The meaning of environmental control systems (ECS) for people with spinal cord injury: An occupational therapist explores an intervention

Environmental Control Systems (ECS), enable people with high cervical Spinal Cord Injury (high SCI) to control and access everyday electronic devices. In Ireland, however, access for those who might benefit from ECS is limited. This study used a qualitative approach to explore the insider experience of an ECS starter-pack developed by the author, an occupational therapist. The primary research questions: what is it really like to live with ECS, and what does it mean to live with ECS, were explored using a phenomenological methodology conducted in three phases. In Phase 1 fifteen people with high SCI met twice in four focus groups to discuss experiences and expectations of ECS. Thematic analysis (Krueger & Casey, 2000), influenced by the psychological phenomenological approach (Creswell, 1998), yielded three categories of rich, practical, phenomenological findings: ECS Usage and utility; ECS Expectations and The meaning of living with ECS. Phase 1 findings informed Phase 2 which consisted of the development of a generic electronic assistive technology pack (GrEAT) that included commercially available constituents as well as short instructional videos and an information booklet. This second phase culminated in a one-person, three-week pilot trial. Phase 3 involved a six person, 8-week trial of the GrEAT, followed by individual in-depth interviews. Interpretative Phenomenological Analysis IPA (Smith, Larkin & Flowers, 2009), aided by computer software ATLAS.ti and iMindmap, guided data analysis and identification of themes. Getting used to ECS, experienced as both a hassle and engaging, resulted in participants being able to Take back a little of what you have lost, which involved both feeling enabled and reclaiming a little doing. The findings of this study provide substantial insights into what it is like to live with ECS and the meanings attributed to that experience. Several practical, real world implications are discussed.

A study of the Zhiqing identity

More than seventeen million Chinese urban youth (Zhiqing in Chinese) went to the countryside, lived and engaged in agricultural work there during the Up to the Mountains and Down to the Countryside (UMDC) Movement (1967-1981). Although this movement was officially terminated in 1981, it has left an imprint on these people – the Zhiqing identity by which they are still characterized as a unique group in Chinese society and a special generation in Chinese history. Historical and sociological perspectives are combined in this study. By applying Glen H. Elder’s life course approach, the study reveals how Zhiqing’s life trajectories are embedded in the social history and identifies a series of interrelated factors that made Zhiqing into a unique generation. With the guidance of Henri Tajfel’s social identity theory, the study uncovers the emergence of the Zhiqing group and the Zhiqing identity, explains individuals’ acquisitions of the Zhiqing identity and analyzes how it has kept influencing individuals’ lives during and after the UMDC Movement. Using Zhiqing’s life stories allowed the researcher to combine the historical and sociological aspects in her examination of Zhiqing’s identity issues. In each life story, the narrator reviewed his/her life experience, reflected on socio-historical changes and expressed his/her emotions and ideas about identity issues. Utilizing methods of in-depth interview and thematic analysis, the researcher completed the study and presents this thesis as one interpretation on the Zhiqing identity, which, as according the researcher’s hermeneutic stance, is open to further discussion and future research.

The quality of diabetes care in the community: practice, policy and culture

Aim: Diabetes is an important barometer of health system performance. This chronic condition is a source of significant morbidity, premature mortality and a major contributor to health care costs. There is an increasing focus internationally, and more recently nationally, on system, practice and professional-level initiatives to promote the quality of care. The aim of this thesis was to investigate the ‘quality chasm’ around the organisation and delivery of diabetes care in general practice, to explore GPs’ attitudes to engaging in quality improvement activities and to examine efforts to improve the quality of diabetes care in Ireland from practice to policy. Methods: Quantitative and qualitative methods were used. As part of a mixed methods sequential design, a postal survey of 600 GPs was conducted to assess the organization of care. This was followed by an in-depth qualitative study using semi-structured interviews with a purposive sample of 31 GPs from urban and rural areas. The qualitative methodology was also used to examine GPs’ attitudes to engaging in quality improvement. Data were analysed using a Framework approach. A 2nd observation study was used to assess the quality of care in 63 practices with a special interest in diabetes. Data on 3010 adults with Type 2 diabetes from 3 primary care initiatives were analysed and the results were benchmarked against national guidelines and standards of care in the UK. The final study was an instrumental case study of policy formulation. Semi-structured interviews were conducted with 15 members of the Expert Advisory Group (EAG) for Diabetes. Thematic analysis was applied to the data using 3 theories of the policy process as analytical tools. Results: The survey response rate was 44% (n=262). Results suggested care delivery was largely unstructured; 45% of GPs had a diabetes register (n=157), 53% reported using guidelines (n=140), 30% had formal call recall system (n=78) and 24% had none of these organizational features (n=62). Only 10% of GPs had a formal shared protocol with the local hospital specialist diabetes team (n=26). The lack of coordination between settings was identified as a major barrier to providing optimal care leading to waiting times, overburdened hospitals and avoidable duplication. The lack of remuneration for chronic disease management had a ripple effect also creating costs for patients and apathy among GPs. There was also a sense of inertia around quality improvement activities particularly at a national level. This attitude was strongly influenced by previous experiences of change in the health system. In contrast GP’s spoke positively about change at a local level which was facilitated by a practice ethos, leadership and special interest in diabetes. The 2nd quantitative study found that practices with a special interest in diabetes achieved a standard of care comparable to the UK in terms of the recording of clinical processes of care and the achievement of clinical targets; 35% of patients reached the HbA1c target of <6.5% compared to 26% in England and Wales. With regard to diabetes policy formulation, the evolving process of action and inaction was best described by the Multiple Streams Theory. Within the EAG, the formulation of recommendations was facilitated by overarching agreement on the “obvious” priorities while the details of proposals were influenced by personal preferences and local capacity. In contrast the national decision-making process was protracted and ambiguous. The lack of impetus from senior management coupled with the lack of power conferred on the EAG impeded progress. Conclusions: The findings highlight the inconsistency of diabetes care in Ireland. The main barriers to optimal diabetes management center on the organization and coordination of care at the systems level with consequences for practice, providers and patients. Quality improvement initiatives need to stimulate a sense of ownership and interest among frontline service providers to address the local sense of inertia to national change. To date quality improvement in diabetes care has been largely dependent the “special interest” of professionals. The challenge for the Irish health system is to embed this activity as part of routine practice, professional responsibility and the underlying health care culture.

An examination of the construction of meanings for obesity in Ireland

Obesity has been defined as a consequence of energy imbalance, where energy intake exceeds energy expenditure and results in a build-up of adipose tissue. However, this scientific definition masks the complicated social meanings associated with the condition. This research investigated the construction of meaning around obesity at various levels of inquiry to inform how obesity is portrayed and understood in Ireland. A multi-paradigmatic approach was adopted, drawing on theory and methods from psychology and sociology and an analytical framework combining the Common Sense Model and framing theory was employed. In order to examine the exo-level meanings of obesity, content analysis was performed on two media data sets (n=479, n=346) and a thematic analysis was also performed on the multiple newspaper sample (n=346). At the micro-level, obesity discourses were investigated via the thematic analysis of comments sampled from an online message board. Finally, an online survey assessed individual-level beliefs and understandings of obesity. The media analysis revealed that individual blame for obesity was pervasive and the behavioural frame was dominant. A significant increase in attention to obesity over time was observed, manifestations of weight stigma were common, and there was an emotive discourse of blame directed towards the parents of obese children. The micro-level analysis provided insight into the weight-based stigma in society and a clear set of negative ‘default’ judgements accompanied the obese label. The survey analysis confirmed that the behavioural frame was the dominant means of understanding obesity. One of the strengths of this thesis is the link created between framing and the Common Sense Model in the development of an analytical framework for application in the examination of health/illness representations. This approach helped to ascertain the extent of the pervasive biomedical and individual blame discourse on obesity, which establishes the basis for the stigmatisation of obese persons.

Medieval Irish vision literature: a genre study

This dissertation examines medieval literary accounts of visions of the afterlife with an origin or provenance in Ireland from the perspective of genre, analysing their structural and literary characteristics both synchronically and diachronically. To this end, I have developed a new typology of medieval vision literature. I address the question in what manner the internationally attested genre of vision literature is adapted and developed in an Irish literary milieu. I explore this central research question through an interrogation of the typological unity of the key texts, both in formal arrangement and in the eschatological themes they express. My analysis of the structure and rhetoric of these narratives reveals the primary role of identity strategies, question-and-answer patterns and exhortation for their narrative cohesion and didactic function. In addition, I was able to make a formal distinction at text-level between the adaptation of the genre as an autonomous unit and the adaptation of thematic motifs as topoi. This further enabled me to nuance the distribution of characteristic features in the genre. My analysis of the spatial and temporal aspects of the eschatological journey confirms a preoccupation with personal eschatology. It reveals a close connection between the development of the aspects of graded access and trial in the genre and a growing awareness of an interim state of the soul after death. Finally, my dissertation provides new editions, translations and analyses of primary sources. My research breaks new ground in the hitherto underexplored area of genre adaptation in Ireland. In addition, it contributes significantly to our understanding of the nature of vision literature both in an Irish and a European context, and to our knowledge of the transmission of eschatological thought in the Latin West. Discusses the visions of: Laisrén, Fursa, Adomnán, Lóchán, Tnugdal, Owein and Visio Sancti Pauli Redactions VI and XI.

Becoming a father of a child with an intellectual disability- a narrative inquiry of Irish fathers’ stories

Background: This thesis explored men’s experiences of becoming a father of a child with an intellectual disability in the early years. In Ireland, it is estimated that there are almost 97% (n= 9,914) children with intellectual disabilities living at home in the care of parents, siblings, relatives or foster parents. While mothers and fathers are the primary caregivers, mothers’ experiences are well documented in comparison to the dearth of reports on fathers’ experiences. This descriptive narrative study aims to redress this gap in knowledge and understanding of men’s experiences of becoming a father of a child with an intellectual disability in the early years. Method: Narrative inquiry was employed for this study as it allows stories told by fathers to be collected as a means of exploring men’s transition to becoming a father of a child with an intellectual disability. A sample of 10 fathers of children with intellectual disabilities aged between thirteen months and five years of age were recruited from a large intellectual disability Health Service Provider (HSP) in the South of Ireland. Data were collected through semi-structured interviews which were audio-recorded, transcribed, and analysed using a narrative thematic approach. Findings: Findings are presented in four themes: i) ‘becoming a father’, ii) ‘something wrong with my child’, iii) ‘entering the world of disability’ and iv) ‘living a different life’. For all 10 fathers the time of being told that their child had an intellectual disability was laden with negative emotional responses irrespective of whether the diagnosis was at birth or more gradual over the child’s early developmental period. When fathers found out that ‘something was wrong’ they spoke of ‘moving on’ and entering the world of disability. In their narratives, becoming the father of a child with an intellectual disability had changed their lives and would inevitably change their futures. Fathers’ positivity was clearly evident with many fathers identifying that the diagnosis of their child with an intellectual disability was not a life ending event but rather a life changing event. Conclusions: Healthcare professionals have a critical role in supporting fathers during the transition to becoming a father of a child with an intellectual disability. Factors which require consideration include recognising that each father’s experience is unique; that fathers require support; and that fathers achieve personal growth because of their experiences of their transition to becoming a father of a child with an intellectual disability in the early years.

Living with acquired brain injury

This study found that natural community supports were comprised of two distinct groupings; firstly immediate families, friends and peer support groups; secondly neighbours and local community groups such as sporting and activity- based organisations and groups. The findings of this study indicate that living with acquired brain injury involves a process where the person moves from acute high intensity health services onto rehabilitative services and then onto re-establishing independent lives. It is evident that smooth transitions and interconnectivity of services are essential in facilitating this recovery process. Instrumental to the recovery is the support of immediate family and close friends, who form people’s immediate natural support network and go a long way towards facilitating individuals in rebuilding their lives. A key finding of this study is that broader natural community supports do not appear to play as central a role in supporting individuals to live independent lives when compared to the role of family and friends. The lack of involvement of broader community groups, in many ways, prompted individuals to contact formal support services. For the majority of participants, independence is facilitated through the combination of immediate natural community supports and formal services. The role of formal support services is key to developing broader community support networks. This study found a blurred division between formal services and broader community support networks. The authors recommended that the role of formal supports services in acting as a bridge between the needs of the individual and the development of meaningful community networks, be formally recognised and further developed. Additionally, they argued that the importance of the role of broader natural community, supports such as those provided by community and sporting groups must be enhanced. Greater awareness of the issues faced by people living with acquired brain injury and its often invisible nature is necessary in this endeavour. The authors stated it is important to recognise that there are multiple issues impacting on independent living and these issues intersect, for instance with age, gender, employment, qualifications and so on. A lack of public awareness of acquired brain injury was found to be a key barrier to independent living, along with issues relating to socialising, access to employment and finances. The findings of this study reflect the complexities of living with acquired brain injury and the need for holistic support that is cognisant of the factors which impact on integration. It is vital that flexible, personalised services are developed which are fit for purpose and meet the needs of not only people with acquired brain injury but also their immediate natural community support network. Recognition of the intersection between immediate/ broader natural community supports and formal services is also key to developing the comprehensive and practical supports required to achieve an independent life. This was a qualitative study and all participants were sourced through Headway, a community based service provider for people with ABI. Data collection was divided into two stages: firstly focus groups, followed by individual interviews. Four focus groups were convened in Cork (2), Dublin (1) and Limerick (1). Each focus group was facilitated by at least two members of the research team and a total of twenty-six individuals participated in the focus groups. Thematic analysis of the data was undertaken to guide and inform the second stage of the study; the individual interviews. Ten interviews were undertaken with individuals who presented with ABI in the Cork and Limerick regions.

'Muchos Méxicos': widening the lens in Rulfo's cinematic texts

It is difficult to overstate the importance of Juan Rulfo’s two major pieces of fictional narrative work—his haunting, enigmatic novel Pedro Páramo (1955) and his unrelenting depictions of the failures of post-revolutionary Mexico in his short story collection El Llano en llamas (1953). In her foreword to the Margaret Sayers Peden English translation, Susan Sontag hails Pedro Páramo as ‘not only one of the masterpieces of 20th Century world literature, but one of the most influential of the century’s books’. García Márquez has compared the influence of Rulfo on 20th Century world literature to that of Sophocles: ‘No son más de 300 páginas, pero son casi tantas y creo tan perdurables como las que conocemos de Sófocles’ and, completing this oftrepeated triumvirate of recommendations, Jorge Luis Borges has referred to Pedro Páramo as: ‘una de las mejores novelas de las literaturas de lengua hispánica, y aun de la literatura.’ Despite the praise heaped upon Rulfo’s two most famous books, when his third book of fiction, El gallo de oro y otros textos para cine, was finally published in 1980, just six years before his death, it was greeted with almost critical silence. It is precisely this publication that provides the focus of this investigation. The collection contains three texts—El despojo, La fórmula secreta and El gallo de oro. Constituting a third of the fictional work he published in his lifetime, expanding upon themes present in El Llano en llamas and Pedro Páramo while, at the same time, examining new ground, no thematic discussion of Rulfo’s written output is complete without including these texts. Yet they are frequently dismissed. In this way this investigation attempts to go some way towards filling this critical gap in the work of one of the most influential writers of the twentieth century

Public evaluations of novel food technologies: a qualitative citizen-scientist deliberative discourse approach

This qualitative research expands understanding of how information about a range of Novel Food Technologies (NFTs) is used and assimilated, and the implications of this on the evolution of attitudes and acceptance. This work enhances theoretical and applied understanding of citizens’ evaluative processes around these technologies. The approach applied involved observations of interactive exchanges between citizens and information providers (i.e. food scientists), during which they discussed a specific technology. This flexible, yet structured, approach revealed how individuals construct meaning around information about specific NFTs. A rich dataset of 42 ‘deliberate discourse’ and 42 postdiscourse transcripts was collected. Data analysis encompassed three stages: an initial descriptive account of the complete dataset based on the top-down bottom-up (TDBU) model of attitude formation, followed by inductive and deductive thematic analysis across the selected technology groups. The hybrid thematic analysis undertaken identified a Conceptual Model, which represents a holistic perspective on the influences and associated features directing ‘sense-making’ and ultimate evaluations around the technology clusters. How individuals make sense of these technologies is shaped by: their beliefs, values and personal characteristics; their perceptions of power and control over the application of the technology; and, the assumed relevance of the technology and its applications within different contexts. These influences form the frame for the creation of sense-making around the technologies. Internal negotiations between these influences are evident and evaluations are based on the relative importance of each influence to the individual, which tend to contribute to attitude ambivalence and instability. The findings indicate the processes of forming and changing attitudes towards these technologies are: complex; dependent on characteristics of the individual, technology, application and product; and, impacted by the nature and forms of information provided. Challenges are faced in engaging with the public about these technologies, as levels of knowledge, understanding and interest vary.

Corporeal prisons: dynamics of body and mise-en-scène in three films by Paul Schrader

This thesis focuses on the complex relationship between representations of the human body and the formal processes of mise-en-scène in three consecutive films by the writer-director Paul Schrader: American Gigolo (1980), Cat People (1982) and Mishima: A Life in Four Chapters (1985). While Schrader’s work has typically been critiqued under the broad category of masculinity in crisis (and often as a subset of the films of his more famous long-time collaborator, Martin Scorsese), I focus on a fiveyear early period of his filmography when he sought to explore his key themes of bodily crisis, fragmentation and alienation through an unusually intense focus upon the expressive potential of film form, specifically via the combined elements of colour, lighting, camerawork and production design. By approaching these three films as corporeal character studies of troubled figures whose emotional and psychosexual neurosis is experienced in and through the body, I will locate Schrader’s filmmaking process and style within the thematic and aesthetic contexts of both his own early film criticism and the European and Japanese art cinemas that he claims as his primary influence. In doing so, I will establish Schrader’s position as a director whose literary and theological background differentiated him from his peers of the postclassical Hollywood generation, and who thus continually sought to develop his own visual literacy through his relationship with the camera and his collaborations with more overtly style-oriented film artists. But instead of merely focusing on mise-en-scène to gain a formalist appreciation of these films, I mobilise stylistic analysis as a new critical approach towards the problematic discourses of identity and embodiment that have haunted Schrader’s career from the beginning. In particular, I argue that paying closer attention to Schrader’s formal choices sheds new light on how these films – which he approached as exercises in style – repeatedly deal with the volatile and unavoidably body-oriented categories of race, gender and sexuality. In the process, I argue that a formalist attentiveness to mise-en-scène can also provide valuable cultural insights into Schrader’s oeuvre.

Perceptions, expectations, and informal supports influence exercise activity in frail older adults

This study aims to explore frail older adults’ perceptions of what influences their exercise behaviors. A qualitative descriptive design was used. Semi-structured, open-ended interviews were conducted with 29 frail older adults. Thematic content analysis established the findings. Frail older adults perceive exercise as a by-product of other purposeful activities such as manual work or social activities. Progression into frailty appears to be associated with a decline in non-family support, changing traditional roles within family support networks, and lower baseline activity levels. Frail older adults perceive exercise as incidental to more purposeful activities rather than an endpoint in itself. Therefore, exercise programs concentrating on functional outcomes may be more relevant for this population. Strategies that educate and promote social support networks may also benefit frail older adults.