Aims: Unmet needs have mainly been investigated with formal and informal adult caregivers and ill individuals within psycho-oncology; findings indicate unmet needs are associated with negative affective state and caregiver burden. Research relating to adolescent children’s experiences of unmet needs during parental illness has, in the main, been based upon parental reports or professional opinion, yet research suggests that parental reports can downplay the effects and it is important to ask the adolescent child for their opinion. Adolescence is a transitional time in development; this may make the illness experience and subsequent needs vary from those of formal and informal adult caregivers. This thesis pragmatically investigates adolescent children’s firsthand accounts of unmet psychosocial and supportive care needs when they have a parent with a non-communicable disease. Methods: Systematic Review: To inform the direction of the thesis and capture all relevant published literature, a comparative systematic review was carried on adolescent’s experiences of unmet needs when they have a parent with a NCD, cancer or psychological problem. The review was conducted using standardized procedures and guidance from the Cochrane collaboration. Interpretative Phenomenological Analysis: Qualitative methodology was used to investigate seven adolescent’s experiences of unmet psychosocial and supportive care needs in relation to having a parent with a NCD. Participants were recruited through institutions of further and higher education. Quantitative Research: Pearson’s correlation and multiple regressions were used to test associations between unmet needs, depression, stress, anxiety and quality of life, and to determine the applicability of the revised version of the Offspring Cancer Needs Inventory (OCNI) for individuals who have a parent with a NCD. One hundred and seven adolescent children completed the revised version of the OCNI, the DASS-21 (depression, anxiety, and stress) and AC-QoL (Adult carers’ quality of life) scales. Findings: Systematic Review: In the review 1479 papers were considered. Seven met the inclusion criteria, of these five papers related to cancer, one to chronic illness and one to psychological problems. Results suggest that adolescents had informational, supportive and recreational needs, and did not want to worry parents by asking them questions. The lack of hits and the disparity between illness groups is problematic in making comparisons and drawing definitive conclusions. Interpretative Phenomenological Analysis: Four interdependent themes emerged from the data, two relating to interpersonal needs (Information Needs and Support Needs), and two relating to intrapersonal needs (Need for 4 Acknowledgement and Need to be Them-Self), each had their own number of sub-themes. Adolescent’s had a variety of needs that could be partially met through honest and accurate information, interpersonal support and acknowledgment of their caring role within the family. The interdependence of the needs indicated that the fulfilment of one need has the potential of meeting other needs. Unmet needs were comparable to those of adolescent children who have a parent with cancer; as such it was deemed that the new version of the OCNI would be suitable for use with individuals who had a parent with a NCD. Quantitative Research: Ninety-Three percent of adolescents reported at least one unmet need. Analysis suggests that the unmet needs variables were co-dependent and correlated with depression, stress, anxiety, and quality of life. Certain unmet need variables predicted stress, anxiety, depression, and quality of life. Conclusion: The findings of this thesis indicate that adolescent children who have a parent with a NCD have a variety of unmet needs, and that these are associated with affective state and well-being. It is suggested that counselling psychologists are well placed to provide psychological and needs based interventions based upon the findings within this thesis. More research is required in this area to determine cause and effect; owing to counselling psychologists working with the lifespan they would be well placed to further the knowledge in this area.

The social work practice problem of this doctoral action research project was the unmet mental health needs of veterans 65 and older in Puerto Rico. This action research project explored the experiences and challenges of social workers when they offer mental health services to veterans 65 and older. This study was framed using social support theory, integrating the 3 core elements of tangible support, emotional support, and informational support. The data collection technique included a semistructured interview protocol used in a focus group setting. Purposive sampling was used to identify 9 participants who were licensed social workers in Puerto Rico. Through content analysis, the findings were coded and organized into the following themes: educational background; ethics and wellbeing aspects; evaluation, interventions, and treatments; professional social and cultural competencies; social support experiences; multidisciplinary service coordination processes; and the elderly veterans' unmet needs. The results of this study could be used by social workers and administrators to contribute to positive social change through the improvement of social work practices and the development of innovative knowledge when intervening with veterans 65 and older and their families in Puerto Rico.

Master of Philosophy (Medicine) / Health care evaluation serves the purpose of monitoring the quality of health care provided by Health Care Providers (HCP), so that health care services can be provided most effectively and efficiently. Patient satisfaction studies are widely used to assess the quality of outpatient care. A client satisfaction study was conducted at an HIV health care facility in Sydney, Australia during 2007-2008. There were three objectives: 1.) To validate a questionnaire for future determination of client satisfaction in HIV health care facilities. 2.) To identify the levels of satisfaction of clients, and investigate any dissatisfaction and unmet needs towards HIV health care. 3.) To provide recommendations for improving client satisfaction levels in HIV health care. This research used a mixed method approach and consisted of two phases. The first phase was a quantitative survey conducted with 166 clients (both HIV positive and negative) at Albion Street Centre (ASC) using a newly-devised questionnaire. Clients were asked to answer demographic questions, rate their levels of satisfaction with each aspect and each HCP category, and provide suggestions for improvement. Quantitative statistical analysis was conducted to obtain a general view of client satisfaction levels. Dissatisfaction and unmet needs of clients were then investigated in-depth in the second phase of the research through qualitative face-to-face semi-structured interviews. Twenty-two clients (both HIV positive and negative) at ASC were interviewed individually and asked about their attitudes, perceptions, and experiences towards their HCP and the HIV health care services received. Thematic analysis was used to categorise and interpret the qualitative data. More than 90% of the clients were satisfied with most of the aspects covered in the survey, with a mean overall satisfaction score of 84 out of 100. Clients were most iii satisfied with the “technical quality” and “interpersonal manner” of the HCP, and were least satisfied with “waiting time” and “availability of HCP”. The HCP category with which the clients has the highest level of satisfaction was “nurses” (86%), followed by “psychologists” (84%), then “doctors” (83%). Clients who were HIV negative, had a full time job, visited ASC less frequently, or did not possess any type of Health Care Card were more satisfied with the services overall. No common dissatisfaction or unmet needs towards HIV health care service were identified. “Technical quality of HCP” and “the relationship with HCP” were the two most important determinants of client satisfaction, which outweighed the inconvenience contributed by the poor availability of HCP and the location of ASC. The maintenance of “confidentiality/privacy” was shown to be fundamental in HIV health care facilities. The multi-disciplinary nature of ASC increased the degree of convenience and satisfaction level among clients. Suggestions for improvement in client satisfaction levels include increasing the attractiveness of the physical environment and the variety of educational reading materials in the waiting area; introducing beverages, and encouraging clients to be involved in their treatment decisions. Health care administrative staff in particular are reminded not to neglect the importance of the availability of HCP, accessibility, and physical environment when establishing a new HIV health care facility. The mixed method approach (quantitative survey and qualitative interviews) proved beneficial. It increased the validity of the findings by assessing client satisfaction levels using more than one method. This enabled clarification of ambiguities noted in the initial survey through probes used in the interviews, and also allowed investigation of the determinants of client satisfaction through understanding their experiences in HIV health care. Future client satisfaction studies would benefit from using this approach.

As the number of cancer survivors continues to rise, there is an increasing need for psychological research to better understand and help individuals cope with their cancer journey. According to Socioemotional Selectivity theory (SST), shortened time perspective and mortality awareness heighten the importance of social and emotional goals. In the present analysis, SST is applied to the unmet needs of cancer survivors. This is done to provide a better understanding of the association between unmet needs of cancer survivors and the impact of such needs on the survivors' psychological well-being, especially in the case of survivor’s awareness of his/her mortality. In keeping with SST theory, we anticipated that for those with higher mortality awareness (e.g., recurrence of cancer, older age, greater mortality ratio), high unmet social and emotional needs, above else, will be associated with lower psychological well-being. Partial support was found for these hypotheses and results are discussed in terms of their contribution to a better understanding of the nature of psychological well-being of cancer survivors.

Introduction: Cancer survivors continue to experience psychological distress and challenges in their daily lives long after the completion of treatment. Caregivers play a pivotal role in the lives of cancer survivors by providing support in various domains of their lives. The cancer experience between support persons and cancer survivors is intertwined. The interdependence theory will serve as a theoretical framework to guide the purposes of this study. Objective:The purpose of this research was to gain a better understanding of unmet needs of caregivers supporting long-term cancer survivors and explore how fulfilling the needs of caregivers influenced the psychological well-being of cancer survivors. Specifically, an emphasis was placed on exploring the level of dependence present in marital relationships, and how this impacted the relationship between caregiver unmet needs and the psychological outcomes of cancer survivors. Method: Data was drawn from The Cancer Support Persons’ Unmet Needs Survey (SPUNS) (Campbell et al., 2009) and The Cancer Survivors’ Unmet Needs Survey (SUNS) (Campbell et al., 2009). Regression models tested for significant interactions between caregiver unmet needs and factors influencing survivor dependence with psychological distress in cancer survivors. Results: Findings revealed main effects between caregivers’ depression, anxiety, and stress with the respective psychological outcomes in cancer survivors. Caregivers’ concerns about the future predicted elevated depression in cancer survivors. Caregivers with needs pertaining to information or emotions predicted higher anxiety in cancer survivors. Information needs, future concerns, and health care access and continuity needs of caregivers predicted higher survivor stress. Conversely, work and financial needs of caregivers predicted lower depression, anxiety and stress in cancer survivors. Significant interactions were found for caregivers’ concerns about the future by recurrence of diagnosis with decreased survivor anxiety, health care needs of support persons by recurrence of illness with increased survivor anxiety, caregivers’ personal needs by severity of illness with higher survivor anxiety, support persons’ emotional needs by severity of illness with lower survivor anxiety, caregivers’ emotional needs by severity of illness and decreased survivor stress, and finally, support persons’ health care needs by severity of illness with higher survivor stress. Conclusion: Findings did not fully support the hypotheses of this present study. Nonetheless, the significant results revealed in the findings would be useful to generate alternative hypotheses in future studies regarding interdependence, unmet needs and psychological well-being. The findings for the present study will also provide direction towards improvement in treating caregivers and cancer patients as a conglomerate, and inform programs, services and policies in cancer care.

Introduction: Cancer survivors continue to experience psychological distress and challenges in their daily lives long after the completion of treatment. Caregivers play a pivotal role in the lives of cancer survivors by providing support in various domains of their lives. The cancer experience between support persons and cancer survivors is intertwined. The interdependence theory will serve as a theoretical framework to guide the purposes of this study. Objective:The purpose of this research was to gain a better understanding of unmet needs of caregivers supporting long-term cancer survivors and explore how fulfilling the needs of caregivers influenced the psychological well-being of cancer survivors. Specifically, an emphasis was placed on exploring the level of dependence present in marital relationships, and how this impacted the relationship between caregiver unmet needs and the psychological outcomes of cancer survivors. Method: Data was drawn from The Cancer Support Persons’ Unmet Needs Survey (SPUNS) (Campbell et al., 2009) and The Cancer Survivors’ Unmet Needs Survey (SUNS) (Campbell et al., 2009). Regression models tested for significant interactions between caregiver unmet needs and factors influencing survivor dependence with psychological distress in cancer survivors. Results: Findings revealed main effects between caregivers’ depression, anxiety, and stress with the respective psychological outcomes in cancer survivors. Caregivers’ concerns about the future predicted elevated depression in cancer survivors. Caregivers with needs pertaining to information or emotions predicted higher anxiety in cancer survivors. Information needs, future concerns, and health care access and continuity needs of caregivers predicted higher survivor stress. Conversely, work and financial needs of caregivers predicted lower depression, anxiety and stress in cancer survivors. Significant interactions were found for caregivers’ concerns about the future by recurrence of diagnosis with decreased survivor anxiety, health care needs of support persons by recurrence of illness with increased survivor anxiety, caregivers’ personal needs by severity of illness with higher survivor anxiety, support persons’ emotional needs by severity of illness with lower survivor anxiety, caregivers’ emotional needs by severity of illness and decreased survivor stress, and finally, support persons’ health care needs by severity of illness with higher survivor stress. Conclusion: Findings did not fully support the hypotheses of this present study. Nonetheless, the significant results revealed in the findings would be useful to generate alternative hypotheses in future studies regarding interdependence, unmet needs and psychological well-being. The findings for the present study will also provide direction towards improvement in treating caregivers and cancer patients as a conglomerate, and inform programs, services and policies in cancer care.

As the number of cancer survivors continues to rise, there is an increasing need for psychological research to better understand and help individuals cope with their cancer journey. According to Socioemotional Selectivity theory (SST), shortened time perspective and mortality awareness heighten the importance of social and emotional goals. In the present analysis, SST is applied to the unmet needs of cancer survivors. This is done to provide a better understanding of the association between unmet needs of cancer survivors and the impact of such needs on the survivors' psychological well-being, especially in the case of survivor’s awareness of his/her mortality. In keeping with SST theory, we anticipated that for those with higher mortality awareness (e.g., recurrence of cancer, older age, greater mortality ratio), high unmet social and emotional needs, above else, will be associated with lower psychological well-being. Partial support was found for these hypotheses and results are discussed in terms of their contribution to a better understanding of the nature of psychological well-being of cancer survivors.

Master of Philosophy (Medicine) / Health care evaluation serves the purpose of monitoring the quality of health care provided by Health Care Providers (HCP), so that health care services can be provided most effectively and efficiently. Patient satisfaction studies are widely used to assess the quality of outpatient care. A client satisfaction study was conducted at an HIV health care facility in Sydney, Australia during 2007-2008. There were three objectives: 1.) To validate a questionnaire for future determination of client satisfaction in HIV health care facilities. 2.) To identify the levels of satisfaction of clients, and investigate any dissatisfaction and unmet needs towards HIV health care. 3.) To provide recommendations for improving client satisfaction levels in HIV health care. This research used a mixed method approach and consisted of two phases. The first phase was a quantitative survey conducted with 166 clients (both HIV positive and negative) at Albion Street Centre (ASC) using a newly-devised questionnaire. Clients were asked to answer demographic questions, rate their levels of satisfaction with each aspect and each HCP category, and provide suggestions for improvement. Quantitative statistical analysis was conducted to obtain a general view of client satisfaction levels. Dissatisfaction and unmet needs of clients were then investigated in-depth in the second phase of the research through qualitative face-to-face semi-structured interviews. Twenty-two clients (both HIV positive and negative) at ASC were interviewed individually and asked about their attitudes, perceptions, and experiences towards their HCP and the HIV health care services received. Thematic analysis was used to categorise and interpret the qualitative data. More than 90% of the clients were satisfied with most of the aspects covered in the survey, with a mean overall satisfaction score of 84 out of 100. Clients were most iii satisfied with the “technical quality” and “interpersonal manner” of the HCP, and were least satisfied with “waiting time” and “availability of HCP”. The HCP category with which the clients has the highest level of satisfaction was “nurses” (86%), followed by “psychologists” (84%), then “doctors” (83%). Clients who were HIV negative, had a full time job, visited ASC less frequently, or did not possess any type of Health Care Card were more satisfied with the services overall. No common dissatisfaction or unmet needs towards HIV health care service were identified. “Technical quality of HCP” and “the relationship with HCP” were the two most important determinants of client satisfaction, which outweighed the inconvenience contributed by the poor availability of HCP and the location of ASC. The maintenance of “confidentiality/privacy” was shown to be fundamental in HIV health care facilities. The multi-disciplinary nature of ASC increased the degree of convenience and satisfaction level among clients. Suggestions for improvement in client satisfaction levels include increasing the attractiveness of the physical environment and the variety of educational reading materials in the waiting area; introducing beverages, and encouraging clients to be involved in their treatment decisions. Health care administrative staff in particular are reminded not to neglect the importance of the availability of HCP, accessibility, and physical environment when establishing a new HIV health care facility. The mixed method approach (quantitative survey and qualitative interviews) proved beneficial. It increased the validity of the findings by assessing client satisfaction levels using more than one method. This enabled clarification of ambiguities noted in the initial survey through probes used in the interviews, and also allowed investigation of the determinants of client satisfaction through understanding their experiences in HIV health care. Future client satisfaction studies would benefit from using this approach.

Caregivers while, the biggest providers of palliative care for terminally sick patients, are often neglected in the process of providing care, which inadvertently affects their overall health and well-being. This study aims to explore the experiences of the unmet needs of the caregivers in palliative care. The literature review is based on seven quantitative, four qualitative and one mixed methodology approach studies. Results show a shortage of information given to caregivers regarding disease progression, symptomatology, support services and financial services. Furthermore the themes of unmet needs that emerged are physical, psychological, emotional, social and spiritual needs. Caregivers also reported the shortage of standard services provided by healthcare sector.  A healthy relationship scenario, where caregivers are supported to look after themselves as well as their loved ones, would boost the support they render to the patients.  The provision of needed services to caregivers, nurses, and healthcare personnel is required to fulfill a healthy relationship and further develop it by learning from the caregivers’ experiences. In conclusion, effective communication between caregivers and care providers is found to be a prerequisite for building trust and could contribute to satisfy the informational, medical, social and spiritual needs while helping to decrease health strains of caregivers.

Mental illness is far higher among prisoners than in general populations, especially for female prisoners. Previous research has discovered that traumatic experience plays a crucial role in the development of psychiatric disorder and other mental health issues in female prisoners. The present paper reviews eight articles, investigating into the negative outcomes associated with trauma-related mental health issues for female prisoners, and how their trauma-related mental health needs are addressed in prison. Systematic text condensation was used to discover similar themes and meanings throughout the articles. The results found a high prevalence of unrecognized and misdiagnosed trauma-related mental health issues across the articles, in particular post-traumatic stress disorder, with treatment having too much focus on substance abuse rather than addressing trauma directly. The review concludes that current prison screening measures and interventions do not identify trauma-related mental health issues adequately or address trauma directly. As a result, prison services do not meet the complex trauma needs of women. Further research needs to be conducted in this area for this population, as trauma-specific treatment is in its infancy.