This thesis explores in which ways and why research informs and influences the public policy making process, and the extent to which existing theories and models add to our understanding of this. Since the late 1990s, the UK government has aspired to evidence-based policy making, particularly policy that is informed by research on what works. In practice, there are many barriers to this aspiration and the instrumental research use of 'what works' knowledge seems relatively rare. Existing research utilisation models offer some insights into why this is the case but they are not well supported by empirical evidence and they tend to underplay the complexities of the policy making process. Additional insights are provided by the literature on the policy process, but this does not pay much attention to research use. This thesis thus combines these perspectives. The thesis is guided by a conceptual framework that combines insights from the advocacy coalition framework (ACF), the stages heuristic, the research utilisation typology, practical rationality and the epistemic communities framework. Two qualitative case studies of Scottish national mental health policy making are considered using this conceptual framework: a suicide prevention policy and a review of mental health law. Data analysis combines 23 in-depth interviews and extensive document review. The ACF is used as a heuristic device to focus on aspects of the policy sub-system that are key to understanding research use. The findings demonstrate that despite limited research evidence on what works in mental health, research was used in the agenda setting and formulation stages of the policy making process, enriching the process and influencing policy sub-system dynamics. Five types of research use are identified; they do not occur in isolation but are layered and interlinked, and are at times contingent on one another. Research use is found to be bound up with the ways in which those involved in the policy making process work with others who share or oppose their policy beliefs, using similar or different knowledge bases. Research influenced policy beliefs, which in turn influenced policy making behaviour. Discussion of research enabled the inclusion, consideration and appreciation of new and different policy positions. It empowered weaker coalitions as well as cementing coalition dominance. It influenced policy direction and encouraged innovation and policy learning. The findings indicate that the current common usage of three categories of research use (instrumental, conceptual and political) may be too crude; real benefit was gained from applying Weiss' original seven research use types. Combining Weiss' research utilisation typology with the ACF deepened understanding of how research influences the policy making process. The findings only partially support the ACF hypotheses concerning research use, and they highlight weaknesses in a number of the ACF's assumptions and definitions. In terms of policy implications, the findings indicate a need to broaden governments' view of research use from an almost exclusive focus on the problem-solving use of 'what works' research knowledge to a wider appreciation of the ways in which research contributes to and enhances policy making.

The present doctoral thesis focuses mainly on the experiences of 20 women and men of becoming and being parents of a prematurely born child and on their perceptions of their contacts with health and medical care services. An additional aim was to investigate the utilisation of health care during the first year of life and its relation to high-risk diagnoses in the neonatal period. Data were obtained by interviews of the 20 sets of parents to infants born at a gestational age of <34 weeks with no serious congenital defects. These parents were interviewed 1-2 weeks after the infant’s birth and at 2, 6 and 18 months of age. The interview texts were subjected to phenomenological and content analysis. Data was also obtained from the records of 36 infants born at a gestational age of <31 weeks and with a birth weight of <1500 g and 36 full-term infants. The records included information regarding contact with health care services including the child health centres (CHCs) and the outpatient clinics of the paediatric and ophthalmic clinics. Finally data from the other two quantitative studies were obtained from three questionnaires: Quality of Care from The Patient’s Perspective, The Swedish Parenthood Stress Questionnaire and The Toddler Behaviour Questionnaire. The result of the studies showed that the utilisation of health care by the very low birth weight infants was higher than that by the fullterm infants in paediatric and ophthalmic outpatient clinics. High-risk diagnoses in the neonatal period did not correlate with utilisation of care except for visits to the paediatric outpatient clinic, especially planned visits. The internalisation of parenthood was described by the parents as a time-dependent process, with four syntheses of experiences – alienation, responsibility, confidence and familiarity. The development and construction of the mothers’ and fathers’ parental identity followed a pattern that could be summarised into three themes: Unexpected start of parenthood, integration of parenthood into the sense of identity and recognition of parental identity. Important turning points in experiences of parenthood often occurred when the infant could be removed from the incubator, when it was discharged from the ward, and when the infant appeared normal compared to full-term infants. The quality of care was judged, from the parents’ and nurses’ perspective. In general the subjective importance of the given care was rated higher than the care actual given in both neonatal care and care at the CHCs. Higher ratings were given to neonatal care compared with the care at CHSs for medico-technical competence. It was also of importance, of both parents, to receive an optimal identity-oriented approach and socio-cultural atmosphere in the neonatal care and the care at the CHSs. High-risk diagnoses in the newborn did not affect the answers. Parental stress of very preterm children, at 18 months of age, did not differ notably from those parents of children born somewhat less premature, but they assessed their children as being rather later in the development of social behaviours. Parents of children who had had a difficult neonatal period were not more stressed when the child was 18 months old than those who had no problems in the neonatal period. In sum, this research project showed that the parents’ expectations and experiences of becoming mothers and fathers in preterm birth was a process of integrating the unexpected start of parenthood into the parents’ sense of identity and their way of being. When the parents developed a relationship with the infant, actively participated in its care on the basis of their own preferences, and received recognition as parents, this process was strengthened. It is therefore important that the professional caring of the staff should meet and involve the natural caring of the parents.

The purpose of this study was to describe the utilisation of maternal and child health (MCH) care services by mothers from four selected health facilities in the Balaka District of Malawi. A non- experimental quantitative descriptive research was conducted to determine the knowledge of mothers with regard to MCH services and to identify factors that impact on the utilisation of the MCH care, based on the Andersen’s behavioral model of health services utilization. A combination of proportionate stratified sampling and convenience sampling was used and data was collected by means of self-administered questionnaires. It was found that mothers know the available services and that a number of factors have an impact on the utilisation of health care services. These relate amongst others to educational level, finances and cultural beliefs. / Health Studies / M.A. (Public Health)

The purpose of this study was to describe the utilisation of maternal and child health (MCH) care services by mothers from four selected health facilities in the Balaka District of Malawi. A non- experimental quantitative descriptive research was conducted to determine the knowledge of mothers with regard to MCH services and to identify factors that impact on the utilisation of the MCH care, based on the Andersen’s behavioral model of health services utilization. A combination of proportionate stratified sampling and convenience sampling was used and data was collected by means of self-administered questionnaires. It was found that mothers know the available services and that a number of factors have an impact on the utilisation of health care services. These relate amongst others to educational level, finances and cultural beliefs. / Health Studies / M.A. (Public Health)