Relational provisions from pets in the context of the family : implications for perceived social support and human health

This thesis examines how the psychology of human relationships can be applied to the phenomenon of pet ownership. Current views on the origins of pet ownership and reasons for its popularity, and the application of concepts from the psychology of human-human relationships to human-pet relationships are reviewed. The most popular model, attachment theory, is critically evaluated and examined empirically in a preliminary study. Attachment seems not to provide a satisfactory model. A functional approach, investigating what human-pet relationships do rather than what relationships they resemble, was pursued in the remainder of the thesis. Individuals in a pet-owning family may all interact with the pet in quite different ways, yet are often all labelled equally as pet owners. Investigation of human-pet relationships in the family context facilitated an analysis of characteristics of owning a pet, such as exclusivity. Differences among human-pet relationships were examined according to family role of the owner, and pet species. Pets are frequently regarded as members of their owners' social network, and as a source of relational provisions at levels which are in some cases comparable to those from human relationships. For some pet owners, support from pets may have a buffering effect against stressful life events, and protect owners against adverse psychological symptoms. Important differences were found between species. Dogs provide higher levels of provisions than cats, and cats are rated more highly than other pet species. There is therefore a need for caution against generalising from one species to pets in general. The social provisions approach is shown to be productive, but it is not the only model from human social relationships that might be used, and alternative or complementary models should also be explored

Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home : cross sectional survey

Objective To examine parents' reported knowledge and use of harm reduction strategies to protect their infants from exposure to tobacco smoke in the home, and the relation between reported use of strategies and urinary cotinine to creatinine ratios in the infants. Design Cross sectional survey. Settings Coventry and Birmingham. Main outcome measures Parents’ reported knowledge and use of harm reduction strategies and urinary cotinine to creatinine ratios in their infants. Participants 314 smoking households with infants. Results 86% of parents (264/307) believed that environmental tobacco smoke is harmful, 90% (281/314) believed that infants can be protected from it in the home, and 10% (32/314) were either unaware of measures or reported using none. 65% of parents (205/314) reported using two or more measures, but only 18% (58/314) reported not allowing smoking in the home. No difference was found in mean log e transformed urinary cotinine to creatinine ratio in infants from households that used no measures compared with households that used less strict measures. Mean log cotinine to creatinine ratios were significantly different in households banning smoking in the home compared with those using less strict or no measures. Banning smoking in the home was independently associated with a significant reduction in urinary cotinine to creatinine ratio by a factor of 2.6 (1.6 to 4.2) after adjustment for average household cigarette consumption, tenure, and overcrowding. Conclusions Less than a fifth of parents in smoking households ban smoking in the home. Banning smoking was associated with a small but significant reduction in urinary cotinine to creatinine ratio in infants, whereas less strict measures compared with no measures had no effect on the infants’ exposure to environmental tobacco smoke

Maternal and fetal genetic effects on birth weight and their relevance to cardio-metabolic risk factors.

Birth weight variation is influenced by fetal and maternal genetic and non-genetic factors, and has been reproducibly associated with future cardio-metabolic health outcomes. In expanded genome-wide association analyses of own birth weight (n = 321,223) and offspring birth weight (n = 230,069 mothers), we identified 190 independent association signals (129 of which are novel). We used structural equation modeling to decompose the contributions of direct fetal and indirect maternal genetic effects, then applied Mendelian randomization to illuminate causal pathways. For example, both indirect maternal and direct fetal genetic effects drive the observational relationship between lower birth weight and higher later blood pressure: maternal blood pressure-raising alleles reduce offspring birth weight, but only direct fetal effects of these alleles, once inherited, increase later offspring blood pressure. Using maternal birth weight-lowering genotypes to proxy for an adverse intrauterine environment provided no evidence that it causally raises offspring blood pressure, indicating that the inverse birth weight-blood pressure association is attributable to genetic effects, and not to intrauterine programming.The Fenland Study is funded by the Medical Research Council (MC_U106179471) and Wellcome Trust

Women's experiences of comfort eating : an interpretative phenomenological analysis

Literature Review: Emotional eating is being increasingly considered in the understanding of obesity and weight change (Ganley, 1989; Buckroyd, 2011). This review examined qualitative research grounded in emotional eating being a key factor of obesity and weight change. Six electronic databases were searched between August 2012 and January 2013. Included articles were published between 2000 and 2013 from the USA and Western Europe. Twenty-one articles were analysed using thematic analysis to integrate findings and generate relevant themes. Four core themes were identified: Vulnerability; Triggers; Function; and Emotional Aftermath. The findings indicated how emotional eating formed a cyclical pattern of behaviour with weight gain implicated as a primary consequence. Implications for future research and clinical practice are discussed. Research Report: Emotional eating was defined as van Strien et al. (2007) by 'the tendency to overeat in response to negative emotions such as anxiety or irritability' (p.106). The study aimed to explore women’s experiences of comfort eating, a form of emotional eating which provides self-comfort or self-soothing. Seven semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA), finding three superordinate themes: ‘The private experience of comfort eating’; ‘My emotional relationship with comfort eating’; and ‘Mind-body connection’. Themes linked to comfort eating being used to mask (Polivy & Herman, 1999) or escape (Heatherton & Baumeister, 1991) negative emotion. Vulnerabilities to comfort eating included restrained eating (Herman and Mack, 1975) childhood eating patterns and critical parental rules around food. Implications for research and clinical practice are discussed. Critical Appraisal: The processes involved in conducting a research project are discussed reflectively in the critical appraisal section. This includes: personal reflections; limitations in terms of data collection and analysis; and implications for research and clinical practice.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Adolescents' attitudes towards psychological therapy

The literature review explored adolescents‟ experiences of psychological therapies. Sixteen studies were reviewed and a narrative synthesis found that therapist characteristics, the wider context of mental health and personal feelings were important aspects of the therapeutic encounter for the adolescent population. Synthesis of the evidence was limited by methodological weaknesses. Further research regarding what hinders engagement in therapy and macro-level influences on the therapeutic encounter was suggested. The research study utilised a qualitative, semi-structured interview design to explore adolescents‟ experiences of psychological therapy. The accounts of eight adolescents were analysed using Grounded Theory methodology (Glaser & Strauss, 1967). The findings suggested that adolescents‟ attitudes towards psychological therapy were affected in a complex and dynamic manner by their experiences of the therapeutic process, their experiences of the therapist and their views about what others‟ think. The research also suggested that adolescents represent a high risk group for disengagement from psychological therapy. The findings were discussed in the context of existing research and it was suggested that professionals providing psychological therapy should consider taking an active political role in shaping future service developments to enable services to engage better with this client group. Further research exploring whether these findings are more widely generalisable was suggested. A personal account of the researchers‟ reflections on the research process is provided in the critical appraisal.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Women's experiences of vaginismus and its treatment : an interpretative phenomenological analysis

Female sexual pain is a common problem affecting women worldwide yet remains a poorly researched area of women’s sexual health. Dyspareunia and vaginismus are two types of sexual pain disorder each having psychological and physical health consequences for women and their partners. Part 1: A literature review of the qualitative research literature exploring women’s experiences of sexual pain disorders and their treatment was conducted adopting a narrative synthesis approach. Searches of psychological and medical electronic databases highlighted the paucity of research exploring women’s experiences of sexual pain disorders. Ten studies met the inclusion criteria for the review. The type of qualitative method and quality varied. Findings highlighted the complexity of women’s experiences of sexual pain. Positive experiences of treatment identified alternative benefits of treatment in addition to the traditional outcome of vaginal penetration and penetration without pain. Existing literature has focussed on dyspareunia, and further research is needed on vaginismus. Part 2: The research study used an Interpretative Phenomenological Analysis (IPA) of women’s experiences of vaginismus. Three women were interviewed about their experiences of vaginismus and the treatment they received. Interview transcripts were analysed using IPA. The findings identified the complexity of experiencing vaginismus, the struggle the women faced when trying to make sense of their vaginismus and the wider impact of these experiences on their identity. The findings highlight the value of psychological therapy with this client group and of the need to raise awareness amongst primary care professionals whom women with vaginismus are likely to consult in the first instance. Part 3: A critical appraisal of the research process is presented with focus on the experience of conducting qualitative research as a trainee clinical psychologist. A discussion of the findings is presented in the context of critical reflections on both the strengths and limitations of the study.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Long-term consequences of gastric bypass surgery : a qualitative exploration of patients' eating patterns and behaviours

Obesity is a growing problem throughout the world and accompanies many physical and psychological issues. Increasingly Bariatric Surgery is being turned to as a means of losing weight, often after many failed attempts to use diet and exercise. The focus of this project is on the experiences of patients who opt for Bariatric Surgery. The literature review explored the qualitative studies on experiences after Bariatric Surgery. It adopted a Narrative Synthesis approach and the findings were analysed for themes. A total of twelve papers were included and three main themes emerged. They were titled “Transformation”, “Adjustment & Coping” and “The Paradoxes”. The review highlighted clinical recommendations regarding patients unmet needs after surgery and suggested topics for further research. The research report explored the longer term experiences of patients who had undergone Gastric Bypass Surgery (GBS), which is a frequently used procedure for weight loss. The study utilised Grounded Theory techniques to collect and analyse the data. Seventeen participants were interviewed, all of whom had undergone GBS three to eight years ago. A core category titled “The Battle for Control” was found to permeate the majority of experiences pre and post surgery. A theoretical model was devised to propose factors that enabled the participants to develop self-control after surgery, such as viewing the bypass as a tool and learning to self monitor. It also outlined circumstances that impeded this process, such as finding ways to cheat the bypass. Issues relating to food addiction and body image also emerged from the data. The findings are discussed in relation to existing literature, along with theories relating to self-efficacy and locus of control. Further recommendations for clinical practice and research are also given. The critical appraisal is a reflective, personal account that discusses some of the important issues relating to quality in qualitative research.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Sikhs and dementia : cultural and religious constructions in this minority population

South Asians are at a greater risk of developing dementia due to also having a higher incidence of diabetes than the UK population as a whole (Department of Health, 2002). However little is known about this ethnic groups understanding of dementia. A review of the literature on the understanding of dementia in South Asian’s living in the community suggests that differences in the perceptions of the causes and treatment of dementia exist within South Asians. Further research has been suggested to explore minority groups within the umbrella term ‘South Asian’. NICE guidelines require treatment for dementia to be culturally, religiously and spiritually sensitive. However, the South Asian population is not an homogenous group, and there may be differences on what constitutes a sensitive approach for different sub-groups. This study sought to focus on one section, the Sikh community. A focus group design was used to explore how culture and religion influences the conceptualisation of dementia in the Sikh community. Six focus groups were undertaken, consisting of 28 participants and data was analysed using constant comparative methodology (Charmaz, 2006). Four themes emerged including awareness and interpretation of the characteristics of dementia, multiple perspectives of the same symptoms, cause of dementia and coping. The findings have been discussed in the context of existing research and provide an introductory insight into informing culturally appropriate interventions for dementia awareness in the Sikh community. The final section, the critical appraisal, reports an account of the researcher’s reflections throughout the research process.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Barriers to accessing mental health services for postnatal depression in the UK: a literature review

Postnatal depression (PND) is believed to affect 10-15% of mothers in the early months after birth (Cooper et al., 1988; O’Hara & Swain, 1996, Leverton & Elliott, 2000). It has a negative effect on the quality of life for these women, is also associated with high levels of depression in fathers (Ballard, 1996) and impacts on the cognitive and social development of children (Cooper & Murray, 1995; Murray & Cooper, 1997; Martins & Gaffan, 2000). Many of those affected by PND may not be receiving appropriate care: the NHS Direct webpage reports: “A study carried out into postnatal depression showed that only 1 in 4 women sought any help” (NHS Direct Online Health Encyclopaedia). This review aims to provide a critical interpretive synthesis (CIS) of the evidence concerning barriers to access to mental health services for PND in the UK. The research data on this topic are varied and include evaluations of interventions, quantitative surveys that tap the views of patients and health professionals, and qualitative interviews accessing the experiences of women with PND and of health professionals. Methods for reviewing and synthesising such diverse forms of evidence have been the topic for much recent debate. CIS has been demonstrated to provide a useful framework that draws upon qualitative methodology to analyse diverse evidence, generate categories and consider the links between them in order to develop new explanatory theory (Dixon-Woods et al. 2006). CIS does not exclude papers on the basis of any hierarchy of evidence or quality checklist. Dixon-Woods et al., (2006) argue that this is not desirable for several reasons: there is no ‘hierarchy of evidence’ for qualitative data and no consensus on how to appraise papers for inclusion in reviews; quality check lists can exclude papers that may make a substantial theoretical contribution on the basis of ‘surface mistakes’ (Dixon-Woods et al., in press; Sandelowski, 1997). Instead, CIS is inclusive in order to ensure that any papers that may make valuable contributions are not excluded and involves criticism, at all stages of analysis and synthesis, throughout the process. This requires a recursive and reflexive approach. This review focuses on UK evidence because it aims to inform policy making and practice within a NHS, UK context. Whilst research in other countries may inform theories concerning what influences women’s access to mental health services for PND, there are likely to be differences arising from the variations in service delivery and cultural and social contexts between countries. It is therefore considered preferable to review each country independently before attempting to achieve a broader synthesis