How Do People with Inflammatory Bowel Disease Understand their Pain

Volume one of this thesis comprises three parts. Part I presents a conceptual introduction which aims to give a broader overview to the empirical study presented in part II. A review of the literature is used to present the key ideas, concepts and theories that are pertinent to this research and its objectives. The discussion outlines Inflammatory Bowel Disease (IBD), chronic pain and specifically, visceral pain. Experience and understanding of IBD pain are discussed and placed in a broader context. Qualitative research on making sense of pain is presented and synthesised. Part II presents an empirical study exploring individuals’ understanding of their IBD pain. IBD pain is a neglected area of research, despite being one of the most common and debilitating symptoms in IBD. The study interviewed 20 people adults with IBD utilising the Grid Elaboration Method (GEM). Thematic analysis was used to analyse the data and produce three, overlapping themes: making sense of my pain, navigating my care and support and it takes its toll. The findings showed that making sense of one’s pain is experiential, inextricably linked with navigating support and managing the impact of pain. The findings indicate that IBD pain warrants more attention and should be proactively integrated into assessments and management approaches. Part III of this thesis presents a critical appraisal of the research process, including both its learning opportunities and challenges, as experienced by the researcher. This section encompasses ideas gathered from a bracketing interview and reflective research journal which was kept throughout the research process to aid reflexivity

Diagnostic reasoning in medical students using a simulated environment

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Epistemische Überzeugungen Lehramtsstudierender

Die vorliegende Arbeit untersucht die intuitiven Auffassungen Lehramtsstudierender bezüglich der Genese, Sicherheit und Rechtfertigung von bildungswissenschaftlichem Wissen – sogenannte epistemische Überzeugungen. In mehreren Teilstudien mit insgesamt N = 1365 angehenden Lehrerinnen und Lehrern wurde kumulativen Forschungsfragen nach der Domänen- und Kontextspezifität, der Relevanz für Prozesse selbstregulierten Lernens und der Assoziation mit der wahrgenommenen Praxisrelevanz nachgegangen sowie eine theoretische Verhältnisbestimmung von epistemischen Überzeugungen und Professionalität im Lehrerinnen- und Lehrerberuf vorgenommen. Bezüglich der ersten Frage nach der Spezifität epistemischer Überzeugungen konnte mehrfach Evidenz für die Hypothese der dualen Natur epistemischer Überzeugungen generiert werden, wonach die Überzeugungen sowohl einen gegenstands- /domänenspezifischen als auch einen globalen Charakter haben. In einer Studie zur Rolle epistemischer Überzeugungen in der präaktionalen Phase selbstregulierten Lernens zeigte sich, dass epistemische Überzeugungen Lehramtsstudierender prädiktiv für die Lernstrategienwahl sind, wobei Studierende mit sog. ”sophistizierteren“ Überzeugungen ihre Lernstrategien stärker an die Komplexität von Aufgaben anpassten. Desweiteren konnten Nachweise erbracht werden, dass mit der Praxisrelevanzeinschätzung eine zentrale motivationale Variable Lehramtsstudierender mit dem Entwicklungsstadium epistemischer Überzeugungen assoziert ist. Die überwiegend quantitativ-empirischen Studien wurden durch eine theoretische Verhältnisbestimmung der Rolle epistemischer Überzeugungen für die Professionalität im Lehrerinnen- und Lehrerberuf aus der kompetenz- und strukturtheoretischen sowie der berufsbiographischen Perspektive gerahmt

Health Promotion at School

For decades the health of children and adolescents has been a topic of interest in all parts of Europe. And there is quite a consensus that schools are the most appropriate setting to promote health. Childhood and adolescence constitute key stages for learning and adopting a health-related and active lifestyle which includes physical activity and sports. The book describes a new approach to enhance students` health awareness through experimental learning settings in P.E. class, cross-subject teaching, and project work.Teaching health topics requires a pedagogical and didactical framework based on the concept of health literacy and interdisciplinary research discussed by the authors. Teaching examples to improve students` health knowledge, health competencies and skills as well as health behaviour and habits at school implicates a new teaching structure presented in the book

Decentralisation in the post-conflict environment of Guatemala: a critical examination of the evaluation process of community participation in a health sector reform context

This thesis focuses on a critical and comprehensive analysis of community participation within a health sector reform process in a post-conflict environment. The aim is to examine how evaluation of such processes should be guided, how decentralising policies should be implemented, and how the assumptions of existing evaluations limit their relevance and effectiveness. The thesis argues that comprehensive analysis demonstrates the need for a much deeper and more extensive understanding of the multiple complexities present in post-conflict environments than is often achieved. It is necessary to carry out a historical, comparative and analytical evaluative exercise, beyond mainstream structural-functionalist evaluations, because the latter generally do not address relevant external and internal variables affecting the conditions of the community. Utilising this proposed approach fieldwork in the communities of San Juan Chamelco and San Miguel Tucurú (in the northern department of Alta Verapaz) examined examples of the limitations of and potentials for the incorporation of traditional medicine into the institutional healthcare system. This fieldwork is used to inform development of a comprehensive framework for evaluation with wide potential as a technical-conceptual tool. The Guatemalan case is presented as an illustrative example of how this tool can be developed and elaborated within a specific historical, political, social and cultural context. Building on the findings of a sectoral evaluation carried out under the auspices of the Ministry of Health the comprehensive evaluation presented identifies key problems that prevented health decentralisation policies from having a significant and positive impact at the local level. In this complex post-conflict environment, local organisation and community participation are shown to be still in their infancy having been obliterated by the counter-insurgency policies during the course of prolonged conflict.sub_iihdunpub3_ethesesunpu

ICT for development reconsidered: a critical realist approach to the strategic context in Kenya's transition to e-governance

This study contributes to critical information systems research understanding of the broader strategic context of information systems initiatives in developing countries. It investigates contextual influences with structural impacts that may lead to instabilities and discontinuities in the immediate project context using a critical realist paradigm. It was informed by literature on development as discourse, ICT4D policy and technology transfer, E-Government adoption, and information systems research paradigms and applications in developing countries. A disconnection was observed between ICT4D policy practice that favors positivist technology diffusion models and research findings that suggest interpretive and critical contextual approaches. A theoretical framework was developed to reconsider ICT4D from a postcolonial country perspective by integrating critiques of modernity from Critical realism and postcolonial theory. An empirical case study investigation of change in Kenya‘s transition to E-Governance was then conducted and analyzed using a critical realist research framework, the Morphogenetic approach, supplemented by Q-methodology to study subjectivity. Finally ICT change was interpreted using critical realist concepts for structure, culture, and agency, with an overriding direction towards greater freedom. The main research contribution is a new approach to ICT4D where change is conceived within a dialectical framework that assumes people are moral and ethical beings possessing values. Research findings have implications for understanding the strategic context of E-Governance and ICT4D, time and temporality in contextual integrative frameworks, and suggest an alternative approach to strategy analysis in situations of rapid political and institutional change. They highlight the importance of political leaders and development agencies as mediators and interpreters of the strategic context. Development was conceived as a dialectical process towards transformative praxis, which together with the suggested approach to the strategic context, may require us to rethink the meaning of IS project success or failure in postcolonial developing countries

Effects of an e-learning programme on osteopaths’ back pain attitudes: a mixed methods feasibility study

A thesis submitted to the University of Bedfordshire, in partial fulfilment of the requirements for the degree of Doctor of Philosophy.i. Background Guidelines recommend the biopsychosocial (BPS) model for managing non-specific low back pain (NSLBP) but the best method for teaching this model is unclear. Printed material and face-to-face learning have limited effects on practitioners’ attitudes to back pain. An alternative way is needed and e-learning is a promising option. E-learning is becoming an important part of teaching, but little guidance is available to the osteopathic profession. ii. Purpose This study had four aims. First to assess the feasibility of running a main trial to test the effectiveness of an e-learning programme on the BPS model for NSLBP on experienced practitioners’ attitudes to back pain; secondly, to assess the acceptability of the e-learning programme and the use of the internet as a mode of CPD; thirdly to provide an effect size estimate; and finally to explore the participants’ views on the e-learning programme and its possible impact on their reported behaviour. iii. Methods First a scoping review of the BPS factors and assessment methods for NSLBP was conducted. It informed the content of an e-learning programme that was designed and developed, and informed by a behaviour change model and an e-learning developmental model. An explanatory mixed methods feasibility study was conducted: first, a pilot Randomised Controlled Trial (RCT) assessed experienced osteopaths’ attitudes before and after the intervention, using the Pain Attitudes and Beliefs Scale (PABS) and the Attitudes to Back Pain Scale for musculoskeletal practitioners (ABS-mp); then semi-structured interviews explored participants’ views on the e-learning programme and its possible impact on their reported practice behaviours. ii iv. Results 45 osteopaths, each with at least 15 years of experience consented to, and took part in, the study. The two trial arms were: a 6-week e-learning programme (intervention group) and a waiting-list group (control group). 9 participants were interviewed for the qualitative strand. The feasibility of conducting a main trial was good, the intervention was well accepted and the adherence to the intervention was good. An effect size estimate was calculated to inform sample size for a main trial. In the qualitative strand, participants’ views on the BPS model fell in with the themes of being Not structural enough, being Part of existing practice and being Transformative. v. Conclusion(s) This study provided new knowledge that had not been reported before in several areas:  how an e-learning programme for experienced manual practitioners should be developed,  a new intervention was reported (e-learning programme), including its design and acceptability,  osteopaths’ views on using the internet as a form of CPD,  information on the challenges faced in implementing a BPS approach

Educational work with factory women in Malaysia

Most women workers' education focuses on women's objective-material situation namely employment conditions and rights as workers. Hence, consciousness-raising on exploitation and the importance of workers unity are the usual agendas. Women's subjectivities, their individual personally lived experiences are rarely taken on board. Even in situations where gender agendas are covered, their unspoken thoughts, repressed feelings and pains, especially the personally felt emotional subordination tend to be overlooked. This thesis explores how silenced experiences of emotional subordination, powerlessness and inferiority can be taken on board in and as educational work with factory women. Guided by principles of participatory research and feminist research I used multiple methods to review current and past educational work with factory women in Malaysia, to explore a way of approaching and doing educational work that is empowering for factory women and that is based on their lived experiences. Specifically the research (i) undertook a historical and critical review of women workers education in Malaysia and identified the neglected dimensions 1 (ii) probed the lived gendered experiences of factory women, and (iii) evolved a pedagogy that can evoke and reconstitute silenced experiences of emotional subordination. Storying, as a narrative methodology for negotiating and constructing meaning from experience (and practice) frames the epistemological and methodological approach to this study. The study established that although emotional suffering is only one dimension of factory women's lived experiences and one dimension of women's subordination, it is however, a critical area to address in educational work concerned with factory women's empowerment, given the pervasiveness of debilitating emotional subjectivities amongst them. Story-telling-sharing in small groups was found to be effective in facilitating the constructive unfolding of differences and commonalities while also fostering an emotionally safe space in which women can rebuild self-esteem and confidence and discover solidarity. Indeed, story-telling-sharing that incorporates processes of reflective talking and making sense is the educational method par excellence. It commences with lived experiences and experienced feelings to reconstitute women's subjectivities. These findings bring significant insights to the pedagogy and content of educational work with women on the global assembly line, and for women and workers' education in general