Close encounters: international exhibitions and the material culture of the British Empire, c.1880-1940

Apparitions of empire and imperial ideologies were deeply embedded in the International Exhibition, a distinct exhibitionary paradigm that came to prominence in the mid-nineteenth century. Exhibitions were platforms for the display of objects, the movement of people, and the dissemination of ideas across and between regions of the British Empire, thereby facilitating contact between its different cultures and societies. This thesis aims to disrupt a dominant understanding of International Exhibitions, which forwards the notion that all exhibitions, irrespective of when or where they were staged, upheld a singular imperial discourse (i.e. Greenhalgh 1988, Rydell 1984). Rather, this thesis suggests International Exhibitions responded to and reflected the unique social, political and economic circumstances in which they took place, functioning as cultural environments in which pressing concerns of the day were worked through. Understood thus, the International Exhibition becomes a space for self-presentation, serving as a stage from which a multitude of interests and identities were constructed, performed and projected. This thesis looks to the visual and material culture of the International Exhibition in order to uncover this more nuanced history, and foregrounds an analysis of the intersections between practices of exhibition-making and identity-making. The primary focus is a set of exhibitions held in Glasgow in the late-1880s and early-1900s, which extends the geographic and temporal boundaries of the existing scholarship. What is more, it looks at representations of Canada at these events, another party whose involvement in the International Exhibition tradition has gone largely unnoticed. Consequently, this thesis is a thematic investigation of the links between a municipality routinely deemed the ‘Second City of the Empire’ and a Dominion settler colony, two types of geographic setting rarely brought into dialogue. It analyses three key elements of the exhibition-making process, exploring how iconographies of ‘quasi-nationhood’ were expressed through an exhibition’s planning and negotiation, its architecture and its displays. This original research framework deliberately cuts across strata that continue to define conceptions of the British Empire, and pushes beyond a conceptual model defined by metropole and colony. Through examining International Exhibitions held in Glasgow in the late-Victorian and Edwardian periods, and visions of Canada in evidence at these events, the goal is to offer a novel intervention into the existing literature concerning the cultural history of empire, one that emphasises fluidity rather than fixity and which muddles the boundaries between centre and periphery.

Conceptualisation, design and development of a primary school based child healthy weight intervention

INTRODUCTION: In common with much of the developed world, Scotland has a severe and well established problem with overweight and obesity in childhood with recent figures demonstrating that 31% of Scottish children aged 2-15 years old were overweight including obese in 2014. This problem is more pronounced in socioeconomically disadvantaged groups and in older children across all economic groups (Scottish Health Survey, 2014). Children who are overweight or obese are at increased risk of a number of adverse health outcomes in the short term and throughout their life course (Lobstein and Jackson-Leach, 2006). The Scottish Government tasked all Scottish Health Boards with developing and delivering child healthy weight interventions to clinically overweight or obese children in an attempt to address this health problem. It is therefore imperative to deliver high quality, affordable, appropriately targeted interventions which can make a sustained impact on children’s lifestyles, setting them up for life as healthy weight adults. This research aimed to inform the design, readiness for application and Health Board suitability of an effective primary school-based curricular child healthy weight intervention. METHODS: the process involved in conceptualising a child healthy weight intervention, developing the intervention, planning for implementation and subsequent evaluation was guided by the PRECEDE-PROCEED Model (Green and Kreuter, 2005) and the Intervention Mapping protocol (Lloyd et al. 2011). RESULTS: The outputs from each stage of the development process were used to formulate a child healthy weight intervention conceptual model then develop plans for delivery and evaluation. DISCUSSION: The Fit for School conceptual model developed through this process has the potential to theoretically modify energy balance related behaviours associated with unhealthy weight gain in childhood. It also has the potential to be delivered at a Health Board scale within current organisational restrictions.

An exploration of treatment burden and patient capacity in people with stroke

Background and aims: Advances in modern medicine have led to improved outcomes after stroke, yet an increased treatment burden has been placed on patients. Treatment burden is the workload of health care for people with chronic illness and the impact that this has on functioning and well-being. Those with comorbidities are likely to be particularly burdened. Excessive treatment burden can negatively affect outcomes. Individuals are likely to differ in their ability to manage health problems and follow treatments, defined as patient capacity. The aim of this thesis was to explore the experience of treatment burden for people who have had a stroke and the factors that influence patient capacity. Methods: There were four phases of research. 1) A systematic review of the qualitative literature that explored the experience of treatment burden for those with stroke. Data were analysed using framework synthesis, underpinned by Normalisation Process Theory (NPT). 2) A cross-sectional study of 1,424,378 participants >18 years, demographically representative of the Scottish population. Binary logistic regression was used to analyse the relationship between stroke and the presence of comorbidities and prescribed medications. 3) Interviews with twenty-nine individuals with stroke, fifteen analysed by framework analysis underpinned by NPT and fourteen by thematic analysis. The experience of treatment burden was explored in depth along with factors that influence patient capacity. 4) Integration of findings in order to create a conceptual model of treatment burden and patient capacity in stroke. Results: Phase 1) A taxonomy of treatment burden in stroke was created. The following broad areas of treatment burden were identified: making sense of stroke management and planning care; interacting with others including health professionals, family and other stroke patients; enacting management strategies; and reflecting on management. Phase 2) 35,690 people (2.5%) had a diagnosis of stroke and of the 39 co-morbidities examined, 35 were significantly more common in those with stroke. The proportion of those with stroke that had >1 additional morbidities present (94.2%) was almost twice that of controls (48%) (odds ratio (OR) adjusted for age, gender and socioeconomic deprivation; 95% confidence interval: 5.18; 4.95-5.43) and 34.5% had 4-6 comorbidities compared to 7.2% of controls (8.59; 8.17-9.04). In the stroke group, 12.6% of people had a record of >11 repeat prescriptions compared to only 1.5% of the control group (OR adjusted for age, gender, deprivation and morbidity count: 15.84; 14.86-16.88). Phase 3) The taxonomy of treatment burden from Phase 1 was verified and expanded. Additionally, treatment burdens were identified as arising from either: the workload of healthcare; or the endurance of care deficiencies. A taxonomy of patient capacity was created. Six factors were identified that influence patient capacity: personal attributes and skills; physical and cognitive abilities; support network; financial status; life workload, and environment. A conceptual model of treatment burden was created. Healthcare workload and the presence of care deficiencies can influence and be influenced by patient capacity. The quality and configuration of health and social care services influences healthcare workload, care deficiencies and patient capacity. Conclusions: This thesis provides important insights into the considerable treatment burden experienced by people who have had a stroke and the factors that affect their capacity to manage health. Multimorbidity and polypharmacy are common in those with stroke and levels of these are high. Findings have important implications for the design of clinical guidelines and healthcare delivery, for example co-ordination of care should be improved, shared decision-making enhanced, and patients better supported following discharge from hospital.