This constructive design research dissertation aims to understand how design can be used as part of a composite research approach to generate knowledge about how complex phenomena are composed through their interactions and relationships with various actors, both human and non-human. It has done this by investigating a single phenomenon, the patient experience of radiotherapy. Through the purposeful selection and application of methods, theories, and existing research from design, nursing, and STS, this thesis utilizes a mixed-method approach comprised of qualitative, quantitative methods, and design experimentation, across multiple research sites and patient populations, in three research projects – PERT, DUMBO, and POIS – to generate rich and layered knowledge of the patient experience. Experience prototypes are used to challenge, through intervention or provocation, the relationships between the various radiotherapy actors identified through the empirical methods. Together, the research generated in PERT, DUMBO, and POIS construct a map of the networked, interdependent actors which shape the patient’s emotional experience of radiotherapy: the staff, technology, information, environment, and institutions. It also calls attention to the problematic relationship between radiotherapy patients and the technologies used to treat them, which can lead to anxiety, worry, and fear. This thesis offers contributions related to both improving patient experience and designing for complex social issues. First, this research suggests that individuals, other than primary users, need to be acknowledged in the design of medical technologies. It proposes calling attention to patients by naming them as interactors in their relationships with the aforementioned technologies, removing them from the role of implicated actor. Second, this thesis problematizes treating the actors within a network as independent entities, which medical research and user-centered design often does, and calls for a new type of design practice which attends to these networked relationships. Third, this thesis suggests two ways in which design research practice should be shifted methodologically if it wants to engage with and design for complex social issues like patient experience; widening the researcher’s perspective on the issue through the use of a composite methodology, and having the researcher maintain this scope by remaining closely connected to their research context. The implications of this work concern how design research, design education, and design practice might shift their approaches to fully acknowledge and attend to the complexity of systems like healthcare.

Published Article / This paper reports on a mixed methods study that investigated access to, use, and perceptions of current and emerging technologies among Information Technology (IT) staff and students at universities of technology (UoTs) in South Africa. Fifty-eight IT staff and 410 IT students from 4 UoTs participated in the study. The primary research instrument was an online survey questionnaire, which was supplemented by semi-structured interviews with 31 of the study participants. Web investigations and conversations with IT support staff from UoTs also formed part of the mixed methods employed in the study. The findings of the online survey are analysed both from individual institutional perspectives and in aggregate form representative of the sector as a whole. Cross tabulations are used to analyse the data across institutions. The quantitative analysis reveals interesting trends and patterns in how students and staff are taking advantage of the potential held by Information and Communication Technologies (ICTs) for teaching and learning and for use in their daily lives. The qualitative findings question the assumptions that have been made about a digital divide between digital native students and their digital immigrant lecturers, suggesting that we need to develop a more sophisticated understanding of the role that technologies play in the lives of both students and staff. Results indicate that while students are very enthusiastic about using various ICTs and Web 2.0 tools, most have still to be convinced about their use for formal academic functions. Academic staff, on the other hand, continues to be cautiously optimistic about the use of ICTs in teaching and still harbour a number of concerns.

The studies included in this dissertation investigated the experiences of individual romantic partners as secret keepers and couples as collective secret keepers. Study 1 investigated the topics of secrets kept by individual romantic partners and public perception of secret keeping in the context of romantic relationships via qualitative content analysis. The analysis of secret topics resulted in the following themes: (1) secrets about the Redditors’ relationship, (2) secrets about the Redditor, and (3) a discussion of secrecy. The analysis of public perception resulted in the following themes: (1) normalization, (2) advice, (3) comfort, (4) personal reactions, and (5) a request for more information. Study 2 investigated the experiences of collective secret keepers. Inductive analysis was used in the analysis of participants’ (n = 522) responses to questions investigating: (1) the topics of collective secrets, (2) the reasons for keeping or disclosing the secret, and (3) the reasons for disagreeing over the disclosure of the secret. Further analyses revealed a relationship between secret topic and the overall relational impact of collective secret keeping (F(27, 385) = 1.64, p < .05, 2 = .10); some topics were found to be more distancing than others. A relationship between relationship satisfaction and disagreement between spouses over the disclosure (F(1, 310) = 5.83, p < .05, η2 = .02) was also found; disagreement on the disclosure of a secret was found to result in lower relationship satisfaction. Study 2 also investigated the relationship between collective secret functions and relational outcomes via multilevel modeling. A relationship between secret functions and the following relational outcomes were found when the collective secret was kept: relational impact (χ2= 14.18, df = 1, p < .001), relational closeness (χ2= 14.18, df = 1, p < .001), and relationship satisfaction (χ2= 17.60, df = 1, p < .001). A relationship between secret functions and the relational impact was also found when the collective secret was disclosed (χ2= 3.12, df = 1, p < .10).

The National Health Insurance Scheme (NHIS) in Ghana was introduced to alleviate the problem of citizens having to pay for healthcare at the point of delivery, given that many did not have the financial resources needed to do so, and as such were unable to adequately access healthcare services. The scheme is managed from the national headquarters in the capital Accra, through satellite offices located in districts right across the length and breadth of the country. It is the job of these offices to oversee the operations of the scheme within that particular district. Current literature however shows us that there is a digital divide that exists between the rural and urban areas of the country which has led to differences in the management of information within urban-based and rural-based districts. This thesis reviews the variables affecting the management of information within the scheme, and proposes an information management model to eliminate identified bottlenecks in the current information management model. The thesis begins by reviewing the theory of health insurance, information management and then finally the rural-urban digital divide. In addition to semi-structured interviews with key personnel within the scheme and observation, a survey questionnaire was also handed out to staff in nine different district schemes to obtain the raw data for this study. In identifying any issues with the current information management system, a comparative analysis was made between the current information management model and the real-world system in place to determine the changes needed to improve the current information management system in the NHIS. The changes discovered formed an input into developing the proposed information management system with the assistance of Natural Conceptual Modelling Language (NCML). The use of a mixed methodology in conducting the study, in addition to the employment of NCML was an innovation, and is the first of its kind in studying the NHIS in Ghana. This study is also the first to look at the differences in information management within the NHIS given the rural-urban digital divide.

This study addresses issues concerning religion in the public sphere, brought about by the debates over the perceived resurgence of religion and the post-secular. The aim is to analyze the participation of religious actors in the public, using three newspaper debate pages as the empirical material. Building on theories by Casanova, especially his concept of public religions, as well as mediatization theory and Habermas' writings on religion in the public sphere, 639 opinion pieces signed by religious actors were analyzed. The mixed-methods content analysis was conducted in two steps: first a quantitative overview of the religious actors published, to what extent and on what issues. The second step consisted of three qualitative case studies based on the results of the first step: an argument analysis of the debate over same-sex marriage; an exploration of the specific position of the Church of Sweden and the idea of the national church as a public utility; and finally a discourse analysis of articles by Jewish and Muslim authors. These were analyzed on the basis of criteria for public religions developed from Casanova’s theory and from the media logic of debate articles. While the results show no clear increase in the number of religious actors during the period under scrutiny, one notices a clear presence of Muslim and Jewish actors, eventhough Christians of varying denominations dominate the material. There are also clear differences between the different religions: minority religion contributions are limited in terms of issues and scope, while Christian groups write about more varied issues. Muslims often relate to negative media discourse towards Islam, while Jewish signatories write on a limited number of themes closely related to the group itself. In many articles, one found a meta-debate over the place of religion in the public sphere even when specific issues were debated. The contribution of this dissertation is to critically discuss the concepts and assumptions underlying the debate over the place of religion in the public sphere. It stresses the importance of media perspectives as well as empirical studies for analyzing issues of authority, visibility, private/public and religion in late modern, mediated contexts. / The Impact of Religion - Challenges for Society, Law and Democracy

With the introduction of the UK Government’s inclusive ideology in the late 20th century, increased pressure was put on schools serving adolescent psychiatric units to support their pupils to return to mainstream education. However, there is a perception that a factor that makes the transition process difficult is the attitude of mainstream pupils towards their peers with mental health problems. The purpose of this research was to explore mainstream pupils’ perceptions of mental health problems and the extent to which their understandings might lead to stigmatising attitudes. A theoretical perspective encompassing the ideas of social constructionism, interpretavism and symbolic interactionism, combined with a linguistic based approach, underpinned the development of an empathetic methodological approach to researching sensitive topics with adolescents. The research involved collecting data using a sequence of questionnaires, individual interviews and group interviews with pupils in three secondary schools within socially diverse communities. The questionnaire was presented in comic booklet form and included such techniques as cartoons, vignettes, and adapted familiarity and social distance scales. This dissertation reveals ways in which young people create their personal constructs around mental health and the complexities of the nature of stigma. It also highlights the implications that these findings have for staff and pupils involved in the transition process and for the development of practice in this field.

Over the past twenty years there has been growing recognition that young people who have sexually harmed should not simply be treated as younger versions of adult sex offenders. Changes in terminology and recommended treatment reflect the fact that these young people are still developing and have a range of strengths and needs including harmful sexual behaviour. In acknowledging the harm caused by sexual abuse to victims it is also important to see that many young perpetrators have also been victims of abuse, domestic violence and sexual exploitation. Practitioners and Government reports have asserted that work with these young people should be holistic, but this word ‘holistic’ is used with a range of meanings and emphases. This study identifies broadly accepted meanings of working holistically with young people who have sexually harmed and presents associated benefits, challenges and implications for practice. The study used a mixed methods approach, utilising an initial breadth survey of practitioners across England and Wales before focusing in on a depth study based in one city Youth Offending Team. Key themes from the breadth survey were tested during the fieldwork placement with observations and interviews with professionals within the team and external therapists, social workers and residential staff. Additional interviews included contributions from volunteer panel members, young people and a parent. Grounded theory analysis led to the identification of four main themes of holistic work: seeing the whole young person; working with wider family and peers; working in a multiagency way and using a range of creative methods. Findings are discussed in relation to ‘what works’ and ‘evidence based practice’. Each of these areas contributes benefits and challenges to the work and leads to implications for practice. The study concludes with recommendations for practitioners and policy-makers to make work more holistic and effective.

Drawing on a critical realist approach and especially Derek Layder’s ‘Domain Theory’ (Layder 1997; 2006) this thesis explores the richness and complexity of young people’s social capital. The study used a mixed methods design which incorporated sequential and concurrent data collection and analysis comprising 16 in-depth interviews, 17 discussion groups and a survey questionnaire (n=500). Twenty one organisations participated in this study, accessed through youth groups, the youth justice system, one school and one college from the Midlands area, in the 13-19 age range. The total sample using all research methods was 574 young people. Young people’s maintenance and enhancement of social capital is seen as a process which has to be negotiated in a continuous interaction between self, situated activity, social settings and contexts. Within this, critical creative agency, a positive outlook on life and being able to make the leap of trust become agentic mediating factors which help young people to navigate life situations and take the necessary risks to develop a more dynamic social capital. The study challenges some common discourses on diversity, especially those referring to bonding and bridging social capital (Putnam 2000). Contexts of privilege but also of gender and ethnicity are important mechanisms that have a strong impact on the access to social capital resources and points towards the resiliency young people are able to build. Policy and practice need to build on the situated activity of young people and not erode it. Enhancing young people’s existing social capital is achieved by building on their existing resourcefulness, strengthening their existing support networks, opening up new horizons and creating access to new resources within a strength perspective. Institutions need to enhance resiliency and positive risk taking, nurture trusting relationships with significant others and enhance young people’s outlook on life.

Backpacker tourists frequently express “anti-tourist” attitudes and are confident that they contribute positively to their destinations. Ironically, they are sometimes characterised by stakeholders in destinations in less developed countries as neo-colonial invaders. In spite of their anti-tourist attitudes, in reality, backpacker tourists tend to stay in backpacker enclaves where the cultural and moral values of backpackers are dominant. This happens because they encounter many obstacles to enjoying the backpacking experience in an unfamiliar interregional (intercultural) environment. Given such contradictory phenomena surrounding backpacker tourists in less developed countries, one question is how they manifest their responsible behaviour. Therefore, this research aims to explore the nature and degree of responsible behaviour amongst backpacker tourists in Thailand, which is one of the most popular backpacker destinations in the world. Through mixed method research, this principally explores (1) the frequency levels of backpackers’ behavioural intentions, their actual responsible behaviour, and the gap between them based on a series of items representing responsible behaviour, and (2) their definitions and perceived experiences of responsible behaviour. The research found that whilst backpacker tourists tend to report their frequent responsible behaviour and perceive themselves as “responsible” tourists, in reality, they experience many difficulties in behaving responsibly in an unfamiliar interregional (intercultural) tourism setting in spite of their intention to do so, and while being well aware of the importance of behaving responsibly. There is a propensity among backpacker tourists to exaggerate the importance of small and fleeting experiences of responsible behaviour outside backpacker enclaves (e.g. a moment of demonstrating a respectful attitude towards local people). Also, cultural experiences within backpacker enclaves, which are staged authentic manner (e.g. participation in a cultural or cookery class), tend to be exaggerated in importance and regarded as highly responsible behaviour. Moreover, whilst backpacker tourists appreciate themselves as “responsible” tourists and during their travels they respect others and behave so as not to disturb others which are required to do so regardless of place, culture and custom even in the home in daily life, they represented their reluctance to “engage” in responsible behaviour, especially altruistic and philanthropic activities (i.e., engagement in volunteering work or donating to local communities). These propensities were common to all types of backpacker tourists in this study; even those who reported their own outstandingly frequent intention and actual responsible behaviour (i.e., backpacker tourists who travel extensively with the strong motivation to explore destination countries). The principal conclusion in this research is that, whilst the behaviour reported by the backpacker tourists was never harmfully irresponsible, there are several contradictions between their evaluation of their responsible behaviour and their actual behaviour patterns. Moreover, there is a gap between their behavioural pattern of responsible behaviour and the concept of “responsible tourism” for backpacker tourists. The declared good intentions and instances of actually behaving in a responsible manner by backpacker tourists do not necessarily mean that they behave altruistically and philanthropically that the concept of responsible tourism aims to engender.

The student experience is a unique journey of challenge and opportunity, for which their success, subjective well-being (SWB) and psychological health are key elements. In three related investigations, this mixed-methods research programme examined the effects of Time-Perspective (TP: An individual’s psychological relationship with time) and Character-Strengths (CS: 24-positive traits associated with good character) on these outcomes. Investigation 1 involved developing a Likert-type scale to measure students’ success in areas they felt were important to the construct. Qualitative content analysis identified that HE students and staff collectively defined success as a multifaceted construct, consisting of numerous academic, non-academic and social aspects. These informed the development of a reliable and valid questionnaire for measuring success perceptions in seven of these areas. This was used in the following investigation to assess a range of outcome variables pertaining to student success. Investigation 2 was a longitudinal study assessing the effects of TP and CS on the success, good/poor psychological health and SWB of Year-1 HE students. In line with previous research, excessive or insufficient use of certain TP orientations was associated with, and could predict multiple positive and negative outcomes. For example, Future and Past-Positive orientations were predictive of academic success, perceived student success and SWB. Student psychological problems were associated with a bias towards Past-Negative and Present-Fatalist orientations. Additionally, a new formula for calculating a continuous Balanced Time Perspective (BTP) variable was devised and tested. High levels of BTP were associated with many positive aspects of the HE experience. Strengths were mainly associated with SWB and perceptions of success. However, Hope and Self-Regulation were inversely related with depression, anxiety, stress and negative-affect. Investigation 3 was a follow-up interview study with six student participants, who presented interesting profiles in Investigation 2. They talked about their experiences of psychological ill-health/well-being and student success in relation to TP and CS. Five super-ordinate themes were identified, including ‘Living with negative past experiences’, ‘A balancing act’ and ‘Using my strengths’. Psychological difficulties represent an escalating problem in HE, and student success and SWB are important outcomes. Both TP and CS offer additional understandings of these areas, adding value in academic, practical and theoretical contexts. This research has indicated that interventions focused on TP modification (i.e. developing a BTP) and strength development, may potentially offer preventative mental-illness strategies for susceptible students and enhance their success and SWB.