This thesis explores and analyses the manifold relations between migration and health, what I call the migration-health nexus, in the contemporary Nicaraguan context. The study is based on fieldwork in León and Cuatro Santos and a mixed-methods approach combining qualitative in-depth interviews and quantitative survey data. In the thesis health is “traced” within the migration process; i.e. in places of origin, during travel, at the destination and after return, including the situation and consequences for both migrants and family members to migrants (“left-behinds”). The study shows that migration-health relations in Nicaragua are connected to broader economic, social and political factors and to the country’s historical experiences of colonization, neo-colonization and structural adjustments. Contemporary Nicaraguan migrations are primarily related to the strategies of making a living and the struggle for a better life (i.e. a practice of mobile livelihoods). In the study setting health concerns were both indirectly embedded in people’s mobile livelihoods, as well as directly influencing decisions to move or to stay, and migration involved both advantages and disadvantages for health. Through migration, women could see an end to physical violence and sexual abuse. Internal migrants could improve their access to health care and medicine. Vulnerabilities related to the unpredictable nature conditions could be avoided through moving. And, through the money made from migrant work people’s everyday lives and health could be improved, in terms of better nutrition, housing, and access to education, health care and medicine. However, remittances do not necessarily lead to development, as they are used to compensate for the lacking public sector in Nicaragua. Under these circumstances, I argue that the Nicaraguan population is not guaranteed their social rights of citizenship. I also argue that the negative aspects surrounding migration must be taken into account when discussing the development potentials of migration and remittances. Both internal and international migrants in this study experienced stress while moving to a new place. International migrants had difficulties accessing health care in the destination, particularly those lacking documentation. The separation within families due to migration often caused emotional pain. Family members left behind did not rate their physical health as good as often as non-migrant families. The vulnerability, stress experiences and sufferings of migrants and left-behinds varied, however. I therefore conclude that social differences (in terms of e.g. gender, class, skin colour, and legal immigration status) are key for the enactment of the migration-health nexus, and that an interplay of individual, social and structural factors influence the outcome.

The ‘social turn’ in applied linguistics and second language acquisition (SLA) has seen the emergence of a range of socially-oriented perspectives, such as sociolinguistic, sociocultural, socio-historical and situated learning, yet this has not resulted in L2 learners’ social origins and backgrounds being given sufficient attention in L2 research. The present study therefore argues for taking a sociology of language learning perspective to investigate L2 learners’ social biographies and their academic achievement in English. This social perspective is informed by the sociology of education as well as critical approaches to applied linguistics. Learners’ social biographies consist of learner-internal (personal) and -external (social) factors. These factors are conceptualised as learner habitus and family educational capital (economic, social and cultural) respectively, with reference to Bourdieu’s theories in the sociology of education. The study investigates secondary school students’ English learning outcomes in relation to their habitus and family capital situations in a rural context in Bangladesh. It uses a mixed methods research design and draws on both quantitative and qualitative data. It also utilises multiple perspectives, provided by 10th grade students (n = 228) and their English teachers, head teachers and parents. The data collection instruments include a questionnaire survey, an English proficiency test and participant interviews. The study shows that aspects of family economic and cultural capital and learner habitus are significantly associated with the students’ English achievement. However, social capital, operationalised as parental input into the students’ English studies, is not associated with their academic achievement in English, although it is significantly correlated with learner habitus and parental education. The students’ perceptions of their family capital situations and the perceived impact of these situations on their academic experience were supportive of structuralist determinism. Despite the constraining effects of family capital disadvantage on academic experience, disadvantaged students can neutralise these effects by means of their habitus and thus negate social determinism in the context of their scholastic achievement. The study also shows that contrary to the widening gap in the academic achievement of students in favour of females in many social contexts, the female students in the present context performed somewhat less well than their male counterparts in the school-leaving examination. Finally, the students’ English learning and academic outcomes were embedded in their social biographies. Their academic achievement or underachievement cannot be fully understood without recourse to their familial and social worlds, their lived experiences, their desires for better futures and their disadvantage, and lack of means to pursue those desires.Despite some caveats, the findings have important implications for the theory and practice of teaching English in Bangladesh and other social contexts. First, it is necessary to include both learner-internal and -external family/social factors in the investigation of L2 learners’ English learning experience and outcomes. Second, ELT policies should have provisions that address these beyond-the-school factors in order to develop English language skills across social classes and geographic locations. Finally, schools should embrace the question of inequality in English learning outcomes and devise mechanisms for the reduction of inequalities within their limited resources and capacities. The major contribution of the study is to our understanding of the factors associated with English language learning in rural communities in developing societies. In particular, the study substantiates non-cognitive, non-methodological and non-curricular approaches to EFL/ESL. Identification of these factors is facilitated by the perspective of sociology of English learning and the concept of social biography. In addition, the study designs a theoretical and conceptual framework and instruments for researching student achievement in English in relation to family capital and learner habitus.

Top-down, centralised approaches to reform of mental health services implemented over the past 15 years in Australia have failed to achieve the widely shared aim of comprehensive, integrated systems of care. Investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain however in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Intersectoral collaboration that includes the diverse range of non-medical primary health and social care services is one of the most fundamental remaining challenges facing mental health system reform.

Doctor of Philosophy / Research has shown that the school-based experiences of same-sex attracted (SSA) young people are frequently less than ideal, often fraught with verbal and physical harassment and social isolation from peers. School-based victimisation of SSA students has been correlated with their negative mental health outcomes, drug and alcohol use, decreased academic outcomes and lowered tertiary aspirations. These outcomes raise issues related to duty of care for educators, including the general responsibility of schools to create safe, equitable learning environments for all of their students. In order to better meet the needs of SSA students in Australia’s secondary schools, this nationwide study examined the current school climate toward same-sex attraction as described by SSA young people aged 14-19 through their reported experiences and perceptions of environmental stresses and supports, using Margaret Spencer’s PVEST model as the theoretical framework. A web-based survey instrument, advertised through both mainstream and lesbian/gay/bisexual-orientated youth sources, was used to sample Australian SSA students (N = 282). The relationships between SSA students’ perceptions of their school climate (including the treatment of SSA students and topics), their sense of connection to their school community, and their reported academic self-concept and motivation toward learning were investigated using bivariate and multivariate techniques, including structural equation modelling. In-depth interview sessions were conducted with six SSA young people in order to further examine these findings. Results indicated that SSA students’ perceptions of their school climate were directly related to their sense of safety within the school environment, their social connection to their peers and teachers, and their feelings of connectedness to the school environment in general. SSA students’ connection to their teachers and their school environment had the strongest total impact on their academic self-concept and motivation to learn. Of key import was the clear indirect impact of SSA students’ perceptions of their school climate on both of these important academic outcomes, through their connection to both their school community and general school environment. These findings allow for the generation of informed recommendations for school policy and practice with the academic outcomes of Australia’s SSA students in mind.

Nurses report high rates of back pain with consequent disability, work absenteeism and attrition from the profession. In the current climate of an international nursing shortage, efficacious interventions to reduce the impact of back pain must be developed. It is uncertain what components a back pain preventive intervention should comprise. Appropriate and reliable means to assess back pain and disability in nurses is also undetermined. The first aim of this thesis was to undertake a mixed methods program of research to inform the development of an intervention to prevent back pain in nurses. The second aim of the thesis was to examine the psychometric and measurement properties of back pain and disability outcome instruments frequently applied in nursing samples. Epidemiological studies were undertaken to examine factors associated with back pain in nursing cohorts. In student nurses, a history of manual handling work was found to be significantly associated with neck and back pain outcomes. In a large population cohort study of nurses and midwives, pain characteristics (pain severity and radiation), pain-related cognitive and behavioural factors (kinesiophobia and passive pain coping), job characteristics (job classification and manual handling task frequency) as well as demographic interactions explained sick leave due to back pain. A systematic review was undertaken to determine the efficacy of interventions aiming to prevent back pain and back injury in nurses. Due to methodological heterogeneity, a qualitative synthesis of evidence was undertaken on the 16 studies that met inclusion criteria. The review identified moderate level evidence from multiple trials that manual handling training in isolation is not effective and multidimensional interventions are effective in preventing back pain and injury in nurses. Single trials provided moderate evidence that stress management programs do not prevent back pain and limited evidence that lumbar supports are effective in preventing back injury in nurses. There was conflicting evidence regarding the efficacy of exercise interventions and the provision of manual handling equipment and training. A qualitative description study was employed to explore the beliefs and perceptions of nursing stakeholders regarding risk factors for back pain and strategies to prevent back pain in nurses. Stakeholders identified individual, intrapersonal, organisational and environmental risk factors that were consistent with the social ecological view of health. They believed that interventions targeting the individual would be ineffective in the absence of workplace and other reforms. At the individual level, they recommended strategies that address physical, psychological and occupational preparedness for nursing work. In addition, they suggested ecological intervention strategies to induce change at the intrapersonal, organisational, community and policy levels. A mixed method synthesis of evidence was performed to develop an evidence-based and stakeholder-relevant intervention that aims to reduce the impact of back pain in nurses. The proposed intervention incorporates evidence-based multidimensional strategies that address individual and organisational level factors, and proposes ecological factors that may warrant inclusion once evidence of their causal association with back pain is established. Methodological studies examined the psychometric and measurement properties of key instruments used to assess back pain and disability in nursing populations. An extended version of the Nordic Musculoskeletal Questionnaire – that is frequently modified when applied in nursing cohorts - was developed and deemed to have acceptable test-retest reliability. The Oswestry Disability Index was found to have unacceptable measurement properties for application in nursing samples, and is therefore not recommended for future studies of back pain related disability in the nursing population. In summary, this program of research contributes novel insights that can meaningfully inform understanding of back pain prevention in nurses. Factors not previously assessed in nursing populations have been examined and shown to be significantly related to back pain outcomes. The strength of existing evidence for the prevention of back pain and injury in nurses has been established, and methodological advances regarding appropriate and reliable measurement of back pain and disability have been made. The views and perceptions of stakeholders from multiple levels and vantage points have been considered and integrated within the interpretation of evidence from multiple mixed method studies. In fact, stakeholders have played a crucial role in the identification of an appropriate theoretical framework – the social ecological paradigm - to conceptualise back pain causality in nurses and identify relevant solutions. A future research agenda of expanded scope is implicated to adequately address back pain prevention in nurses.

<b>Introduction:</b> Children's social, emotional, and behavioural difficulties are associated with reduced academic performance, stressed teacher-child relationships, and other negative academic and life outcomes. The Incredible Years Teacher Classroom Management (IY TCM) programme is one intervention developed to address problematic behaviours via training teachers to use positive and proactive management strategies. The overall aim of this DPhil is to use the Incredible Years Teacher Classroom Management programme as a case study for applying mixed methods at the systematic review level to ascertain what is known about both the programme's effectiveness and how people experience the course, and subsequently to use the systematic review's findings as a springboard (rather than as an end goal) for more exploratory research into 'for whom' the programme might work. <b>Method:</b> Study One is a mixed methods systematic review of IY TCM. It applied multilevel meta-analysis to RCT outcome data and grounded theory meta-synthesis to interview and focus group data on stakeholders' experiences of IY TCM. Quantitative and qualitative findings were cross-synthesised and mapped using an integrative grid. Study Two moves the field forward by filling a gap in the evidence base, as identified in Study One. Semi-structured telephone interviews were conducted with special educational needs coordinators (SENCos) across Devon, exploring the acceptability and appropriateness of expanding IY TCM to the subgroup of children with special educational needs (SEN) in mainstream schools. Data were analysed thematically and mapped onto IY TCM content. <b>Results:</b> In Study One, nine studies reported across 14 papers met inclusion criteria for either quantitative or qualitative strands of this systematic review. Multilevel meta-analysis of RCTs (n=4) indicated that the programme produced teacher- and child-level results in the desired directions. Clear trends across all measured outcomes favoured the intervention group over the treatment-as-usual comparison. Qualitative meta-synthesis (n=5) illuminated a cyclical learning process and broader conceptualisation of teacher and child outcomes than was evident in the quantitative evidence. Notably, RCT data on teacher outcomes were limited to self-reported or observed behaviours, while teachers described other benefits from IY TCM including increased knowledge and emotional well-being. Cross-synthesis of findings from the two review strands highlighted harmony across the RCT and qualitative evidence but also a number of areas in which constructs that were prioritised by one type of research were not integrated into the other. Study Two generated classroom management strategies from SENCos, which aligned closely with strategies taught in IY TCM, indicating that IY TCM would be both acceptable and applicable (if not sufficient) for use when working with children identified with SEN and behavioural difficulties in schools. <b>Discussion:</b> Based on the positive effects of implementing IY TCM despite very few studies to power analyses, the programme appears to offer tangible benefits to both teachers and children. It is possible that results are underestimated due to limited types of outcomes measured and absence of experiential data from additional stakeholders (e.g., parents). Depending on current provision of special educational needs services, schools operating inclusion models are likely to find these strategies beneficial for children identified with SEN, and this subgroup should be explicitly examined in future IY TCM studies.

There is a growing recognition of the role that walking and cycling can make in reducing traffic congestion and air pollution whilst also contributing to improved personal health and wellbeing. While studies suggest that infrastructure is required to promote walking and cycling, there is a lack of evidence at the micro level on how interventions aimed at improving connectivity for walking and cycling influence travel behaviour and whether they promote a modal shift away from short car journeys. The aim of this study was to investigate the extent to which the implementation of a high quality traffic free route, delivered by a recent programme targeted at everyday walking and cycling in the UK - the Sustrans Connect2 Programme - influenced individuals' day-to-day travel decisions, changed the spatial and temporal nature of their journeys and impacted on overall carbon emissions from motorised travel. To achieve this aim an in-depth longitudinal panel study of a community of residents living next to a totemic Connect2 scheme in Penarth, Cardiff, was conducted. A panel of purposively selected participants (N=50) were interviewed and asked to record their travel behaviour using personal GPS devices and travel diaries over two seasonally matching 7-day time periods in 2011 and 2012. This novel GPS based mixed-method approach provided a detailed account of participants' travel behaviour in the local area (n=2664 journeys) and a comprehensive understanding of how, why and for whom the Connect2 intervention was likely to influence travel behaviour and the longevity of effects. The findings revealed that participants used the new Connect2 scheme regularly during the period of the study (36&percnt; in 2011; 26&percnt; in 2012); however, the new scheme was likely to have a greater impact for recreational journeys rather than for everyday travel. Spatial data provided new insights into the complexities of walking behaviour and factors influencing cycling for everyday travel or recreation, including route choice decisions, destinations where activities were conducted and the role of the new Connect2 infrastructure in supporting this. Further findings support the potential of active travel in replacing short car trips (20&percnt;) and its impact on carbon emissions from personal travel (4.9&percnt; among the study sample). However, results suggest that the new Connect2 scheme alone was unlikely to promote a significant change in travel behaviour and carbon emissions from (displaced) car journeys. The study contributes to the debate on the effectiveness of interventions targeted at promoting walking and cycling and the importance of wider infrastructural improvements that may be required to encourage their wider uptake. The combination of methods for data collection developed and employed in this study also helps to inform future travel behaviour research.

The study was an investigation into the teaching decisions that mathematics teachers make over time. I view a mathematics classroom as a didactical system of teacher, learners and content within an educational institution, where content is the material that brings teachers and learners together. Within such a system I view the teacher's role as making content available to learners. Prior research has often investigated the teacher's role by comparing teaching practices nationally or internationally, but these comparisons have tended to use the lesson as the unit of analysis. I propose that how teachers make content available can change over the course of a series of lessons and so my study used the lesson series as the unit of analysis. I purposefully designed the study so that it involved four cases, which allowed me to explore the role of the teacher and the topic in how content was made available. To investigate how teachers made content available to learners in each case, I developed an analytical approach from which I could study the modes of teacher interaction that featured across the lesson series, the forms of mathematical content made available and the sequencing of these forms. Attending to forms of content - rather than content itself - allowed for comparison of teaching of different topics. This original analytical approach represents a contribution to both mathematics education and mixed methods research. Within this small sample of cases, quantifiable differences were identified in how content was made available between classwork and seatwork, from lesson to lesson and between cases. Between-case differences in the nature of teaching 'between-the-desks' during seatwork were also identified. These differences illuminated teaching decisions to which teachers and classroom researchers may not routinely attend. The findings therefore contribute - and identify additional lines of enquiry that might contribute further - to a more extensive understanding of teaching practices.

Engaging youth with Type 1 diabetes (T1D) in the self-management of daily tasks and decision- making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. The process of shared decision making (SDM) comprises four key elements – acknowledge, consider, decide, act - and is identified as an optimal approach to making self-management decisions, yet it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision making. Using a sequential two-phased investigation, this dissertation describes how PHRs can be designed to enable SDM and integrated into clinical practice to engage youth with T1D in self-management decision making. Phase 1 proposed an integrated SDM–PHR (e-PHR) functional model justified by youth with T1D (n=7) and providers (n=15) via a user-centered design approach. Located within an interconnected EHR ecosystem, e-PHR integrates 23 PHR functionalities for the SDM process, whereby each SDM element was mapped to PHR functions with a moderate level of agreement between patients and providers (Cohen's kappa 0.60-0.74). The Phase 2 mixed methods, pre-implementation evaluation utilized an online measurement instrument and survey and individual interviews, underpinned by the Normalization Process Theory (NPT), to describe the four cognitive and behavioural processes (coherence, cognitive participation, collective action, reflexive monitoring) known to influence the success of complex socio-technical implementations. Youth with T1D (n=8), providers (n=11), and EHR/clinical leaders (n=8) in British Columbia participated. Reliability tests of NPT-based instrument negated the use of scores for the coherence and reflexive monitoring constructs. Qualitative results indicated that e-PHR made sense as explained by two themes for ‘Coherence’: game changing technology and sensibility of change. Participants strongly agreed (mean score=4.6/5) with ‘Cognitive Participation’ processes requiring an investment in commitment, explained by two themes: sharing ownership of the work and enabling involvement. Weak agreement (mean score=3.6/5) was observed with ‘Collective Action’ processes requiring an investment in effort, explained by one theme, uncovering the challenge of building collective action, and 3 sub-themes, assessing fit, adapting to change together, and investing in the change. Participants appraised e-PHR as explained by two themes for ‘Reflexive Monitoring’: reflecting on value, and monitoring and adapting. Finally, participants strongly agreed (mean score=4.5/5) that e-PHR would positively affect engagement in self-management decision making in two themes: care is efficient and care is person-centred. The establishment of a e-PHR functional model is a precursor to system design requirements. Using the NPT framework, findings from the process evaluation indicated participants invest in sense-making, commitment and appraisal work of this technology. However, successful integration of e-PHR into clinical practice to positively affect engagement in self-management decision making will only be attained when systemic effort is invested to enact it. Further research is needed to explore this gap to inform priorities and approaches for future implementation success. / Graduate

Energy plays a significant role in a country’s development. Usage of an improved stove that produces biochar could help to reduce the pressure of deforestation, amend soil productivity, and provide cleaner technology for cooking. In Kwale, a county located on the south coast of Kenya, firewood is still used as the primary cooking fuel followed by charcoal. This research aims to investigate the improvements for a Top-litUpDraft (TLUD) biochar-producing gasifier stove, which the users aspired through co-designing. Transformative mixed methods were used as the research design to empower the users’ involvement in the biochar and smallholder farmers in Kenya – improved use efficiency of farm-level organic resources in relation to energy, crops and soil project. Triangulation was used to process the collected data through structured user observations, a focus group discussion, and a semi-structured interview. Between two stakeholders, TLUDgasifier stove users and the manufacturer, there was a difference of opinion for the main priority. Ease of use was the main concern for the users while the manufacturer put forward energy efficiency. Further, the users desired for an increase in the stove’s dimension as its capacity to produce biochar would increase.