Understanding Suicide and Help-seeking in Urban and Rural Areas in Northern Ireland

Funded by HSC R&D Division, Public Health Agency Why did we start? Most people who complete suicide are in contact with their family doctors or other services in the months prior to death. A better understanding of the nature of these contacts and the various pathways experienced by suicidal people should reveal the gaps and barriers to effective service provision. We also need better information about the difficulties experienced by family carers, both prior to the death and afterwards. Of particular interest to policy makers in Northern Ireland was a concern that people from rural areas may be at increasing risk of suicide. We were commissioned by the Health and Social Care R&D Division of the Northern Ireland Public Health Agency to address the gaps in our understanding of suicide in NI. What did we do? We undertook a mixed methods study in which we examined the records of 403 people who took their own lives over a two-year period between March 2007 and February 2009. We linked these data to GP records and then examined help-seeking pathways of people and their contacts with services. We did in-depth face-to-face interviews with 72 bereaved relatives and friends who discussed their understanding of the events and circumstances surrounding the death, the experience of seeking help for the family member, the personal impact of the suicide, and use of support services. Additionally, we interviewed 19 General Practitioners about their experiences of managing people who died by suicide.            

Étude d’évaluabilité et évaluation des processus et des effets d’un programme de prévention de l’usage de substances psychoactives lors de la transition primaire-secondaire

La mise en œuvre d’activités de prévention de la consommation de substances psychoactives (SPA) (tabac, alcool et cannabis) en milieu scolaire est une stratégie couramment utilisée pour rejoindre un grand nombre de jeunes. Ces activités s’inspirent, soit de programmes existant, soit d’innovations dictées par le contexte d’implantation ou l’existence de données de recherche. Dans un cas comme dans l’autre, l’évaluation de ces programmes représente la meilleure voie pour mesurer leur efficacité et/ou connaître comment ceux-ci sont implantés. C’est cet impératif qui a motivé une commission scolaire du Québec a recommandé l’évaluation de l’Intervention en Réseau (IR), un programme développé en vue de retarder l’âge d’initiation et de réduire la consommation problématique de SPA chez les élèves. Ce programme adopte une approche novatrice avec pour principal animateur un intervenant pivot (IP) qui assure le suivi des élèves de la 5e année du primaire jusqu’en 3e secondaire. Inspiré des modèles en prévention de la santé et de l’Approche École en santé (AES), le rôle de l’IP ici se démarque de ceux-ci. Certes, il est l’interface entre les différents acteurs impliqués et les élèves mais dans le cadre du programme IR, l’IP est intégré dans les écoles primaires et secondaires qu’il dessert. C’est cet intervenant qui assure la mobilisation des autres acteurs pour la mise en œuvre des activités. Cette thèse vise à rendre compte de ce processus d’évaluation ainsi que des résultats obtenus. L’approche d’évaluation en est une de type participatif et collaboratif avec des données quantitatives et qualitatives recueillies par le biais de questionnaires, d’entrevues, de groupes de discussion, d’un journal de bord et de notes de réunions. Les données ont été analysées dans le cadre de trois articles dont le premier concerne l’étude d’évaluabilité (ÉÉ) du programme. Les participants de cette ÉÉ sont des acteurs-clés du programme (N=13) rencontrés en entrevues. Une analyse documentaire (rapports et journal de bord) a également été effectuée. Cette ÉÉ a permis de clarifier les intentions des initiateurs du programme et les objectifs poursuivis par ces derniers. Elle a également permis de rendre la théorie du programme plus explicite et de développer le modèle logique, deux éléments qui ont facilité les opérations d’évaluation qui ont suivi. Le deuxième article porte sur l’évaluation des processus en utilisant la théorie de l’acteur-réseau (TAR) à travers ses quatre moments du processus de traduction des innovations (la problématisation, l’intéressement, l’enrôlement et la mobilisation des alliés), l’analyse des controverses et du rôle des acteurs humains et non-humains. Après l’analyse des données obtenues par entrevues auprès de 19 informateurs-clés, les résultats montrent que les phases d’implantation du programme passent effectivement par les quatre moments de la TAR, que la gestion des controverses par la négociation et le soutien était nécessaire pour la mobilisation de certains acteurs humains. Cette évaluation des processus a également permis de mettre en évidence le rôle des acteurs non-humains dans le processus d’implantation du programme. Le dernier article concerne une évaluation combinée des effets (volet quantitatif) et des processus (volet qualitatif) du programme. Pour le volet quantitatif, un devis quasi-expérimental a été adopté et les données ont été colligées de façon longitudinale par questionnaires auprès de 901 élèves de 5e et 6e année du primaire et leurs enseignants de 2010 à 2014. L’analyse des données ont montré que le programme n’a pas eu d’effets sur l’accessibilité et les risques perçus, l’usage problématique d’alcool et la polyconsommation (alcool et cannabis) chez les participants. Par contre, les résultats suggèrent que le programme pourrait favoriser la réduction du niveau de consommation et retarder l’âge d’initiation à l’alcool et au cannabis. Ils suggèrent également un effet potentiellement positif du programme sur l’intoxication à l’alcool chez les élèves. Quant au volet qualitatif, il a été réalisé à l’aide d’entrevues avec les intervenants (N=17), de groupes de discussion avec des élèves du secondaire (N=10) et d’une analyse documentaire. Les résultats montrent que le programme bénéficie d’un préjugé favorable de la part des différents acteurs ayant participé à l’évaluation et est bien acceptée par ces derniers. Cependant, le roulement fréquent de personnel et le grand nombre d’écoles à suivre peuvent constituer des obstacles à la bonne marche du programme. En revanche, le leadership et le soutien des directions d’écoles, la collaboration des enseignants, les qualités de l’IP et la flexibilité de la mise en œuvre sont identifiés comme des éléments ayant contribué au succès du programme. Les résultats et leur implication pour les programmes et l’évaluation sont discutés. Enfin, un plan de transfert des connaissances issues de la recherche évaluative est proposé.

Resilience and the cultural landscape : the case of the Lower Ninth Ward after Hurricane Katrina

Le but de cette recherche est d’évaluer l’importance du paysage culturel dans la résilience des communautés urbaines post-catastrophes. Ce travail se concentre sur le quartier du Lower Ninth Ward dans la ville de La Nouvelle-Orléans (États-Unis) après le passage de l’ouragan Katrina en 2005. Les catastrophes naturelles prennent une envergure et causent des dommages considérables lorsqu’elles touchent des villes. La reconstruction post -désastre est donc très dispendieuse pour les villes et les gouvernements, d’autant que certaines régions sont dévastées au point qu’elles doivent être reconstruites au complet. Cependant, le coût le plus lourd à assumer reste celui en vies humaines et si rebâtir les éléments concrets d’une ville est une tâche difficile à entreprendre, reconstruire une communauté est considérablement plus complexe. Dans le but de comprendre une telle démarche, cette recherche se concentre sur les éléments intangibles, comme l’attachement au lieu et les réseaux sociaux, dont une communauté a besoin pour se reconstituer de façon durable et résiliente. Le concept de résilience est très contesté dans la littérature et plusieurs chercheurs se sont essayés à le mesurer. Cette recherche adopte une perspective critique sur le concept et le revisite d’un point de vue holistique pour mettre en lumière sa complexité. Cette démarche permet de remettre en question l’importance de mesurer un concept finalement en perpétuelle redéfinition dans le temps et selon les échelles géographiques. De plus, en établissant une relation entre résilience et paysage culturel, il a été possible de mieux comprendre la complexité de la résilience. Touchant à plusieurs disciplines (architecture de paysage, urbanisme et sociologie), cette recherche utilise une méthodologie qui reflète son aspect multidisciplinaire : les méthodes mixtes. Ces dernières permettent la collecte de données quantitatives et qualitatives qui produisent une vue globale de la situation post-Katrina à travers le regroupement de recensions statistiques, d’observations de terrain et d’articles de journaux. Parallèlement, des entretiens ont été réalisés avec des résidents du quartier ainsi qu’avec des professionnels pour mieux comprendre les différents points de vue. Cette méthodologie a permis de produire des résultats au niveau du cas d’étude autant qu’au niveau théorique. La recherche valide l’importance de prendre en compte le paysage culturel dans les situations post-catastrophes, (en particulier) dans la mesure où il s’agit d’un élément souvent négligé par les urbanistes et les acteurs locaux. En effet, les éléments constitutifs du paysage culturel tels que l’attachement au lieu et les réseaux sociaux, participent d’un sentiment d'appartenance (« home ») et d’une volonté, pour les résidents, de reconstruire leurs habitations, leur communauté ainsi que leur quartier. Toutefois, il faut reconnaître que ces éléments ne suffisent pas à retrouver ce qu’ils ont perdu. Ainsi, l’étude du paysage culturel permet non seulement de mieux comprendre la complexité de la résilience, mais démontre également que cette dernière est une construction sociale.

Doctoral Supervisor: Coach, Mentor or Master? Developing an Alternative Paradigm for Doctoral Supervision

This working paper is the second in a series of working papers presenting the on-going findings from a longitudinal research project grounded in exploring the experience of doctoral supervision and developing practice. In the first paper and phase one of this research study, Cook, Nichol and Loon (2014) explored the existing context for doctoral supervision and, drawing from literature on the problematic nature of doctoral supervision and coaching and mentoring, considered the value of drawing on coaching and mentoring models in formulating alternative paradigms for doctoral supervision. This paper reports the findings of phase one, a mixed methods study of experiences of doctoral supervision with supervisors and students in one UK university business school, from which the Collaborative Action Doctoral Supervision conceptual model emerged. The paper also introduces phase two, a collaborative action research study with doctoral supervisors and students who are applying, reflecting on and developing further this doctoral supervision model. We are aiming to answer the question of whether the use of coaching and mentoring in doctoral supervision enables the transfer and sustainability of learning from the doctoral supervision session to outside the experience and improves the quality. Is the doctoral supervisor coach, mentor or master? Key words Doctoral supervision, coaching, mentoring, collaborative action research.

‘Théorie’, ‘hypothèse’, ‘modèle’ et ‘méthode’ dans le domaine de la linguistique: perspectives sémasiologique et onomasiologique

'Theory', 'hypothesis', 'model' and 'method' in linguistics: Semasiological and onomasiological perspectives The subject of this thesis is the use of generic scientific terms, in particular the four terms 'theory', 'hypothesis', 'model' and 'method', in linguistic research articles written in French and in Finnish. The thesis examines the types of scientific constructs to which these terms are applied, and seeks to explain the variation in the use of each term. A second objective of the thesis is to analyze the relationships among these terms, and the factors determining the choices made by writers. With its focus on the authentic use of generic scientific terms, the thesis complements the normative and theoretical descriptions of these terms in Science Studies and offers new information on actual writing practices. This thesis adheres to functional and usage-based linguistics, drawing its theoretical background from cognitive linguistics and from functional approaches to terminology. The research material consisted of 120 research articles (856 569 words), representing different domains of linguistics and written in French or Finnish (60 articles in each language). The articles were extracted from peer-reviewed scientific journals and were published between 2000 and 2010. The use of generic scientific terms in the material has been examined from semasiological and onomasiological perspectives. In the first stage, different usages related to each of the four central terms were analyzed. In the second stage, the analysis was extended to other terms and expressions, such as 'theoretical framework', 'approach' and ‘claim’, which were used to name scientific constructs similar to the four terms analyzed in the first stage. Finally, in order to account for the writer’s choice among the terms, a mixed methods approach was adopted, based on the results of a previously conducted questionnaire concerning the differences between these terms as experienced by linguists themselves. Despite the general ideal that scientific terms should be carefully defined, the study shows that the use of these central terms is not without ambiguity. What is understood by these terms may vary according to different conceptual and stylistic factors as well as epistemic and disciplinary traditions. In addition to their polysemy, the semantic potentials of these terms are in part overlapping. In most cases, the variation in the use of these terms is not likely to cause serious misunderstanding. Rather, it allows the researcher to express a specific conceptualization of the scientific constructs mentioned in the article. The discipline of linguistics, however, would benefit from a more elaborate metatheoretical discussion.

Adolescent boys’ health : managing emotions, masculinities and subjective social status

The health of adolescent boys is complex and surprisingly little is known about how adolescent boys perceive, conceptualise and experience their health. Thus, the overall aim of this thesis was to explore adolescent boys’ perceptions and experiences of health, emotions, masculinity and subjective social status (SSS). This thesis consists of a qualitative, a quantitative and a mixed methods study. The qualitative study aimed to explore how adolescent boys understand the concept of health and what they find important for its achievement. Furthermore, the adolescent boys’ views of masculinity, emotion management and their potential effects on wellbeing were explored. For this purpose, individual interviews were conducted with 33 adolescent boys aged 16-17 years. The quantitative study aimed to investigate the associations between pride, shame and health in adolescence. Data were collected through a cross-sectional postal survey with 705 adolescents. The purpose of the mixed methods study was to investigate associations between SSS in school, socioeconomic status (SES) and self-rated health (SRH), and to explore the concept of SSS in school. Cross-sectional data were combined with interview data in which the meaning of SSS was further explored. Individual interviews with 35 adolescents aged 17-18 years were conducted. In the qualitative study, data were analysed using Grounded Theory. In the quantitative study, statistical analyses (e.g., chi-square test and uni- and multivariable logistic regression analyses) were performed. In the mixed method study, a combination of statistical analyses and thematic network analysis was applied. The results showed that there was a complexity in how the adolescent boys viewed, experienced, dealt with and valued health. On a conceptual level, they perceived health as holistic but when dealing with difficult emotions, they were prone to separate the body from the mind. Thus, the adolescent boys experienced a difference between health as a concept and health as an experience (paper I). Concerning emotional orientation in masculinity, two main categories of masculine conceptions were identified: a gender-normative masculinity and a non-gender-normative masculinity (paper II). Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite that their expressions are in contrast to each other. Non-gender-normative masculinity included an orientation towards sincerity, emphasising the personal values of the boys. Emotions were expressed more independently of peer group norms. The findings suggest that different masculinities and the expression of emotions are intricately intertwined and that managing emotions is vital for wellbeing. The present findings also showed that both shame and pride were significantly associated with SRH, and furthermore, that there seems to be a protective effect of experiencing pride for health (paper III). The results also demonstrated that SSS is strongly related to SRH, and high SRH is related to high SSS, and further that the positioning was done in a gendered space (paper IV). Results from all studies suggest that the emotional and relational aspects, as well as perceived SSS, were strongly related to SRH. Positive emotions, trustful relationships and having a sense of belonging were important factors for health and pride was an important emotion protecting health. Physical health, on the other hand, had a more subordinated value, but the body was experienced as an important tool to achieve health. Even though health was mainly perceived in a holistic manner by the boys, there were boys who were prone to dichotomise the health experience into a mind-body dualism when having to deal with difficult emotions. In conclusion, this thesis demonstrates that young, masculine health is largely experienced through emotions and relationships between individuals and their contexts affected by gendered practices. Health is to feel and function well in mind and body and to have trusting relationships. The results support theories on health as a social construction of interconnected processes. Having confidence in self-esteem, access to trustful relationships and the courage to resist traditional masculine norms while still reinforcing and maintaining social status are all conducive to good health. Researchers as well as professionals need to consider the complexity of adolescent boys’ health in which norms, values, relationships and gender form its social determinants. Those working with young boys should encourage them to integrate physical, social and emotional aspects of health into an interconnected and holistic experience.

Music Learning Networks: Supporting the Music Learning of Adolescents

Thesis (Ph.D.)--University of Washington, 2016-08

Newham’s Every Child a Sports Person (NECaSP): A Summative Process Evaluation of a School-and-Community Based Intervention in East London, UK

Background: The NECaSP intervention aspires to increase sport and physical activity (PA) participation amongst young people in the UK. The aims of this paper are to report on a summative process evaluation of the NECaSP and make recommendations for future interventions. Methods: Seventeen schools provided data by students aged 11-13 (n=1,226), parents (n=192) and teachers (n= 14) via direct observation and questionnaires. Means, standard deviations and percentages were calculated for socio-demographic data. Qualitative data was analysed via directed content analysis and main themes identified. Results: Findings indicate further administrative, educational and financial support will help facilitate the success of the programme in improving PA outcomes for young people, and of other similar intervention programmes globally. Data highlighted the need to engage parents to increase likelihood of intervention success. Conclusions: One main strength of this study is the mixed-methods nature of the process evaluation. It is recommended that future school based interventions that bridge sports clubs and formal curriculum provision, should consider a more broad approach to the delivery of programmes throughout the academic year, school week and school day. Finally, changes in the school curriculum can be successful once all parties are involved (community, school, families).

Stakeholder perceptions of ecosystem services of the Wami River and Estuary

Management of riverine and coastal ecosystems warrants enhanced understanding of how different stakeholders perceive and depend upon different kinds of ecosystem services. Employing a mixed methods approach, this study compares and contrasts the use and perceptions of upstream residents, downstream residents, tourism officials, and conservation organizations regarding the value of 30 ecosystem services provided by the Wami River and its estuary in Tanzania, and investigates their perceptions of the main threats to this system. Our findings reveal that all of the stakeholder groups place a high value on the provision of domestic water, habitat for wild plants and animals, tourism, and erosion control, and a relatively low value on the prevention of saltwater intrusion, refuge from predators, spiritual fulfillment, nonrecreational hunting, and the provision of traditional medications and inorganic materials for construction. Differences emerge, however, between the groups in the value assigned to the conservation of riverine and estuarine fauna and the provision of raw materials for building and handicrafts. Declining fish populations and an increasing human population are identified by the residents and conservation employees, respectively, as their prime concerns regarding the future conditions of the Wami River and its estuary. These groups also acknowledge increasing salinity levels and the loss of mangroves as other key concerns. The identification of these mutual interests and shared concerns can help build common ground among stakeholders while the recognition of potential tensions can assist managers in balancing and reconciling the multiple needs and values of these different groups.

Exploring Intrinsic Gender Identity Using Second Life

Virtual Worlds (VWs) provide an environment to understand and explore notions of gender and identity, particularly given the ability for users to experiment with gender in online worlds. Our study analyses gender identity using the virtual space of Second Life (SL) to explore experiences and responses to gender in an avatar. We introduced 46 novice users to the VW of SL in order to see if real life gender influenced their choices of avatar. Participants selected the gender of their original avatar and once they were used to SL, they were then asked to change the gender of that avatar. We used mixed methods research consisting of paper based questionnaires (n=34) and focus groups (n=46) conducted in SL. Nearly all participants chose an initial avatar that reflected their real-life gender with females (n=22) reporting higher levels of identification with this initial avatar. Females were significantly more concerned with the gender-specific appearance of their initial avatar. On swapping gender, females reported higher levels of discomfort and many changed back before 7 minutes. Males (n=24) did not report significant discomfort with their changed-gender avatar and did not revert back to their original avatar as quickly. Our findings suggest that female participants in this study tended to reinforce gender binaries through such things as clothing, hairstyles and behaviors of their avatars. Male participants were less likely to experience discomfort through changing the gender of their avatar (with the males noting they still perceived an avatar with a female appearance as male).

Competency Based Assessment Using Virtual Reality (VERT): Is It a Realistic Possibility ?

The education of the radiography profession is based within higher education establishments, yet a critical part of all radiography programmes is the clinical component where students learn the practical skills of the profession. Assessments therefore not only have to assess a student’s knowledge, but also their clinical competence and core skills in line with both Health and Care Professions Council and the Society and College of Radiographers requirements. This timely thesis examines the possibility of using the Virtual Environment for RadioTherapy (VERT) as an assessment tool to evaluate a student’s competence so giving the advantage of a standard assessment and relieving time pressures in the clinical department. A mixed methods approach was taken which can be described as a Quantitative Qualitative design with the emphasis being on the Quantitative element; a so called QUAN  qual design. The quantitative evaluation compared two simulations, one in the virtual reality environment and another in the department using a real treatment machine. Students were asked to perform two electron setups in each simulation; the order being randomly decided and so the study would be described as a randomised cross-over design. Following this, qualitative data was collected in student focus groups to explore student perspectives in more depth. Findings indicated that the performance between the two simulators was significantly different, p < 0∙001; the virtual simulation scoring significantly lower than the hospital based simulation overall and in virtually all parameters being assessed. Thematic analysis of the qualitative data supported this finding and identified 4 main themes; equipment use, a lack of reality, learning opportunities and assessment of competence. One other sub-theme identified for reality was that of the environment and senses.

Supervision For School Staff: What is Valuable about Solution Circles?

Group supervision is used for support, education and/or monitoring. Despite the potential value of these elements for school staff, it is rarely practised. This mixed methods research, from a critical realist perspective, explored the use of Solution Circles to structure staff supervision groups in three schools. Five circles were run in each school, involving thirty-one participants, eighteen of whom contributed data. Thirteen staff trained as facilitators. The self-efficacy, resilience and anxiety levels of the staff taking part were not found to be significantly different as a result of the intervention. However, a small effect size was noted for self-efficacy, perhaps worthy of further investigation in the context of the small sample size. Thematic analysis of participant feedback (gathered during the last circle, which ran as a Focus Group) indicated the following mechanisms as affecting the value of Solution Circles for staff supervision groups: the structure of the sessions; aspects linked to the groups meeting a ‘need to talk’; elements which helped participants to ‘feel like a team’; and, school context factors. Semi-structured interview data from six facilitators indicated that the structure of the circles, individual characteristics of facilitators, the provision of support for facilitators, and elements of the wider school context, were all mechanisms which affected the facilitation of the programme. Further research might implement elements of these mechanisms and measure their impact.

Music teacher biography and its impact on teaching practice

This paper describes research carried out as part of a wider doctoral study on ‘the biography of music teachers, their understanding of musicality and the implications for secondary music education’. Music teachers will come from a range of diverse backgrounds, though research data would suggest that most seem to have been educated as ‘classical’ music performers which will have an affect on what they perceive to be central competencies in the development of young musicians. In turn, this will determine, to some extent, what is taught and learned in the secondary music classroom. This study explores the impact of the biography of secondary music teachers as they seek to develop the musicianship of their pupils and present the activities in which the young people will be expected to participate. A mixed methods approach has been taken, including surveys, observation and interviews. Surveys amongst a sample of experienced and trainee teachers have produced a range of quantitative data on respondents’ experience of and values related to music education; whilst qualitative data in the form of lesson observation notes and transcription of semi-structured interviews have been the result of working with a small sub-set of participants. The outcomes of study have suggested a clear link between biography and classroom practice but that there are also other potential tensions which arise, such as in the subject knowledge development of practitioners as they move from musician to teacher. Implications for a variety of stakeholders in secondary music education include a consideration of the development of subject knowledge together with potential review of national and local education policy, the nature of undergraduate music study and the ‘shape’ of initial teacher training in England.

Growing Well-beings: the Positive Experience of Care Farms

Objectives: Care farms enable people who are in some way vulnerable to engage with agricultural places and farming activities. This study investigates how this impacts on the health and well-being of service users and explores associated processes and outcomes. Design: A mixed methods design was adopted that allowed for the integration of quantitative measurements of change with qualitative descriptions of this change. A pragmatic approach provided sufficient flexibility to support the investigation of complex contexts. Methods: A total of 216 service users completed an initial questionnaire, and 137 (63%) of this number provided comparative data in a follow-up questionnaire. Questionnaires contained multiple choice and open-ended questions alongside standardized health and well-being measures requiring Likert-format responses. Semi-structured interviews with 33 service users allowed personal experiences to be detailed. Results: Statistical analysis of well-being measure scores identified significant positive relationships with the length of time people had been attending the care farm. Questionnaire and interview data presented health benefits as being enabled by the farm environment, the positive experience as supporting personal development, and associated social interactions as becoming increasingly influential as time progressed. Conclusions: The health and well-being outcomes that result from participating at a care farm influence multiple elements of the human condition and apply amongst vulnerable people with a wide range of personal needs. Care farms have access to a potentially unique range of resources that can support many service users in becoming happier and healthier individuals.

Conflict and Stability in the Neoliberal Era: Explaining Urban Unrest in Latin America

Thesis (Ph.D.)--University of Washington, 2016-08