Men's health and illness : the relationship between masculinities and health

This thesis presents men’s discussions and experiences of health and illness and its relation to, and implications for, the practices of masculinity amongst a diversity of men. Fifty five men participated in fourteen semi-structured focus group interviews. Diversity in men’s experiences of health and illness and in their constructions of masculinity was sought within the sample by age (range 15-72 years), occupational status, socio-economic background and current health status. Groups of men were recruited who had had ‘everyday’ or unremarkable experiences of masculinity and health and groups of men with health experiences that could have prompted reflection on masculinity and health. This included groups with men who had prostate cancer, coronary heart disease, mental health problems, and Myalgic Encephalomyelitis (ME). All of the men that participated in the study lived in central Scotland (Glasgow, Edinburgh, Dundee, Lanarkshire and Perthshire) and just one group was conducted with men of Asian origin, which reflects the limited ethnic diversity in this part of Britain. The first data chapter examines participants’ descriptions of their masculinity and their health-related beliefs and behaviours. The data capture both the experiences of men who felt pressured to engage in behaviours that may be harmful to their health in order to appear masculine and the accounts of those who regarded themselves as freer to embrace salutogenic health practices as they perceived there to be fewer consequences for their masculinities. These considerations are then followed by an examination of how participants re-negotiated male identity in the light of illness. The final data chapter presents participants’ discussions and experiences of help seeking and its relation to the practice of masculinity. The data suggests a widespread endorsement of a ‘hegemonic’ view that men ‘should’ be reluctant to seek help, particularly amongst younger men

The reflective component of the Mellow Bumps parenting intervention: Implementation, engagement and mechanisms of change

Understanding why parenting programmes work or do not work, and for whom, is crucial for development of more effective parenting interventions. In this paper we focus on a specific component of Mellow Bumps: reflection on one’s own childhood/past/life. We explore how this component was implemented, how participants engaged with it, the facilitating and constraining factors shaping this, whether and how it appeared to work, or not, and for whom. The paper analyses data from the Process Evaluation of the Trial of Healthy Relationships Initiatives for the Very Early years, which is evaluating two antenatal interventions delivered to vulnerable women, one of which is Mellow Bumps. Data were collected from January 2014 to June 2018 for 28 groups, 108 participants and 24 facilitators in a comprehensive and rigorous Process Evaluation designed to complement the Outcome Evaluation. Data were gathered at various time points using multiple methods, and were synthesised to triangulate findings. The reflective component was implemented with fidelity and participants engaged with it to varying degrees, dependent largely on the coherence of the group. Patchy attendance compromised the coherence of some groups, with the development of rapport, which is key to delivering reflective exercises, more difficult when group composition varied from week to week. Where there was a coherent group, powerful mechanisms of change, leading to stress reduction, included: relief through unburdening, empowerment through support given and received, reduced isolation through sharing anxieties, and control through self-care advice. A minority of highly vulnerable mothers seemed not to benefit from the reflective exercises and were marginalised within their groups. In order to minimise potential harmful effects of such exercises, allocation of participants to groups should strive to maximise group homogeneity. More research is needed to explore how very vulnerable parents can be supported in attending parenting interventions from start to finish

A realist process evaluation of Enhanced Triple P for Baby and Mellow Bumps, within a Trial of Healthy Relationship Initiatives for the Very Early years (THRIVE): study protocol for a randomized controlled trial

Background: THRIVE is a three-arm randomised controlled trial (RCT) that aims to evaluate whether antenatal and early postnatal interventions, Enhanced Triple B for Baby (ETPB) plus care as usual (CAU) or Mellow Bumps (MB) plus CAU (versus CAU alone), can: 1) improve the mental health and well-being of pregnant women with complex health and social care needs; 2) improve mother-infant bonding and interaction; 3) reduce child maltreatment; and 4) improve child language acquisition. This paper focuses on THRIVE’s realist process evaluation, which is carefully monitoring what is happening in the RCT. Methods: Realistic evaluation provides the theoretical rationale for the process evaluation. We question: 1) how faithfully are MB and ETPB implemented? 2) What are the mechanisms by which they work, if they do, and who do they work for and how? 3) What contextual factors are necessary for the programmes to function, or might prevent them functioning? The mixed-methods design includes quantitative measures, which are pre- and post-training/intervention questionnaires for facilitators and mothers-to-be, and post-session evaluation forms. Qualitative data collection methods include participant observation of facilitator training and the delivery of a series of antenatal sessions in selected intervention groups (n = 3 for ETPB and n = 3 for MB), semi-structured interviews with facilitators, pregnant women, partners, and referring facilitators, and telephone interviews examining the content of the postnatal components of ETPB and MB. Discussion: The findings of this process evaluation will help researchers and decision makers interpret the outcomes of THRIVE. It will provide a greater understanding of: how the interventions work (if they do); the extent and quality of their implementation; contextual factors facilitating and constraining intervention functioning; variations in response within and between subgroups of vulnerable parents; and benefits or unintended consequences of either intervention. Few studies to date have published detailed research protocols illustrating how realist process evaluation is designed and conducted as an integral part of a randomised controlled trial

What are LGBTQ+ People’s Experiences of Alcohol Services in Scotland? A Qualitative Study of Service Users and Service Providers

This current qualitative study focused specifically on LGBTQ+ people who had accessed alcohol services or peer support in Scotland to explore their experiences and discover how services could be improved. We also explored the views of service providers to provide a more rounded account

No backstage: the relentless emotional management of acute nursing through the COVID-19 pandemic.

The COVID-19 pandemic disordered the routine delivery of health care. We explored nurses' experiences of working in COVID and non-COVID facing roles, focusing on staff in the acute sector of one Scottish health board. The study covered the period between April and July 2021, and was conducted through twenty in-depth interviews. Interactions between patients, family members and nurses changed due to inflection control measures. Staff experienced a range of conflicting emotions, e.g. fear of infection and transmission but a strong sense professional duty to contribute to the pandemic effort. Nurses were dissatisfied with the care they provided and experienced moral dilemmas, distress and injury from the emotional labour caused not only by working under the infection control measures, but also by the virulence and uncertainty of this new disease. We draw on earlier works - Goffman's (1967) presentation of self, Hochschild's (1983) work on emotional labour, and Bolton and Boyd's (2003) work furthering emotional labour - to illustrate that the usual rules and routines of interaction between patients, family and staff were abandoned. Nurses were able to mask their distress and injury, but were often unable to effectively deliver the correct emotional response due to infection control measures, such as protective clothing (PPE) and social distancing. The 'backstage' spaces, important for dealing with the emotion of front stage performances, were missing for those in COVID-facing roles. The isolating work, and the removal of spaces for the donning and doffing of PPE, resulted in limited or no opportunity for humour and the enacting of collective care. Their private space offered little reprieve with the constant media attention on infection levels, death and nursing 'heroes'

What are LGBTQ+ people’s experiences of alcohol services in Scotland? A qualitative study of service users and service providers.

This current qualitative study focused specifically on LGBTQ+ people who had accessed alcohol services or peer support in Scotland to explore their experiences and discover how services could be improved. We also explored the views of service providers to provide a more rounded account

The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

<B>OBJECTIVES</B> To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. <B>METHODS</B> Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. <B>RESULTS</B> Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. <B>DISCUSSION</B> We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial

Learning to teach (LETS): developing curricular and cross curricular competences in becoming a 'good' secondary teacher: executive summary

The aim of this research, the Learning to Teach Study (LETS), the first of its kind on the Postgraduate Diploma in Education (PGDE) in Ireland, funded by the Department of Education and Skills (DES), was to develop and implement a study of initial teacher education in the PGDE in post-primary education, in the School of Education, University College Cork. Its aim was to identify the individual and contextual dynamics of how student teachers develop curricular and cross-curricular competences during initial teacher education (ITE). Within an overall framework that explores how student teachers develop their skills, competences and identity as teachers, it focuses on curricular competences in mathematics, science and language teaching, and on the cross-curricular competences of reading and digital literacy and the development of inclusive teaching practices. LETS is the first programme level research on the PGDE, familiarly known to generations of student teachers and teachers as ‘the Dip’ or ‘the HDip’. Drawing on research on teacher education both in Ireland and internationally, the LETS report is divided into six sections encompassing thirteen chapters. Section 1 includes the review of literature and study aims in Chapter 1 and the research methodology in Chapter 2. Adopting an interpretive approach, LETS involved the collaborative development of three interviews protocols and a survey by the research team. Seventeen (n=17) students were interviewed three times over the course of PGDE programme, and one hundred and thirty three students completed a detailed survey on their learning to teach experience (n=133, i.e. response rate of 62.7% of the 212 students in the PGDE 2008/09 cohort). The four chapters in Section 2 focus on professional identity as a central dimension of learning to teach. Among the dimensions of learning to teach addressed in this section are the role of observation and cultural scripts in becoming a teacher, the visibility/invisibility of PGDE students as learners and the relationships between emotions, resilience and commitment to teaching. The three chapters in Section 3 focus on mathematics, modern languages and science respectively in the context of conventional and reform-oriented visions of good teaching. A number of common as well as subject-specific themes emerged in this section in relation to subject matter teaching. Section 4 focuses on PGDE students’ experience of inclusion (chapter 10) and reading literacy (chapter 11) while learning to teach. Section 5 focuses on a key aspect of initial teacher education, namely, the school-university partnership. The final section provides a summary of the findings, identifies seven key issues emerging from these findings, makes Learning to Teach Study (LETS) recommendations under four headings (system, teacher education institutions, partnerships in ITE and further research) and discusses some implications for research, policy and practice in initial teacher education. Among the main findings emerging from the study are: (i) schools provide valuable support for PGDE students but this typically does not focus on classroom pedagogy, (ii) PGDE students typically felt that they had to be ‘invisible’ as learners in schools to gain and maintain authority and status, (iii) inherited cultural scripts about what it means to be a ‘good’ subject teacher shaped teacher identity and classroom practice, and (iv) as PGDE students begin to feel competent as teachers of maths, modern languages and science, this feeling of competence typically does not include their capacity to teach for inclusion and reading literacy within their subject teaching. In the context of research on teacher education, many of the findings are not unique to the PGDE or to UCC but reflect perennial dilemmas and emerging challenges in initial teacher education. This fact is important in setting a context for the wider dissemination2 of the Learning to Teach Study