The aim of this study was to investigate the effects of the diagnostic label ‘antisocial personality disorder’ on health care staff’s causal attributions of challenging behaviour, their emotional responses to that challenging behaviour, their optimism about treatment and behavioural change and their propensity to help. Of additional interest was how three aspects of burnout might impact on the above variables. This study employed a between subjects questionnaire methodology. There were 62 participants that comprised of healthcare staff working in low and medium secure mental health settings. Participants were given a case vignette describing a challenging behaviour. In one group, the character in the case vignette was described as having a diagnosis of ‘antisocial personality disorder’, in another group he was described as having a diagnosis of ‘schizophrenia’ and in the third group no diagnosis was provided. Participants then rated the causal attributions, emotional responses, optimism and helping behaviour. All ratings were taken on seven point bipolar scales. Finally they completed the Maslach Burnout Inventory (1996). Participants who were given the vignette with the ASPD diagnosis gave higher ratings for causal attributions of control. The no label group responded with the highest ratings of anger. On the sample as a whole, attributions of controllability and internality were correlated. Controllability was correlated with emotional responding and helping behaviour. Optimism was correlated with helping behaviour. Emotional exhaustion was associated with attributions of controllability and internality. Depersonalisation was also associated with attributions of controllability. Diminished personal accomplishment was associated with optimism. The label antisocial personality disorder may influence how staff make causal attributions of control. This may have implications for how staff respond to such patients. Attributions of control were associated with more anger, less sympathy and less helping behaviour. In addition staff that are experiencing high levels of stress may also have been more vulnerable to making attributions of control. This study found that qualified nursing staff were more likely to experience stress. These findings are discussed in relation to current literature and the clinical implications are described particularly in relation to the formulation of interventions for healthcare staff.

The research reported in this thesis investigates the self-efficacy construct in the context of (real world) diabetes self-management programmes. Self-efficacy interventions, although widely implemented in diabetes care, lack basic information on what exactly was delivered. More importantly, there has been no assessment tool which would enable researchers to externally evaluate the use of self-efficacy-based techniques in interventions and provide accurate report information about the process of intervention delivery. To address this gap, the present PhD aimed to develop a reliable and valid coding tool to assess the use of self-efficacy-based techniques among nurses delivering education for people with diabetes and test its clinical utility by delivering a self-efficacy-based intervention to diabetes nurses. The four sources of self-efficacy: mastery experience, role modelling, verbal persuasion and physiological and affective states formed the conceptual basis of the coding tool. The findings of the literature review and observation of three educational programmes provided an operationalisation of the four sources of self-efficacy and resulted in 11 verbal behavioural techniques. Four coders rated diabetes programmes to establish reliability of the coding tool. Cross-sectional and longitudinal data from 52 patients, based on self-report and objective measures, as well as demographic information about five nurses were related to nurse-led self-efficacy based techniques to establish the validity of ASSET. In a single pre-post design, the feasibility and effectiveness of ASSET-based interventions delivered to five nurses were evaluated. The key findings were that ASSET could be a useful tool to identify the use of self-efficacy in interventions. The use of self-efficacy-based techniques reflected nurses’ work-related experience gained prior to the study, and to some extent predicted patientrelated outcomes including intention and behaviour regarding diabetes management. The use of self-efficacy based techniques by nurses, however, did not predict patients’ selfefficacy beliefs. ASSET-based training guided nurses in reflecting on their practice. As a result of that, nurses started using more self-efficacy-based techniques when delivering group-based education. The effect was, however, not maintained over time. Nurses who were less experienced prior to the intervention increased their use of self-efficacy-based techniques to a greater extent than those with prior experience. One of the major limitations of the thesis was that only the author of the thesis coded all nurse-led speech utterances. The other three coders rated a selection of utterances. Therefore, there is no sufficient evidence to conclude on the reliability or validity of ASSET.

Objective: Physical activity has been shown to improve sleep, fatigue and mood among breast cancer patients during treatment. However, few studies have focused on assessing the effect of activity on these symptoms after treatment is complete. Using a correlational design, this study aimed to explore associations between physical activity, sleep, fatigue and mood in women who had completed treatment for breast cancer and to evaluate the reliability and validity of the short-version International Physical Activity Questionnaire. Methods: Twenty-eight women (aged 43 to 75 years) with stage I and II breast cancer were recruited at 6-months post-diagnosis and after completion of active treatment. Respondents completed measures of activity, sleep, fatigue, depression and anxiety. Six participants also undertook actigraphic monitoring to obtain objective activity levels. Results: Descriptive analyses suggest the sample was relatively active with 50% of participants engaging in moderate-intensity activities. Despite this, however, only 18% were sufficiently active to meet national guidelines. No significant relationships were found between total physical activity, sleep, fatigue or depression, whereas, anxiety and activity were significantly correlated. Reliability of the IPAQ was low, however, comparison with objective actigraphy data suggests high criterion validity. Conclusion: These findings have implications for designing interventions to reduce anxiety among breast cancer patients returning to physical activity after treatment. However, the choice of assessment instrument may have a significant impact on research results.