Dissertations / Theses on the topic 'Multiple chronic illnesses'
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1
Porter, Tom. "A sociological study of social resources and the patient experience of multiple chronic illnesses." Thesis, Keele University, 2015. http://eprints.keele.ac.uk/2326/.
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The number of people living with multiple chronic illnesses (multimorbidity) is increasing and this trend is set to continue. In recent years, there has been a significant increase in epidemiological and clinically informed research into this patient population. However, the extant literature offers relatively little insight into how lay individuals make sense of multimorbidity. Social resources, or the physical and emotional sustenance provided by others, are recognised increasingly as a means towards affecting health outcomes. Social resources are apparent as a nascent theme at the levels of health and social care policy, service organisation, and increasingly, at the level of primary care delivery. However, the apparent enthusiasm for social resources is not universal, and critics have questioned both the socio-political motives behind this trend as well as its underlying social theory. This study employs in-depth qualitative interviews and applies an interpretive approach to analysis. 15 participants living with (at least) osteoarthritis and cardiovascular disease took part in up to two interviews. In addition, a small number of participants’ spouses (four) were recruited into the study. Findings illustrate the ways in which lay individuals make sense of multimorbidity. This thesis draws attention to certain biomedical assumptions made by clinically informed literature. These assumptions are discussed with regard to the concept of illness prioritisation and the relevance of multimorbidity (in conceptual terms) to lay experience. Findings also illustrate the complexity of social resource exchange during illness. A novel conceptual model is developed to elucidate participants’ accounts of supportive practices. Further, findings highlight the role of morality in shaping the experience of support. These observations are synthesised under the theoretical banner of gift-exchange theory, and implications are identified for the application of social resources in policy and service delivery.
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Squillace, Mary. "Fine Motor Skills and the Occupations of Young Adults with Multiple Sclerosis." Diss., NSUWorks, 2018. https://nsuworks.nova.edu/hpd_ot_student_dissertations/62.
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Objective: Multiple sclerosis (MS) is one of the most common neurological diseases affecting adults of working age, and those of younger ages of onset have been increasingly recognized. Twenty-seven percent of people with MS (PwMS) are age 30 years old or younger. The burden of MS for young adults puts them at risk for poorer outcomes regarding their education, family planning, vocation, and social skills as they transition to adulthood. Fine motor (FM) skill impairment might impede performance within the daily occupations of young adults who are transitioning into adulthood. Few studies focus on the occupations and occupational performance of younger adults with MS. Method: Forty participants with MS between the ages of 18 to 30 were recruited to participate in a study. Two standardized measures were used to identify possible FM dexterity deficits and one standardized self-report was used to measure the perceived satisfaction and performance of occupations for this population. A semi-structured interview was conducted with a subgroup of 18 participants to understand the lived experiences of young adults with MS (YAwMS) and their FM performance during their occupations. Results: With quantitative and qualitative analysis, a relationship was suggested between FM scores and both perceived performance and satisfaction scores of an adapted performance measure. Conclusion: Young adults with MS perceive difficulties with occupations that are influenced by their FM status. It is recommended that occupational therapy professionals consider the motor skill needed to perform and complete occupations that specifically require FM skills.
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Earll, Mary Louise. "Coping with chronic neurological illness : an analysis using self-regulation theory." Thesis, University College London (University of London), 1994. http://discovery.ucl.ac.uk/1317876/.
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Self-regulation theory was used to examine how people cope with the diagnosis and management of chronic neurological illness. Three studies are reported, all of which examined the three main elements of self-regulation theory as outlined by Leventhal et al (1984), people's representations of their condition, the actions they took to manage and their evaluation of those efforts, and the outcome as assessed by their feelings about themselves, their emotional wellbeing and severity of disability. A longitudinal study examined 20 people at three stages, before coming into hospital for tests and investigations for multiple sclerosis, 6 weeks and 6 months later. This study provided some support for representations as being important in guiding coping. However, both representations and people's own evaluations of their coping efforts were more predictive of outcome. The second, cross-sectional study compared people being investigated for three differing chronic diseases; the previous 20 people being investigated for multiple sclerosis, 11 and 22 people being investigated for motor neurone disease and liver disease respectively. Results showed that how people represented their condition, and not the diagnosis, was related to outcome. The third study was pseudo-longitudinal and examined people at different times since the diagnosis of multiple sclerosis. People at six months (n=20 from first study), 2 years (n=19), and over 7 years (n=25) from diagnosis were included. This study again highlighted the relationship between representations and outcome; perceiving more symptoms and adverse consequences being associated with poorer outcomes of all types. Coping was also associated with outcome, in particular, more social supports and greater satisfaction with that support being associated with higher Self Esteem, better emotional wellbeing and less severe disability. It is concluded that self-regulation theory is a useful framework within which to understand how people cope with chronic neurological illness, in chronic illnesses with no cure or effective palliative treatments people's representation of their condition and evaluation of their coping efforts predicted outcome. The low level of psychological distress found in all studies suggests that while no particular coping actions are associated with better outcomes, it may be that taking some kind of action, rather than taking no action, in a situation where there is nothing the medical profession can do is sufficiently motivating to minimise depression.
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Phillips, Mark W. "Spiritual dimensions coping with chronic illness such as multiple sclerosis /." Theological Research Exchange Network (TREN), 2000. http://www.tren.com.
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Henriksson, Freddie. "Economic aspects of chronic diseases : multiple sclerosis and diabetes mellitus /." Stockholm, 2001. http://diss.kib.ki.se/2001/91-628-5023-7/.
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Reed, Jonathan. "The development of a theory of psychological adjustment to multiple sclerosis based on accounts of subjective experience." Thesis, Open University, 1997. http://oro.open.ac.uk/57711/.
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This study explores the process of psychological adjustment to multiple sclerosis. Fourteen participants who were given a definite diagnosis of multiple sclerosis between five and forty years prior to the study and who experienced the relapse-remitting form of the disease were interviewed face to face using a semi structured interview schedule. Grounded theory was used to analyse the interviews and to build a theoretical account of the process of psychological adjustment to multiple sclerosis. The results suggest a model of adjustment in which some individuals with multiple sclerosis move from a stance of denial to a position of acknowledgement in response to the progress of the disease. Reaching acknowledgement allows individuals to adopt an active coping stance which can protect against negative psychological consequences. This adjustment process takes place against an overall process in which individuals experience multiple sclerosis as a progression through a series of different disease phases. Findings suggest that individuals also have to adjust within the social context. Role adjustment and communication were found to be central issues in the family adjustment process. Communication was also central to adjustment in the wider social context. Participants' service use suggests that they also undertake an adjustment from reliance on medical approaches to seeking out self help and alternative approaches. It is argued that this service use process reflects the individual adjustment process. The findings are critically evaluated and compared to existing models of adaptation to chronic illness. The clinical and service implications are discussed. A critical discussion of the methodology is presented and implications for further research are explored.
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Powell, Deborah Lynn. "An exploration of space, time and chronic illness : multiple perspectives on stroke." Thesis, Lancaster University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368049.
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Isaksson, Ann-Kristin. "Chronic sorrow and quality of life in patients with multiple sclerosis." Doctoral thesis, Örebro : Örebro universitetsbibliotek, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-846.
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Vickers, Margaret H. (Margaret Heather) 1962, of Western Sydney Nepean University, and Faculty of Commerce. "Life and work with 'invisible' chronic illness (ICI) :authentic stories of a passage through trauma - a Heideggerian, Hermeneutical, phenomenological, multiple-case, exploratory analysis." THESIS_FC_XXX_Vickers_M.xml, 1997. http://handle.uws.edu.au:8081/1959.7/826.
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This study is research into Invisible Chronic Illness (ICI): illness that cannot be seen by another, but that can have a major, sometimes catastrophic, effect on the lives of people concerned, especially their working lives. Each chapter deals, in some detail,with certain aspects of chronic illnesses that cannot be readily seen. The research is argued to be a vital excavation - a recognition of authentic and previously unheard voices and a methodology of primary value in researching the incommensurable, the difficult, the nasty in organisational lifeDoctor of Philosophy (PhD)
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Canellopoulou, Mary. "An investigation into the roles of frontal-lobe dysfunction, mood states and individual imaging abilities in the efficacy of imagery-based mnemonics in patients suffering from multiple sclerosis." Thesis, Brunel University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.389988.
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Chalk, Holly McCartney. "Coping with Multiple Sclerosis: coping strategies, personality, and cognitive appraisals as predictors of adjustment among multiple sclerosis patients." Columbus, Ohio : Ohio State University, 2007. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1178213739.
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Kobelt, Gisela. "Health economic assessment of medical technology in chronic progressive diseases : multiple sclerosis and rheumatoid arthritis /." Stockholm, 2003.
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Townsend, Anne Frances. "Multiple morbidity and moral identity in mid-life : accounts of chronic illness and the place of the GP consultation in overall management strategies." Thesis, University of Glasgow, 2005. http://theses.gla.ac.uk/2414/.
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This study was conceived against the backdrop of academic and medically based discussions about inappropriate use of General Practice, in the context of an overburdened and under resourced National Health Service. Both frequent and less frequent consulters prioritised dilemmas around functional ability, reporting attempts to control illness, and resist loss of normal life and familiar selves. Despite our attempts to sample frequent and less frequent users with similar levels of morbidity in the more detailed qualitative interviews the frequent consulters conveyed more severe illness, which limited their lives and challenged their coherent and moral identities. Cultural, structural and social factors combined to influence health actions; personal troubles were linked to public matters. The accounts revealed how the severity of condition combined with social position influenced the place of the GP consultation in overall management strategies. Women and men communicated common problems, but also discussed experiences which were related to their traditional family roles. Housing status was not revealed as significant, in the context of a complex combination of micro and macro influences on experience. In the frequent consulters’ accounts the role of the GP was magnified in lives diminished and disrupted by chronic illness, whereas the less frequent consulters’ accounts presented a more peripheral role for their GP. Using Bourdieu’s central concepts, the GP was conceptualised as a ‘dispenser of capital’. Throughout, all of the participants described the hard work of illness management, and they used the accounts to display their moral competence. The medical encounter was conveyed against a moral backdrop, and this may have had implications for frequency of consulting. Overall, the symbolic and physical burden of chronic illness was highlighted.
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Stanners, Melinda Nicole. "An exploration of the prevalence, diagnosis and treatment of depression in patients with multiple chronic conditions." Thesis, 2013. http://hdl.handle.net/2440/82543.
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Introduction: The likelihood of developing two or more chronic illnesses (‘multimorbidity’) increases with age. Depression is common with chronic physical illness, but may not be detected or treated in multimorbid patients. This thesis is comprised of a series of related studies designed to explore the prevalence, diagnosis and management of depression in patients with multiple chronic conditions using an explanatory mixed methods design. Data and participants were sourced from a multidisciplinary outpatient clinic in metropolitan Adelaide. Study One: Clinic Database Analysis. The study estimated the prevalence of a) depression diagnoses and b) depressive symptoms using the Geriatric Depression Scale (GDS) in an outpatient clinic population, exploring agreement between clinician diagnoses of depression and GDS scores. Doctor-diagnosed depression was recorded for 15% of patients. Based on GDS scores, 50% of patients reported threshold-level depression symptoms, although many had no corresponding depression diagnosis. This suggests that whilst many multimorbid patients experience depressive symptoms, these may not be detected. Study Two: Comparing the GDS, HADS and CIDI. Study Two compared GDS scores with Hospital Anxiety and Depression Scale (HADS) scores and Composite International Diagnostic Interview (CIDI) diagnoses. The GDS identified more depression-positive cases than the HADS and the CIDI, but the CIDI failed to detect severe depressive symptoms in several patients. During the study, concerns arose relating to the use of the CIDI with older multimorbid patients; consequently, the study was terminated early. Study Three: Patient Symptom Priority Scale. The Patient Symptom Priority Scale was developed to explore patient perceptions of symptom burden and functional impact, and piloted in the clinic. Patients described more physical symptoms than emotional symptoms. Age correlated positively with chronic illness and physical symptom counts, and negatively with psychological symptom impact. Geriatric Depression Scale scores correlated with all psychological variables. Study Four: GP experiences of depression diagnosis and management with multimorbid patients.
Semi-structured interviews were conducted with GPs who had referred patients to the clinic, to explore GP perceptions of depression diagnosis and treatment with multimorbid patients and generate a grounded theory model reflecting the role of multimorbidity in their practice. Multimorbidity generated increased time to determine symptom causation and build relationship with the patient. GPs offered medical and social depression interventions.
Study Five: Experiences of depression diagnosis and treatment amongst multimorbid patients.
To explore the patient perspective, further qualitative interviews were undertaken with multimorbid clinic patients who had been diagnosed with depression. Thematic analysis revealed common diagnosis and treatment experiences amongst these multimorbid patients with depression. All patients attributed depression onset to the loss of their normal life, with stigma emerging as an underlying influence in patient decisions about treatment.
Conclusion: This is the first study to compare depression symptoms with depression diagnoses in a multimorbid population, and found that many patients experience threshold-level depression symptoms that are not being addressed. General practitioners are aware of contextual factors, and try to address them, but also make assumptions about their patients that may not be accurate. This may account for the number of patients still suffering. The findings suggest that a thorough symptom profile is necessary for effective detection and treatment of depression in this vulnerable population.Thesis (Ph.D) -- University of Adelaide, School of Medicine, 2013
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Cheng, Cheng. "Coping with multiple chronic conditions: a mixed methods study." Thesis, 2020. http://hdl.handle.net/1959.13/1424354.
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Research Doctorate - Doctor of Philosophy (PhD)Multiple chronic conditions (MCCs) pose a significant burden on individuals’ health and present challenges for healthcare providers and systems. How people cope with chronic conditions is an important factor that influences their health. However, little research has been undertaken in this area, especially in Asian populations. Informed by the transactional theory of stress and coping (TTSC), this research aimed to explore coping in people with MCCs in China, where the population is ageing faster than almost any other country in modern history. More specifically, the current research aims were to: (1) validate the Brief Coping Orientation to Problems Experienced (COPE) inventory among Chinese people with MCCs, (2) examine the relationship between coping strategies, illness perceptions, socio-demographic characteristics, MCC-related characteristics, and quality of life (QoL) among Chinese people with MCCs, (3) investigate the experiences of coping with MCCs in Chinese people, and (4) identify the cultural effects on coping among this population. This research was conducted in a university-affiliated hospital based in north Anhui, China, from December 2017 to October 2018 following Human Research Ethics Committee approval of the University of Newcastle, Australia and the participating hospital. An explanatory, sequential, mixed methods design with a three-phase approach was employed: Phase (1) a validation phase of the Brief COPE inventory administered in 290 participants; Phase (2) a quantitative cross-sectional survey involving 351 participants examining associations between coping strategies, illness perceptions, QoL, and socio-demographic and clinical characteristics; and Phase (3) a qualitative face-to-face, semi-structured interviews study undertaken among 14 participants to explore people’s experiences of coping with MCCs. Results from the quantitative and qualitative phases were integrated into the final analysis. The key findings were: 1. A psychometrically sound, Chinese version of the Brief COPE inventory with five sub-scales was developed. 2. Participants reported high illness concerns over MCCs, duration of MCCs, and control of MCCs. They prioritised their chronic conditions for management. 3. Most participants used positive adaptation to cope with their chronic conditions with both problem-focused and emotional-focused strategies. 4. Seeking alternative treatments, changing lifestyles, and coping at the family level and social level were critical coping strategies, which were influenced by the Chinese culture. 5. People with MCCs had impaired QoL in physical and mental domains compared to the general population in China. Rural participants reported worse QoL than their urban peers. 6. Older age, lower educational level, and more chronic conditions were significantly associated with worse QoL among people with MCCs. 7. Psychological distress was common in older adults with MCCs and might account for poorer QoL scores. 8. Greater concerns about perceived illness consequences and timelines were associated with worse QoL. Frequent use of coping by denial and disengagement was related to worse QoL. Strong faith about perceived treatment control was linked with improved QoL. These findings serve as a basis for further psychometric research on coping in the Chinese population, as well as a reference for cross-culture coping research. Perceptions and coping strategies found in this study, especially the coping taxonomy ascertained, play a unique role in explaining QoL among people with MCCs. This work echoed Lazarus’s theory, there was a strong link between coping and individuals’ health. The current research provided evidence to support clinical practice in people with MCCs. Coping-based interventions that foster positive coping and alter negative illness perceptions of MCCs should be implemented. Cultural impact is a key factor in healthcare delivery in different social contexts. More attention should be primarily addressed to those in rural areas, those with lower educational backgrounds, and those having a greater number of chronic conditions.
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Viviers, Linde Juana. "The different voices of chronic illness." Diss., 2005. http://hdl.handle.net/10500/1247.
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This study aimed at exploring chronic illness from both the perspectives of the patient, living with the illness and the professional, treating the illness.
The epistemological framework is social constructionism. Qualitative research was selected as the research approach. Three in-depth interviews with three patients, suffering with a chronic illness were conducted, as well as three interviews with professionals, who had experience with patients diagnosed with chronic illnesses. Thematic analysis was the method used for the analysis of data.
The stories of the participants were reconstructed in terms of themes. A comparative analysis for both participants groups was done, and linked to the relevant literature
This study created an understanding of the complexity of chronic illness. The themes identified, highlighted the importance of the patient-professional relationship, specifically in the context of chronic illness.Psychology
M.A. (Clinical Psychology)
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"Living well with multiple autoimmune diseases: An interpretive description." Thesis, 2013. http://hdl.handle.net/10388/ETD-2013-06-1068.
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Autoimmune diseases (ADs) are a classification of chronic of illnesses in which the immune system mistakes healthy cells for foreign invaders and attacks the body’s own tissues or organs. They are unique in that the diagnosis of one AD makes the individual more susceptible to developing other ADs, and the symptoms of one AD, influence the disease activity of the others. Disease activity may also be influenced by a mind-body connection due to the relationship between stress and the immune system. The purpose of this study was to provide empirical evidence to generate new knowledge and expand our understanding of how individuals diagnosed with multiple ADs are living well. The methodology of interpretive description guided analysis. Five women with their ages ranging from early twenties to late seventies who were diagnosed with two or more ADs participated. The participants’ experiences were illuminated through semi-structured interviews. Four major interconnected themes and 13 sub-themes emerged. They discussed their challenges and successes, their attitudes towards their illnesses, and how they managed living with multiple ADs. The knowledge of the importance of a holistic lens through which to view healthcare provides important insights for those working in physical or mental health settings.
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Bevilacqua, Patrica Kaye. "Renegotiating identity : exploring the impact of chronic illness on the identities of three high school teachers." 2005. http://link.library.utoronto.ca/eir/EIRdetail.cfm?Resources__ID=232531&T=F.
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Esposito, Jessica. "Understanding Unpredictable Chronic Illness and its Links to Posttraumatic Stress and Growth: The Case of Multiple Sclerosis." Thesis, 2016. https://doi.org/10.7916/D8JM29WB.
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The present study was conducted to help understand the impact of living with multiple sclerosis (MS), an unpredictable, chronic illness that is widely known to have a large influence on psychosocial functioning, mental health, and life satisfaction (Motl & Gosney, 2007; Weiner, 2004). Recent research has begun to position certain chronic illnesses, such as MS, as traumatic events that influence mental health in both beneficial and detrimental ways. Thus, the present study investigated the positive and negative consequences of centralizing one’s identity within their MS experiences as related to trauma, growth, and psychosocial influences via a path model with 616 individuals with MS. The results indicate strong support for the hypothesized paths between the variables of interest—centrality of MS, posttraumatic stress, posttraumatic growth, social support, personal mastery, depression, and life satisfaction. Specifically, results indicate that posttraumatic stress and posttraumatic growth partially mediated the relations between centrality of MS with depression and life satisfaction. Moderation analyses indicated that social support and personal mastery did not moderate any relations between centrality of MS with depression and life satisfaction. Rather, additional analyses suggest social support and personal mastery may be viewed as additional mediators between centrality and posttraumatic stress and posttraumatic growth. The results of the present study is the first known study to extend trauma literature to the population of MS in order to provide an approach to help understand the high rates of depression and inconsistent findings on quality of life for this population. Implications for practice, theory and research are discussed.
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Gibbons, Ruth Elizabeth Anne. "A table of metaphors : the visual representation of chronic illness : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Social Anthropology at Massey University, Albany, New Zealand." 2010. http://hdl.handle.net/10179/1520.
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For people who live with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome, Fibromyalgia and Multiple Chemical Sensitivity syndrome illness is a hidden construct. The body does not display the chronicity of the internal experience. This thesis removes the barrier between what is experienced and what is visible by creating visual means of communicating the body’s hidden experience. The place of the viewer is part of this discussion. Through visual methods digital photographic techniques and the current interest in sensory anthropology the embodied sensory chronic illness experience is explored. The hidden experiences were made visual creating “MeBoxes” and masks which showed both the external and embodied internal experiences of chronic illness. As the process of working with and walking beside the participants developed, I found that the discourse on imaging within the literature was inadequate to show the real lived experiences of those with chronic illness. My interactions with the people of this thesis and the process of honouring their experiences required a model that would encourage the viewer to new and perhaps unrealised depths of participation to understand the participant’s multi-faceted and multi-layered experiences. Part of the discussion is the ability of images to communicate sensory experience as is the case with Munch’s The Scream and Picasso’s Guernica. Through the use of a hypertextual self-scape I show how participants created access to their experiences through their visual representations and through a collaborative approach became composite hypertextual self-scape metaphors.
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Krampe, Henning. "Zur Rolle der Therapeutenrotation und von Patientenmerkmalen für die Wirksamkeitsprozesse der Ambulanten Langzeit-Intensivtherapie für Alkoholkranke (ALITA)." Doctoral thesis, 2004. http://hdl.handle.net/11858/00-1735-0000-0006-ADC8-C.
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