The role of community pharmacy (CP) in health promotion has developed over the last decade and a half following the introduction of the new National Health Service (NHS) plan in 2000. CPs have been turned into healthy living centres where individuals can access a variety of services designed to prevent disease and promote health. In 2005, three types of pharmacy service were introduced; essential, advanced and enhanced (currently known as locally commissioned). Enhanced pharmacy services were provided by Primary Care Trusts (PCTs) (until 2010) based on local needs identified by PCTs. In 2010, the Government decided to abolish the PCTs by 1‘"t April 2013; hence, PCTs entered a transition phase between 2010 and April 2013. By February 2011, each PCT was required to publish Pharmaceutical Needs Assessment (PNA) report regarding the provision and need for pharmacy services. The national commissioned vascular and sexual health enhanced pharmacy services in England are Stop Smoking Service (SSS), NHS health check, Emergency Hormonal Contraception (EHC) and chlamydia screening and treatment services. In 2012, the Healthy Living Pharmacy (HLP) scheme, which was piloted in Portsmouth PCT, was expanded to 30 PCTs known as HLP pathfinder PCTs. The aim of this research was to identify the correlation between needs, provision and uptake of vascular and sexual health pharmacy services at a PCT and CP level. It also aimed to investigate whether the provision of those services was cost effective. Finally, it aimed to determine the impact of the introduction of the HLP scheme on the provision and uptake of those services. At a PCT level, the PNA reports were used to identify the CP provision of SSS, EHC service and chlamydia screening service for the financial year 2009/2010. The local need for SSS (prevalence of smoking adults) and EHC services (rates of teenage pregnancy) were obtained from Health Profiles for each PCT. The need for chlamydia screening service (prevalence of positive chlamydia infection) was obtained from the National Chlamydia Service Programme (NCSP). Uptake and cost attributed to provision of those services for the financial year 2009/2010 were obtained from a short questionnaire targeted the public health leads for the related services in PCTs where the provision of services and the needs were identified. Simple cost-effectiveness analyses were performed on CP SSS and CP EHC provision, based on identified uptake and cost. At a CP level, a cross-sectional survey was conducted on 1 249 CPs in 28 PCTs across England in 2013. PCTs were chosen based on provision of SSS, EHC and chlamydia screening service identified in the PNA reports. 7 PCTs out of 28 PCTs were HLP pathfinder PCTs. CPs were allocated to one of five groups based on deprivation. The response rates for SSS, EHC and chlamydia screening surveys were 30% (42/138), 30% (42/139) and 19% (21/111) respectively. Data analysis identified that the need for SSS and EHC services were highly correlated with deprivation, with Spearman's rank correlation coefficients (rho) of 0.76 and 0.83 respectively (both P 0.001). The correlation between deprivation and the need for a chlamydia service was weak (rho = 0.25, P = 0.009). Higher number of CPs per 25 000 population were observed in more deprived PCTs (rho = 0.63, P < 0.001). CP provision (percentage of CPs offering a service out of total CPs in a PCT) of SSS, EHC and chlamydia service did not correlate with needs. The uptake of SSS, EHC and the chlamydia screening service did not correlate with increasing need or deprivation. However, pharmacists in areas of higher need dealt with a greater number of clients in relation to SSS and EHC services to meet their local needs, with rho of 0.4 and P of 0.01 in case of SSS and Pearson's correlation coefficient (R) of 0.36 and P of 0.02 in case of EHC. A cost-effective analysis of CP SSS provision found it to be cost effective when compared to no intervention based on NHS perceptive and the incremental cost per Quality Adjusted Life Year (QALY) gained. was £1 511. Similarly, the CP EHC service was also found to be cost effective with an NHS saving of £689 per unintended pregnancy prevented. The response rate for the CP survey was 19.3% (241/1 249). No significant differences were identified in terms of provision or uptake of SSS, EHC, chlamydia screening and NHS health check services between CPs with different deprivation neighbourhoods. 18.5% (31/168) of the respondent community pharmacists were working in HLPs. The uptake of SSS through HLPs (median = 6) was higher than that through non-HLPs (median = 4; P = 0.02)._Playing a more active role in health promotion was cited as the main driver for pharmacists to adopt an HLP scheme. Respondent pharmacists indicated that the introduction of an HLP scheme had improved public awareness of vascular and sexual health services available in CPs and they suggested the use of social media websites to further improve public awareness. Lack of time and the provision of similar services via other providers were considered the main barriers. Local Authorities should increase the provision of vascular and sexual health pharmacy services to meet the needs of their localities. They should use the latest technology to improve public awareness regarding availability of those services in CPs.

The re-conceptualisation of stroke unit provision towards acute and hyperacute care has been a relatively recent development in the United Kingdom. This hermeneutic phenomenological study aimed to explore how the acute stroke unit (ASU) experience, as the phenomenon of interest, was meaningfully lived from a human lifeworld perspective. Eight participants: four stroke survivors and four healthcare practitioners: took part in semi-structured interviews, and if they agreed, an optional creative element. Interviews were recorded then transcribed. Detailed hermeneutic analysis drawing on interpretative phenomenological analysis (IPA) was undertaken firstly on each person’s account, and then across the collective from each perspective. An additional close textual reading was developed for one stroke survivor and one healthcare practitioner. A particular feature of the analysis was its influence in generating an innovative graphic interpretation of the research findings. The stroke survivors experienced the ASU as a lived space in two differentiated forms. The ASU holding space, through the spatial practices of nurses, and others, including similar others (patients), was understood to provide them with protection and safe haven; holding them intimately but also at a distance, so that they could think, make sense, plan and work towards transition. The transitional space of the ASU was experienced by three of them in more disparate ways, and represented how they transitioned their self (for protection, necessity and for recovery) in response to the stroke, the hospital space and the spatial practices of the ASU. The healthcare practitioners experienced the ASU as a space that they produced and appropriated for themselves and others. This was intertwined with their work as existential project; through their relationships with others, and their contribution to patients’ transitional work, they were understood to experience authenticity and belonging. This project was always in the making, and was undertaken amidst the day-to-day pressures on the unit. As a result, three of the health practitioners looked to make sense, navigate, and survive the vulnerability they experienced in relation to their meaningful work, as part of their ASU experience. Further synthesis of these two horizonal1 perspectives elucidated 3 key areas of new insight and understanding: the spatiality of the lived experience of the acute stroke unit, suffering and thriving as a human being, and the intertwining of multiple selves in time and place. The implications of this new knowledge for clinical practice, education, and research are further discussed in this thesis.

The purpose of the research is to examine the wage-gap that occurs among men and women working in health professions. The data used for this research is drawn from the 2004 Current Population Survey (CPS). Data analysis reveals that there is a 61% wage-gap that occurs among men and women in health professions. / Thesis (M.A.)--Wichita State University, College of Liberal Arts and Sciences, Dept. of Sociology.

The majority of research on academic procrastination has been conducted among undergraduate students, and there is relatively little research investigating procrastination among doctoral students. PhD students are different from undergraduates: they might need a higher level of self-regulatory ability to conduct research. The aim of this thesis was to fill the research gap in the investigation of academic procrastination among PhD students in the UK. More specifically, the current investigation combined different perspectives to examine the extent to which PhD students procrastinate, explores the relationships between a variety of psychological variables, doctoral satisfaction and academic procrastination, and identifies the antecedents and influence of procrastination in relation to PhD students’ own experience. This thesis comprises three studies. Firstly, a cross-sectional study (N=285) was conducted in order to assess the relationship between doctoral satisfaction, Big Five personality traits, self-efficacy, self-esteem, anxiety, depression, and academic procrastination. In Study 2, a longitudinal research design was employed to examine the stability of the identified relationships over a 12-month period (N=79). The results indicated that doctoral satisfaction and depression had long-term influence on PhD students’ procrastinatory behaviour. In addition, conscientiousness was found to have an effect on academic procrastination only in the cross-sectional study, while openness was found to predict procrastination longitudinally. Moreover, doctoral satisfaction also had meditional effect on the relationship between personality traits, self-efficacy, anxiety, and procrastination. In Study 3, the antecedents and consequences of academic procrastination in terms of UK PhD students’ own perspectives were explored in twenty-one in-depth interviews. Data were thematically analysed and a description of the themes concerning antecedents, positive and negative consequences of procrastination, and coping strategies used to help reduce procrastination, is provided. The findings indicates that PhD students’ procrastination is a multifaceted phenomenon with cognitive, affective, and behavioul factors influencing its likelihood. Causes and effects of academic procrastination among PhD students are discussed on the basis of findings from the quantitative and qualitative studies, by considering individual differences, psychological state, and contextual factors in a new conceptual model of academic procrastination. The findings point to a range of possible procrastination-reduction interventions focused on doctoral satisfaction and psychological wellbeing. The strengths and limitations of this work are discussed.

Substantial benefits can be gained by participating in regular physical exercise, however only a minority of women meet current pregnancy exercise recommendations and there is limited understanding of women’s decision-making regarding exercise in pregnancy. The purpose of this constructivist grounded theory study was to develop a theoretical insight into the factors that influence women’s decisions regarding exercise in pregnancy and how they process the influences and multiple alternatives they encounter. The constructivist approach drew on the subjective researcher/participant interrelationship to co-construct meaning from the data and ultimately render the women’s experiences into theoretical interpretations. The theory presented was built inductively from the experiences of 10 pregnant women who exercised regularly, supplemented by insights from theoretical sampling of fitness experts, internet forums and extant literature. Longitudinal, audio-recorded semi-structured interviews occurred twice during each pregnancy and 6-8 weeks postnatal. Data generation and data analysis ran concurrently and iteratively using the constant comparative method of analysis. Theoretical constructs generated by the data were progressively amplified and clarified through a series of inductive-deductive cycles and theoretical sampling that drove the evolving interview schedules. Theorising ideas in the form of detailed memos was a fundamental part of the analysis and enabled a detailed audit trail to be established. The resultant substantive theory of ‘Accommodating the pregnant self’ conceptualises pregnancy as a transitional period during which women’s self-identity is modified. ‘The exercising self’ was a salient and valued facet of the women’s self-identity and continuing to exercise enabled women to maintain a degree of continuity and control that was integral to their sense of maintaining and to a degree regaining their past valued self. Decisions regarding exercise were influenced by a complex interplay of contextual factors that simultaneously encouraged exercise and rest. This consequently triggered a degree of identity conflict between two domains of their self-identity, ‘the exercising self’ and ‘the pregnant self’. The women reacted to the challenges to their identity through the process of self-identity regulation. Through this process they gradually re-constructed their self-identity to accommodate their pregnant self while contemplating possible future selves against various self and social normative standards. Negotiating conflicting identities was an integral component of the decision-making process, and ultimately resulted in many of the women modifying their activities to accommodate the pressures they faced to conform to social ideologies of ‘the pregnant self’. The theory explores a range of strategies that the women used to deal with identity conflict, particularly drawing on selective perception and self-justification to resolve cognitive dissonance. It also highlights a duality in the factors that influenced their decisions which suggests women’s identity characteristics resulted in a propensity for behaviour to be steered by either internal (personal) or external (relational and environmental) influences. The substantive theory underscores the significance of self-identity in steering the decisionmaking process. The findings provide insight into how women might be better supported to make informed and assured decisions regarding lifestyle choices. The theoretical potential to inform interventions to enhance activity levels in a wider population is highlighted.

The extent and nature of the impact of rheumatoid arthritis (RA) in the feet from the point of view of those with the disease is unknown. Most epidemiological studies of foot involvement in RA have been based upon radiological scoring or the findings of clinicians' examination of feet in clinically based populations. This thesis aimed to explore foot involvement in RA from the perspective of people with the disease integrated with the perceptions of rheumatologists and podiatrists. Three questionnaires were developed de novo through an iterative process of integrating information gained from focus groups, illness narratives and literature reviews. Following piloting, questionnaires sent to participants enquired about symptoms in the feet, the anatomical distribution of those symptoms, and their impact on quality of life from the perspectives of 1040 people with RA, 78 podiatrists and 414 rheumatologists throughout the UK. Additionally, the availability of podiatric services and the usefulness of interventions for foot symptoms and foot function were triangulated from participants. Quantitative data were analysed using SPSS and a process of thematic analysis was used to interpret qualitative data. Results from participants indicated that symptoms due to RA were prevalent in all parts of the foot and ankle but the metatarsophalangeal and ankle joints were most commonly and severely affected. Most people with RA (79%) reported suffering recurrent, moderate or severe foot pain every day. Other symptoms (stiffness, numbness and swelling) were also common. Overall, these findings were greater than those that have been reported previously. Foot complaints were noted to have a profound effect on quality of life, with loss of mobility due to symptoms in the feet, and difficulties finding comfortable footwear, leading to loss of independence, anger, frustration and depression; findings that have not been previously reported in detail. A gap between the need for specialist foot care and receiving such care was highlighted, with a total 82% of respondents having discussed their foot symptoms with their rheumatologist. Amongst these patients 64% had been referred to a podiatrist. Clinicians' assessment practices varied widely both within and between professions. Patients reported that on average rheumatologists examined their hands every 6.2 months, whereas their feet were only examined every 16.5 months; this led some patients to feel that rheumatologists were disinterested in their foot complaints. Additionally, the type of assessment undertaken by clinicians did not fully take account of the issues people with RA were reporting. Issues that were key to patients were quality of life and the ability to participate in valued life activities. Difficulties with obtaining adequate foot health care were noted by those with the disease and clinicians alike. Symptoms in the feet in RA are common, severe and tend to be under-reported by clinicians. Involvement of the metatarsophalangeal joints and ankles is especially troublesome. Motion in these joints is vital for normal propulsive gait. Severe involvement causes reduced mobility and impedes independence with considerable consequences for social integration. Outcome measures that exclude the feet discourage foot examination and thus do not fully account for domains of importance to those with RA. Rheumatologists and podiatrists need to work more closely in order for a more patient-centred service to be developed, where a biopsychosocial approach to foot care would more fully address the needs of people with RA.

Previously documented evidence suggests that motherhood is potentially an important time for change in drug-using behaviour. My research interest for this longitudinal phenomenological study stemmed from practice observations where methadone-treated women struggled to prove their trustworthiness as mothers. They consistently reported frustration in the face of continued professional suspicion of their identity as drugusers. The essence of the phenomenon is therefore described as an existential tension experienced by breastfeeding mothers in methadone maintenance treatment during the first 12 weeks of motherhood. The aim of this thesis is to reveal the previously hidden inter-subjective and social realms of their lived worlds.

The presence of environmental variables associated with the occurrence of podoconiosis was indicated in studies by Price in the 1970s. Observation of red clay soil of volcanic origin and barefoot people in podoconiosis-endemic areas were starting points for investigating these factors. Recently, demonstration of genetic susceptibility to the disease has shown the added value of understanding individual level variations and the presence of gene-environment interactions in the development of podoconiosis. Deeper understanding of which environmental and individual variables determine the development of podoconiosis, and at what spatial scale these variables act, will assist intervention at national and local levels. The present study aims to investigate individual and environmental level variables related to podoconiosis at local scale.

Caesarean birth accounts for a quarter of all births in England and is the most commonly performed operation. Despite this, little is known of how individual women experience planned Caesarean birth. Reviews of the literature reveal that rising rates of Caesarean birth are preceived to be problematic by women ,clinicians and policy makers but women's experiences are either absent from this debate or perceived as universally realised. This qualitative study involved listening to the stories of eight women to reveal how planned Carsarean birth was experienced, understood and constructed.

The aim of the research was to examine the ways in which occupational therapists construct meaning in their professional lives and, in doing so, shed light on the wider dialogue of the meaning of occupation. A secondary aim was to provide a framework to assist occupational therapists to unravel, articulate and position themselves within the meaning of their work. Hermeneutic phenomenology was chosen as a research approach to enable particpants to examine their own actions and for the insider researcher to be visible via hermeneutic reflection.