Understanding the reasons for non participation in self-manegement intervemtions amongst aptienrs with chronic conditions: addressing and increasing opportunities for patients with advanced chronic obstructive pulmonary disease to access self-management

Background In chronic obstructive pulmonary disease (COPD), understanding the problem of poor patient participation in evidence-based self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as SM support programmes) is critical. This thesis aimed to improve understanding of poor patient participation and retention in these programmes; how participation might be improved; and how might patients be better supported with their SM. Methods Using the Medical Research Council guidance on complex interventions this thesis (1) quantified the ‘actual’ patient participation and completion rates; (2) explained, using theory, the factors that influenced participation in studies of SM support including the programmes among chronic disease and COPD patients; and (3) explored patient and expert stakeholders’ perspectives on the reasons for non-participation in SM support programmes, how participation might be improved, how might patients be supported with their SM. Results (1) Among 56 studies, high study participation rates and completion rates were seen however, the incomplete reporting of participant flow confused the problem of participation. (2) Among 31 studies, participation among patients with chronic disease including COPD was shown to be influenced by their ‘attitude’ and ‘perceived social influence/subjective norms’; ‘illness’ and ‘intervention perceptions’. (3) From 38 interviewees, besides patients’ beliefs, non-participation was also influenced by resignation and denial of the illness; health systems; and programme organisational factors. Professionals building relationships and supporting patients with their SM alongside programme organisational improvements might encourage patient participation in SM and the programmes. Conclusions Patient participation is a complex behaviour, besides socio-behavioural factors, participation behaviour can by influenced by a mix of several health system and programme organisational factors. Changing the behaviour of health professionals and indeed the wider health system, towards normalising a patient partnership approach, with implementation of SM support in routine care might help more patients to consider participation in their care and improve patient participation in COPD SM support programmes.The National Institute for Health Researc

Jewish women's lives in London and Sydney, 1850-1900

A persistent focus on the activities and achievements of the wealthiest and most Orthodox Jewish men, justified a rigorous reevaluation of overlooked historical source material in order to provide a basis for our understanding the distinctive role of Jewish women within the interconnected British cities of London and Sydney in the second half of the nineteenth century. The chapters are divided into subsections that focus on topics that were significant to Jewish women and girls. The experiences and thoughts of the wealthiest and most influential Jewish women, including women from the de Rothschild and Montefiore families, are presented aside the poorest and most disempowered Jewish females, such as girls, widows and orphans in order to present the widest range of perspectives. The dissertation begins by exploring Jewish women's involvement in the politics related to Jewish emancipation and women's enfranchisement, and the way that Jewish migration into London promoted changes to their social and religious networks and sparked interest in Australia as a destination for Jewish colonists. This provides a basis for understanding the nuances of British-Jewish women's role within the family and the way a preference for smaller families intersected with religious reforms and altered women's attitude toward attending the mikvah and following the laws of Niddah. The dissertation also investigates the distinctive culinary traditions and holiday observances of British-Jewish women, which varied somewhat from American and European women's traditions, as did their role in the synagogue. The educational achievement, employment opportunities, and the contributions of Jewish women as they volunteered in Jewish settings within Sydney and London are explored. These subjects enhance our understanding of women's daily lives and their desire for equality not only with Jewish men, but also with their non-Jewish neighbors. This dissertation provides a basis for future scholars to include the experiences of English and Australian Jewish women in trans-regional and cross-cultural histories and broadens our knowledge of female migrants from a numerically small religious group