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Background In 2014, 27.0% of births in England and Wales were to mothers born outside of the UK. Compared to their white British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. Although existing literature highlights the importance of midwife-woman relationships in care satisfaction and pregnancy outcomes health professionals report difficulty in providing services to minority ethnic and migrant women. However little research has explored the factors contributing to the midwife-woman relationship for migrant and minority ethnic women. Research Aims To explore relationships between migrant Pakistani women and midwives in South Wales; focusing on the factors contributing to these relationships, and the ways in which these factors might affect women’s experiences of care. Method A focused ethnography in South Wales; semi-structured interviews with 10 migrant Pakistani participants (eight pregnant women, one husband and one mother) and 11 practising midwives, fieldwork in the local migrant Pakistani community and local maternity services, observations of antenatal booking appointments, and longitudinal reviewing of relevant media outputs, such as UK news reports of issues relating to migrant people. Data were analysed concurrently with collection using thematic analysis. Findings The midwife-woman relationship was important for participants’ experiences of care. A number of social and ecological factors influenced this relationship; including family relationships, culture and religion, differing healthcare systems, authoritative knowledge, and communication of information. However, differences were seen between midwives and women in the perceived importance of these themes. Findings therefore suggest that in order to understand how midwife-woman relationships are created and maintained, more needs to be done to recognise and address these differences. Due to the complexity of the relationships between themes a social ecological model of relationships is forwarded as a means of visually capturing the complexity of the findings, as well as potentially shaping midwifery education and clinical midwifery practices. Conclusions and Implications Findings from this study provide new theoretical insights into the complex social and ecological factors at play during maternity care for migrant Pakistani women. These findings can therefore be used to create meaningful dialogue between women and midwives, encourage collaborative learning and knowledge production, and facilitate future midwifery education and research.

Introduction: For the majority of those who leave the Armed Forces, reintegration into society is generally smooth and veterans are more resilient than the public believe. The minority who struggle to adjust to life outside the services report finding it challenging fitting in to post-service life and identity. These individuals often require additional support to truly resettle, which may be provided through third-sector services. There is currently little UK based evidence on the appropriateness and effectiveness of the third-sector provision for the Armed Forces community. There is also limited knowledge on UK military-civilian occupational identity. Methods: This thesis employed a mixed methods approach to address these gaps. The study data came from an independent evaluation of the support provided by the charity Walking With The Wounded (WWTW); Head Start, a mental health programme; First Steps, an vocational support programme; and Home Straight, an employment support programme for homeless veterans. Alongside this, interviews were conducted with beneficiaries of the charity to provide an understanding of the needs/views of both their WWTW and post-military experiences. WWTW aimed to use this evaluation to improve their service provision. Results: The Head Start programme achieved sustained, significant clinical improvement in anxiety symptoms, with significant improvements in functional impairment for those who achieved clinically symptomatic improvement. This was not found for symptoms of depression. Due to low response rates, First Steps and Home Straight could only be evaluated qualitatively. Additionally, qualitative exploration led to the identification of five veteran identity typologies (Transformed Veteran, Civilian Veteran, Enduring Soldier, Lost Veteran and Rejected Veteran), each with varied social and economic outcomes. Findings suggests that acceptance of identity change (influenced by validation, gratitude, military support and group status) contributes to our understanding of the relationship between pre-discharge and discharge experiences/identity and post-military identity. Conclusion: Findings suggest that occupational identity may be crucial for later occupational and societal integration and support services have a vital role in aiding this process (alongside earlier resettlement provision). The recommendations and implications for these findings include, increasing the harmony and collaboration by necessary AF community stakeholders (e.g. charities, government, civilian employers and the AF) to encourage positive transition and acceptance of change. This may include psychological preparation for civilian life and work, both earlier in the discharge process and in later third-sector support for those who continue to find the transition a challenge. The role work readiness and support services play in occupational transition is also discussed.

Frequent relocations, disruptive separations and reunions, fragmented social support and the involvement of Service personnel in deployments are all major aspects of the military lifestyle. Despite the potential for these unique pressures to have negative influences on the mental health and well-being of spouses and partners (S/Ps) of Service personnel, there are few published studies on this population within the UK. This thesis uses both quantitative and qualitative methodologies to address the gaps in the literature by exploring the mental health and well-being of UK S/Ps. Quantitative data from 405 UK S/Ps were used to estimate the prevalence of employment, mental health, alcohol use and marital satisfaction in this population. The qualitative study explored S/Ps experiences of employment, family and social networks during accompanied postings, their relationship with the military institution and the influences on well-being. The findings suggested the mental health and well-being of S/Ps was poorer compared to women in the general population, with an increased prevalence of probable depression, hazardous alcohol consumption and a lower prevalence of relationship happiness. S/Ps described how accompanied postings restricted their sense of agency and challenged to their identity. The sense of connectedness women described with other S/Ps within the military community was described as mitigating some of these negative influences; however, women reported that such connections could be lost or weakened when they moved away from friends, other S/Ps and family, leading to isolation and disconnection. The recommendations of these findings include the provision of additional support for S/Ps to alleviate the common childcare issues women described during accompanied postings. S/Ps and their family members should be made aware of the symptoms of probable depression and hazardous alcohol use among S/Ps to improve help-seeking and additional services provided. S/Ps and Service personnel may benefit from additional relationship support.

Approximately 60% of UK military personnel who experience mental health problems, do not seek help. Typical demographics of military personnel provide one explanation for this, as help-seeking is lowest in young males in the general population. There are, however, further issues concerning the military, such as heightened stigma concerns and the effect of military culture on help-seeking behaviours. The overarching aim of this thesis is to determine the main social influences, barriers and facilitators of help-seeking for mental health problems in UK military personnel (Service Personnel, Reserves and ex-Service personnel). The thesis is comprised of three studies and utilises a mixed methods approach. The two qualitative studies examine factors which were barriers and facilitators of help-seeking for mental health problems. The quantitative study explores how social support, military characteristics, attitudes towards mental health treatment, and stigma are associated with help-seeking. All studies utilise male only samples. The first qualitative study sample (N=16) of non-helpseekers and help-seekers is taken from phase two of a longitudinal cohort study of UK military personnel. The second qualitative study sample (N=10) was recruited from helpseeking beneficiaries of Combat Stress, an Armed Forces mental health charity. In-depth semi-structured telephone interviews were conducted for both qualitative studies and analysed using thematic analysis. The quantitative study sample (N=453) is taken from a clinical telephone interview study investigating help-seeking behaviours from a sample of respondents in phase three of the military cohort study. Descriptive analyses exploring the relationship between help-seeking and stigma/barriers to care are presented. Key findings show that public stigma, self-stigma, attitudinal preferences for selfmanagement of problems, and poor social support are barriers to seeking help. The main facilitator of help-seeking was supportive social networks. The research compares findings with existing literature in military and general populations. Recommendations for future research and policy implications are discussed.