Chronic illness in non-heterosexual contexts: towards a critical LGBTQ health psychology

In this thesis, I contribute to the expansion of lesbian, gay, bisexual, trans and queer (LGBTQ) psychology by examining chronic illness within non-heterosexual contexts. Chronic illness, beyond the confines of HIV/AIDS, has been a neglected topic in LGBTQ psychology and sexual identity is often overlooked within health psychology. When the health of lesbian, gay and bisexual (LGB) people has been considered there has been an over-reliance on quantitative methods and comparative approaches which seek to compare LGB people?s health to their heterosexual counterparts. In contrast, I adopt a critical perspective and qualitative methods to explore LGBTQ health. My research brings together ideas from LGBTQ psychology and critical health psychology to explore non-heterosexuals? experiences of chronic illness and the discursive contexts within which LGB people live with chronic health conditions. I also highlight the heteronormativity which pervades academic health psychology as well as the „lay? health literature. The research presented in this thesis draws on three different sources of qualitative data: a qualitative online questionnaire (n=190), an online discussion within a newsgroup for people with diabetes, and semi-structured interviews with 20 LGB people with diabetes. These data are analysed using critical realist forms of thematic analysis and discourse analysis. In the first analytic chapter (Chapter 3), I report the perspectives of LGB people living with many different chronic illnesses and how they felt their sexuality shapes their experiences of illness. In Chapter 4, I examine heterosexism within an online discussion and consider the ways in which sexuality is constructed as (ir)relevant to a diabetes support forum. In Chapter 5, I analyse LGB people?s talk about the support family and partners provide in relation to their diabetes and how they negotiate wider discourses of gender, sexuality and individualism. In Chapter 6 I explore how diabetes intersects with gay and bisexual men?s sex lives. In the concluding chapter, I discuss the contributions of my research for a critical LGBTQ health psychology and identify some possible areas for future research.

New networked technologies and carers of people with dementia: an interview study

Dementia is one of the greatest contemporary health and social care challenges, and novel approaches to the care of its sufferers are needed. New information and communication technologies (ICT) have the potential to assist those caring for people with dementia, through access to networked information and support, tracking and surveillance. This article reports the views about such new technologies of 34 carers of people with dementia. We also held a group discussion with nine carers for respondent validation. The carers' actual use of new ICT was limited, although they thought a gradual increase in the use of networked technology in dementia care was inevitable but would bypass some carers who saw themselves as too old. Carers expressed a general enthusiasm for the benefits of ICT, but usually not for themselves, and they identified several key challenges including: establishing an appropriate balance between, on the one hand, privacy and autonomy and, on the other: maximising safety; establishing responsibility for and ownership of the equipment and who bears the costs; the possibility that technological help would mean a loss of valued personal contact; and the possibility that technology would substitute for existing services rather than be complementary. For carers and dementia sufferers to be supported, the expanding use of these technologies should be accompanied by intensive debate of the associated issues.

Managing people and performance:An evidence based framework applied to health service organizations

People and their performance are key to an organization's effectiveness. This review describes an evidence-based framework of the links between some key organizational influences and staff performance, health and well-being. This preliminary framework integrates management and psychological approaches, with the aim of assisting future explanation, prediction and organizational change. Health care is taken as the focus of this review, as there are concerns internationally about health care effectiveness. The framework considers empirical evidence for links between the following organizational levels: 1. Context (organizational culture and inter-group relations; resources, including staffing; physical environment) 2. People management (HRM practices and strategies; job design, workload and teamwork; employee involvement and control over work; leadership and support) 3. Psychological consequences for employees (health and stress; satisfaction and commitment; knowledge, skills and motivation) 4. Employee behaviour (absenteeism and turnover; task and contextual performance; errors and near misses) 5. Organizational performance; patient care. This review contributes to an evidence base for policies and practices of people management and performance management. Its usefulness will depend on future empirical research, using appropriate research designs, sufficient study power and measures that are reliable and valid.

Managing people to promote innovation

There is growing evidence available to suggest that Human Resource Management (HRM) practice is an important predictor of organizational performance. Drawing upon organizational learning perspectives, we argue that HRM systems also have the potential to promote organizational innovation. We present longitudinal data from thirty-five UK manufacturing organizations to suggest that effective HRM systems – incorporating sophisticated approaches to recruitment and selection, induction, appraisal and training – predict organizational innovation in products and production technology. We further show that organizational innovation is enhanced where there is a supportive learning climate, and inhibited (for innovation in production processes) where there is a link between appraisal and remuneration.

Positive psychology approaches to public services leadership: An introduction to strengths-based leadership

To readers of the popular press, the words ‘positive psychology’ may conjure up images of happiness gurus and people having their feet massaged, their heads resting peacefully on pink, fluffy clouds. But in this article, our aim is to demonstrate how the new science of positive psychology speaks powerfully to - and has much to contribute to - the development of leadership and the practices and processes of organisations, whether in the public or private sectors. Much of our work is concerned with the applications of this new field, and particularly with building strengths-based organisations. A key pillar of this work is around enabling strengths-based leadership, and provides our focus for this article.

Edges and bars: where do people see features in 1-D images?

There have been two main approaches to feature detection in human and computer vision - based either on the luminance distribution and its spatial derivatives, or on the spatial distribution of local contrast energy. Thus, bars and edges might arise from peaks of luminance and luminance gradient respectively, or bars and edges might be found at peaks of local energy, where local phases are aligned across spatial frequency. This basic issue of definition is important because it guides more detailed models and interpretations of early vision. Which approach better describes the perceived positions of features in images? We used the class of 1-D images defined by Morrone and Burr in which the amplitude spectrum is that of a (partially blurred) square-wave and all Fourier components have a common phase. Observers used a cursor to mark where bars and edges were seen for different test phases (Experiment 1) or judged the spatial alignment of contours that had different phases (e.g. 0 degrees and 45 degrees ; Experiment 2). The feature positions defined by both tasks shifted systematically to the left or right according to the sign of the phase offset, increasing with the degree of blur. These shifts were well predicted by the location of luminance peaks (bars) and gradient peaks (edges), but not by energy peaks which (by design) predicted no shift at all. These results encourage models based on a Gaussian-derivative framework, but do not support the idea that human vision uses points of phase alignment to find local, first-order features. Nevertheless, we argue that both approaches are presently incomplete and a better understanding of early vision may combine insights from both. (C)2004 Elsevier Ltd. All rights reserved.

Communication in investigative and legal contexts:integrated approaches from forensic psychology, linguistics and law enforcement

Communication in Forensic Contexts provides in-depth coverage of the complex area of communication in forensic situations. Drawing on expertise from forensic psychology, linguistics and law enforcement worldwide, the text bridges the gap between these fields in a definitive guide to best practice. • Offers best practice for understanding and improving communication in forensic contexts, including interviewing of victims, witnesses and suspects, discourse in courtrooms, and discourse via interpreters • Bridges the knowledge gaps between forensic psychology, forensic linguistics and law enforcement, with chapters written by teams bringing together expertise from each field • Published in collaboration with the International Investigative Interviewing Research Group, dedicated to furthering evidence-based practice and practice-based research amongst researchers and practitioners • International, cross-disciplinary team includes contributors from North America, Europe and Asia Pacific, and from psychology, linguistics and forensic practice

People, technology, processes and risk knowledge sharing

The present global economic crisis creates doubts about the good use of accumulated experience and knowledge in managing risk in financial services. Typically, risk management practice does not use knowledge management (KM) to improve and to develop new answers to the threats. A key reason is that it is not clear how to break down the “organizational silos” view of risk management (RM) that is commonly taken. As a result, there has been relatively little work on finding the relationships between RM and KM. We have been doing research for the last couple of years on the identification of relationships between these two disciplines. At ECKM 2007 we presented a general review of the literature(s) and some hypotheses for starting research on KM and its relationship to the perceived value of enterprise risk management. This article presents findings based on our preliminary analyses, concentrating on those factors affecting the perceived quality of risk knowledge sharing. These come from a questionnaire survey of RM employees in organisations in the financial services sector, which yielded 121 responses. We have included five explanatory variables for the perceived quality of risk knowledge sharing. These comprised two variables relating to people (organizational capacity for work coordination and perceived quality of communication among groups), one relating to process (perceived quality of risk control) and two related to technology (web channel functionality and RM information system functionality). Our findings so far are that four of these five variables have a significant positive association with the perceived quality of risk knowledge sharing: contrary to expectations, web channel functionality did not have a significant association. Indeed, in some of our exploratory regression studies its coefficient (although not significant) was negative. In stepwise regression, the variable organizational capacity for work coordination accounted for by far the largest part of the variation in the dependent variable perceived quality of risk knowledge sharing. The “people” variables thus appear to have the greatest influence on the perceived quality of risk knowledge sharing, even in a sector that relies heavily on technology and on quantitative approaches to decision making. We have also found similar results with the dependent variable perceived value of Enterprise Risk Management (ERM) implementation.

Feminist Post-structuralist discourse analysis: a new theoretical and methodological approach?

This chapter serves three very important functions within this collection. First, it aims to make the existence of FPDA better known to both gender and language researchers and to the wider community of discourse analysts, by outlining FPDA’s own theoretical and methodological approaches. This involves locating and positioning FPDA in relation, yet in contradistinction to, the fields of discourse analysis to which it is most often compared: Critical Discourse Analysis (CDA) and, to a lesser extent, Conversation Analysis (CA). Secondly, the chapter serves a vital symbolic function. It aims to contest the authority of the more established theoretical and methodological approaches represented in this collection, which currently dominate the field of discourse analysis. FPDA considers that an established field like gender and language study will only thrive and develop if it is receptive to new ways of thinking, divergent methods of study, and approaches that question and contest received wisdoms or established methods. Thirdly, the chapter aims to introduce some new, experimental and ground-breaking FPDA work, including that by Harold Castañeda-Peña and Laurel Kamada (same volume). I indicate the different ways in which a number of young scholars are imaginatively developing the possibilities of an FPDA approach to their specific gender and language projects.

How do older people with sight loss manage their general health? A qualitative study

Purpose: Older people with sight loss experience a number of barriers to managing their health. The purpose of this qualitative study was to explore how older people with sight loss manage their general health and explore the techniques used and strategies employed for health management. Methods: Semi-structured face-to-face interviews were conducted with 30 participants. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Health management challenges experienced included: managing multiple health conditions; accessing information; engaging in health behaviours and maintaining wellbeing. Positive strategies included: joining support groups, clubs and societies; using low vision aids; seeking support from family and friends and accessing support through health and social care services. Conclusion: Healthcare professionals need to be more aware of the challenges faced by older people with sight loss. Improved promotion of group support and charity services which are best placed to share information, provide fora to learn about coping techniques and strategies, and give older people social support to prevent isolation is needed. Rehabilitation and support services and equipment can only be beneficial if patients know what is available and how to access them. Over-reliance on self-advocacy in current healthcare systems is not conducive to patient-centred care. Implications for Rehabilitation Sight loss in older people can impact on many factors including health management. This study identifies challenges to health management and highlights strategies used by older people with sight loss to manage their health. Access to support often relies on patients seeking information for themselves. However, self-advocacy is challenging due to information accessibility barriers. Informal groups and charities play an important role in educating patients about their condition and advising on available support to facilitate health management.

Linkages between ecocentric values and action in expert discourse: the case of genetically modified food in the UK

Attitudes towards the environment can be manifest in two broad categories, namely anthropocentric and ecocentric. The former regards nature as of value only insofar as it is useful to humanity, whereas the latter assigns intrinsic value to natural entities. Industrial society can be characterised as being dominated by anthropocentrism, which leads to the assumption that a majority of people hold anthropocentric values. However, research shows the most widely held values are ecocentric, which implies that many people's actions are at variance with their values. Furthermore, policy relating to environmental issues is predominantly anthropocentric, which implies it is failing to take account of the values of the majority. Research among experts involved in policy formulation has shown that their values, often ecocentric, are excluded from the policy process. The genetic modification of food can be categorised as anthropocentric, which implies that the technique is in conflict with widely held ecocentric values. This thesis examines data collected from interviews with individuals who have an influence on the debate surrounding the introduction of genetically modified foods, and can be considered 'experts'. Each interviewee is categorised according to whether their values and actions are ecocentric or anthropocentric, and the linkages between the two and the arguments used to justify their positions are explored. Particular emphasis is placed on interviewees who have ecocentric values but act professionally in an anthropocentric way. Finally, common themes are drawn out, and the features the arguments used by the interviewees have in common are outlined.

Education and self-management for people newly diagnosed with type 2 diabetes: a qualitative study of patients' views.

OObjectives: We explored the perceptions, views and experiences of diabetes education in people with type 2 diabetes who were participating in a UK randomized controlled trial of methods of education. The intervention arm of the trial was based on DESMOND, a structured programme of group education sessions aimed at enabling self-management of diabetes, while the standard arm was usual care from general practices. Methods: Individual semi-structured interviews were conducted with 36 adult patients, of whom 19 had attended DESMOND education sessions and 17 had been randomized to receive usual care. Data analysis was based on the constant comparative method. Results: Four principal orientations towards diabetes and its management were identified: `resisters', `identity resisters, consequence accepters', `identity accepters, consequence resisters' and `accepters'. Participants offered varying accounts of the degree of personal responsibility that needed to be assumed in response to the diagnosis. Preferences for different styles of education were also expressed, with many reporting that they enjoyed and benefited from group education, although some reported ambivalence or disappointment with their experiences of education. It was difficult to identify striking thematic differences between accounts of people on different arms of the trial, although there was some very tentative evidence that those who attended DESMOND were more accepting of a changed identity and its implications for their management of diabetes. Discussion: No one single approach to education is likely to suit all people newly diagnosed with diabetes, although structured group education may suit many. This paper identifies varying orientations and preferences of people with diabetes towards forms of both education and self-management, which should be taken into account when planning approaches to education.

Metaphors in Hugo Chávez's political discourse:conceptualizing nation, revolution and opposition

This dissertation examines Hugo Chávez's choice of metaphors in his efforts to construct and legitimize his Bolivarian Revolution. It focuses on metaphors drawn from three of the most frequent target domains present in his discourse: the nation, his revolution, and the opposition. The study argues that behind an official discourse of inclusion, Chávez's choice of metaphors contributes to the construction of a polarizing discourse of exclusion in which his political opponents are represented as enemies of the nation.The study shows that Chávez constructs this polarizing discourse of exclusion by combining metaphors that conceptualize: (a) the nation as a person who has been resurrected by his government, as a person ready to fight for his revolution, or as Chávez himself; (b) the revolution as war; and (c) members of the opposition as war combatants or criminals. At the same time, the study shows that by making explicit references in his discourse about the revolution as the continuation of Bolívar's wars of independence, Chávez contributes to represent opponents as enemies of the nation, given that in the Venezuelan collective imaginary Simón Bolívar is the symbol of the nation's emancipation.This research, which covers a period of nine years (from Chávez's first year in office in 1999 through 2007), is part of the discipline of Political Discourse Analysis (PDA). It is anchored both in the theoretical framework provided by the cognitive linguistic metaphor theory developed by George Lakoff and Mark Johnson described in their book Metaphors We Live By, and in Critical Metaphor Analysis (CMA) as defined by Jonathan Charteris-Black in his book Corpus Approaches to Critical Metaphor Analysis.The study provides the first comprehensive analysis of metaphors used by Chávez in his political discourse. It builds upon the findings of previous studies on political discourse analysis in Venezuela by showing that Chávez's discourse not only polarizes the country and represents opponents as detractors of national symbols such as Bolívar or his wars of independence (which have been clearly established in previous studies), but also represents political opponents as enemies of the nation.

But it’s not all about the sex:mothering, normalisation and young learning disabled people

This paper is about mothering, young learning disabled people, their sexualised and relationship lives and normalisation - not through the lens of the disabled person, but via a mothers perspective and theoretical discussion. As a mother who has a learning disabled daughter, a feminist and an academic, my own mothering experience, my PhD research and social theory are woven throughout this paper with the intention of opening up debate about sex, intimacy, normalisation, and how this impacts upon young learning disabled people. I suggest that the relationship between sex, reproduction, intimacy and intellectual impairment, and a project to decipher what it means to be human, in all its dirty glory are also part of the discourse that needs to be discussed experientially and theoretically. So much so that the messy world within which we all live can be variously and differently constructed.

Optimising primary care for people with dementia

This review considers key areas in primary care regarding the diagnosis of dementia. Issues surrounding assessment, policy and incentives are considered. In addition, the relevance of non-medication approaches for dementia in primary care, which aim to enhance or maintain quality of life by maximising psychological and social function in the context of existing disabilities, is deliberated. Finally, key issues about primary care medication management are considered, and relevant therapeutic strategies with recommendation for a collaborative approach that improve outcomes by linking primary and secondary healthcare services - including general practice and pharmacy - with social care needs are weighed up. A key aspect of such a collaborative approach is to support informal carers in optimising medication.