With an increasing ageing population, it is important to explore factors that can contribute to healthy ageing. Physical activity (PA) and sedentary behaviour (SB) are associated with psychological and physical health in older adults. This thesis therefore aims to explore the associations between PA as well as SB and a range of health, motivational, environmental factors in older adults from assisted living facilities (ALFs) and community settings using various methodological approaches. Study 1 used latent profile analyses to group people based on PA, SB, and physical function in resident of ALFs. It was found that those classed as high physical function with an active lifestyle had better mental health compared to those who had lower physical function and an inactive lifestyle. These findings suggest that in order to improve mental health in older adults, interventions should take all these variables into account. Study 2 used latent profile analyses to classify people based on the degree of autonomy support from important others and perceptions of the physical environment, and subsequently examined differences in engaging in light PA and moderate-to-vigorous PA (MVPA) between these groups. Results suggest that perceptions of the physical environment should be taken into account along with support from important others to facilitate increases in levels of PA. Study 3 employed ecological momentary assessment to examine the within-person association of light PA, MVPA, and SB in relation to bodily pain and fatigue in older community dwelling adults. This study revealed associations between bodily pain and PA, as well as SB. Furthermore, daily fatigue was influenced by typical fatigue and physical health. The overall conclusion of the studies presented in this thesis implies that individual, social, and environmental factors and its interactions can all contribute to mental health, PA, SB, bodily pain, and fatigue outcomes in older adults.

Within the field of psychology there has been growing interest in Schema Focused Therapy and the theoretical underpinning on which it is based. The overall aim of this thesis was to explore the current application of this model and consider how appropriate and effective it is, with a particular emphasis being drawn to the female forensic population. In order to investigate this three key aspects were explored. Firstly, the Young Schema Questionnaire (Young & Brown, 1990) was reviewed. Good psychometric properties were indicated, however, it is suggested the latest version would benefit from further examination. In the following chapter details of a systematic review are provided. This demonstrated the expanding use of Schema Focused Therapy across general psychiatric inpatients and outpatients with a range of difficulties, and initial use within forensic services. Information on the effectiveness is provided. From the literature reviewed however, there appears to be no substantial evidence base to date for female secure mental health patients. Owing to this an exploratory qualitative analysis was conducted on how the schema model applies to female forensic patients, whereby a template was developed in relation to their experiences of early maladaptive schemas. This enabled links with risk to be made and identified a potential new schema mode. The final chapter summarises the evidence gained throughout the thesis, discusses the implications of the findings and makes recommendations for future research.

Positive Psychological Change (PPC) following trauma is a developing field for which there is no standard terminology. The plethora of labels, of which Post Traumatic Growth (PTG) is probably the most common descriptor, arguably masks a significant gap in clinical and theoretical understanding of the phenomenon. One specific gap addressed by this study is PPC following psychological trauma stemming from a Road Traffic Accident (RTA) in which the person involved has subsequently received Eye Movement Desensitisation & Reprocessing (EMDR). To investigate this gap in knowledge, an Interpretative Phenomenological Analysis (IPA) approach was used and twelve participants recruited via a snowball sampling method. The participants were then interviewed using a Semi-structured Interview Questionnaire (SSIQ) and the interviews were then transcribed for IPA analysis. Key themes that emerged included Navigational Struggle (NS) to describe Negative Psychological Change (NPC), and Network Growth (NG), to describe PPC. At any one post-RTA/EMDR point there was a preponderance of one over the other, however, NS and NG were inseparable and found to co-exist along an NS-NG continuum. In addition, Figurative Language Use (FLU) had a significant role in both NS and NG yet was independent of both and apparently driving change towards the development of NG. Whilst NS and NG were both post-trauma phenomena, FLU seemed to hallmark expansion of memory networks as part of a general maturation process post-RTA. Furthermore, there was evidence that participants were incorporating their traumatic experiences via FLU into the rebuilding of their assumptive worlds. To account for these findings, an extension to Adaptive Information Processing (AIP) – the theory widely accepted to underpin EMDR - is proposed based upon a hypothesised Plasticity of Meaning (PoM), which is observable through FLU. PoM predicts which, why and how memory networks connect resulting in the adaptive processing predicted by AIP. The study’s findings are re-examined in terms of consequential modifications to the clinical use of EMDR. Extensive suggestions for further research are provided.

Background: Respiratory disorders manifest themselves with chest symptoms including shortness of breath and decline in lung function. An innovative cost-effective therapy is needed and there is a growing body of evidence to suggest that singing in a group may have health and wellbeing benefits for these patients. Method: The key objectives of this research were to review current knowledge and to evaluate the potential impact of group singing as an intervention for health and wellbeing. The research is divided into three components which aimed to: - Review, synthesise and consolidate current research in the area of singing for COPD. - Evaluate the impact of group singing on health and wellbeing for a group of COPD patients - Evaluate the usability of specially designed resources for home practice for respiratory patients. Results: A broad systematic review showed that availability of high quality evidence that singing for COPD improves physical health, dyspnoea or respiratory-specific quality of life is still very limited. This is due to the low number of high quality studies and small sample sizes. The study reported here found statistically significant positive changes in both total mean Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and COPD Assessment Test (CAT) scores for twenty-one COPD participants of two community singing groups over a twelve-week period. These changes were maintained up to thirty-weeks for sixteen participants that continued. The research also successfully piloted the use of resources designed for self management. Conclusion: There are promising findings from this and other studies on the impact of singing for COPD on health and wellbeing. However, the outcomes of this research are consistent with those outlined in recent reviews and it is recommended that larger randomised controlled trials with longer durations are conducted.

Background: Choice has become the defining characteristic of service users’ relationship with the National Health Service (NHS) in the UK. Decades of market-orientated policy have encouraged greater customer focus, and the NHS is now subject to the same consumer drivers that can be identified elsewhere in society. Aim: The aim of this study is to understand whether the introduction to the NHS of market reforms designed to encourage and improve choice and experience have influenced the way in which service users access care and interact with service providers when receiving it. Method: This study utilises an ethnographic approach to data collection combined with the structure, theoretical under-pinning and replication logic afforded by comparative case study. Both approaches allow for the inclusion of qualitative and quantitative data and use multiple data collection instruments in a triangulating fashion. Two minor injury units (MIUs) were selected as research sites/cases since they serve a large community with multiple and diverse needs and provide a crucial stepping-stone between primary and secondary care services. Results: Although very few service users at either case identified themselves as ‘customers’ or ‘consumers’ of healthcare per se, there was general consensus that high standards of customer service were both important and desirable in a healthcare context. Similarly, regardless of whether service providers believed that service users should be viewed as ‘customers’ or ‘consumers’ of healthcare, they consistently demonstrated modes of behaviour that treated them as such. Conclusions: Through careful analysis of the data, it is possible to identify five different healthcare consumer typologies: passive, reluctant, assertive, pragmatic and knowledgeable. The broad range of views and positions demonstrated by these typologies in relation to healthcare consumption seem to be the result of social values and practises that have developed in response to consumer culture and society as well as previous experience of healthcare services.

Research shows that mental health professionals hold stigmatizing and negative attitudes towards people with mental health problems. Professionals can engage in “othering” whereby they create distance between themselves and the “different” patient, diminishing discomfort. There are significant mental health difficulties amongst professionals, but there is insufficient research exploring clinicians with lived experience, including how this impacts and/or enhances clinical practice. How professionals manage occupying multiple positions, such as professional and patient, has not been sufficiently explored, perhaps owing to the stigma in the profession. I employed Autoethnography, a method and methodology (Campbell, 2016), to critique, contribute to and extend existing research and theory. I seek an increase of insight, facilitation of social consciousness, and societal change (Adams, Linn & Ellis, 2015, p. 33). This research is a direct response to the persistent gap in literature when it comes to firsthand accounts of inpatient psychiatric treatment (Short, Turner & Grant, 2013, p. 41) and a call for more writing from professionals working in mental health with lived experience. I used my insider knowledge of a cultural phenomenon (life of a wounded healer in training) and a life-altering experience (being admitted to a psychiatric institution) to critique cultural norms and practices amongst mental health professionals, including myself. The data collection and analysis was iterative and resulted in the production of an evocative narrative. I provide the reader with a theoretical chapter that discusses salient themes that arose during this process and link these themes with parts of the narrative. I demonstrate that autoethnography can be a particularly valuable method for counselling psychologists and conclude with a number of implications and suggestions for practice stemming from my research. By using myself as both the researcher and the researched, while highlighting my hybrid identity of patient and professional, I blur the boundaries that could otherwise perpetuate othering.

Mortality amenable to health care intervention are premature deaths which, theoretically, should not occur in the presence of timely and effective health care. As Scotland has a universal health care system, where health care is freely provided at the point of access to all residents, there should be no socioeconomic inequalities in rates of amenable mortality (AM). However, gradients in rates of AM have been found in many countries, using various measures of socioeconomic position. The routine monitoring of rates of AM, and subgroups of amenable conditions, will contribute towards an indicator of health care performance. Records of all deaths occurring between 1980 and 2013, records of hospitalisations for amenable conditions, and mid-year population estimates were used to calculate rates of age standardised mortality and incident hospitalisations respectively. Absolute and relative inequalities in both rates for the total population were estimated using an area based measure of material deprivation, the Carstairs index. Individual level measurements of socioeconomic position, such as educational attainment, were used to measure inequalities in rates of deaths for a sample of the population, allowing for some comparison with European countries. Rates of AM in Scotland and England were compared in two natural experiments in the final two chapters, aiming to explore the direct and indirect effects of policy changes on health care systems abilities to effectively prevent amenable deaths. Rates of AM in Scotland have been found to be decreasing for both men and women. Mortality rates within two of the three subgroups of amenable conditions have also declined, with the third having too few deaths to comment on trends. The rates of incident hospitalisations of amenable conditions between 1996 and 2013 have remained relatively stable, suggesting that rates of AM may be reflecting improvements in the detection, treatment, and management of amenable conditions. Absolute and relative inequalities in mortality rates were largest when estimated using educational attainment, whilst occupational measures produced the smallest inequalities. The rate of decline in rates of AM slowed in Scotland, relative to England, following devolution, however the attempts to adequately control for differing levels of deprivation were unsuccessful. The final chapter saw step increase in rates of AM in England, compared to Scotland, following the publication of a White Paper for the Health and Social Care Act - however, this failed to reach statistical significance. This thesis concludes that the continued study of amenable mortality in Scotland is worthwhile, given that mortality rates continued to decline against stable rates of incident hospitalisations, and relative inequalities in mortality rates were found to be increasing, despite decreasing absolute inequalities. The monitoring of inequalities in rates of AM provides the potential for weaknesses in the provision and delivery of care to be identified and corrected.

Since Cohn’s investigation of the cause a of short-sight and the striking evidence which he brought forward as to the part which Education played in connection therewith, we have been accustomed to regard the schools as the "hot bed" of myopia. In view of the apparently conclusive nature of the statistics obtained by Cohn after an examination of over 10,000 scholars in German Schools, supplemented, as these have been, by the work of Snellen, Priestley Smith, Straub (Amsterdam) and many other eminent ophthalmologists, one reads with something of surprise the memoir or Pearson and Barrington “ A First Study of the Inheritance of Vision, and of the relative influence of Heredity and Environment on Sight “. In this memoir, which was issued in 1909 under the auspice of the Eugenic Laboratory of London University, the authors have carefully analysed, by modern statistical methods, much of the evidence adduced in support, of the generally accepted theory that short-sight is largely the result of Educational Environment.

Stair climbing is an ideal activity to promote in worksites due to its availability and associated health benefits. To date findings are equivocal regarding stair climbing intervention success in this setting, thus more research is needed. Chapter two of this thesis confirmed that a calorific expenditure message can increase stair climbing in a train station. Based on this finding, chapter three implemented a point-of-choice intervention using a longer calorific expenditure message in four buildings and successfully increased stair climbing. The inability to translate intervention success on public access staircases to the worksite setting is likely to be due the random availability of the lift. Consequently, chapter four examined the effect of lift availability on stair use, concluding that reduced lift availability increases stair use. Lift availability can rarely be modified however, so chapter five assessed whether a point-of-choice intervention using an aspirational climb Mt. Everest message can increase stair climbing. Whilst no increase in stair climbing was recorded during this intervention, the same calorific expenditure message as used in chapter three increased stair climbing in the same building. Collectively, these findings demonstrate the effectiveness of point-of-choice prompts using calorific expenditure messages in increasing stair climbing in the worksite setting.

This thesis describes studies of the requirements, applications and benefits of external quality assessment (EQA) of clinical chemistry laboratories. The involvement of EQA in assessing the analytical quality of results from clinical chemistry laboratories is well-established. This thesis addresses the contribution of EQA in improving clinical chemistry practice and therefore patient care rather than as a method of 'policing' laboratory performance which is the objective of many national EQA schemes. The use of EQA in the assessment of interlaboratory agreement, of analytical methods, of individual laboratory performance, and of quality control and calibration materials is discussed. Surveys are examined as a means to assess the prevailing standard of performance and determine priorities for further EQA to improve performance. The contribution of scoring systems to scheme success by making the information more intelligible to participants is described. The importance of reliable target values is shown, and the reproducibility and accuracy of consensus values in such schemes have been studied. EQA data are shown to be invaluable in providing information on the relative performance of analytical procedures, and on factors such as analyte concentration and laboratory workload which affect performance. The stepwise interpretation of the Variance Index scoring system, and the use of graphical presentations in assisting the assessment of laboratory performance are described. Finally, the use of EQA data in the study of the suitability of quality control materials is examined, with particular reference to their commutability, their use in calibration, and the effects of manufacturing procedures upon their properties. This thesis illustrates the importance of EQA to clinical chemistry practice and to patient care.