The recontextualisation of architecture and accounting education: Views from the academy and the professions

This thesis reports on a study of the relationship between practice and higher education. It examines the nature of architecture and accounting professional disciplinary knowledge following the recontextualisation and shift of professional learning into higher education in New Zealand. This study set out to examine how and in what way architecture and accounting knowledge and professional identity are shaped by education policy, professional practice, and other contextual influences. In part, it was prompted by a paucity of research on the effects of recontextualisation on the construction of professional disciplinary knowledge, practitioners and academics, and the framing of curriculum content in New Zealand. Participant data for this study were collected through one-to-one interviews with practitioners and focus groups with academics. This enabled in-depth accounts of the cases of architecture and accounting together through the lenses of a range of individuals. Analysis of participant data revealed convergence across the cases of architecture and accounting, particularly in relation to how professions engaged with higher education. The recontextualisation of professional learning into the academy was identified by participants as having created issues of authenticity, autonomy and surveillance. As a result, new practitioners were viewed as struggling to develop skills, behaviours and dispositions expected of practising professionals. Critical factors were the lack of authentic practice within curriculum, and professional learning taking place in risk-averse, highly regulated contexts as mandated by the state. Professional degree designers and teachers struggled to adequately prepare practitioners for relational aspects of practice, and did not appear to easily foster classical notions of professional identity, namely expertise, altruism and autonomy. A critical analysis of documents that shape and otherwise have a bearing on professional learning, practice and professional identity revealed discursive effects of neoliberal education policy and a preoccupation with measurability, surveillance and employability. There are a number of implications for both practice and higher education that can be drawn from this study. At stake is the nature of professional disciplinary knowledge and the development of professionals as autonomous experts practising in New Zealand society. Recommendations are made that point to changes that might enhance professional education programmes within higher education and that call for imagination, criticality and a re-positioning by the state and the professions. To what extent this can occur within the national and global context is the challenge that is presented. A number of future research opportunities are identified. Investigation could continue by examining architecture and accounting knowledge, curriculum and pedagogy in more detail. This study could be replicated to consider other recently recontextualised professional programmes and understand the influences being brought to bear. This study, then, adds to research that considers the legitimacy, power and nature of professional disciplinary knowledge, the discursive effects of a mediated, neoliberal education agenda, and relationships between the academy, practice and society.

"I'm Managing My Diabetes between Two Worlds": Beliefs and Experiences of Diabetes Management in British South Asians on Holiday in the East-A Qualitative Study.

Background. Diabetes is disproportionately high among British South Asians compared to the general UK population. Whilst the migrant British South Asians group has received most attention on research related to diabetes management, little consideration has been given to impact of travel back to the East. This study aimed to explore the role of social networks and beliefs about diabetes in British South Asians, to better understand their management behaviours whilst holidaying in the East. Methods. Semistructured interviews were conducted in Greater Manchester. Forty-four participants were recruited using random and purposive sampling techniques. Interviews were analysed thematically using a constant comparison approach. Results. Migrant British South Asians expressed a strong preference to be in a hot climate; they felt they had a healthier lifestyle in the East and often altered or abandoned their diabetes medication. Information acquisition on diabetes and availability of social networks in the East was valued. Conclusion. Social networks in the East are a valued source of information and support for diabetes. The lack of adherence to medication whilst abroad suggests that some migrant British South Asians have a poor understanding of diabetes. Future research needs to explore whether patients are seeking professional advice on diabetes management prior to their extended holiday

"Always paracetamol, they give them paracetamol for everything": a qualitative study examining Eastern European migrants' experiences of the UK health service.

BACKGROUND: The enlargement of the European Union since 2004 has led to an increase in the number of Eastern European migrants living in the UK. The health of this group is under-researched though some mixed evidence shows they are at higher risk of certain physical health conditions such as heart attacks, strokes, HIV and alcohol use and have poorer mental health. This is compounded by poor or insecure housing, low pay, isolation and prejudice. We aimed to understand the health needs and health service experiences of the Eastern European population in a town in Northern England. METHODS: Five semi structured one-to-one and small group interviews and five focus groups were conducted with 42 Eastern European participants between June and September 2014. The majority of participants were Polish and other participants were from Belarus, Hungary, Latvia, Russia, Slovakia and Ukraine. The data were analysed using thematic framework analysis. RESULTS: Key findings included a good understanding the UK health service structure and high registration and use of general practice/primary care services. However, overall, there were high levels of dissatisfaction, frustration and distrust in General Practitioners (GP). The majority of participants viewed the GP as unhelpful and dismissive; a barrier to secondary/acute care; reluctant to prescribe antibiotics; and that GPs too often advised them to take paracetamol (acetaminophen) and rest. CONCLUSIONS: Overwhelmingly participants had strong opinions about access to primary care and the role of the general practitioners. Although the design of the UK health service was well understood, participants were unhappy with the system of GP as gatekeeper and felt it inferior to the consumer-focused health systems in their country of origin. More work is needed to promote the importance of self-care, reduce antibiotic and medication use, and to increase trust in the GP

Exploring Charity Worker Perceptions of the Social Value and Sustainability of Solar Lighting in Malawi, Kenya and Zambia: A Scoping Study

Approximately 600 million people in sub-Saharan Africa have no access to electricity and use kerosene as a source of light. Solar lighting is a safer and cost effective alternative allowing families to study, work and live without the harmful effects of kerosene. Qualitative, semi-structured interviews were undertaken with staff from a United Kingdom (UK) based charity to explore the social value of solar lighting (n=7). These staff were based in the UK, Malawi, Kenya and Zambia. Two overarching themes: ‘The Social Value of Solar Lighting’ and ’Improving the Sustainability and Economic Viability of Solar Lighting’ illustrated perceived multi-faceted and wide reaching benefits on the micro-level creating positive social, economic and environmental outcomes. Future studies may look to identify the impact that solar lights may have upon the macro-level, and medium to long-term outcomes; and estimated social return on investment in different developing countries

A Constellation of Misfortune. Narrative Accounts of Adverse Life Events, Chronic Illness, and Subjective Social Status

Quantitative studies have drawn attention to the patterning of health inequalities in relation to subjective social status (SSS). There is currently little insight into the complexities of the social and biographical aspects that lie behind these findings. Narrative accounts were gathered in a mixed-methods study involving a population of people with coronary heart disease (CHD) and/or diabetes in a region of the United Kingdom with above average levels of socio-economic deprivation. The aim of this secondary qualitative analysis was to examine the accounts of interviewees with low socio-economic status (SES) who ranked themselves either low or high in terms of SSS. The results highlight the multiplicity of adverse circumstances leading to subjective assessments of low SSS. Loss of employment status contributed more to a feeling of being “at the bottom of the ladder” than the symptoms of chronic illness did, perhaps because having somewhere to go is central to the accrual of social, economic, and cultural capital. The narratives of those who ranked themselves highly (in spite of low SES) appeared to have more family and community connections. The findings contribute to theories of socio-economic biographies or trajectories, subjective social status, and engagement with the self-management aspects of chronic illness

Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support

Background: increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support.Methods: drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support.Discussion: the translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.<br/

Supporting patients self-managing respiratory health: a qualitative study on the impact of the Breathe Easy voluntary group network

Self-management strategies are designed to improve lung and respiratory health through structured self-management plans with regular practitioner reviews. Strategies have not however focused upon how patient support groups and advocacy networks can help with the management of these conditions, therefore it is unknown what impact they may have on patient self-management. A qualitative study was designed to help understand what impact the British Lung Foundation’s (BLF) Breathe Easy (BE) groups have with patients managing their lung and respiratory conditions. A semi-structured telephone interview schedule was developed to study the network. Topics covered included: perceptions about the BE groups; current referrals systems and integration pathways; benefits of attending the BE groups; and integration of the BE groups into the respiratory pathway. Key themes explored included: shared patient experience and peer-support; patient self-management and self-education, attendance of healthcare professionals, and the impact of integrating BE groups into the respiratory pathway. BE networks were shown to support self-care initiatives for people attending the groups and members expressed a social and educational benefit. BE networks were working with the local NHS to become an integral part of the respiratory pathway, yet, there was evidence of resistance from the health service in incorporating the networks

Participation in voluntary and community organisations in the United Kingdom and the influences on the self-management of long-term conditions

Voluntary and community organisations (VCOs) have health benefits for those who attend and are viewed as having the potential to support long-term condition management. However, existing community-level understandings of participation do not explain the involvement with VCOs at an individual level, or the nature of support, which may elicit health benefits. Framing active participation as ‘doing and experiencing’, the aim of this qualitative study was to explore why people with long-term vascular conditions join VCOs, maintain their membership and what prevents participation. Twenty participants, self-diagnosed as having diabetes, chronic heart disease or chronic kidney disease, were purposefully sampled and recruited from a range of VCOs in the North West of England identified from a mapping of local organisations. In semi-structured interviews, we explored the nature of their participation. Analysis was thematic and iterative involving a continual reflection on the data. People gave various reasons for joining groups. These included health and well-being, the need for social contact and pursuing a particular hobby. Barriers to participation included temporal and spatial barriers and those associated with group dynamics. Members maintained their membership on the basis of an identity and sense of belonging to the group, developing close relationships within it and the availability of support and trust. Participants joined community groups often in response to a health-related event. Our findings demonstrate the ways in which the social contact associated with continued participation in VCOs is seen as helping with long-term condition management. Interventions designed at improving chronic illness management might usefully consider the role of VCOs

Aligning everyday life priorities with people's self-management support networks: an exploration of the work and implementation of a needs-led telephone support system

Background: Recent initiatives to target the personal, social and clinical needs of people with long-term health conditions have had limited impact within primary care. Evidence of the importance of social networks to support people with long-term conditions points to the need for self-management approaches which align personal circumstances with valued activities. The Patient-Led Assessment for Network Support (PLANS) intervention is a needs-led assessment for patients to prioritise their health and social needs and provide access to local community services and activities. Exploring the work and practices of patients and telephone workers are important for understanding and evaluating the workability and implementation of new interventions. Methods: Qualitative methods (interviews, focus group, observations) were used to explore the experience of PLANS from the perspectives of participants and the telephone support workers who delivered it (as part of an RCT) and the reasons why the intervention worked or not. Normalisation Process Theory (NPT) was used as a sensitising tool to evaluate: the relevance of PLANS to patients (coherence); the processes of engagement (cognitive participation); the work done for PLANS to happen (collective action); the perceived benefits and costs of PLANS (reflexive monitoring). 20 patients in the intervention arm of a clinical trial were interviewed and their telephone support calls were recorded and a focus group with 3 telephone support workers was conducted. Results: Analysis of the interviews, support calls and focus group identified three themes in relation to the delivery and experience of PLANS. These are: formulation of ‘health’ in the context of everyday life; trajectories and tipping points: disrupting everyday routines; precarious trust in networks. The relevance of these themes are considered using NPT constructs in terms of the work that is entailed in engaging with PLANS, taking action, and who is implicated this process. Conclusions: PLANS gives scope to align long-term condition management to everyday life priorities and valued aspects of life. This approach can improve engagement with health-relevant practices by situating them within everyday contexts. This has potential to increase utilisation of local resources with potential cost-saving benefits for the NH

Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management

Early detection of long term conditions is predicated on assumptions that lifestyle changes and medications can be used to reduce or manage the risk of condition progression. However, ambiguity remains about the nature and place of diagnostic disclosure to people in newly recognised or asymptomatic ‘pre’ conditions such as early stage chronic kidney disease (CKD). The disclosure of a diagnosis is relevant to instigating strategies which rely on actively engaging patients as self-managers of their own care. Whilst primary care routinely records a diagnosis of early stage CKD, little is known about how patients learn about the fact that they have CKD or how they respond to this. This study aimed to explore patients' experiences of disclosure of CKD in primary care settings. A nested qualitative study of participants recruited to a trial of an intervention for CKD patients in Greater Manchester, UK was undertaken. A purposive sample of 26 patients, with a mean age of 72 years (range 59e89, median 71), were interviewed during 2012. Interview transcripts were analysed using constant comparative techniques. Narrative accounts reflected limited or partial disclosure of CKD; often cast in vague terms as “nothing to worry about”. How patients described themselves in terms of participation and their tendencies towards ‘active’ or ‘passive’ involvement in consultations emerged as important components of narratives around disclosure. The findings illuminate the ways in which diagnosis is oriented in a context where it is possible to meet the requirements for remuneration under a pay for performance system of primary care, whilst apparently not disclosing a label or a diagnosis to patients. This challenges the presumptions inherent in wider health policy objectives that are increasingly built on the notion of responsible patients and the ethos of the active support of self-management for pre-conditions