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The United Kingdom (UK) is the second most popular country for international students (ISs). The literature review and empirical paper highlight that there are limited studies that address the challenges faced by Asian international students (AISs) and Indian international students (IISs). The aim was to understand barriers to accessing university well-being and mental health services. Thematic synthesis was adopted for the systematic literature review. A record of the inclusion and exclusion criteria has also been published on the International Prospective Register of Systematic Reviews (PROSPERO) (registration number is: CRD42021249135). Reflexive thematic analysis was kept in mind during data analysis of the 11 individual interviews conducted online for the empirical paper. The themes generated under the results section shed light on the barriers and the challenges faced. ISs leave their home country to further their careers and face challenges with adjustment. Individually, these challenges may not appear to be difficult to manage but facing them altogether increases the pressure faced by both AISs and ISs. The study highlights the importance of viewing this population separately, so as to ensure the nuances of their culture are not overlooked. Their challenges led to struggles with feeling insecure when expressing themselves and conversing with peers. Lastly, participants have also provided suggestions for advertising well-being and mental health services.

The rising prevalence of dementia cases due to ageing population presents a global challenge. Despite different types of memory aid devices available, evidence reveal that it is not widely accepted (Thordardottir et al., 2019). The current study aimed to understand the attitudes of people living with dementia and mild cognitive impairment (MCI) living in the community and caregivers on the factors influencing memory aid technologies acceptance. A mixed research method was employed which used online survey data from 119 caregivers of people living with dementia for the quantitative approach, and the qualitative approach involved nine people living with dementia and MCI who were provided with a digital memory prompting calendar to provide their opinions based on a type of memory-aid technological device. Results: the multiple regression analysis revealed that the technology acceptance model significantly predicted technology acceptance; perceived usefulness: β = .264, t (113) = 3.623, p < .001; perceived ease of use: β = .422, t (113) = 6.059, p < .001; and attitudes: β = .387, t (113) = 5.763, p < .001. Also, caregivers' sense of competence; β = -.024, t (113) = -2.471, p = .015; age; β = .331, t (114) = 2.431, p=.017; and dementia severity: β =.145, t (114) = 4.521, p < .001 significantly predicted technology acceptance. However, experience with technology, β =.036, t (114) = .330, p=.724; technology possession, β=-.068, t (114) = -.234, p = .815; and education, β=.036, t (114) =.330, p=.724, did not significantly predict technology acceptance. The Chi-Squared analysis revealed that technology access was not significantly associated with household income, Χ² (5, 119) = 4.822, p = 0.438. The thematic analysis findings from the qualitative approach identified three themes; (1) self-preservation of dignity as illustrated by; "I think a lot of people cannot or will not admit that they are losing their marbles", (2) past the age of learning as illustrated by "I'm sure they are very useful to a younger generation", and (3) attitudes towards memory aid technologies as illustrated by; "Who would need one of those". These demonstrated that the relationship with technology was complex and self-protective. While this study has shown that memory aid technologies possess the potential of playing a significant role in dementia care, there are issues around its acceptance at the cost of diminishing the users' sense of dignity because of the dementia it signifies. Future memory aid developments are recommended to be inclusive of intended users, clinicians and academic professionals to be involved in order to develop socially acceptable devices that could make the devices more acceptable.

The recent dramatic growth in the number of international schools globally has led to significant changes in the types of pupils who attend. Newer international schools are increasingly being established to educate the children of wealthy local populations, as opposed to the traditional international school pupil population of children of expatriate and itinerant workers. As a result, the proportion of children attending international schools identified as having special educational needs (SEN) may have increased significantly. The study explores the responses of international schools to these changes and examines the factors that can promote inclusion and support for pupils with special educational needs in international schools. This research is timely as inclusive philosophies and practices are being increasingly adopted within national education systems across the world. The situation of international schools as being generally separate to, and at times exempt from, national mandates and requirements has meant that until now there has been little by way of incentive for international schools to adopt inclusive philosophies and practices. Nevertheless, the changes in pupil demographic have meant that international schools may need to adapt in order to support a broader range of pupils with different learning needs and abilities. The study investigated the factors that influenced the admission, inclusion and support procedures for pupils with SEN in a selection of six international schools, located in four different global regions. The design was a multiple case-study that allowed comparisons to be made between some of the schools on a local basis, as well as generally across the whole group of six participant schools. The study adopted an interpretivist paradigm, using qualitative data in the form of attitudes and opinions of school leaders, SENCOs and classroom teachers. Data gathering tools included questionnaires, semi-structured interviews and analysis of related school documentation. Data was triangulated in order to allow for comparisons to be made between the responses of school leaders, SENCOs, classroom teachers and external agencies. The findings showed that host-state intervention and related legislative requirements were the most significant factors in influencing schools within specific areas towards adopting more inclusive practices in supporting pupils with SEN. Other important factors were an inclusive leadership and governance that supported and implemented effective inclusive policies and practices. These were found to influence other factors, such as the levels of professional development offered to teachers for support of pupils with SEN. The least significant factors were associated with the limitations offered by the environment within which the international schools were located, for example, those relating to the relative scarcity of English-medium specialist support services available to schools in some regions.

Introduction: Perinatal death has a significant impact on the physical, emotional and mental health of women. This requires adequate bereavement care to limit the impact in the short and long term and on the quality of life. Women and families in sub-Saharan Africa and South Asian countries are most affected as they carry the highest burden of perinatal death. The experience of care and support in these countries has not been explored. Thus, there is a lack of understanding of the care and support received by women, and provided by healthcare professionals in South-Western Nigeria, one of the regions with the highest rate of perinatal death globally. Aim: The aims of this thesis were (i) to identify, synthesise and critically reinterpret the findings of existing literature on the care and support following perinatal death in high burden settings, and to reveal gaps and new understanding, (ii) to explore the lived-experience of women and families of care and support following perinatal death in South-Western Nigeria and (iii) to explore the lived experience of health care professionals who provide care and support following perinatal death in South-Western Nigeria. Methods: A metaethnographic metasynthesis was undertaken in synthesising and critically reinterpreting existing studies on womens care and support following perinatal death in high burden settings. Qualitative hermeneutic phenomenological studies using semi-structured interviews were conducted in exploring the lived experience of women, families and health care professionals of care and support following perinatal death. Results: Perinatal death is not appropriately acknowledged, thus care and support in high burden settings is inadequate. Women are not adequately supported whilst in hospital and receive no follow-up care from health care professionals in the community following discharge. Nurses endeavour to provide support as far as is possible within the hospital but this is determined by their practice as there is no recognised guideline for bereavement care following perinatal death in South-Western Nigeria. Thus, there is a lack of consistency in care and support. Nonetheless, nurses recognise the need for post-discharge follow-up and provide this within their own leisure time, outside of their role. Conclusion: Overall, bereavement care following perinatal death is limited in South-Western Nigeria; rather nurses provide care and support based on their own practice. There is a need for further research into and a development of sufficient bereavement care in Nigeria for women who experience perinatal death. In addition, the experience of other health care professionals and family members including partners of care and support also requires further research.

Part A: Presented is a systematic literature review on the experience of friendship for individuals post TBI. A meta-synthesis approach was used to analyse seven papers with a variety of methodologies. The MMAT was used to appraise each paper's quality prior to synthesis. Two superordinate themes emerged: 'Loss' and 'Response'. The proposed model highlights that physical disability, impact on cognition, and communication difficulties all result from TBI. These losses contribute to the loss of friendship, which in turn creates feelings of loneliness, like being an outsider. This impacts on the individual emotionally. The model captures how the participants coped with these changes. The implications for clinical practice and research are discussed. Part B: Presented is an empirical paper describing the development of a grounded theory of complexity for neuropsychology service-users. A cyclic model was developed consisting of six main categories and 13 sub-categories. These consisted of the psychologist's reaction,interventions, service-user conformity, service conformity, time, and communication. The model shifts the focus of complexity away from the service-user and towards the professional's experience of them. The implications for clinical practice and research are discussed.

Background: A public inquiry into failings in maternity services and care in England (Kirkup, 2015) identified that the dual roles of midwifery statutory supervision, namely support and regulation, should be separated. As a result, support was to be delivered by introducing new clinical supervision models provided by employers of midwives, and regulation was the sole responsibility of the Nursing and Midwifery Council. The new model of clinical supervision in Scotland was launched in 2018 after statutory supervision of midwives ended in 2016, and this study evaluated its implementation and midwives' participation in the new model. To begin the study, a systematic review of the literature was completed, which identified that no empirical research existed about the new model of clinical supervision, how it was implemented or midwives' experiences of participating in it. Aims: To understand and analyse midwives' participation in the new model of clinical supervision in Scotland and how this new model was implemented. Methods: A qualitative case study design was used to evaluate Scotland's new model of clinical supervision. Purposive sampling and snowballing strategies were utilised to select midwife participants who had participated in clinical supervision. In-depth semi-structured interviews were conducted at 1) a meso-level with ten Heads of Midwifery in ten NHS Health Boards and 2) at a micro-level with eighteen midwives in two case sites. Additionally, four non-participant observations in the two case sites were completed. A theoretical framework was used to design and present the study using four of Proctor et al.'s (2011) implementation outcomes, acceptability, adoption, feasibility, and fidelity. In addition, framework analysis (Gale et al., 2013) was used to analyse the generated data. Findings: The findings identified three main factors 1) time, 2) trust, and 3) perceptions of clinical supervision as a tick-box exercise were the main barriers to implementing clinical supervision and midwives' experiences of participating in it. First, the time available to prepare for and participate in clinical supervision was limited. As the new model was delivered predominantly in groups, participants were affected by a lack of trust in groups which affected their participation. Finally, clinical supervision was perceived as an item to 'tick off' to evidence attendance. Conclusions: This study revealed that the acceptability of the new clinical supervision model was affected by how it was delivered and the content of the new model, especially reflection and resilience-building. The adoption of the new model was impacted by how often midwives participated in clinical supervision, which was affected by advertising and promotion, and the simultaneous implementation of a major new midwifery policy, Best Start (Scottish Government, 2017). Significantly, the previous model of statutory supervision influenced midwives' engagement with and the uptake of the new clinical supervision model. Clinical supervision was considered a feasible intervention, although its feasibility was affected by midwives' feelings and emotions related to participation and the lack of resources available to deliver the intervention. Finally, midwives showed varied understanding of the new clinical supervision model, which altered the ability to adhere to and deliver clinical supervision as intended.

Higher education has seen huge growth in the past two decades with degree study becoming an anticipated next step after high school. But access to higher education is still riddled with inequality, and society is calling for equal access for all. The Scottish government have introduced policies to address this imbalance with a focus on working class backgrounds, students with disabilities and specific black minority ethnic groups. Under-represented groups are more likely to access college education and routes from college into university are recognised by the Commission on Widening Access (CoWA) as being fundamental to helping address this imbalance. In 2013, the SFC introduced additional funded places for students taking this route. The students are known as associate students. This thesis presents empirical work exploring the transition experiences of associate students into computing degrees in Scotland. Students on this journey face transitional barriers as they adapt to the change in culture, come to terms with their altered student identity, and overcome academic and social integration issues. This work explores their experience. Although several studies (Harris et al., 2013; Jansen & van der Meer, 2012; Polach, 2004) have examined transition into university, no studies have focused on associate students. This thesis provides unique insight into the lived experiences of associate students within the School of Computing and employed the graphical research method of photo-elicitation to gather and document perceptions of students during the first stage of their higher education journey, as they prepare to make the transition from college into a university. Further participants share their experience of transition during the first few weeks at university through photovoice and in-depth IPA interviews, providing insight into the usually unseen aspects of transition, moving home, adjusting to a long commute, experiencing loneliness and anxiety, benefiting from peer support and friendship. Through graphical research methods and interpretative phenomenological analysis, the participants have shaped the research through their narrative, their photographs, and their discussion to form a representation of the phenomenon under examination. Five superordinate themes emerged from the data demonstrating the significance of social aspects, self-concept, the physical environment, academic differences and preparation. Findings are shared which identified this as a 'journey that motivated', one that 'made university possible' and one that combined two 'different worlds'. This thesis found that the students' perceptions and experiences of transition were diverse and highlight the need to understand the key aspects of adjustment. This study explores a theoretical framework adapted from the Model of Organisational Influence on the Development of Learner Identity (Briggs, Clark, & Hall, 2012), that can be applied across institutions for all students in transition. Grounded in the literature, the framework demonstrates the student perspectives before the transition and their experience after the transition. This framework provides a mechanism for improving the transition for students moving into university study and makes a valuable contribution to computing education.

This thesis uses an exploratory, grounded theory methodology (GM) approach to seek, through constant comparison, an understanding of the extent to which dyslexia can be socially and contextually constructed. GM can be defined as an active, continuous systematic process of analytic steps, while simultaneously being open to proceed and explore a phenomenon. In this case, the phenomenon is dyslexia, including the support and inclusive practises in schools to legitimately adhere to Special Educational Needs policy in schools (both locally and internationally) to cultivate diversity in education. In this thesis, I used GM, which includes semi-structured interviews (SSI), field notes, observations on learning support departments, school websites and school inspection reports, rather than follow a guided deductive of being an expert in the field of dyslexia support and a directed approach of content or GT. I decided to use GM to focus on building social and contextual relationships between data, which unlike GT can lead to an eventual endpoint, using GM I hope that instead my contextual data findings can generate and develop new areas of research. In short, using GM does not lead my research to an endpoint, but provides a new point to start, expand, and develop new research on dyslexia support and inclusion. Five schools in Abu Dhabi, UAE, each with a different curriculum, were included in the study. Interviews were conducted with school principals, special educational needs coordinators, and support teachers. Besides, 9 mothers with children identified with having dyslexia and one parent with a daughter identified with having dyslexia from Dubai were interviewed. The hypotheses were developed in line with the purpose of this research, which was to identify and explore the barriers and obstacles that can hinder effective support for dyslexia and inclusion, using the process of open coding, axial coding, and selective coding through data analysis. This thesis concludes with suggestions for further, more extensive, and significant support for dyslexia, with active parental engagement, and schools being receptive to a community of shared practices and decisions on effective learning strategies that work for each child's dyslexia. Also, if schools say they are inclusive or follow the values underpinning inclusion, then they need to promote active awareness and understanding of dyslexia, with transparency and accountability regarding all concrete steps towards inclusion. This should include compulsory and continuous teacher training, which includes how to effectively screen for dyslexia and use an Individualized Education Program (IEP) effectively and investment in resource centres to support schools, teachers, parents, and learners within the community.

The narrative of parents of children who are in contact with the youth justice system is conflicted. They are both responsiblised and stigmatised when their child is involved with the justice system, yet integral in official policy rhetoric of support, desistence and citizenship engagement in making communities safer. However, little is understood of the actual lived day to day experiences of parents, or their needs in supporting their children during these times, yet they are essential to mandated decision making processes and forums concerning them. This study adopted a qualitative methodological approach to understand parents' experiences and needs as they support their children through involvement with the youth justice system. The research design used semi-structured interviews and focus groups to explore their reality with the justice system and other agencies they and their children must engage with during these times. Data was thematically analysed with findings showing that parents in Northern Ireland whose children are in contact with the justice system experience circumstances prior to contact with the system, and initial and ongoing contact, as traumatic. Processes and events involving agencies in the justice system are almost always further traumatising and shaming, reinforcing the stigma and sense of blame. Parents endure multiple losses personally, within their immediate and extended families, and in their communities. The legacy of conflict in Northern Ireland means parents often contend with the unique trauma of threatened or actual paramilitary violence in the lives of their children and families. Mutual support and self-help can be transformational in providing opportunities for sharing experiences, coping, challenging exclusion, and creating hope. However, few parents have access to needs led coordinated support let alone parent led collective user involvement.

Introduction: Patients may be significantly disabled after a major stroke but two patients in the same disability level according to outcome scales such as the modified Rankin scale (mRs) can vary with respect to their specific abilities (e.g. ability to walk, talk and eat) and therefore may have different views on their quality of life. Treatment decisions after major stroke are often made based on predictions of survival and independence. Many treatments can prolong the survival of patients who may be significantly disabled. Knowledge of patient abilities and preferences for such treatments are needed to make treatment decisions in keeping with their wishes. However, shared decision-making after major stroke can be challenging. Aims: First, to understand how patients may vary with regards to their specific abilities and reported quality of life after major stroke. Second, to understand the experiences, preferences, needs and involvement in decision-making regarding treatments by patients (who retained mental capacity) and family members (where the patient lacked capacity) in the early period after major stroke and their feelings six months later. Third, to develop ways to communicate diagnosis and prognosis after major stroke better. Methods: I used a range of clinical research methodologies: i) A prospective cohort study (n=403) to investigate the progress and outcomes of patients admitted with a major stroke with respect to several domains (disability, quality of life and specific abilities e.g. walking, talking, eating.) ii) Qualitative interviews to explore the experiences, views, needs (information and support) and shared decision-making approaches of patients admitted with a major stroke who retained mental capacity (n=15) and family members where the patient lacked capacity (n=24). iii) Questionnaires to evaluate communication between doctors (n=9) and participants (n=24). iv) Statistical modelling to develop (n=13,117) and externally validate (n=403) models predicting specific abilities after stroke. Results: Patients varied with respect to their specific abilities even though they may be in the same disability level according to global outcome scales (e.g. mRs). In the early period after major stroke, patients looked for hope and were not ready to participate in shared decision-making. However, six months later they wished they had been better prepared for the impact of major stroke by having been given realistic information and psychological support. Family members who were involved in decision-making considered the patient's state of health and preferences before stroke. Some found communication of specific abilities after major stroke useful to decision-making. Based on our expert judgement, longitudinal cohort and qualitative interviews, we developed and externally validated prognostic models to predict six specific abilities after stroke. These models have limitations and need further evaluation. In the future, they may be useful for doctors as a sense check of their judgement of the patients' prognosis, and to provide hope or information to understand impact of major stroke and/or make treatment decisions. This thesis details the challenges of communicating prognosis and involving patients and families in shared decision-making after major stroke and will inform a future intervention to deliver tailored information.

This qualitative study used semi structured interviews to gain an in-depth knowledge of individual's experiences of interventions/support on their journey to ceasing non-suicidal self-injury (NSSI). Twelve adults from the community participated and their interviews were analysed using thematic analysis. Four main themes were generated from the data. Experiences of professional support, Experiences of informal support, Identity: Impact on sense of self, and Importance of relationships. Participants spoke about the unhelpful, detrimental interactions when attending accident & emergency (A&E) and spells on the mental health wards. They also spoke about their fear of reaching out as they feared the consequences of doing so. On the whole participants found therapy to be beneficial except for those aspects of interventions where support was withdrawn following NSSI. Participants valued informal support such as self- help, family and support from the community. It was evident the detrimental impact on sense of self that unhelpful interventions/support afforded. The opposite effect was evident when positive and helpful interactions had occurred. Participants shared the importance of consistency and connection when forming relationships enabling feelings of safety and trust to ensue. Implications of these findings highlight the need for professionals and the community to reflect on how they respond to people presenting with NSSI and adjust their responses accordingly. It also highlights the need for more education, training and supervision.

Language interpreters are pivotal in ensuring equal access to psychological therapy for refugees and asylum seekers in the United Kingdom. However, historical conceptualisations of interpreters as ‘invisible’ in therapy appear to have contributed to a lack of research in this setting. The current study sets out to explore interpreters’ experiences of therapy with refugees and the professional support they need in this setting. Eleven interpreters participated in semi-structured interviews, which were then analysed using Thematic Analysis. Three overarching themes were identified: What is my Role?; Emotionally Connected vs Detached; and Current Context vs Aspiration. Results highlight participants’ experiences of an ambiguous and complex role and of a unique setting that poses technical and emotional challenges; interpreters' conceptualisation of their preferred support; the experienced precarity of an unregulated and poorly recognised profession; and the personal growth being an interpreter brings about. This study has clinical and policy implications, such as organisations’ obligations to offer specialised, multi-modal support to interpreters and the urgency of granting interpreting protection of title.

Evidence increasingly shows that male caregivers have a different approach to caregiving than their female counterparts. Consequently, they may require a different form of support to enable them to sustain their caregiving role. Given that caregiving has traditionally been seen as a feminine activity, previous research has comprised predominantly female samples, and the impact of caregiver support for male caregivers is under-researched. The aim of this study was therefore to address this gap in the literature, by exploring the impact of support services in identifying and meeting the support needs of older male caregivers caring for a chronically ill spouse/partner at home. A mixed methods approach was employed, which was informed by masculinity and coping theories, over four distinct phases. Quantitative data were collected through a survey (n=39), qualitative data were collected though individual interviews (n=24), focus groups (participants: n=84) and a deliberative workshop (participants: n=36). Study findings related to three key areas. Firstly, it was recognised that the approach of older male spousal caregivers can be influenced by views on masculinity that are aligned to traditional hegemonic masculinity theories. Secondly, caregiving can involve social isolation, loneliness and challenges to spousal intimacy for older males. Thirdly, support providers should understand and be responsive to the gendered nature of caregiving and consider this when engaging and delivering support to older male caregivers. Findings demonstrated that older male caregivers experienced negative caregiver outcomes, which were not necessarily alleviated by existing support services. The current study makes an original contribution to knowledge by advancing understanding about how existing caregiver support impacts on older male caregivers, in light of their particular approach to their caregiving role. Recommendations include improving awareness of this amongst formal support providers, and drawing on developments and ideas from other male-centred initiatives in men’s healthcare and health promotion.

This is a study of mental health and transition. Despite concern about professional mental health, and a suicide rate among veterinary surgeons three to four times that of the general population, studies of veterinary professional mental health have largely been cross-sectional and descriptive; characterising a problem, and raising concern, but not exploring how professional mental health and work interrelate. This study is different. Following individuals over time, and exploring experiences in detail, it seeks to understand experiences of work and mental health at a significant point in veterinary working lives: the transition from university to professional practice. There is a lack of evidence around the impacts of transition from study to professional practice. The Veterinary Transition Study starts to address this gap in understanding. It is a qualitative, prospective, cohort study: first meeting participants in their final year of veterinary study, it follows them through graduation, and into their second year of veterinary practice. Three interviews with each participant in total over the 3 years of the study facilitate an in depth understanding of the process of transition, and participants’ experiences of mental health as they transition from student life to that of a professional veterinary surgeon. Thirty six participants were recruited. All but one took part in at least one subsequent interview at 1-2 months or 19-27 months post-graduation. The study explores mental health, experiences of support, and the development of professional identity. New findings included the importance of informal support for veterinary students and new graduates, which was as important as formal support, and a reluctance to access formal support for fear of career detriment. Those vets who experienced the greatest difficulty at transition were not those who had reported mental health problems as students. Participants’ experiences of support at transition included being let down, and a mismatch between their experience and clinical responsibility given to them. Through the analysis and trying to distinguish veterinary and non-veterinary factors affecting mental health, the importance of veterinary identity became more prominent. Most participants had been determined to become vets from an early age. However, participants did not identify as vets at the point of graduation but rather self-identified as vets only once they could operate as independent practitioners and not perceive that they needed support. Separating personal and veterinary factors was in many cases not possible, so central was the identity of being a vet to participants’ lives during transition to professional work, and all aspects of their lives were affected by it. Mental health both affected identity, and was affected by it, with personal identity and shared culture acting both for and against participants’ mental health. This study examines this relationship, and goes on to make suggestions from the findings for individual vets moving from university to professional work, for employers of new graduate vets, and for universities.

Background: An estimated 1.2 million stroke survivors living in the United Kingdom (UK), currently rely on family caregivers for daily support. The needs of stroke family caregivers are not routinely assessed by most stroke services. An early identification of their needs and support is crucial to maintain their well-being and caregiver role. At present, stroke-specific caregiver screening tools are lacking. Aim: To adapt the Carers’ Alert Thermometer (CAT), a short screening tool developed in the context of end-of-life care and develop the CAT-S for use with stroke family caregivers. Methods: This was a multi-phase study, underpinned by principles of action research. Between February 2016 to December 2017 qualitative and quantitative data were collected sequentially from purposive samples of stroke family caregivers (n=76) and staff working within stroke services (n=238) in the UK. Semi-structured interviews were conducted to inform the contents of the CAT-S. Key items for inclusion were identified through a modified Delphi survey and consultation with an expert panel. The CAT-S was then piloted in North West England to test its usability and usefulness in practice to identify the needs of family caregivers of stroke survivors. Thematic analysis and content analysis were used to analyse qualitative data. Quantitative data were analysed using descriptive statistics. Findings: The CAT-S comprises the key challenges that are experienced by stroke family caregivers. Additional items that were not present on the original CAT were identified and included. These were the training needs of family caregivers to provide care and support for their emotional needs. The CAT-S was found to be useful and acceptable by both staff and stroke family caregivers and resulted in action plans and support being provided. The CAT-S is a potentially valuable tool in prioritising family caregivers requiring comprehensive assessments.

In this thesis, I explore 42 autistic individuals' transitions into further and higher education (FHE) in England, drawing on personal experience as well as interview data. I was diagnosed with Asperger's Syndrome in 1998 at the age of 13. At the age of 15, my mother introduced the topic to me, and autism soon became the foundation of my socio-political identity. The discussion is divided into three themes; stigma and perception management strategies, formal and informal support networks and the interplay of autism with institutional factors. I draw upon Tringo's (1970) work on the hierarchy of impairment and Goffman's (1963) work on stigma. Tringo's (1970) hierarchy of impairment led me to my intra-communal hierarchy of impairment (perpetuated by autistic individuals against autistic individuals) and Goffman's (1963) work on stigma led me to my four degrees of openness; autistic individuals can be indiscriminately open, or indiscriminately reticent, but openness if relevant, and openness if necessary, are more common strategies. UPIAS' (1976) work on the social model of disability laid the foundation for my socio-political identity and this thesis. I argue autism has been largely absent from the political arena. I outline how there are four ideals; the ideals of self-regulation, normalcy, ability and independence. Eager to conform to these ideals, eager to self-present as 'independent', 'self-regulating', 'normal' or 'capable', some autistic students are reluctant to request support and accommodations, complicating the transition to FHE.

Background & Aim: This study set to explore what young people [YP] think of the wellbeing and mental health [MH] support available to them in their school and community as such views are currently underrepresented in the literature. It aimed to contribute to our understanding of young people's psychological needs and preferences of mental health services including its delivery and performance. Study Design: YP (11 to 16 years) were invited to take part in semi-structured interviews to discuss their experiences of MH and wellbeing support available to them. Twenty-one participants from a secondary school based in the North of the UK took part in the study. A representative sample with the following characteristics was recruited: YP with experiences of past MH issues; long-term health conditions; no known MH issues or other conditions. A comparable gender and age representation was ascertained in the sample. Data Analysis: The participants' interviews were transcribed and further analysed through the use of thematic analysis (Braun & Clarke, 2006). Results & Discussion: The findings suggest that YP are an informed consumer group of wellbeing and MH provision and were aware of the benefits of psychological support. They identified the need for more services and voiced strong views on helpful and unhelpful features of support that was available at their school and community, both on an interpersonal and service-user level. This study contributed to the literature on help-seeking and psychological coping in young people. It was observed that help-seeking was mediated by the perceived need for support, self-confidence and individual differences. Identified barriers to accessing support were lack of services and perceived stigma. Conclusion: The findings showed that young people favoured a person-centred approach to care (Ahmad, Ellins, Krelle & Lawrie, 2014). They wanted to feel valued, respected, listened to, be a part of collaborative planning and involved in the decision-making and management of their mental health care.

This thesis explores experiences of education for young men incarcerated in a Scottish prison. This study utilised the research of Erving Goffman (1961) as a starting point for understanding the social world of people in custody. The core objectives of this study are aimed at understanding the personal biography of prisoners, exploring how prisoners interpret and give meaning to learning and education in prison, the role of the institution in providing an environment of learning, and the potential outcomes of prisoners participating in learning and education in custody. This study also examines how and why learning may be impactful to prisoner identity, self-perception, and assesses the importance of formal and informal learning for people in custody. The findings of this study suggest that the prisoner experience is influenced by individual motivation, self-awareness, support systems, and relationships. This research further reflects a strong connection between student identity and positive traits (i.e. resilience, hope, and optimism) as directly correlated with learning in prison and also suggests that the choice to engage in learning while in prison is representative of ongoing change and individual growth. Research related to the prisoner experience is further enhanced by understanding that identity for people in custody may be perceived differently depending on the age and/or gender of the incarcerated person. Identity development may prove to be critical to combating stigma and labelling as a result of incarceration as this research identified that prisoners tend to associate themselves with socially constructed stereotypes as a method of coping.

Some research has suggested that guided play (GP) is a better support type for children to learn, but other research has suggested direct instruction (DI) is better for teaching children physics. These research fields formed the basis of this study, in addition to also considering the role of executive function (EF) and metacognition (Mc) due to their potential links to physics task performance. This research was carried out with 38 3- and 4-year-olds over three time points (TP), six weeks apart. Children completed the same EF, Mc, and physics task at each time point, as well as a transfer ramps physics task at TP3. Children were split into one of two support type two groups to carry out the balance beam tasks: GP or DI. No significant links between EF and Mc were detected, and no role of EF or Mc in physics task performance was seen. A small association between Mc rate and strategies used was seen at one TP only. A significant difference in Mc behaviours displayed by each group during the balance beam task was found at each TP, due to GP scoring significantly higher than DI, but no significant difference in Mc interview scores was found. No significant link between GP's higher Mc rate scores and other measures was detected. There was a significant difference in balance beam performance between the groups at TP3, due to DI scoring significantly higher than GP. The results from the balance beam task did not significantly correlate with the transfer ramps task, suggesting support type did not have a strong transferable effect to another physics task. It was found that vocabulary was associated with EF and Mc interview scores, suggesting language was an important individual factor. The study has highlighted that young children's learning of balance beam concepts is complex, with individuals showing a variety of strategies to solve different balance beam problems. It provides support that DI could be a better support type for teaching children balance beam concepts. The data are discussed with reference to different theories and to the issues surrounding the small sample size and low statistical power, which are potentially impacting the conclusions that can be drawn.

This study is an exploration of students who study part-time to achieve a Master of Education award in the context of continuing professional development. Particularly interesting to this study is identity development and the effects on confidence/self-esteem as MA Education Students' cope with the interacting dimensions of personal, professional and study contexts. The research found a triangle of tensions between professional, personal and developing postgraduate identities to be at the heart of transitions into becoming a postgraduate student. Students' investments of finance, time, cognitive effort and reprioritisation of lifestyle is made without guarantee of return. They experience low professional self-concept; they are daunted by self-doubts about meeting the demands of master's study; troubled by imposter feelings and preoccupied by their professional identities. However, confidence and self-esteem improve as study progresses and by harnessing personal qualities, and some support networks, students overcome barriers to achieve positive outcomes, which for some can be transformative. An interpretivist methodology has been adopted using a case study approach with data collected from MA Education students at one post-1992 university. Twenty-five students were included in: two focus group interviews (each of five participants); five individual interviews and ten students participated in a series of four sets of email questions posed at regular points in one year of their degree. Braun and Clarke's (2013) approach to thematic analysis was adopted and themes emerged inductively. There are several recommendations arising for both practice and policy. For practice all aspects of curriculum design and delivery must be mindful of the professional and personal qualities, not just student academic competencies, which contribute to masterliness. However, programme and module specific induction must include strategies to encourage students' envisioning of their possible selves as student in order to grow their confidence and self-esteem as students. Lecturers must be mindful about the motivations behind part-time, higher level study for continuing professional development and the factors which constrain deep learning. Recommendations for wider policy relate to urging government and educational leaders to validate the value of educationalists, of all types. This should be achieved by fully resourcing accredited master's study in both practical and financial ways.

There is considerable research about individuals’ negative experiences of the process of obtaining an autism diagnosis (Crane et al., 2018), however less is known about experiences of post-diagnostic support. A systematic review of the literature showed a gap for research focused on people’s experiences of post-diagnostic support for children and young people on the autism spectrum. A qualitative approach was taken, and an inductive thematic analysis was chosen to investigate this topic. Eight parents, eleven school staff, and four young people on the autism spectrum, all from one London borough, were interviewed about their experiences, either individually or in a focus group. Thematic analysis of the data revealed five main themes: a lack of knowledge and understanding about autism, a system overwhelmed by unmet needs, the impact of communication on relationships, negative impacts on quality of life, and hope for the future (developing the system to make it work). The overwhelming finding was of a significant lack of post-diagnostic support, and a system poorly designed to support children on the autism spectrum and their families. Findings are discussed in the context of the ecological systems model (Bronfenbrenner, 1992), and in relation to previous research. Important clinical implications and recommendations are presented with the aim of improving post-diagnostic support for children and young people on the autism spectrum, and their families, in the future.

This research explores homicidal bereavement experiences, particularly for individuals with longer-term difficulties after their loss, and evaluates the impact of a residential, psychoeducational intervention offered by a national charity, Escaping Victimhood (EV). To achieve those goals, a longitudinal mixed method design was implemented prospectively with participants as they attended an EV intervention and retrospectively with those who had attended 2-5 years before. The literature review (Chapter 1) demonstrates that violent losses (homicide) tend to have greater impacts on individuals' lives (e.g., psychological, financial and social difficulties), compared with non-violent deaths, given the particular characteristics of the homicide itself and aftermath post-event. Furthermore, this review highlighted a lack of evidence-based research investigating what psychological interventions have been evaluated. This led to the systematic review (Chapter 2) to evaluate which interventions are most available, as well as how EV elements compared with those interventions. This is followed by three empirical chapters (chapters 3-5). Chapter 3 (qualitative study) explores the individuals' perceptions about the post-homicide reality, impacts and experiences of support. Chapter 4, a longitudinal study estimates patterns of psychological difficulties, coping and resilience over time and post-EV intervention. Finally, Chapter 5 qualitatively explored how 29 EV participants (14 were interviewed 6-9 months and 15 at 2-5 years post-EV intervention) progressed over time and what changes, barriers to recovery and future hopes they report. The overall discussion (Chapter 6) considers the findings of the two reviews and empirical studies performed where the findings from the outlined independent studies are embedded in three main areas, namely: 1) Post-homicide reality; 2) Psychological difficulties & coping and resilience patterns; and 3) Interventions and support needs. Finally, limitations, recommendations for EV, clinical practice, policy and future research directions are included.

Background: The incidence of haematological cancers is increasing, however developments in treatment and survival rates mean that longer-term prognosis is improving. Nonetheless, the impact of cancer and its treatments remains with both short-term and long-term effects for patients and carers, which often results in persisting unmet supportive care needs. In addition, the shift of care delivery from inpatient to ambulatory setting and earlier hospital discharge, emphasises the need for services to support patients ability to self-manage. The healthcare team in an Italian Comprehensive Cancer Centre hospital implemented an ad hoc symptom management and supportive care telephone intervention based patients expressed feelings of abandonment after discharge. The intervention was unsustainable due to personnel resources and lacked a rigorous evaluation of patient acceptability. The aim of the PhD study was to develop a telephone intervention providing support and symptom management that is acceptable to patients undergoing or having undergone treatment for a haematological malignancy, based on the best available evidence. Methods: The MRC Framework was used as the basis for the development of the intervention. The evidence base to inform development was drawn from 3 sources. Firstly a systematic review of existing literature, and secondly qualitative research with key stakeholders: in-depth interviews with 20 patients with haematological malignancies and focus group(s) with a total of 10 expert haematology nurses. Framework Analysis was used to analyse data from the qualitative research. A synthesis of these findings was presented to a consensus group of key stakeholders within the local hospital setting in the subsequent modelling phase of the intervention development. Results: The application of telephone-based interventions to address cancer patients needs was evident throughout the literature within a variety of settings. Whilst it is said to be convenient, provide accessible and timely reassurance and continuity of care, it was not necessary or desirable for everyone. Stakeholders in qualitative research confirmed these findings, emphasising the need for individuality in interventions to adequately address the uniqueness of needs at different time points in the cancer trajectory. Factors including effective training for the intervention delivery, organisational support and integration into current practice were imperative for the sustainability of an intervention. The consensus group meeting agreed the definition and outline of an intervention delivered by the Primary Nurse, to monitor patients for physical, social or psychological needs and provide support through individualised care planning that can be trialled in practice. Conclusion: Unmet needs persist in patients with haematological malignancies throughout their survival trajectory, and telephone based interventions are one means of addressing these supportive care needs. The use of the MRC Framework as a guide has resulted in the development of a detailed intervention incorporating evidence from key stakeholders in order to arrive at an intervention that is acceptable both for those receiving and those delivering the intervention. Such a model may be the basis for supportive intervention in other clinical areas.

All nurses should have the ability and disposition to engage in therapeutic relations with people who have learning disabilities. Therapeutic commitment is described as a therapeutic attitude that is influenced by nurses' perceptions of role competency and role support. It is essential to the provision of nursing care leading to improved patient outcomes. The study aimed to explore final year adult (AD), mental health (MH) and learning disability (LD) student nurses' perceptions of therapeutic commitment towards people with learning disabilities and the factors they perceived influenced it. A mixed method, convergent approach for complementarity and expansion purposes was used. A survey collected quantitative and qualitative data from 398 final year student nurses across four Higher Education Institutes in Scotland. Integrated findings suggested when caring for people with learning disabilities that student nurses are therapeutically committed, with LD student nurses' perceptions being greater than their counterparts. LD student nurses also perceived greater role competency and reported they could access experienced support more readily. Having education, a personal experience, the opportunity to provide care whilst on clinical placement and previous work experience with people with learning disabilities influenced the therapeutic commitment and role competency all students perceived. Other influencing factors included receiving thanks, being challenged by the task and the attitudes and qualities held by the nurse. Some AD and MH student nurses believed that people with learning disabilities characteristics negatively influenced their therapeutic commitment. This study has implications for nursing practice and education as it builds on the theory of therapeutic commitment, providing new knowledge of the factors that influence it, either positively or negatively when caring for people with learning disabilities. This knowledge will support nurses to engage in positive therapeutic relationships with people with learning disabilities to enhance the delivery of nursing care.

Research has highlighted the multiple barriers women who have experienced domestic violence and abuse (DVA) face in 'disclosing' abuse. However, 'disclosure' is but the first step in women accessing 'support' for a wide range of needs; less is known about women's experiences once they have accessed 'support'. Existing research has frequently identified what is termed 'secondary victimisation' within services, however this has typically been studied within separate spheres - medical, legal and so on - preventing a more integrated understanding of women's experiences. This research applies a feminist perspective to explore how women experience accessing 'support' from formal and informal systems after DVA, and considers what constitutes support, for them. The research involved consultation and collaboration with service users and staff at a specialist DVA organisation. Nine women who were engaged with the organisation took part in semi-structured interviews. The interviews were analysed using thematic analysis within a critical realist contextualist epistemology. Three main themes were identified: theme one, "It's the Seeing It and Acknowledging It": Who, Where and How?; theme two, The Duality of Help, and theme three, "We've Had Enough". Theme one considers how constructing experiences as abuse intersected with women's experiences of 'help'. The second theme explores the paradoxes associated with navigating 'support systems' and their possible harms. The final theme explores how women describe being impacted by and responding to their experiences, both of abuse and within 'support systems'. Results of the analysis are discussed in relation to empirical and theoretical literature. In discussing findings, the use of power within services is explored and the importance of relational aspects of care. Implications are considered at a community, service and research level.

Background: People with intellectual disabilities (ID) remain at high risk of developing type 2 diabetes (T2D) due to lifestyle associated risk factors such poor diets and low physical activity levels. Interventions have been adapted which target ongoing T2D self-management. However, there are no adapted programmes which prevent T2D through reducing risk factors. The present research project addresses this gap through a three-phase study on the existing literature, theoretical basis, and process evaluation of a T2D prevention programme. Methods: Phase 1: The literature reviews identified that the support needs of people with ID with T2D are currently not being met. Appropriate training needs to be delivered so that people with ID can self-manage or reduce the risk of T2D effectively. Given the early onset of T2D in people with ID and their often shorter lifespan, there is rationale for a preventative agenda in T2D education. Four potential mainstream intervention programmes were identified, and the self-efficacy model was found to be the most prevalent successfully implemented theoretical model. Phase 2: Nine sub-themes were identified following analysis of the data: 1) "Mastery through knowledge"; 2) "Mastery through tools and strategies"; 3) "Mastery through autonomy"; 4) "Influence of social setting"; 5) "Positive social comparisons"; 6) "Positive and negative self-statements"; 7) "Feedback from Caregivers"; 8) "Adjustment experiences"; 9) "Symptom awareness". These were mapped onto Bandura's (1977) Four Sources of efficacy enhancement model and were consistentwith its proposed mechanisms. The Four Sources model serves as a useful mode of enquiry for exploring people with ID's experiences and perceptions of self-managing diabetes. It also confirms the appropriateness of ssself-efficacy as a potential intervention component for this population. However, additional support may be required for people with ID to reflect meaningfully on their experiences and thus have a sense of self-efficacy. Phase3: 96% of invited students agreed to participate. The Walking Away programme was positively received, and some short-term impact was described, yet there were limitations to accessibility of the program due to the complexity of the language and materials. Suggestions for further adaptations regarding materials and content were provided, and there was perceived scope for a long-term implementation built into college curriculum. Results: Phase One: The literature reviews identified that the support needs of people with ID with T2D are currently not being met. Appropriate training needs to be delivered so that people with ID can self-manage or reduce the risk of T2D effectively. Given the early onset of T2D in people with ID and their often shorter lifespan, there is rationale for a preventative agenda in T2D education. Four potential mainstream intervention programmes were identified, and the self-efficacy model was found to be the most prevalent successfully implemented theoretical model. Phase Two: Nine sub-themes were identified following analysis of the data: 1) "Mastery through knowledge"; 2) "Mastery through tools and strategies"; 3) "Masterythrough autonomy"; 4) "Influence of social setting"; 5) "Positive social comparisons"; 6) "Positive and negative self-statements"; 7) "Feedback from Caregivers"; 8) "Adjustment experiences"; 9) "Symptom awareness". These were mapped onto Bandura's (1977) Four Sources of efficacy enhancement model and were consistent with its proposed mechanisms. The Four Sources model serves as a useful mode of enquiry for exploring people with ID's experiences and perceptions of self-managing diabetes. It also confirms the appropriateness of self-efficacy as a potential intervention component for this population. However, additional support may be required for people with ID to reflect meaningfully on their experiences and thus have a sense of self-efficacy. Phase Three: 96% of invited students agreed to participate. The Walking Away programme was positively received, and some short-term impact was described, yet there were limitations to accessibility of the program due to the complexity of the language and materials. Suggestions for further adaptations regarding materials and content were provided, and there was perceived scope for a long-term implementation built into college curriculum. Phase Three: 96% of invited students agreed to participate. The Walking Away programme was positively received, and some short-term impact was described, yet there were limitations to accessibility of the program due to the complexity of the language and materials. Suggestions for further adaptations regarding materials and content were provided, and there was perceived scope for a long-term implementation built into college curriculum. Conclusions: The findings provide basis for a further trial incorporating the suggested adaptations. A self-efficacy informed prevention programme was highly acceptability to students and teaching staff. Further education colleges provided a supportive setting and yielded a rich sample.

This thesis explored the experiences and support needs of male partners of women with postnatal mental health problems using qualitative methodologies. The thesis consists of three papers: 1) a systematic literature review, 2) an empirical study and 3) a critical reflection of the research process. The systematic review (paper 1) is a qualitative meta-synthesis of the experiences of men whose partner had postnatal mental health problems, and the impact on men's emotional wellbeing, relationships and support needs. Twenty studies from six countries including the views of 277 men were included and analysed using the thematic synthesis approach. Five main themes, containing 19 subthemes were derived from the analysis: 1) Being a father, 2) Being a partner, 3) Experiencing negative emotions, 4) The ways in which men cope, and 5) Where support is needed. The results suggested that participants' emotional wellbeing, and their roles as a partner and a father are affected by maternal postnatal mental health problems, and their coping can be both hindered and enhanced by the support they receive. In light of these findings recommendations were made for increased awareness of men's support needs and improvements in the delivery of perinatal mental health support. The empirical study (paper 2) reports a qualitative exploration of the support preferences of male partners of women admitted to specialist mother and baby units (MBUs) relating to the content, delivery and timing of support. Ten men were interviewed and data were analysed using thematic analysis. Five main themes, with 15 corresponding subthemes were identified: 1) A smoother journey to and from the MBU, 2) Feeling included, 3) Uncertainty about 'what is going on', 4) Barriers to support and 5) Facilitators of support. Men described practical, emotional and social support they would have valued, and suggested how this could be delivered. The findings were considered in relation to the existing literature to make recommendations for improvements in the delivery of MBU support. The critical reflection (paper 3) provides a description and appraisal of the research processes, including discussions pertaining to the methodological approached taken. This paper also includes details on the entire body of work, including supplementary projects upon which this research was built, and the impact of the work as a whole.