Mindfulness-Based Cognitive Therapy for older people in a community setting: a mixed methods feasibility study

Rationale: In line with complex intervention development, this research takes a systematic approach to examining the feasibility and acceptability of delivering Mindfulness-Based Cognitive Therapy (MBCT) to older people who experience symptoms of depression. Methods: A mixed methods approach was adopted in line with recommendations made by the MRC Complex Intervention Development framework. Quantitative and qualitative methods were combined by administering questionnaires as well as conducting post intervention interviews. A number of trial feasibility factors were examined such as recruitment and attrition rates. Qualitative data was analysed using Braun and Clarke’s thematic analysis framework. Results: Nine participants started the MBCT intervention and six completed the 8-week programme. The results suggest that MBCT for older people is feasible and acceptable. Participants reported improved mindfulness skills. Participants responded positively to being asked to take part in research and appeared to particularly value the group delivery format of the intervention. Conclusions: MBCT is both feasible and acceptable for older people experiencing symptoms of depression. Further research is required with larger sample sizes to allow for more robust statistical exploration of outcome measures, including mechanisms of change.

Using an end-of-life care pathway in acute stroke: a mixed methods study of decision-making and care experiences

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.

Cultural citizenship and its implications for citizenship education: Chinese university students’ civic experience in relation to mass media and the university citizenship curriculum

A growing body of research has argued that university citizenship curricula are inefficient in promoting civic participation, while there is a tendency towards a broader citizenship understanding and new forms of civic engagements and citizenship learning in everyday life. The notion of cultural citizenship in this thesis concentrates on media practices’ relation to civic expression and civic engagement. This research thus argues that not enough attention has been paid to the effects of citizenship education policy on students and students’ active citizenship learning in China. This thesis examines the civic experience of university students in China in the parallel contexts of widespread adoption of mass media and of university citizenship education courses, which have been explicitly mandatory for promoting civic morality education in Chinese universities since 2007. This research project raises significant questions about the meditating influences of these two contexts on students’ perceptions of civic knowledge and civic participation, with particular interest to examine whether and how the notion of cultural citizenship could be applied in the Chinese context and whether it could provide certain implications for citizenship education in China. University students in one university in Beijing contributed to this research by providing both quantitative and qualitative data collected from mixed-methods research. 212 participants contributed to the questionnaire data collection and 12 students took part in interviews. Guided by the theoretical framework of cultural citizenship, a central focus of this study is to explore whether new forms of civic engagement and civic learning and a new direction of citizenship understanding can be identified among university students’ mass media use. The study examines the patterns of students’ mass media use and its relationship to civic participation, and also explores the ways in which mass media shape students and how they interact and perform through the media use. In addition, this study discusses questions about how national context, citizenship tradition and civic education curricula relate to students’ civic perceptions, civic participation and civic motivation in their enactment of cultural citizenship. It thus tries to provide insights and identify problems associated with citizenship courses in Chinese universities. The research finds that Chinese university students can also identify civic issues and engage in civic participation through the influence of mass media, thus indicating the application of cultural citizenship in the wider higher education arena in China. In particular, the findings demonstrate that students’ citizenship knowledge has been influenced by their entertainment experiences with TV programs, social networks and movies. However, the study argues that the full enactment of cultural citizenship in China is conditional with regards to characteristics related to two prerequisites: the quality of participation and the influence of the public sphere in the Chinese context. Most students in the study are found to be inactive civic participants in their everyday lives, especially in political participation. Students express their willingness to take part in civic activities, but they feel constrained by both the current citizenship education curriculum in universities and the strict national policy framework. They mainly choose to accept ideological and political education for the sake of personal development rather than to actively resist it, however, they employ creative ways online to express civic opinions and conduct civic discussion. This can be conceptualised as the cultural dimension of citizenship observed from students who are not passively prescribed by traditional citizenship but who have opportunities to build their own civic understanding in everyday life. These findings lead to the conclusion that the notion of cultural citizenship not only provides a new mode of civic learning for Chinese students but also offers a new direction for configuring citizenship in China. This study enriches the existing global literature on cultural citizenship by providing contemporary evidence from China which is a developing democratic country, as well as offering useful information for Chinese university practitioners, policy makers and citizenship researchers on possible directions for citizenship understanding and citizenship education. In particular, it indicates that it is important for efforts to be made to generate a culture of authentic civic participation for students in the university as well as to promote the development of the public sphere in the community and the country generally.

Perceptions of climate change, environmental variability and the role of agricultural adaptation strategies by small-scale farmers in Africa: the case of Mwanga district in Northern Tanzania

Abstract The potential impacts of climate change and environmental variability are already evident in most parts of the world, which is witnessing increasing temperature rates and prolonged flood or drought conditions that affect agriculture activities and nature-dependent livelihoods. This study was conducted in Mwanga District in the Kilimanjaro region of Tanzania to assess the nature and impacts of climate change and environmental variability on agriculture-dependent livelihoods and the adaptation strategies adopted by small-scale rural farmers. To attain its objective, the study employed a mixed methods approach in which both qualitative and quantitative techniques were used. The study shows that farmers are highly aware of their local environment and are conscious of the ways environmental changes affect their livelihoods. Farmers perceived that changes in climatic variables such as rainfall and temperature had occurred in their area over the period of three decades, and associated these changes with climate change and environmental variability. Farmers’ perceptions were confirmed by the evidence from rainfall and temperature data obtained from local and national weather stations, which showed that temperature and rainfall in the study area had become more variable over the past three decades. Farmers’ knowledge and perceptions of climate change vary depending on the location, age and gender of the respondents. The findings show that the farmers have limited understanding of the causes of climatic conditions and environmental variability, as some respondents associated climate change and environmental variability with social, cultural and religious factors. This study suggests that, despite the changing climatic conditions and environmental variability, farmers have developed and implemented a number of agriculture adaptation strategies that enable them to reduce their vulnerability to the changing conditions. The findings show that agriculture adaptation strategies employ both planned and autonomous adaptation strategies. However, the study shows that increasing drought conditions, rainfall variability, declining soil fertility and use of cheap farming technology are among the challenges that limit effective implementation of agriculture adaptation strategies. This study recommends further research on the varieties of drought-resilient crops, the development of small-scale irrigation schemes to reduce dependence on rain-fed agriculture, and the improvement of crop production in a given plot of land. In respect of the development of adaptation strategies, the study recommends the involvement of the local farmers and consideration of their knowledge and experience in the farming activities as well as the conditions of their local environment. Thus, the findings of this study may be helpful at various levels of decision making with regard to the development of climate change and environmental variability policies and strategies towards reducing farmers’ vulnerability to current and expected future changes.

The experience of teaching statistics to non-specialist students in Saudi universities

Undoubtedly, statistics has become one of the most important subjects in the modern world, where its applications are ubiquitous. The importance of statistics is not limited to statisticians, but also impacts upon non-statisticians who have to use statistics within their own disciplines. Several studies have indicated that most of the academic departments around the world have realized the importance of statistics to non-specialist students. Therefore, the number of students enrolled in statistics courses has vastly increased, coming from a variety of disciplines. Consequently, research within the scope of statistics education has been able to develop throughout the last few years. One important issue is how statistics is best taught to, and learned by, non-specialist students. This issue is controlled by several factors that affect the learning and teaching of statistics to non-specialist students, such as the use of technology, the role of the English language (especially for those whose first language is not English), the effectiveness of statistics teachers and their approach towards teaching statistics courses, students’ motivation to learn statistics and the relevance of statistics courses to the main subjects of non-specialist students. Several studies, focused on aspects of learning and teaching statistics, have been conducted in different countries around the world, particularly in Western countries. Conversely, the situation in Arab countries, especially in Saudi Arabia, is different; here, there is very little research in this scope, and what there is does not meet the needs of those countries towards the development of learning and teaching statistics to non-specialist students. This research was instituted in order to develop the field of statistics education. The purpose of this mixed methods study was to generate new insights into this subject by investigating how statistics courses are currently taught to non-specialist students in Saudi universities. Hence, this study will contribute towards filling the knowledge gap that exists in Saudi Arabia. This study used multiple data collection approaches, including questionnaire surveys from 1053 non-specialist students who had completed at least one statistics course in different colleges of the universities in Saudi Arabia. These surveys were followed up with qualitative data collected via semi-structured interviews with 16 teachers of statistics from colleges within all six universities where statistics is taught to non-specialist students in Saudi Arabia’s Eastern Region. The data from questionnaires included several types, so different techniques were used in analysis. Descriptive statistics were used to identify the demographic characteristics of the participants. The chi-square test was used to determine associations between variables. Based on the main issues that are raised from literature review, the questions (items scales) were grouped and five key groups of questions were obtained which are: 1) Effectiveness of Teachers; 2) English Language; 3) Relevance of Course; 4) Student Engagement; 5) Using Technology. Exploratory data analysis was used to explore these issues in more detail. Furthermore, with the existence of clustering in the data (students within departments within colleges, within universities), multilevel generalized linear models for dichotomous analysis have been used to clarify the effects of clustering at those levels. Factor analysis was conducted confirming the dimension reduction of variables (items scales). The data from teachers’ interviews were analysed on an individual basis. The responses were assigned to one of the eight themes that emerged from within the data: 1) the lack of students’ motivation to learn statistics; 2) students' participation; 3) students’ assessment; 4) the effective use of technology; 5) the level of previous mathematical and statistical skills of non-specialist students; 6) the English language ability of non-specialist students; 7) the need for extra time for teaching and learning statistics; and 8) the role of administrators. All the data from students and teachers indicated that the situation of learning and teaching statistics to non-specialist students in Saudi universities needs to be improved in order to meet the needs of those students. The findings of this study suggested a weakness in the use of statistical software applications in these courses. This study showed that there is lack of application of technology such as statistical software programs in these courses, which would allow non-specialist students to consolidate their knowledge. The results also indicated that English language is considered one of the main challenges in learning and teaching statistics, particularly in institutions where English is not used as the main language. Moreover, the weakness of mathematical skills of students is considered another major challenge. Additionally, the results indicated that there was a need to tailor statistics courses to the needs of non-specialist students based on their main subjects. The findings indicate that statistics teachers need to choose appropriate methods when teaching statistics courses.

Art, sex, and institutions: defining, collecting, and displaying Shunga

In Edo-Japan (c.1603 – 1868) shunga, sexually explicit prints, paintings and illustrated books, were widely produced and disseminated. However, from the 1850s onwards, shunga was suppressed by the government and it has largely been omitted from art history, excluded from exhibitions and censored in publications. Although changes have taken place, cultural institutions continue to be cautious about what they collect and exhibit, with shunga largely remaining a prohibited subject in Japan. Since the 1970s there has been a gradual increase in the acceptance of shunga outside Japan, as evidenced in the growing number of exhibitions and publications. The initial impetus behind this thesis was: Why and how did shunga become increasingly acceptable in Europe and North America in the twentieth century, whilst conversely becoming unacceptable in post-Edo Japan? I discuss how and why attitudes to shunga in the UK and Japan have changed from the Edo period to the present day, and consider how definitions can affect this. My research examines how shunga has been dealt with in relation to private and institutional collecting and exhibitions. In order to gauge modern responses, the 2013 Shunga: Sex and Pleasure in Japanese Art exhibition at the British Museum is used as an in-depth study – utilising mixed methods and an interdisciplinary approach to analyse curatorial and legal decisions, as well as visitor feedback. To-date there are no official or standardised guidelines for the acquisition, cataloguing, or display of sexually explicit artefacts. It is intended that institutions will benefit from my analysis of the changing perceptions of shunga and of previous shunga collections and exhibitions when dealing with shunga or other sexually explicit items in the future.

Investigating problem-based learning in Saudi Arabian mathematics education: a TIMSS-related study

The aim of this study is to investigate the effectiveness of problem-based learning (PBL) on students’ mathematical performance. This includes mathematics achievement and students’ attitudes towards mathematics for third and eighth grade students in Saudi Arabia. Mathematics achievement includes, knowing, applying, and reasoning domains, while students’ attitudes towards mathematics covers, ‘Like learning mathematics’, ‘value mathematics’, and ‘a confidence to learn mathematics’. This study goes deeper to examine the interaction of a PBL teaching strategy, with trained face-to-face and self-directed learning teachers, on students’ performance (mathematics achievement and attitudes towards mathematics). It also examines the interaction between different ability levels of students (high and low levels) with a PBL teaching strategy (with trained face-to-face or self-directed learning teachers) on students’ performance. It draws upon findings and techniques of the TIMSS international benchmarking studies. Mixed methods are used to analyse the quasi-experimental study data. One -way ANOVA, Mixed ANOVA, and paired t-tests models are used to analyse quantitative data, while a semi-structured interview with teachers, and author’s observations are used to enrich understanding of PBL and mathematical performance. The findings show that the PBL teaching strategy significantly improves students’ knowledge application, and is better than the traditional teaching methods among third grade students. This improvement, however, occurred only with the trained face-to-face teacher’s group. Furthermore, there is robust evidence that using a PBL teaching strategy could raise significantly students’ liking of learning mathematics, and confidence to learn mathematics, more than traditional teaching methods among third grade students. Howe ver, there was no evidence that PBL could improve students’ performance (mathematics achievement and attitudes towards mathematics), more than traditional teaching methods, among eighth grade students. In 8th grade, the findings for low achieving students show significant improvement compared to high achieving students, whether PBL is applied or not. However, for 3th grade students, no significant difference in mathematical achievement between high and low achieving students was found. The results were not expected for high achieving students and this is also discussed. The implications of these findings for mathematics education in Saudi Arabia are considered.

Farm visits: interdisciplinary outdoor learning for primary school pupils and Scotland’s Curriculum for Excellence

There is concern around children’s lack of knowledge and understanding of food sources and production, and more broadly around their apparent disconnection from nature. Spending time in the outdoors has been shown to yield a range of benefits, although the mechanisms underpinning these are not well understood. Studies have suggested, however, that there has been a decline in time spent outdoors by children. The introduction of the ‘Curriculum for Excellence’ guidelines in Scotland was heralded as an opportunity to address this decline. Although the guidelines advocate the use of outdoor environments, little research has been conducted, and little guidance is available, on how teachers can and do use outdoor learning in relation to the guidelines, particularly beyond ‘adventure’ activities. Farms are utilised as an educational resource around the world. This research explored the use of educational farm visits, as an example of outdoor learning, in the context of Curriculum for Excellence. A qualitatively driven, mixed methods study, comprising survey and case study methodologies, was undertaken. A questionnaire for teachers informed subsequent interviews with teachers and farmers, and ‘group discussions’ with primary school pupils. The study found that teachers can link farm visits and associated topics with the Curriculum for Excellence guidelines in a range of ways, covering all curriculum areas. There was a tendency however for farm visits to be associated with food and farming topics at Primary 2-3 (age 6-7), rather than used more widely. Issues to consider in the planning and conduct of farm visits were identified, and barriers and motivations for teachers, and for farmers volunteering to host visits, were explored. As well as practical examples of the use of farm visiting, this research offers a perspective on some of the theoretical literature which seeks to explain the benefits of spending time outdoors. Furthermore, five main recommendations for farm visiting in the context of Curriculum for Excellence are given. These relate to the type of visit appropriate to different age groups, opportunities for teachers to become more familiar with what farms visits can offer, and raising awareness of the organisations and networks which can support volunteer farmers to host visits.

Towards an understanding of Pakistani undergraduates’ current attitudes towards learning and speaking English

The English language has an important place in Pakistan and in its education system, not least because of the global status of English and its role in employment. Realising the need to enhance language learning outcomes, especially at the tertiary level, the Higher Education Commission (HEC) of Pakistan has put in place some important measures to improve the quality of English language teaching practice through its English Language Teaching Reforms (ELTR) project. However, there is a complex linguistic, educational and ethnic diversity in Pakistan and that diversity, alongside the historical and current role of English in the country, makes any language teaching reform particularly challenging. I argue, in this thesis, that reform to date has largely ignored the issues of learner readiness to learn and learner perceptions of the use of English. I argue that studying learner attitudes is important if we are to understand how learners perceive the practice of learning and the use of English in their lives. This study focuses on the attitudes of undergraduate learners of English as a foreign language at two universities in the provinces of Sindh and Balochistan in Pakistan. These provinces have experienced long struggles and movements related to linguistic and ethnic rights and both educate students from all of the districts of their respective provinces. Drawing on debates around linguistic imperialism, economic necessity, and linguistic and educational diversity, I focus on learners’ perceptions about learning and speaking English, asking what their attitudes are towards learning and speaking English with particular reference to socio-psychological factors at a given time and context, including perceived threats to their culture, religion, and mother tongue. I ask how they make choices about learning and speaking English in different domains of language use and question their motivation to learn and speak English. Additionally, I explore issues of anxiety with reference to their use of English. Following a predominantly qualitative mixed methods research approach, the study employs two research tools: an adapted Likert Scale questionnaire completed by 300 students and semi-structured interviews with 20 participants from the two universities. The data were analysed through descriptive statistics and qualitative content analysis, with each set of data synthesised for interpretation. The findings suggest that, compared with the past, the majority of participants hold positive attitudes towards learning and speaking English regardless of their ethnic or linguistic backgrounds. Most of these undergraduate students do not perceive the use of English as a threat to their culture, mother tongue or religious values but, instead, they have a pragmatic and, at the same time, aspirational attitude to the learning and use of English. I present these results and conclude this thesis with reference to ways in which this small-scale study contributes to a better understanding of learner attitudes and perceptions. Acknowledging the limitations of this study, I suggest ways in which the study, enhanced and extended by further research, might have implications for practice, theory and policy in English language teaching and learning in Pakistan.

State-narco networks and the ‘War on Drugs’ in post-transition Bolivia, with special reference to 1989-1993

This thesis examines the development of state-narco networks in post-transition Bolivia. Mainstream discourses of drugs tend to undertheorise such relationships, holding illicit economies, weak states and violence as synergistic phenomena. Such assumptions fail to capture the nuanced relations that emerge between the state and the drug trade in different contexts, their underlying logics and diverse effects. As an understudied case, Bolivia offers novel insights into these dynamics. Bolivian military authoritarian governments (1964-1982), for example, integrated drug rents into clientelistic systems of governance, helping to establish factional coalitions and reinforce regime authority. Following democratic transition in 1982 and the escalation of US counterdrug efforts, these stable modes of exchange between the state and the coca-cocaine economy fragmented. Bolivia, though, continued to experience lower levels of drug-related violence than its Andean neighbours, and sustained democratisation despite being a major drug producer. Focusing on the introduction of the Andean Initiative (1989-1993), I explore state-narco interactions during this period of flux: from authoritarianism to (formal) democracy, and from Cold War to Drug War. As such, the thesis transcends the conventional analyses of the drugs literature and orthodox readings of Latin American narco-violence, providing insights into the relationship between illicit economies and democratic transition, the regional role of the US, and the (unintended) consequences of drug policy interventions. I utilise a mixed methods approach to offer discrete perspectives on the object of study. Drawing on documentary and secondary sources, I argue that state-narco networks were interwoven with Bolivia’s post-transition political settlement. Uneven democratisation ensured pockets of informalism, as clientelistic and authoritarian practices continued. This included police and military autonomy, and tolerance of drug corruption within both institutions. Non-enforcement of democratic norms of accountability and transparency was linked to the maintenance of fragile political equilibrium. Interviews with key US and Bolivian elite actors also revealed differing interpretations of state-narco interactions. These exposed competing agendas, and were folded into alternative paradigms and narratives of the ‘war on drugs’. The extension of US Drug War goals and the targeting of ‘corrupt’ local power structures, clashed with local ambivalence towards the drug trade, opposition to destabilising, ‘Colombianised’ policies and the claimed ‘democratising mission’ of the Bolivian government. In contrasting these US and Bolivian accounts, the thesis shows how real and perceived state-narco webs were understood and navigated by different actors in distinct ways. ‘Drug corruption’ held significance beyond simple economic transaction or institutional failure. Contestation around state-narco interactions was enmeshed in US-Bolivian relations of power and control.

Mixed genotype Hepatitis C virus infections: incidence in Scotland and methods for detection

The diagnosis of mixed genotype hepatitis C virus (HCV) infection is rare and information on incidence in the UK, where genotypes 1a and 3 are the most prevalent, is sparse. Considerable variations in the efficacies of direct-acting antivirals (DAAs) for the HCV genotypes have been documented and the ability of DAAs to treat mixed genotype HCV infections remains unclear, with the possibility that genotype switching may occur. In order to estimate the prevalence of mixed genotype 1a/3 infections in Scotland, a cohort of 512 samples was compiled and then screened using a genotype-specific nested PCR assay. Mixed genotype 1a/3 infections were found in 3.8% of samples tested, with a significantly higher prevalence rate of 6.7% (p<0.05) observed in individuals diagnosed with genotype 3 infections than genotype 1a (0.8%). An analysis of the samples using genotypic-specific qPCR assays found that in two-thirds of samples tested, the minor strain contributed <1% of the total viral load. The potential of deep sequencing methods for the diagnosis of mixed genotype infections was assessed using two pan-genotypic PCR assays compatible with the Illumina MiSeq platform that were developed targeting the E1-E2 and NS5B regions of the virus. The E1-E2 assay detected 75% of the mixed genotype infections, proving to be more sensitive than the NS5B assay which identified only 25% of the mixed infections. Studies of sequence data and linked patient records also identified significantly more neurological disorders in genotype 3 patients. Evidence of distinctive dinucleotide expression within the genotypes was also uncovered. Taken together these findings raise interesting questions about the evolutionary history of the virus and indicate that there is still more to understand about the different genotypes. In an era where clinical medicine is frequently more personalised, the development of diagnostic methods for HCV providing increased patient stratification is increasingly important. This project has shown that sequence-based genotyping methods can be highly discriminatory and informative, and their use should be encouraged in diagnostic laboratories. Mixed genotype infections were challenging to identify and current deep sequencing methods were not as sensitive or cost-effective as Sanger-based approaches in this study. More research is needed to evaluate the clinical prognosis of patients with mixed genotype infection and to develop clinical guidelines on their treatment.