This research aimed to investigate the socio-demographic characteristics alongside the psycho-social factors that impact on the uptake of telephone based healthcare using a socio-cognitive approach. The first study analysed four ‘one month’ periods of national NHS Direct call data (July 2010, October 2010, January 2011 and April 2011) for all 0845 4647 calls in England. Expected and actual usage of NHS Direct was determined for each ethnic group of the population and compared using Chi-square analysis. Results confirmed that White British used NHS Direct more than expected, alongside Mixed (Caribbean/African) and Asian Pakistani groups, with lower representation found for Asian Indian\Bangladeshi, Black African\Caribbean, alongside Chinese ethnic groups. No gender differences were noted. Calls were then analysed for age, gender and deprivation (IMD health, income, employment & education) using negative binominal regression. Results suggest that deprivation increases call rates for adult calls but reduced in calls about children (<15 years). This study also highlights that NHS Direct call rates (all ages combined) are highest in areas with deprivation levels at, or just above, the national average, which remains consistent when accounting for employment, income and education deprivation. The second study, adopted a qualitative approach to explore the psycho-social factors that impact on the uptake of telephone based healthcare. Focus groups were conducted with low user groups (Manchester (N=3) and Mendip (N=4)), alongside high service users (N=2) and service providers (N=2). Five themes emerged: attitudes, structural and perceived barriers, knowledge and awareness of NHS Direct alongside improving access. Findings highlight a preference for instant face-to-face reassurance in low user groups, whereby low users appear to have lower perceived confidence in self-management of symptoms and engaging with telephone based health services. In conclusion the findings suggest there is variation in usage of NHS Direct, influenced by ethnicity, gender, age and deprivation. This research has explored some of the barriers, and has provided a theoretical framework that can be applied to understand uptake of telephone based healthcare. This research can help enable the development of future promotional campaigns that can target particular sections of the population to encourage use of telephone based healthcare services.

Medical radiography is a process by which the internal structures of the human body are imaged using a source of x-rays. The images formed are essentially shadowgrams whose size and intensity is dependent on the geometry of the imaging system and the degree to which the structures attenuate x-ray radiation. The images are blurred because the x-ray source has a finite size, and noisy because the x-ray exposure must be kept as low as possible for the safety of the patient but which also limits the number of photons available for image formation. In such noisy environments traditional methods of Fourier deconvolution have limited appeal. In this research we apply maximum entropy methods (MEM) to some radiological images. We justify the choice of MEM over other deconvolution schemes by processing a selection of artificial images in which the blur and noise mimic the real situation but whose levels are known a priori. A hybrid MEM scheme is developed to address the shortcomings of so-called historic MEM in these situations. We initially consider images from situations in which the model point- spread function is assumed to be three-dimensionally spatially invariant, and which approximates the real situation reasonably well. One technique lends itself well to this investigation: magnification mammography. MEM is offered as a way of breaking some of the conflicting performance requirements of this technique and we explore several new system possibilities with a working MEM system in place. A more complicated blurring function is encountered in linear tomography, which uses opposing movements of the image receptor and x-ray source to generate planar images through an object. Features outside a particular focal plane are smeared to such an extent that detail within the focal plane can be very difficult to detect. With appropriate modification of our MEM technique, processed images show a significant reduction to the blurring outside the focal plane.

Walking in the countryside is an increasingly popular pursuit in Britain. Much previous research within the social sciences has tended to concentrate on the physiological benefits, barriers or facilitators to walking. This thesis explores particular walkers’ complex motivations for and modes of walking, their individual engagements with certain types of (northern) landscapes and the significance of specific kinds of visual images, traditions and wider practices of looking. Constructions and discourses of landscape are considered in relation to the persistence of certain ideas and aesthetic traditions as well as and in relation to current concerns about individual health and social well-being. The research is multi-disciplinary and engages with studies of art history and visual culture, cultural geography, anthropology and sociology. Visual studies research methods are used to explore individual interpretations and experiences of landscapes, and how the circulation and consumption of particular kinds of images might inform attitudes to walks and walking. Walkers’ views and attitudes have been investigated using an ethnographic approach. In-depth qualitative interviews (including photo elicitation) have been undertaken with walkers who regularly walked five or more miles in the countryside either in organised groups, on their own or with friends and family, in order to capture how walking is perceived, felt, and made sense of. A grounded theory approach has been used for the interviews, building on theories that emerged from systematic comparative analysis, and were grounded in the fieldwork. Overall the thesis observes a marked persistence of and some striking similarities between particular ideas, cultural traditions and interpretations of walking in and ways of looking at types of countryside from the Romantic period to the present day.

Contemporary art is seen as an effective way of communicating complicated science to a range of lay audiences, particularly in the context of medical research. This is the premise of ‘sciart’. However this rationale can limit the cultural significance of artworks by overstating their illustrative capacity, an outcome that severely reduces the creative endeavour of the artist. Based on the first-hand experience of an artist whose career has engaged with the opportunities afforded by ‘sciart’, this study seeks to address the illustration problem by exploring new methods of working across art and science that challenge representations of the inherited neuromuscular disorder myotonic dystrophy, a condition which affects one in 8000 adults in the UK. Hazel, a film made by the artist with the participation of eleven women affected by the condition, is placed at the centre of this as a case study. Pioneering work with the UK Myotonic Dystrophy Patient Registry facilitated recruitment, and it is this process that forms the unique contribution to knowledge of the research. By illuminating the multiple loss experienced by families struggling with physical and social decline, this research offers a practical and theoretical image of the capacity contemporary artists have to shape research into myotonic dystrophy. The study will argue that this capacity is more ambitious than illustration, more extensive than the communication of family insights. Thus it can embrace a much-needed form of research leadership that is built upon an artist’s scope to say powerful things by withholding information. In addition, the employment of feminist literature on ageing and appearance, and sociological research into the decline and isolation of affected families, helps define the particular form of leadership that can arise through extreme personal circumstances. As pressures on services increase, cross-sector influence becomes increasingly important and this thesis and body of practical work explores the future impact of contemporary artists taking a lead in shaping research agendas in the genetic sciences.

For women with anorexia nervosa, control and routine are important in managing distress and maintaining a sense of self in challenging situations. The transition to motherhood is characterised by change and uncertainty. Women may struggle to integrate the demands of anorexia alongside the challenges of motherhood. The aim of this thesis was to review the literature regarding the experiences of pregnancy and motherhood for women with eating disorders and develop a grounded theory of the transition to motherhood for women with anorexia nervosa. The literature regarding experiences of pregnancy and motherhood with an eating disorder was reviewed. The findings suggested a trend for remission of eating disorder symptoms in pregnancy followed by relapse during the postpartum period. Women with eating disorders were most likely to experience depression and anxiety during the later stages of pregnancy and postpartum. The review highlighted how eating disorders impacted on women's ability to embrace motherhood and bond with their children. There was a paucity of research exploring the lived experience of motherhood for women with specific eating difficulties, most notably anorexia. A grounded theory was informed by the experiences of eight mothers with anorexia. A core process of breaking the cycle highlighted how women were attempting to make lasting positive changes. They achieved this by protecting their children from anorexia, exploring new perspectives, setting a good example to their children and battling temptation to succumb to anorexia. This study provides a unique insight into the experiences of mothers with anorexia. In the final chapter the research process is reflected upon. It is hoped that these findings will influence clinical practice and help professionals to better understand women's experiences.

Gait problems in Parkinson's disease (PD) are complex and not adequately addressed by current medical and surgical options. The focus of this thesis was a desire to optimise the effectiveness of cues after experience of delivering cueing therapy in the context of a multi-centre RCT. Cues provide information on how to adapt the stepping pattern either through external prompts or internally through focussing attention. Cues are known to improve gait in PD but there is a compromise between strategies which have large effects but limited practical application and those which are easily applied in complex situations but have more modest effects. A laboratory study explored the feasibility of a cueing strategy combining an external rhythmical cue with a focussed instruction to increase step size, targeting both temporal and spatial parameters. A group of 15 PD and 12 age and sex matched controls were tested and gait was measured with an instrumented walkway which uses pressure activated sensors. The combination cue was compared with two single parameter cueing strategies, a rhythmical auditory cue and an attentional strategy asking subjects to walk with large steps. Gait was assessed under single and dual tasks to establish the attentional demands of the different cues. Walking speed and step amplitude significantly increased with the attentional strategy and combination cue in single and dual tasks in PD and controls (see chapter 3). The combination cue had an additional benefit in significantly reducing stride time and double limb support time variability in PD subjects, whilst variability increased in controls (see chapter 4). The effects of cues on and off medication was tested in the home in a group of 50 PD subjects using the same dual task paradigm to explore the mechanisms underlying cueing compared to dopamine on gait control. Gait was measured using an in-shoe footswitch system allowing reliable gait data to be collected in the home. Walking speed and stride amplitude significantly improved with all cues in the single and dual tasks on medication and with the attentional strategy and combination cue off medication suggesting that cues have a different mechanism to dopamine. The greatest improvements were seen with the combination of cues and medication. Gait variability responded differently to cues on and off medication. The combination cue reduced variability on and off medication for single and dual tasks, the auditory cue reduced variability in all conditions except for single task on mediation and the attentional strategy increased variability in the single task on mediation and had no effect in other conditions (see chapter 5). Cues which are delivered externally result in different mechanisms of gait control than those generated internally. Measures of gait variability reflect the attentional cost of movement and underlying neural control but there is limited knowledge on their validity. The final stage of the research examined the clinical characteristics associated with increased gait variability to increase understanding of these variables. Non-cued gait variability was strongly associated with disease severity, but cued gait variability was not adequately explained suggesting involvement of more diverse parameters (see chapter 6). These findings provide new knowledge on the mechanism underlying cued gait, the involvement of dopaminergic pathways and the attentional cost of different cues. Focussed instruction can alter the response to an external cue in the form of a rhythmical auditory tone, targeting both temporal and spatial gait parameters and reducing the attentional cost of walking.

This PhD provides the first organized view of art therapy education in Australia. It focuses on the theories that are used in this specialized teaching and learning process. It evolved from the authors’ immersion in the field as a migrant art therapy educator to Australia from the UK and a desire to be reflexive on this experience. The research questions aimed to discover the field of art therapy education in Australia: to find out what theories and practices were taught; and where the theoretical influences were coming from, in order to develop understanding of this emerging field. Positioned as a piece of qualitative research a bricolage of methods were used to gather and analyse information from several sources (literature, institutional sources, and key participants, including the author) on the theories and practices of art therapy training programs in Australia. This also included investigating other places in the world shown to be influential (USA and UK). The bricolage approach (McLeod, 2006) included: phenomenology; hermeneutics; semi-structured interviews; practical evaluation (Patton, 1982, 1990/2002); autoethnography (Ellis & Bochner, 2000); heuristic (Moustakas, 1990); and visual methodologies (Kapitan, 2010). These were used to develop a body of knowledge in the form of institution/program profiles, educator profiles, country profiles and an autoethnographic contribution using visual processes. Epistemologically, the project is located in a paradigm of personal knowledge and subjectivity which emphasizes the importance of personal experience and interpretation. The findings contribute knowledge to support the development of art therapy education and the profession in Australia, towards the benefit, health and wellbeing of people in society. The findings show a diverse and multi-layered field of hybrid views and innovative approaches held within seven programs in the public university and private sectors. It was found that theories and practices are closely linked and that theoretical views have evolved from the people who teach the programs, location, professional contexts (health, arts, education, social, community) and the prevailing views within these contexts, which are driven by greater economic, socio-political forces and neo-liberal agendas. The university programs generally teach a range of the major theories of psychotherapy underpinned with a psychodynamic or humanistic perspective. Movement towards a more integrative and eclectic approach was found. This was linked to being part of more general masters programs and economic forces. The private sector programs are more distinctly grounded in a particular theoretical perspective or philosophical view. Key words distilled from the profiles included: conflict, transpersonal, survival through art, pedagogy, epistemology, theory driven by context and mental health. Important issues for art therapy education were identified as: the position and emphasis on art; working with the therapy/education tension; the gender imbalance in the profession; Indigenous perspectives; intercultural issues and difference. The horizons of the field revealed the importance of developing the profile of the profession, reconciling differences towards a more inclusive view and the growth of research. A trend towards opportunities in the social, education and community areas was found, driven by the increasing presence of discourses on arts and wellness.