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This research measures police efficiency, effectiveness and public trust for territorial police forces in England and Wales from 2011/12 to 2017/18, under the background of a spending reduction among the police forces from 2011/12 to 2014/15. Research goals: to quantify the efficiency, effectiveness and public trust at the level of police force area during the period of austerity; to compare and analyse whether any police forces performed better than others and in what areas; to analyse factors contributing to improving police performance from the perspective of resource allocation; to investigate any association between efficiency, effectiveness and public trust. Primary research methods: data envelopment analysis to measure police efficiency, panel linear regression to analyse the relationship between performance and resources, and social text mining as a supplement method to measure public trust. Main dataset: Crime Survey for England and Wales (with low-level geographic data), Police Workforce in England and Wales, Tweets extracted from Twitter. Innovations: Although this method is still used in other nations with crime data in recent publications, data envelopment analysis has never been employed to analyse police efficiency in the UK after 2006. This research once again applies the data envelopment analysis method to measure police efficiency. It employs survey data to measure effectiveness outcomes to include hidden crimes that were not reported to the police. To measure public trust, a supplement text mining method, sentiment analysis with Tweets, is proposed to assess attitudes toward the police.

Background: Pharmacogenomics (PGx) is the use of Deoxyribonucleic Acid (DNA) to predict an individuals' response to a drug. Through the lower cost of DNA sequencing and advances in genomic medicine, PGx testing is a viable and valuable tool in improving medicines optimisation for patients. Over recent years, the role of the community pharmacist in England has evolved from dispensing medicines to delivering increasingly complex pharmacy services. In addition, community pharmacy is accessible and convenient for patients, and therefore potentially an appropriate setting for this testing service. Whilst in some parts of the world, community pharmacists have begun offering PGx testing, there is no evidence of any activity in England. There is therefore a research gap in knowledge to establish if this service could be implemented in the culture and context of the healthcare infrastructure and system in England, which differs somewhat from other countries. Method: The principles of co-design were deployed following three sequential phases using action-orientated frameworks and tools. In Phase One, three focus groups were conducted with community pharmacists (n= 10), prescribers (General Practitioners) (n= 8) and patients (n=8) to identify the barriers and enablers to implementing a community pharmacy based PGx service in England. The focus groups were recorded, transcribed and thematically analysed. In Phase Two, barriers and enablers from Phase One were mapped onto the Theoretical Domains Framework (TDF) followed by use of the Theory and Techniques Tool (TATT) to link the identified TDF domain with corresponding Behaviour Change Techniques (BCTs). A consensus questionnaire followed by a Nominal Group Technique workshop were used to facilitate community pharmacists (n=11) selecting their preferred BCTs to include in a service specification. Finally, in Phase Three, a draft service specification was developed, and a joint participant (n=12) consensus panel was convened for critical comment. The service specification was refined based on the feedback. Results: Five barrier and enabler themes were developed in Phase One: (1) In-principle receptiveness, (2) Appreciation of the benefits, (3) Lack of implementation resources (4) Ambiguity about implications for implementation and (5) Interprofessional relationship challenges. In Phase Two, the qualitative data from the pharmacist focus group were mapped onto six TDF domains: Knowledge, Skills, Social/ professional role and identity, Optimism, Beliefs about Consequences, and Environmental context and resources. Forty-six BCTs were identified using the TATT, of which nine BCTs were selected by the target audience: Review outcome goal(s) (1.7), Information about emotional consequences (5.6), Pros and Cons (9.2), Social support (Practical) (3.2), Feedback on behaviour (2.2), Instruction on how to perform behaviour (4.1), Demonstration of the behaviour (6.1), Credible source (9.1) and Adding objects to the environment (12.5). Finally, in Phase Three, the draft service specification was produced, and progressed into the final version following critical feedback from the mixed participant consensus panel. Conclusion: The co-design methodology using action-orientated frameworks and tools has resulted in the production of a novel service specification for implementation of a PGx community pharmacy testing service in England to fill a gap in research knowledge. This can now be used to implement the service and further research should be carried out to evaluate the service post implementation.

Epigenetics, the study of mechanisms that influence gene expression, has been described as a crucial link by which our environments and lifestyles can influence health outcomes. Research has indicated that early life risk factors can epigenetically 'program' a child's later risk of ill health, but also that the individual's own lifestyle in adulthood can influence epigenetics and health, modifying this risk. Furthermore, it has recently become possible to track biological ageing, using what has been termed 'the epigenetic clock'. The research presented in this thesis is the first to examine the effect of epigenetic accounts of health on stigma, policy support and health behaviour motivation. Previous research has drawn upon attribution theory to suggest a key role of control. Namely, that health outcomes attributed to uncontrollable causes (e.g., genetics) are associated with reduced blame towards individuals and increased assistive policy support, but also increased belief in health outcomes as fixed and reduced health behaviour motivation, compared to health outcomes attributed to controllable causes (e.g., behaviour). By applying attribution theory to epigenetics, this thesis explores whether the same trade-offs of blame, policy support and health behaviour motivation are observed when communicating early life and adult accounts of epigenetic ageing and health. To achieve this, this mixed methods thesis includes online experiments communicating epigenetic aetiologies of obesity (Study 1), and early life vs. adult accounts of epigenetic ageing (Study 2), development and validation of an Epigenetic Belief Scale (Study 3), and an experiment communicating individual vs. societal epigenetic accounts of parenting and children's epigenetic age (Study 4). Lastly, a thematic analysis of interviews with individuals who have undertaken direct-to-consumer epigenetic testing is presented, which aimed to explore motivations for testing, sense-making of results and subsequent health behaviour change (Study 5). Collectively, my findings indicate that communicating epigenetics is associated with trade-offs. Adult malleability accounts are interpreted as high-control causal accounts, and may promote health behaviour motivation, however, may also predict blame and potentially stigma, dependent on context. Early life programming accounts are understood as low-control causal accounts when applied to individual health, and predict increased assistive policy support (context-dependent), and low blame and stigma. However, blame and stigma appear to be transferred to powerful others in the individual's life, and early life programming accounts predict increases in parent blame and stigma, especially towards mothers. These findings indicate the likely psychosocial impacts of communicating epigenetics in health contexts, and implications for researchers and healthcare practitioners are discussed.

Adolescents will face the serious future challenges associated with climate change, yet - compared to adults - there is relatively little research investigating their understandings of climate change. Much of the existing research is concerned with the accuracy of their knowledge or their stated support for particular actions to mitigate climate change. The focus of inquiry is typically prescribed, and the dominant use of quantitative methods means that response options are pre-specified. The aim of this thesis was to elicit and examine the ways adolescents understand and make meaning of climate change, and how and where they position it in relation to their own and others' lives. Four empirical qualitative studies were conducted to explore this focus, with Social Representation Theory used as lens through which to consider the research findings. The participants in these studies represented climate change as a real and anthropogenic phenomenon with potentially devastating consequences for the Earth and its inhabitants. Participants positioned others as more responsible for causing climate change. The more serious consequences of climate change were often - but not always - placed with others or at a distance, with some participants associating climate change consequences - and solutions - with science-fiction-like concepts. Participants argued that government-led political, economic, and social change is required to resolve climate change. They also expressed considerable anger at the intergenerational injustice of climate change and the lack of action being taken. However, although united on the issue of intergenerational injustice and the need for action on climate change, not all participants were fully supportive of the youth climate movement and its adherents. Whilst their representations of climate change mirror adults' in many ways, the issue of intergenerational injustice features prominently in these adolescents' representations. The findings indicate the potential utility of earlier and broader climate change education and of expanding political participation to include older adolescents.

For millennia, we have killed animals for meat. Now, as the ethical, environmental, and public implications of our industrial system of animal farming become clearer, we must look for ways to reduce consumption of animal products which are likely to achieve traction amongst a meat-loving population. This thesis argues for the immorality of animal agriculture, and shows that a range of social and psychological factors impede clear reasoning on this topic. It is demonstrated that many people agree with the ethics of veganism, but are unwilling to reduce their meat consumption in practice. Cultured meat is introduced as a potential solution. Cultured meat, grown in vitro from animal cells can allow us to continue consuming real animal meat whilst circumventing the worst consequences of meat production today. The literature on consumer acceptance of cultured meat is reviewed and areas for further investigation are identified. The empirical work in this thesis includes a cross-country survey on cultured and plant-based meat in India, China, and the USA, where major potential markets are identified. A series of experimental studies explore the best ways to name, frame, and explain cultured meat to maximize consumer acceptance and displace demand for animals. The thesis then reviews the deluge of empirical literature which has been added to the field during this doctorate, and discusses the social implications of cultured meat in terms of religions, regulators, the media, and the broader economy. The concluding section identifies strategies for bringing cultured meat to market and discusses the findings in terms of some theoretical frameworks.

The Patients’ Rights Act (Scotland) 2018 requires that Health Boards in Scotland encourage, monitor and learn from patient feedback. A range of mechanisms are used by healthcare organisations to capture and monitor the quality of care and services they provide, and to stimulate improvement where required. Historically these have been a mix of paper-based methods and face-to-face mechanisms. In recent years these traditional methods are increasingly being augmented by spontaneous sharing through social networking tools like Facebook and Twitter, and through dedicated patient feedback websites like Care Opinion. There is little published evidence regarding the legitimacy of capturing and interpreting patient feedback using social media. This research explores senior healthcare managers’ attitudes to and acceptance of online patient feedback, and its potential to inform improvements to health and care services. It considers the suitability of social media for monitoring patient experience and considers the main barriers to using this information to inform changes to healthcare services. Interviews were conducted with 18 senior clinical and managerial staff from three National Health Service (NHS) Boards in Scotland in order to build an in-depth understanding of their attitudes and experiences regarding the use of social media patient feedback for improvement to health and care services. A process of Framework Analysis was used to identify the key issues, concepts and themes expressed by interview participants. The results of this study show contrasting views on the usefulness and value of patient feedback. Participants highlighted the importance of understanding and accepting the patient perspective on their healthcare experience, whilst others questioned patients’ ability to judge the quality of their own care. The emotional impact of both positive and negative patient feedback on healthcare professionals was a key issue for participants. The findings from this study show that senior healthcare managers’ views on the legitimacy of patient feedback through social media are influenced by a number of factors, these include apprehension around the anonymous nature of social media patient feedback; the impact of age and IT skills; the risk to organisational and professional reputation: and concern about the loss of face-to-face communication with patients. The findings from this research study have a number of implications for the development of healthcare policy regarding patient feedback and experience, as well as for healthcare organisations in trying to maximise the benefit and impact of this information.

Background: Extensive research has highlighted the impact of psychosocial stressors on coping, physical health, and emotions. A novel conceptualisation of this is the distinction between ancient and modern stressors; the idea that established adaptive psychophysiological coping processes exist enabling individuals to cope with ancient stressors whilst being less able to cope with modern stressors. Such a distinction could be observed in differential effects on stress responses and common cold symptoms via allostatic processes. The emotions of shame and guilt have also been distinguishable by their adaptive coping profile and have been associated with increased stress reactivity. Aim: The overall aim of this research programme was to assess the feasibility of distinguishing between ancient and modern stressors within a health context from a psychological perspective. This focus enabled a fuller understanding of psychosocial stress and identified stressors that might have the most deleterious effect on health. Methods: This research employed mixed methods; sequential, quantitative, multiphase designs across three studies. Studies one and two utilised quantitative and qualitative methods (questionnaires, interviews) with younger and older adults. Study three employed an experimental design (computer-based implicit task) and utilised quantitative methods with adults. Main findings: Study one identified psychological characteristics enabling a provisional ancient/modern stressor distinction and that younger adults were more likely to express shame associated with ancient than modern stressors. Study two confirmed this distinction based on these characteristics and found that older adults reported both shame and guilt across ancient and modern stressors. It also found associations between modern stressors and common cold symptoms. Study three identified that the distinction between ancient and modern stressors in adults was present at an implicit level of consciousness and an explicit level of cognition. Conclusion: This research programme provides evidence to support the feasibility of an ancient versus modern distinction in stress categorisation. Younger to older adults appear to be better able to cope with stressors designated as ancient and less able to cope with more modern stressors. Individuals' perceptions and coping resources make a stressor moving along an ancient/modern continuum depending on its characteristics. Findings have important health implications when examining the effects of different types of stressors.

Background: The body of evidence surrounding adult and elderly carer outcomes is well established, however fewer studies have been conducted with young carers (those < 18 years with caring responsibilities). Given the negative outcomes associated with caregiving, the experience can be conceptualised as a risk factor for health, requiring protective factors to promote adaptation. Positive outcomes have also been associated with caregiving, suggesting that protective factors and resilience may be inherent in the caregiving role. Protective resilience factors have been identified in adult and elderly carers, and are typically theorised within the three levels of the socioecological model of resilience (individual, community and society). Biopsychosocial research, from a resiliency perspective is necessary to identify the factors contributing to, and pathways towards, resilience, in order to promote positive outcomes in young carers. Aims: The overall aim of the current research programme was to explore the mechanisms underlying psychophysiological resilience in young carers. Specifically, the aim was to identify protective factors which contribute to perceived stress, resilience and physiological outcomes in this population. Method: A mixed methods, sequential design was used across three studies. First, a systematic review was conducted following Prisma guidelines. Second, qualitative photo elicitation interviews were carried out with young carers and analysed using thematic analysis. Finally, a quantitative study was conducted using questionnaires to measure psychosocial factors, and hair samples to assess hair cortisol concentration in young carers and an age-gender matched noncarer control group; data were analysed using statistical techniques including correlation, t-tests, regression and moderation. Summary of findings: The systematic review identified that coping, social support, stress appraisal and carer activities contributed to carer adjustment and outcomes. Evidence was found for both the transactional model of stress and the socioecological model of resilience. The second study identified 11 factors within the three levels of the socioeconomic model of resilience. Individual factors included pre-empting challenges and planning ahead, cognitive strategies, emotional strategies and seeking solitude. Community factors included family support, friendships, and pets and inanimate objects. Societal factors included professional support, access to carer activities and community, being outdoors and disability aids. The findings of this study provided further support for the socioecological model and also identified potential protective factors in a population of young carers. The final study found that young carers reported significantly greater perceived stress than non-carers but did not demonstrate higher hair cortisol concentration. A negative association was found between perceived stress and resilience in young carers and non-carers, and a positive association between perceived stress and hair cortisol concentration was found in young carers. No significant associations were found between resilience and hair cortisol concentration. A relationship was found between perceived stress and benefit finding in the young carer group and no significant relationships were found between benefit finding and hair cortisol concentration in either group. Mediation analyses of benefit finding and resilience as mediators of perceived stress and hair cortisol were not run due to requirements for this analysis not being met. In addition to resilience, caregiver status and avoidant coping contributed to perceived stress. As well as perceived stress, family support, social support and benefit finding contributed to resilience. There were no significant contributory factors identified for variance in hair cortisol, social support did not act as a moderator of perceived stress on hair cortisol. Conclusions: This programme of research identified a number of potential protective resilience factors in a population of young carers, contributing to an area of literature previously unexplored. The findings of this research support the transactional model of stress and coping, and offer substantial evidence for the relevance and applicability of the socioeconomic model of resilience in young carers. The use of physiological assessment in the form of hair cortisol concentration adds to the general psychoneuroendocrine literature and further develops the stance of immunosenescence in carers. The research makes methodological contributions and provides a basis for both future research with young carers and the development of stress resilience interventions, whereby the factors identified in this work can be harnessed to promote positive outcomes.

Women on opioid substitution treatment (WOST) are a group at risk for sexually transmitted infections (STIs) and blood-borne viruses (BBVs). This study aimed to explore the factors that are associated with sexual health risks among WOST, and the sexual transmission of STIs and BBVs. Also, to explore the opportunities for developing a sexual health service in community pharmacies in England. The design of this research was informed by the Intervention Mapping approach to design health promotion programmes. For this qualitative study, 20 WOST and 14 community pharmacists (CPs) were interviewed between October 2015 and April 2017. Four WOST and three CPs took part in focus groups that took place in September 2017. Recruitment for WOST took place in drug services and a service for sex workers. CPs were recruited through community pharmacies. Data were collected in Bath, Bristol and Midsomer Norton (South West of England). Qualitative data was analysed using Framework Analysis and Content Analysis. Findings indicated that there are multiple factors associated with STI/BBV risk among WOST. A Social-Ecological Model was developed including factors at the intrapersonal level - e.g., worthlessness - interpersonal level - e.g., trust in health professionals - organisational level - e.g., availability of sexual health services - community level - e.g., intersectional stigma - and public policy - e.g., current health policies. Using Intersectionality Theory, this research highlighted that social inequities of health are at the core of sexual health risks among WOST. Multiple public health strategies at different ecological levels need to be designed and implemented to reduce these inequities and prevent STIs and BBVs among WOST. Community pharmacy could play a key role in delivering sexual health services, providing equity and protecting the human rights of WOST. Suggestions for service design in community pharmacy are included in this thesis.

Data design, collection, and use are increasingly part of public life in the United Kingdom. Policy-makers in particular are engaging with these kinds of data technologies to increase efficiencies and cut costs in public service provision. Data technologies are subsequently increasingly important in mediating the processes and relationships of communities, citizens, and government. This thesis aims to examine how publics and policy-makers can engage with emerging data technologies in the context of local and national government in the UK. The objectives are as follows. First, to summarise and evaluate the current research and state of government public engagement with data technologies. Second, to scrutinise the current use of data technologies in government through qualitative semi-structured interviews and other qualitative methods. And third, to examine the potential for new forms of public data engagement in government through qualitative workshops and analysis of public views on government and data technologies. This thesis uses a mixed methods approach, which is primarily qualitative, to explore these objectives including a narrative literature review, ethnography, semi-structured interviews, story completion exercises, focus groups and statistical modelling through difference mediation analysis. Key findings include, first, that current public engagement practice on government data use is often limited in topic and form. For example, small-group discussions on public views of privacy that have no clear line to impact policy change. Second, that data use in government is subject to political motivation that generally takes the form of narrative testing. And third that public engagement in the era of big data in government must focus both on means and ends. Government must move beyond a model of seeing 'the public' as a roadblock on the way to civic datafication and instead as an integral part of debating the components of ethical and socially relevant data practice.

Social media platforms have become key tools for gaining information, but there is currently a limited evidence base as how they are used to support information exchange around health issues. Extending the work that has focused on online support groups, this thesis considered social media use in relation to an increasingly common health concern: food hypersensitivity. Four empirical studies using qualitative and quantitative methods were conducted to explore two broad objectives: 1) how and why social media users utilise platforms for managing their food hypersensitivity, and 2) how these users perceive social media information and authors of this content. Findings demonstrated that social media was a valuable source of information and social support for those managing food hypersensitivities, and that platforms served as useful venues for discussion. An analysis of Twitter data demonstrated that organisations and individuals interact to support a cause and mobilise users on an issue. Social media support was likely to be sought post diagnosis, to support information requirements around managing food hypersensitivity. A network of users were seen to moderate information, discrediting inaccurate sources and calling for additional expertise. The Twitter infrastructure, for example, commenting, retweeting, user-tagging, and hashtag usage, facilitated moderation and mobilisation via these networks. Links within tweets increased ratings of credibility and persuasiveness, and markers of food hypersensitive expertise on social media were identified, such as evidenced posts, and connections with stakeholders and other experts. Medical professionals were taken-for-granted experts on social media, but other users could be considered expert through recognised food hypersensitive lived-experience. Both medical professionals and organisations must engage with social media, support content moderation, and signpost patients to appropriate sources. By engaging with social media platforms, stakeholders may reduce risks associated with proliferation of erroneous information, and instead support those seeking to manage food hypersensitivity.