Thesis Project (M.F.A.)--University of North Carolina at Greensboro, 2005. / "Kala Chaya presents a Sukhad Gokhale film." Title from submission form. Advisor: [??]; submitted to the Dept. of Broadcasting and Cinema.

This study makes an original contribution to the literature on gender differences in health and illness which attempts to explain why 'women get sick and men die'. It focuses on how women and men as parents experience health and illness. It also contributes to studies of motherhood, specifically women's experiences, and extends this by making visible men's experiences of fatherhood. A qualitative study of fifteen working class families, involving both parents, was undertaken. Using a feminist theoretical framework based on parents' lived experiences' of health, I explored gender differences in health status, attitudes and behaviour; and the additional role of material and social resources. Each parent was interviewed three times over the course of a year. Data were also collected using health diaries. The mothers reported more health problems than the fathers. The data lend support to the 'nurturant role hypothesis' ie. that mothers' social role as carer leads them to have different experiences of health and illness from fathers. The mothers experience their role as more stressful than the fathers, particularly with regard to the lack of opportunity to rest. The finding that the 'mothering' role has a significant negative impact on health is supported by data that show that fathers who are more involved in childcare report more health problems than fathers less involved. Three typologies of parenthood have been developed which extend the hypothesis in important ways: (a) the congruence between mothers' ideologies of parenthood and their actual situation; (b) fathers' degree of involvement in childcare; and (c) the congruence between mothers' and fathers' ideologies. An analysis of gender differences in concepts of health adds to the explanation of parents' different health experiences. Finally, the structural context within which women and men carry out their roles as parents helps to account for the health differences found.

„Health for all Children‟ (Hall and Elliman, 2006), gives clear recommendations regarding the screening of young children for possible visual difficulties, the focus of which is the detection of amblyopia, defined as,„poor vision due to abnormal visual experience early in life‟ (Webber and Wood, 2005). This policy with its recommendation of the screening of all children between the ages of 4 and 5 was found to be delivered in many ways by different Health Authorities up and down the UK. This raises various questions, including: „What are the determinants that drive the approach taken in terms of implementing this policy?‟ There is a large body of literature suggesting a link between deprivation/poverty and increased health issues; (Aber et al., 1997; Bramley and Watkins, 2008; Howard et al., 2001; Scott and Ward, 2005). There is also evidence that there is a link to amblyopia specifically, (Williams et al., 2008). This research has looked at links between three variables relating to vision screening for amblyopia in four and five year olds; service costs/funding, practice issues and population characteristics. With regard to the last it looked specifically at levels of deprivation as measured by Indices of Multiple Deprivation, or IMD scores(Noble et al., 2008). IMDscores are a useful way of capturing levels of deprivation in a particular area in that as well as providing an overall „score‟ for deprivation, it is possible to see how this score has been made up from various indicators relating to different aspects of an area. The rationale behind this approach is that where several aspects of an area can be described as involving deprivation, these aspects combine and exacerbate each other producing an effect that is greater than the sum of its parts. This „exacerbation‟ is taken into account in the formula for calculating the overall score. In order to obtain information about cost and practice issues, a questionnaire was issued as a Freedom of Information (FOI) request to each of the 152 Primary Care Trusts (PCTs) which made up the map of service delivery in England at the time of the request. Use of an orthoptist (the key medical practitioner regarding eye muscle control/movement and amblyopia) was found to be the most significant factor in terms of practice and also costs for the screening. In particular, use of an orthoptist resulted in a greater and more up to date range of tests being used as well as in a higher cost for the service. Following this collection of quantitative data, a number of follow up questions were pursued by telephone/email/interview. These „case studies‟ were a sub-sample of orthoptists selected on the basis of peculiarities suggested by their returns from PCTs or because they are „key players‟ regarding the work of orthoptists. One determinant regarding the approach to practice/cost is that eye-care services may be taking account of the socio-economic make-up of an area when deciding how/whether to deliver the screening to the 4 and 5 year olds within it. Using all data and therefore including PCTs that don‟t screen, there was a significant relationship between deprivation and use of orthoptists (p<0.05). Orthoptists are more likely to deliver the screening in areas of deprivation. Practice issues were found to follow from the use of orthoptists as opposed to school nurses/school nurse assistants to deliver the screen. Furthermore, there was an increased cost in using orthoptists to deliver the screen. The „mechanism‟ that results in the use of orthoptists to deliver screening in areas of deprivation, is a combination of this group of professionals engaging actively and using their discretion to commission an orthoptist screen, but alsothe use of a notion of „local justice‟ as exhibited at a textural level in the guidelines on clinical commissioning (as well as in the Hall report itself). Whilst policy exists requiring a thorough visual screen for all children including those in areas of deprivation, it is essentially the conscienceof orthoptists (facilitated by their professional discretion) that ensures that children in areas of deprivation are more likely to receive the screenfrom this key medical practitioner in the area of children‟s eye care.

Health care needs are socially defined and care provision is dependent on these definitions. There is generally poor consideration of the needs of people with genetically determined conditions, especially when they are perceived to be rare. In Britain, sickle cell conditions mainly affect people of African and Caribbean ancestry. Sickle cell is considered to be rare by many health professionals despite the fact that 1 in 10 people from these ethnic groups carry the gene, and that each year more than 200 babies are born with serious sickle cell states in London alone. This study was conducted in two parts. Part 1 examines how much people who with one or more sickle cell genes know about the conditions. It investigates their experiences of and perceived need for health care and their attitudes regarding self-care. The study also examines whether clients have received genetic and other counselling, understood the information provided and whether they were encouraged to use positive health strategies to avoid ill health. Part 2 examines how the socialisation and education of nurses and health visitors may have affected their knowledge of sickle cell conditions. It assesses their experience of caring for people with the conditions and the contributions they could make to patient/client care. Statutory and voluntary sickle cell counsellors were also interviewed regarding the service they provided, their satisfaction with that service and their perceived needs for improving such services. The socialisation of individuals is discussed to show how the different racial groups (ie. largely carers versus clients) involved in the study, develop perceptions of each other, and how this could contribute to misconceptions on both sides as well as to the overall health problems of people with sickle cell conditions. Social environments (ie. housing, employment, education, racism and so on) are also discussed.

It is estimated that there are over 200,000 children in the United Kingdom affected by parental imprisonment each year. Research indicates that these separations are likely to have profound consequences for both parent and child; indeed it is now accepted that in most cases, continuing family contact is a major positive force in the process of rehabilitation and in the well-being of the children of prisoners. There is a growing field of research developing in relation to the families and children of prisoners, highlighting good practice in how schools and other support groups can work with this group to ensure they are full involved in school life. This research however does not consider the extent to which imprisoned fathers are informed about or able to participate in the education of their primary school aged children. This study seeks to examine the facilities and systems in place to allow fathers to keep abreast of the academic progress of their primary school aged children, to participate in their education and therefore be involved in a crucial part of their development. Semi-structured interviews are carried out with three groups of stakeholders– 5 headteachers of primary schools, 10 mothers of the children of male prisoners and 10 male prisoner fathers. The data from these interviews is then analysed and the key themes identified both within stakeholder groups and between them. The study reveals that ‘fatherhood’ is developing; and demonstrates that our social expectations of the role and responsibilities of fathers is moving in an increasingly ‘participatory direction’. There is no work which explores the issues surrounding parental participation by imprisoned fathers in the education of their children. Schools demonstrated that whilst they have developed policies directed to meeting the needs of a wide range of pupils and families, children of imprisoned fathers are, with rare exceptions, neglected. Mothers have a pivotal role to play in any policy directed towards imprisoned fathers’ involvement. Whilst realistic in their expectations, they are not unwilling to facilitate participation and they recognise the potential benefits for their children – not least for the legitimacy it can bring to the school experience. Imprisoned fathers were very positive in their attitudes to the prospect of increased levels of involvement. The study highlights that the barriers to a policy initiative in this field are significant; in addition to the obvious resource implications, the responses of the headteachers interviewed clearly demonstrate considerable hesitation at the prospects of classroom teachers engaging directly (even if remotely) with imprisoned fathers. To have any real prospect of success, the teaching profession would be required to embrace the enterprise and acknowledge its obligations to children whose special needs and indeed rights, have been overlooked.

This thesis presents a series of studies aiming to understand young children's (12 to 41 months of age) distress behaviour during radiological examinations. A multifactorial model is proposed to account for variations in the amount of distress behaviour children exhibit during radiological examinations. By way of testing the model, the research examines the relative contribution of a number of variables to such distress behaviour. The Feasibility Study (n=34) was designed mainly to obtain an overall understanding of the different examinations that young children receive at the Department of Paediatric Radiology in a children's hospital. It involved twelve different examinations. The purposes of the Pilot Study (n=48) were to ensure that it was possible to assess in a systematic way the patterns of behaviour presented by young children undergoing ultrasound scans, and to identify and refine the structure of the instruments to be used in a substantial study which would be submitted to the hospital's Research Ethics Committee. The ultrasound scan was the sole examination observed in this study. The Intervention Study's (n=213) main purpose was to assess whether an approach which involved prior rehearsal of the examination and an active, structured role for the parent and child, was effective in reducing children's distress. For this study, two different examinations, i.e., micturating cystogram and ultrasound scan were included. The aims of the Study of Staff Behaviour (n=41) were to show whether the behaviour of the staff contributed to the child's reduced level of distress during the examination. It comprised observations of the ultrasound scan examinations. The results demonstrated that the ultrasound examination, which was not painful or uncomfortable, was almost as distressing for these young children as an examination (the micturating cystogram) which involved substantial discomfort. Parent-child preparation was not effective in preventing or reducing the children's distress. However, staff behaviour during the initial phase of the examination was an important determinant of the child's subsequent distress behaviour.

The thesis is based on an empirical, longitudinal study of the experiences of 186 first-time, British mothers in dual earner households. These mothers who resumed full-time employment under the statutory maternity leave provisions, are compared with a smaller group of 70 'traditional' British mothers who expected to remain at home, at least for the first year of their children's lives. The study investigates women's experiences at four points after birth, the first when the children were 4-5 months old and the last when they reached three years old. The thesis is focused around four main substantive themes: the resumption of full-time employment following childbirth; the transition to motherhood in the context of the return to paid work; mothers' definitions of their partners' household and childcare contributions; and the availability and experience of support from informal social networks. The data were collected by means of extended interviews with the mothers. A combination of quantitative and qualitative approaches was adopted, both in the fieldwork method and the analysis of the data. The thesis explores the issue of choice versus constraint: the ways in which women construct their experiences of combining motherhood and employment, and the ways in which these experiences are structured and constrained by ideological and situational factors relating to the labour market, marriage, parenthood and social networks.

Tuberculosis is a world-wide problem in less developed countries. In this thesis I report the evaluation of impact, process and objectives of a mass media health education campaign for tuberculosis control developed in Cali, Colombia. The campaign aimed at reducing levels of prejudice against people with this disease and at increasing demand for diagnostic tests. I assessed impact on levels of prejudice using two cross sectional surveys as sources of data. I assessed impact on demand for diagnostic tests with a quasi-experimental evaluation design relying on epidemiological data. I used qualitative and quantitative techniques for assessing the process of the campaign. I used text analysis for assessing the objectives of the campaign, and for identifying the values underpinning these objectives. The results show that the campaign significantly reduced the prejudice, and increased the demand for tests. Process evaluation shows that the campaign managers applied satisfactorily the programme theory of the intervention, that around half of the population was exposed to the campaign, and that it aimed exclusively at reinforcing a medical approach to tuberculosis control, which promoted compliance with medical surveillance, instead of contributing to the creation of an educated public regarding this disease. Assessment of objectives showed that the values underpinning the campaign are Utilitarian which define the worth of human life in terms of its economic productivity. This thesis demonstrates that current evaluation models of health education, which draw only on impact and process, are inappropriate for all those who have an interest at stake in the programme in order to judge its worth and to take policy decisions. Health education programmes are responses to social problems based on a specific idea of what is worthwhile to be pursued by individuals and society. Thus, evaluation research in health education should include not only assessment of impact and process but also assessment of their objectives in order to unveil the values underpinning such responses.

This thesis reports the development in mid-adolescence of a group of children raised in institutions until at least 2 years of age, then adopted or restored to a biological parent. These children were previously followed up at four and a half and at eight years of age. They were compared with a group of individually matched adolescents who had never been in institutional care. IQ depended largely on the type of family placement, and did not appear to be adversely affected by institutionalisation, at least so long as this did not extend beyond age four and a half. The experience of multiple changing caregivers during the period of institutionalisation did not necessarily prevent the children from forming strong and lasting attachment relationships to parents once placed in families, but this too depended on family environment, being much more common in adoptive families. However, some long-term effects of early institutionalisation were apparent. Ex-institutional adolescents showed more behaviour and emotional difficulties than matched comparisons, according to teacher questionnaires and interviews with the adolescents and their parents. They also showed greater orientation towards adult attention, and had more difficulties with peers and fewer close or confiding peer relationships than comparison adolescents, again indicating some long term effects of early institutional experience.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2008. / Includes bibliographical references.