of health professionals regarding the world of the stroke patient and effects of culture on recovery and rehabilitation with semi-structured interviews Qualitative data were analysed with thematic analysis. Results: Significant correlations were found between general self-efficacy, and psychosocial adaptation self-efficacy. Self-efficacy (both general and psychosocial adaptation) showed significant correlations with life satisfaction post-stroke. Religious faith was not related to either life satisfaction or self-efficacy. Health professionals‘ interviews identified cultural characteristics specific to stroke patients living in Kuwait. These included family involvement, prevailing attitude towards stroke, dependency and access to maids, religious beliefs, and social stigma. Conclusion: Psychosocial self-efficacy was identified as having the strongest relationship to life satisfaction compared with the other variables tested. This study failed to show any significant relationship between religious faith and self-efficacy or life satisfaction in female stroke patients living in Kuwait. However, results from patient and health professional interviews identified religious beliefs as playing an important role in recovery, behaviour during rehabilitation and in interaction with the health professions. The qualitative aspects of this study, in particular, highlight the importance of taking into consideration religious and cultural influences during the rehabilitation of stroke patients in Kuwait.

Women entrepreneurs in the formal or informal sector continue to encounter social, psychological, political, and religious-related challenges, inhibiting their functioning. Consequently, this study explored the psychosocial experiences affecting the informal female traders at Tshakhuma fruit market in Limpopo, South Africa and the coping strategies employed to mitigate psychosocial experiences. The study adopted an interpretivism approach and applied a qualitative methodology and narrative design. Seven informal female traders shared their psychosocial experiences and coping strategies through stories and were collected using unstructured interviews. The narrative thematic analysis was used to analyse the interviews, and psychosocial experiences and coping strategies themes are developed. The family, work environment, and sociocultural social systems guided the psychosocial experiences themes. Lazarus and Folkman informed the coping strategies themes. The findings provided some understanding of women's entrepreneurship in the informal sector, but the findings cannot be extended in another context / Psychology / M.A. Psychology