Dissertations / Theses on the topic 'Preventative Intervention'

The purpose of this project was to design a 2-year program aimed at addressing the mental health needs of veterans transitioning from deployments in support of Operation Enduring Freedom and Operation Iraqi Freedom to civilian life. The program will address prodromal symptoms of psychosis. With the prevalence of psychotic features in Post Traumatic Stress Disorder, the veteran population is particularly at risk. The program will offer individual and group therapies to assist in symptom management and will utilize case management supportive services to assist in addressing additional needs that the participants may have that hinder help seeking activities, such as housing and substance abuse referrals. The National Institute of Mental Health, National Institutes of Health was selected as the funding source for this grant. The actual submission and/or funding of this grant were not a requirement for the successful completion of this project.

Healthy romantic relationships are associated with a multitude of positive physical and mental health outcomes. Conversely, low relationship quality and relationship dissolution are associated with risk for poor health outcomes. Accordingly, numerous studies investigate ways to preserve healthy relationships through the use of preventative relationship education interventions, many of which improve relationship outcomes. However, evidence for the efficacy and effectiveness of these interventions is somewhat mixed, and promising interventions often fail to reach at-risk populations due to high participant burden. There is a movement within clinical psychology to create easily accessible, targeted therapy protocols in order to increase the broad availability of these evidence-based interventions. The current study aimed to replicate and extend the Marriage Hack (MH), a brief, evidence-based preventative relationship intervention designed to stabilize the natural decline in relationship quality over time. This study addressed four specific aims designed to: 1) examine the efficacy of the MH intervention using an abbreviated protocol; 2) extend the original MH intervention by investigating theory-based mechanisms of change and assessing individual health outcomes; 3) explore how theory-based mechanisms change over time; and, 4) evaluate the relationship between within-person and between-person variance in process variables and outcome measures. Seventy-eight (N = 78) couples were randomized to the 4-week MH protocol (n = 41) or control condition (n = 37). Results demonstrated men in the intervention group exhibited 1) greater improvements in relationship satisfaction and 2) decreases in both anxiety and depression compared to men in the control group. This study did not replicate the findings of the original MH for additional outcome variables and process variables for men or women. No support was found for mediating effects of additional theory-based mechanisms of change on outcome measures. However, exploratory intensive longitudinal analyses revealed noteworthy relationships between within-person and between-person variance in process variables and treatment outcomes. Research recommendations to further improve preventative relationship interventions and clinical implications of the current findings are discussed.

Thesis (MBA)--Stellenbosch University, 2002.
ENGLISH ABSTRACT: Until recently, there was little awareness of the phenomenon of workplace bullying, or of the means by which it is carried out. Even today, many people still know very little or nothing of what goes on behind closed office doors. The prevalence of workplace bullying seems to indicate a worsening trend, and it may be that everyone in the workplace is now at risk of having "an experience". Workplace bullying is the deliberate, hurtful mistreatment of a person by a bully driven by her or his need to control others at work. It is quite simply, psychological violence in the workplace, and the results thereof include psychological trauma, loss of dignity, and feelings of shame in the person being targeted or victimised. Bullying can be regarded as the use or abuse of position or power to coerce others by fear or persecution or to oppress them by force or threat. It has been identified as a more crippling and devastating problem for both employees and employers than all other work-related stresses put together. Most bullying is insidious in that it is carried out at the psychological level. Although it may be most obvious in screaming and publicly abusive episodes, it is usually more subtle and persistent. Its behaviours can include rumours, gossip and attempts to turn others against a person, stealing credit for others' work, deliberate attempts to sabotage someone's work, highly public and humiliating criticism, blame, threatened job loss or punishment. In the case of physical assault, there is no doubt that an attack has taken place. In the case of bullying, it may be months, perhaps even a year or more, before one begins to realise that the difficulty one is experiencing with a particular individual, or group of individuals, goes beyond what can reasonably be expected in one's place of work. In the research the author explored the impact of workplace bullying on the organisation and the individuals (victims) concerned. The author used a real-life case study / example in Chapter 2 to illustrate the existence and the negative effects of this workplace phenomenon. The author suggests some strategies to victims and employers on how to recognise the tactics of their tormentors, how to stop the hurt and regain their dignity, self-esteem and confidence and, furthermore, how to discourage workplace bullying and eliminate its debilitating effects. Organisations should realise that bullying at work is a hidden menace that can destroy individuals and undermine both individual and teamwork performance, and that people can never perform at their best when they are bullied. Employers and employees therefore have a mutual interest in the eradication of this workplace demoraliser, workplace bullying. Ignoring the problem will not make it go away - it will slowly eat away your organisation's bottom line.
AFRIKAANSE OPSOMMING: Daar was tot onlangs min bewustheid van die verskynsel van werkplektreitering of van die wyse waarop dit toegepas word. Selfs vandag nog weet baie mense baie min of selfs niks van wat eintlik agter geslote kantoordeure aangaan nie. Die voorkoms van werkplektreitering dui op 'n toenemende tendens, en dit kan wees dat elke persoon in die werkplek die gevaar loop om aan hierdie "ervaring" blootgestel te word. Werkplektreitering is die opsetlike en skadelike mishandeling van 'n persoon deur 'n bullebak wat gedryf word deur sy/haar behoefte om almal in die werkplek te beheer. Dit is eenvoudig sielkundige geweld in die werkplek, sowel as die resultaat daarvan, wat insluit sielkundige trauma/geweld, die verlies aan waardigheid, en gevoelens van skaamte in die persoon wat geteiken word of die slagoffer is. Werkplektreitering kan beskou word as die gebruik of misbruik van mag en posisie om vrees by ander in te boesem deur vervolging of onderdrukking of deur dwang of bedreiging. Werkplektreitering is geïndentifiseer as 'n probleem wat meer verlammend en verwoestend is as alle ander werkverwante stressors van werkgewers en werknemers saamgevoeg. Die meeste treitering is verradelik deurdat dit op 'n sielkundige vlak uitgevoer word. Alhoewel 'n geskree en openlike beledigende episodes die ooglopendste is, is dit gewoontlik meer subtiel en aanhoudend. Die gedrag van die werkplekbullebak kan insluit gerugte, skinderpraatjies, pogings om persone teen mekaar op te steek, krediet te neem vir 'n ander se werk, doelbewuste pogings om iemand se werk te saboteer, hoogs openlike en vernederende kritiek, beskuldigings, asook dreigemente met betrekking tot werksverlies of straf. Met fisieke geweld is daar geen twyfel dat 'n aanranding plaasgevind het nie. Met werkplektreitering kan dit egter maande, miskien selfs 'n jaar of meer, neem voordat 'n mens besef dat die probleme wat met 'n spesifieke individu of groep individue ondervind word verder strek as wat redelikerwys binne 'n mens se werkplek verwag kan word. In die navorsingsverslag het die skrywer die moontlike impak van treitering in die werkplek op die organisasie én die individue wat daaraan onderworpe is, ondersoek. Die skrywer het gebruik gemaak van 'n werklike gevallestudie in Hoofstuk 2 om die teenwoordigheid en die negatiewe impak van werkplektreitering binne die werksomgewing te illustreer. Die skrywer stel sekere strategieë aan slagoffers en werkgewers voor oor die wyse waarop die taktiek van die plaaggeeste herken kan word, hoe om die seerkry te stop en waardigheid, selfagting en selfvertroue terug te bring en voorts hoe om werkplektreitering te ontmoedig en die aftakelende gevolge daarvan te elimineer. Organisasies moet besef dat werkplektreitering 'n weggesteekte bedreiging is wat individue kan vernietig en individuele en spanwerkprestasies kan ondermyn en dat mense nooit op hul beste kan presteer wanneer hulle getreiter word nie. Werkgewers en werknemers het dus 'n wedersydse belang in die uitroeiing van hierdie werkplek demorialiseerder, werkplektreitering. Deur die probleem te ignoreer sal dit nie laat verdwyn nie, maar dit sal stadig maar seker tot organisasies se ondergang lei.

Magister Psychologiae - MPsych
There are many theories as to why adolescents engage in substance abuse. These theories have formed the basis of various substance abuse prevention programmes aimed at reducing this problem. Evaluation of these interventions is needed in order to assess their effectiveness and to improve on future prevention strategies. The literature highlights tensions and differences between the primary preventative approaches to substance abuse and the harm reduction model. It also suggests that psychosocial or life skills programmes and interventions employing a harm reduction approach tend to be viewed as more suitable for adolescents than other approaches. This study focuses on a high school intervention programme running since 1996, which has not yet been evaluated. It aimed to identify the programme's strengths and weaknesses, as well as participants' perception of the intervention. A qualitative research method was used, employing focus groups as the tool for data gathering. The sample for the study was made up of 30 volunteers from three grade 10 classes that completed the programme two years prior to this study. Data was transcribed verbatim and analyzed using thematic analysis. Links were made to the two approaches referred to above. Analysis of the data indicated that although stories used to warn and frighten people were shown to have a shocking impact on the participants, pupils found it difficult to make the connection between the speakers' horrific stories and their own experimentation with drugs and alcohol. It was found that participants appreciated the fact that they were being informed about the dangers of substance use, and that they were encouraged to take responsibility for their own decisions regarding this behaviour. The informal, non-judgemental stance of the speakers served to reinforce this message. In conclusion, the study indicated that the different methods used in the various prevention programmes are in fact not altogether different. It is suggested that the various models are potentially compatible, and can perhaps work together to establish an effective preventative strategy.

Doctor of Philosophy
Grossarth-Maticek and Eysenck (1988) demonstrated that personality type as measured by the 70-item Grossarth-Maticek Personality Stress Inventory (GMPSI), predicts mortality and its cause with remarkable accuracy. Further, various forms of autonomy training, such as bibliotherapy and short individual treatment that were designed to reduce the toxic personality features (such as emotional dependence) effectively improved long-term health outcomes. However, several aspects of their theory and research were either insufficiently explicated or require further investigation. For example, the researchers did not thoroughly investigate the psychometric properties of the inventory, and they did not sufficiently examine the mechanisms that may mediate the personality-health relationship. Further, the autonomy training was inadequately described, and perhaps could have been briefer and had the same impact. Three studies were run to investigate these issues further. Study 1 (Chapter 2) investigated the internal consistency, test-retest reliability and convergent, discriminant and concurrent validity of the GMPSI in 312 first-year students, using a variety of statistical techniques (e.g., structural equation modeling, confirmatory factor analysis, and simple correlations). In addition, the psychometric properties of this scale were compared to those of three revised versions of the scale, which were theorised to be psychometric improvements of the original version from basic principles. The revised versions contained reverse-worded items (of different types) to monitor and disrupt acquiescence response sets, and/or an extended response scale to improve internal consistency and stability. Psychometric effects of reverse-wording and the extended response scale on scale reliability were examined via the analysis of construct reliability estimates, personality subscale model fit of congeneric measurement models (a form of structural equation modeling), and test-retest reliability estimates. The original version of the scale appeared to be the most reliable and valid scale of the four versions. This improved reliability of the original version was not an artifact of an acquiescence response set, because this form of responding was not prevalent in the reverse-worded versions. In contrast, it appeared that the incorporation of reverse-wording degraded the internal consistency of the scale as participants appeared to respond to the positive and negative-worded items as if they were measurements of independent constructs, rather than measurements of constructs on opposite ends of a particular dimension. Predicted correlations between the GMPSI and concurrent validity measures offered support for Grossarth-Maticek's theory, and suggest that the GMPSI is an effective and reliable tool for the measurement of these personality types. However, experimental evidence supporting the link between personality, mediating mechanisms and disease is required to further substantiate these findings. The second and third studies (Chapters 3 and 4, respectively) were investigations of the utility of an information pamphlet discussing stress, assertiveness and relaxation, in improving GMPSI personality type stress responses in a student and a community sample (Studies 2 and 3 respectively), and provided an opportunity to investigate the mechanisms mediating the personality-health relationship via experimental manipulation. Specifically, Study 2 investigated the effectiveness of the pamphlet in improving personality scores, mood, coping strategies, health behaviours, and salivary cortisol levels (measured at pre-treatment, 1-month post-treatment and 5-months post-treatment) in 200 first-year university students. Further, two modes of administration of the pamphlet were compared: pure selfadministration versus instruction accompanied by self-administration. Group differences in mood and cortisol reactivity to a visualisation stress task were also assessed. Very few significant differences were found between the two pamphlet administration forms. Both pamphlet forms were effective in improving mood states, some lifestyle habits (e.g., exercise), and salivary cortisol responses to the acute stress task compared to the control group. The strength of these effects ranged from small to medium, and all significant differences were between pre-treatment and the 1-month post-treatment session. The failure to observe differences at the 5-months post-treatment session may have been due to inadequacies of the treatment, or low statistical power for detecting effects from the final session due to the large attrition rate that had occurred by this session. Overall, while large treatment effect sizes were not found, the results could be construed as "clinically" significant when taking into account the low costs of implementing an information pamphlet in the larger community, and the potential benefits on individuals' stress responses and health behaviours. Study 3 aimed to investigate the treatment effects of the same self-administered pamphlet in 77 participants from the general community, who varied largely in age (19 - 77 years). Treatment and control groups were compared in terms of treatment compliance, cortisol levels, health behaviours, personality scores, perceived stress, mood, and coping styles (measured at pre-treatment, 2 weeks posttreatment, 3 months post-treatment, and 6 months post-treatment). In addition, group differences in cortisol reactivity to an acute cognitive stress task were examined. Home visits were arranged for each session to reduce sample attrition. Further, an intervention evaluation form was administered at each post-treatment session to verify and maintain treatment involvement. Several significant treatment effects were observed, including changes in personality scores and non-productive coping strategies, and the strength of these effects ranged from medium to very large. Most participants reported that they found the information pamphlet very appealing and helpful. In addition to the examination of intervention effects in the second and third studies, a path model that aimed to identify direct and mediating relationships between personality and concurrently measured disease was examined for the two samples (Chapter 5). This path model was based on a new integrative theory of personality-disease, which was developed. Eysenck's (1991) proposed personality-disease model formed the foundation of this new theory, and elements of several other generic personality-disease models were also incorporated. This theory was empirically tested using path analysis on the student and community data separately. Common pathways in the two models were then tested for invariance. Overall, most paths proposed by the integrative model were identified in one or both samples; thus, the model was generally supported. All common direct paths were statistically invariant (i.e., equivalent) in the two samples. While personality did not appear to directly predict illness, several significant indirect pathways were identified by which personality appears to affect disease incidence, such as via perceived stress, mood, coping styles, and physical risk factors. These findings appear to support Grossarth-Maticek's theory that personality affects disease incidence via stress responses, as well as other generic approaches (i.e., the personality-induced hyperreactivity model and the stress moderator model) that emphasise the stress-moderating effects of personality on health. However, support for the dangerous behaviours model was not found, which posits that certain personality dispositions seek risky behaviours (e.g., poor health behaviours such as smoking and alcohol consumption) that fit their personality. The final Chapter 6 directly compares the results of these three studies, and discusses their practical and theoretical significance in terms of Grossarth-Maticek's theory and research, views of critics, and other personality-health perspectives and research. In summary, the current studies appear to suggest that the GMPSI is a reliable and valid scale for the measurement of particular personality traits. Further, there appears to be evidence to suggest that personality traits can be changed by an intervention pamphlet. This information pamphlet also appears to be effective in significantly improving responses to stress, and these effects are more prominent in high-risk groups (i.e., subjects with extreme personality trait scores). Moreover, there is some evidence to suggest that personality may have direct effects on several mechanisms involved in the development of disease. Overall, this thesis demonstrates the importance of recognising the role of personality and stress in disease prevention and prediction by providing independent evidence for the benefits of treatment and mechanisms by which benefits may occur.

Aims: Punjabi Sikh immigrants are more likely to develop and live with lifestyle related illnesses than the host population. Identifying factors that influence these health inequalities is challenging. Various socio-cultural factors have shown to pose barriers for this sub-group to access mainstream preventative health services. The current study aimed to explore how elderly Punjabi Sikhs made sense of taking part in a culturally adapted health promoting intervention (CAHPI), to facilitate physical activity and healthy eating behaviours. A newly developed behaviour change model: COM-B underpinned the intervention design and contents. Method: Semi-structured interviews were conducted with a purposeful sample of 7 Sikh immigrants who had taken part in a CAHPI. The resulting data was analysed using Interpretative Phenomenological Analysis, focusing on the participants lived experience of the CAHPI. Results: The following themes were revealed: 1) “for our good health, we are getting some help with our health”, 2) “It was in our Gurdwara”, 3) “We all got together, the time passed nicely”, 4) “We are in a different stage in our lives now, we are not the same people we were 10 years ago, and 5) “You can’t learn all the things in one day, we need some more”. Discussion: The in-depth analysis allowed this generally ‘unheard’ population, to voice their views of taking part in the CAHPI. The findings showed that by incorporating meaningful components relating to the design and delivery of such interventions, wider engagement of the target population can be achieved. The IPA approach helped capture the complexities that exist between individuals within these specific populations, and the meanings they attach to the phenomenon being explored. Conclusion and implications: The current findings show the importance of drawing on a range of disciplines and guidance from the newly developed COM-B model to help identify and understand the mechanisms that facilitate behaviour change in this context. Consequently, meaningful collaboration between health care professionals and local communities can help identify strategies for addressing some of the health inequalities that exist within this marginalised community. In particular, the utility of places of worship and fear appeal approaches for delivering such initiatives, have shown to be invaluable.

Research suggests that the relationship between caregivers and their infants has a significant effect on development and well-being across the lifespan. There is a significant body of research into psychological interventions which focus on this relationship. However, there is only limited research into the impact of antenatal interventions which aim to promote the caregiver-foetus relationship, thus preventing later difficulties in the caregiver-infant relationship. Findings so far suggest that such interventions could be effective, and recommendations have been made for further studies exploring the effect antenatal interventions on the caregiver-foetus relationship. This pilot study explored the impact of a newly developed psychoeducational intervention entitled “Baby World” on the caregiver-foetal relationship. Seventy-nine females and 26 males who were expecting their first child were recruited from an NHS midwife service in London. They were randomly allocated to experimental or control groups. All participants completed questionnaires measuring antenatal attachment, mental health and childhood experiences of caregiving at baseline. Those in the experimental group then attended the Baby World class. All participants then completed the questionnaires for a second time, and then attended the standard antenatal classes. Following attendance at these classes, participants completed the questionnaires for a third time and gave anonymous responses to qualitative questions. Statistical analyses of the quantitative data indicated that the intervention did not have an impact on antenatal attachment. Results did show that antenatal attachment increased over time, whilst anxiety decreased. A significant correlation was found between recollections of maternal caring and antenatal attachment. Qualitative analysis suggested that the intervention did have an impact on aspects of the relationship. In the qualitative responses, the majority of participants wrote that the class had been a positive experience for them, and that it had increased their confidence about being a caregiver. Many of the responses indicated that the class had positively affected their skills in reflective functioning, caregiver sensitivity and attunement, and changed their perspective on how to interact with their infant. The results add to the literature regarding the impact of antenatal interventions on the caregiver-foetus relationship. Further research is needed to explore the impact of the intervention on the relationship more closely, in particular to understand which aspects of the relationship may be affected. There are several limitations of the study, in particular the small sample size and the limited number of expectant fathers who participated. Reasons for these limitations are discussed.

Utmanande beteende kan ofta innebära aktivitetsinskränkningar för individer som lider av beteendet men även för omgivningen. Detta innebär färre möjligheter till aktivitet och delaktighet och riskerar att gå ut över livskvalitén. Idag saknas ett fokus för att utveckla arbetsterapeutiska metoder inom området och forskningen som finns är begränsad. Syftet med examensarbetet var att visa vilka arbetsterapeutiska metoder som beskrivs i litteraturen för att minska utmanande beteende. Studiedesignen som användes var scoping review. Databaserna som användes var AMED, CINAHL, MEDLINE och PsycINFO. Inklusionskriterier för artiklarna var att de var tillgängliga i fulltext, skrivna på engelska och publicerade mellan 2003 och 2018. Sökning resulterade i 124 träffar varav 13 var dubbletter. Resultatet inkluderade 20 artiklar som motsvarade syftet varav 13 var publicerade i USA. Resultatet visade en stor bredd av metoder som delades in i fyra nyckelområden: aktivitetsbaserade metoder, miljöbaserade metoder, sensoriska metoder samt stöd och strategier. Detta är ett relativt outforskat område där det finns stora möjligheter för arbetsterapeuter att bidra med sin kompetens.
Challenging behaviour often results in occupational limitations for the individual that suffer from the behaviour, but also for their surroundings. This entails reduced possibilities to activity and participation which will affect their quality of life. There is a lack of focus on developing occupational therapeutic methods within this area today, also the current research within the field is limited. The aim of this bachelor thesis was to explore occupational therapeutic methods described in the literature to reduce challenging behaviour. Scoping review was used as study design. In AMED, CINAHL, MEDLINE and Psycinfo were 124 articles found, 13 of these were doublets. The result included 20 articles corresponding to the aim, 13 of these were published in USA. and 20 articles which corresponded to the aim was included in the results. All included articles were available in full text, written in english and published between 2003- 2018. A wide range of methods were shown in the results. These were categorized into four key issues: activity based methods, environmental methods, sensory methods and support and strategies. This field is relatively unexplored and there are large possibilities for occupational therapists to contribute with competence.

African American women have the highest rates of HIV infection among women of all racial/ethnic groups in the United States, and over 50% of HIV infected young adults are unaware of their infection. HIV testing is a cost-effective mechanism for reducing HIV transmission. Despite this, limited research has been devoted to developing interventions specifically promoting HIV testing. This two-part study proposed to address this gap through developing a culturally tailored HIV testing message aimed at increasing HIV test intentions among young African American women. Study 1 was a quantitative study that examined predictors of HIV testing history and future HIV test intentions among 109 African American women aged 18-24. Measures on sexual behavior, HIV knowledge, HIV conspiracy beliefs, gender role beliefs, gender ratio imbalance beliefs were included in the survey. Next, a culturally tailored HIV testing message was developed based on findings from Study 1 which identified significant predictors of HIV testing and HIV test intentions. Findings revealed that number of sexual partners, perceived barriers, and perceived benefits were significant predictors of past HIV testing. Number of sexual partners, perceived importance of HIV testing, and perceived seriousness were significant predictors of HIV test intentions in the next 3 months. Study 2 compared the exposure effect of the tailored health message to a generic HIV testing message on self-reported future HIV test intentions. Findings revealed no significant differences between the health message groups on future HIV test intentions. There were also no significant differences between groups on the message acceptability outcomes.

The burden of depression requires modalities other than individual psychotherapy if we are to reduce it. Over the past two decades preventative programs for depression have been developed and refined for different populations. The six years since the last meta-analysis of preventative interventions—inclusive of all program types—have seen a number of new studies. The current study used the greater statistical power provided by these new studies to analyze moderators of, and sub-group differences in, the effect of these interventions on depression. Moreover, this meta-analysis synthesized effect sizes for outcomes other than, but often related to, depression (e.g., anxiety) and for within-group change scores with the goal of better informing program implementation and evaluation. Twenty-nine studies met inclusion criteria and indicated that small, robust effects exist for reductions in depression diagnoses and symptomatology. Significant effects were also observed for anxiety, general health, and social functioning.

The first section of this thesis submission consists of a systematic literature review of randomised controlled trials evaluating intervention programmes aimed at preventing the onset of Anxiety Disorders in ‘at risk’ young people. A total of 16 studies (2545 young people) met inclusion criteria. Intervention characteristics were varied, although most often based on cognitive behavioural therapy. The range of risk factors used for inclusion in selective interventions was wide ranging. Evidence for effectiveness was mixed. Studies included in this review revealed a trend for a reduction of anxiety symptoms post intervention, but inconsistent findings regarding the significance of this decrease in comparison with control groups. The need for future research is discussed. The second part contains an empirical research paper investigating potential predictive factors of spontaneous recovery from childhood anxiety disorders. Sixty-three children, aged 7-12 years old, with a current anxiety disorder took part in the study. The main findings were that children’s spontaneous recovery from childhood anxiety disorders was higher among children with a single anxiety disorder than for children with comorbid anxiety disorders, and for those with parents who displayed lower levels of passivity, threat promotion, or vulnerability promotion. Clinical implications and suggestions for future research are discussed.

Domestic abuse has been widely researched, however one area relatively absent from such research is that of parent abuse, which sees abuse perpetrated by children against parents. Academic research into parent abuse has begun to increase over recent years, yet this still remains a significantly under-researched area of family violence. This thesis seeks to develop an understanding of key themes and collaborative prevention opportunities in relation to parent abuse in Greater Manchester, and makes recommendations for the development of practitioner responses. Accordingly, the research follows a qualitative paradigm in order to build a better understanding of key issues and to explore opportunities for collaborative responding in the current austere economic climate. The research design consisted of in-depth interviews conducted with practitioners drawn from a variety of public and third-sector agencies working within three boroughs across central Greater Manchester, and utilised open coding in a grounded theoretical approach. The research findings suggest that parent abuse is a unique problem that is complicated by bonds that exist between parent-victims and their abusive children. Parental reluctance to report incidents, through a fear of criminalising or losing their children adds to the difficulties for those responding to parent abuse. Furthermore, the research found problems created by an absence of specific policy, resulting in parent abuse being dealt with via child protection, social care or criminal justice processes. The research also revealed that young male perpetrators were highly prone to mental health and behavioural problems, and there was disproportionate cannabis use amongst young perpetrators. Whilst this may also be the case in the wider youth population, the potential for such correlation is worthy of specific consideration when seeking to further an understanding of parent abuse. Additionally, the importance of collaborative working was highlighted, which revealed opportunities for early intervention. Accordingly, the need for an integrated ‘toolkit’ for responding effectively to deal with parent abuse is proposed, which considers the key issues identified within this thesis. These issues contribute towards both academic knowledge and professional practice in an important but under-researched area of crime and victimisation.

A descriptive, phenomenological research design was used to gain a deeper understanding of the nature and meaning of couples’ experiences as they made the transition to parenthood. Specifically, this study examined what is the lived experience of couples making the transition to parenthood and what meaning do they ascribed to the experience of brief, couple-focused, preventative interventions? Five couples who were expecting their first baby participated in this study. From the data provided, two major categories emerged. The first was the couples’ experiences with becoming new parents and the second was the couples’ experiences with therapy. Under the first category, five major themes emerged: (1) physical and emotional challenges, (2) bonding with baby, (3) satisfaction in roles and new identity, (4) impact of social support, and (5) stability of relationship satisfaction. Three themes were discovered under the category related to the couples’ experience with therapy: (1) facilitated communication, (2) stress management, and (3) preparation for the transition. This study concluded by discussing the essence of the phenomenon of couples’ experiences with the transition to parenthood and the meaning they ascribed to therapeutic interventions along with clinical implications of these findings.

This paper is a systematic review of empirical papers investigating preventative strategies and interventions for burnout among healthcare workers. The idea was borne out of a recommendation in the independent NHS Health and Well-being Review (Department of Health, 2009a) commissioned by the Department of Health and led by Dr Stephen Boorman, that is that there should be access to effective interventions for mental health problems faced by NHS staff in all NHS Trusts. 11 studies were included in the review which covered interventions ranging from brief psycho-education, peer-support, intensive residential courses involving individual counselling sessions and whole team-based interventions. Participants both within and between studies included a wide variety of healthcare professionals who worked in a variety of specialities and settings. Intensive residential courses for self-referring nurses and medics produced long-lasting reductions for those with initially high levels of burnout. Peer-support interventions were also valuable. The interventions reviewed tended to include more than one component and so future research should concentrate on determining which components of the interventions are most useful for which groups of healthcare professionals. This portfolio thesis comprises three parts: Part I is a systematic literature review of empirical papers investigating preventative strategies and interventions for burnout among healthcare workers. The idea was borne out of a recommendation in the independent NHS Health and Well-being Review (DoH, 2009a) commissioned by the Department of Health and led by Dr Stephen Boorman, that there should be access to effective interventions for mental health problems faced by NHS staff in all NHS Trusts. Part II is an empirical paper that has also arisen from a recommendation of the Boorman Review (DoH, 2009a), namely that the NHS should adopt a prevention-focused health and well-being strategy for staff. To help enable this, a clearer understanding of how healthcare professionals come to experience difficulties in the course of their work is required. To further this understanding a quantitative test was applied to the Positivity Negativity Ratio Model of the development of Compassion Satisfaction and Compassion Fatigue proposed by Radey & Figley (2007) as applied to mental health workers. Part III comprises the appendixes with additional information relevant to the systematic literature review and empirical paper, and a reflective statement of the research process.

Children's mental health problems are a significant public health concern. They are costly to society in both human and financial terms. This thesis contributes to the 'science of prevention' by examining issues related to the identification of children at risk of mental health problems. In particular, it was of interest to determine whether 'at-risk' children could be identified before the development of significant behavioural or emotional problems. Three areas were explored: family risk factors that predict the development of children's mental health problems, teachers' ability to identify family risk factors, and parent- and teacher-report screening methods. Data were collected from the parents and teachers of over 1000 children in preschool to Year 3 as part of the Promoting Adjustment in Schools (PROMAS) Project. Parents and teachers each completed two questionnaires at two time points, one year apart. Parents completed the Family Risk Factor Checklist - Parent (FRFCP) and the Child Behaviour Checklist (CBCL) and the equivalent instruments for teachers were, respectively, the Family Risk Factor Checklist - Teacher (FRFC-T) and the Teacher Report Form (TRF). The FRFC-P and FRFC-T were original to the current research and were designed to assess children's exposure to multiple family risk factors across five domains: adverse life events and instability (ALI), family structure and socioeconomic status (SES), parenting practices (PAR), parental verbal conflict and mood problems (VCM), and parental antisocial and psychotic behaviour (APB). Paper 1 investigated the psychometric properties of the FRFC-P and the potential for its use at a population-level to establish community risk factor profiles that subsequently inform intervention planning. The FRFC-P had satisfactory test-retest reliability and construct validity, but modest internal consistency. Risk assessed by the PAR domain was the most important determinant of mental health problem onset, while the PAR, VCM, and APB domains were the strongest predictors of mental health problem persistence. This risk factor profile suggests that, for the studied population, the largest preventive effects may be achieved through addressing parenting practices. Paper 2 examined teachers' knowledge of children's exposure to family risk factors using the FRFC-T. While teachers had accurate knowledge of children's exposure to risk factors within the ALI and SES domains, they had poor knowledge of children's exposure to risk factors within the PAR, VCM, or APB domains - the types of risk factors found in Paper 1 to be the most strongly related to children's mental health problems. Nevertheless, teachers' knowledge of children's exposure to risk factors within the ALI and SES domains predicted children's mental health problems at one year follow-up even after accounting for children's behaviour at the first assessment. Paper 3 investigated the potential of both the FRFC-P and FRFC-T for identifying individual, at-risk children. The accuracy of the FRFC in predicting internalising versus externalising disorders was compared against behavioural and simple nomination screening methods. For both parents and teachers, the behavioural screening methods were superior, however, the simple nomination method also showed promise for teachers. Both parents and teachers were more accurate at identifying children at risk of externalising mental health problems than children at risk of internalising problems. The performance of the FRFC and simple nomination methods in identifying children for selective interventions, before the development of significant behavioural or emotional problems, was also tested. Both the FRFC and simple nomination methods showed only modest predictive accuracy for these children. Combined, the results suggest that while on the one hand, the FRFC is useful for population level screening to inform intervention planning, on the other hand, it falls short of achieving good predictive accuracy for individual children. Future research should investigate ways to optimise predictive accuracy for individual children, particularly those at risk of developing internalising disorders. One option may be to use the FRFC in conjunction with behavioural screening methods. The challenge is to develop accurate screening methods that remain practical to complete at a population level. Finally, this body of research provides insight into the feasibility of offering selective preventive interventions within the school setting. While significant obstacles remain, there were several promising indications that using screening methods such as FRFC-T or simple nomination, teachers may be able to identify children earlier on the developmental pathway, before significant behavioural or emotional symptoms have developed.

Non-communicable diseases are on the increase worldwide, causing more than 36 million deaths each year. Evidence of the link between the role of nutrition and reducing non-communicable diseases is predominant in the literature. The factors influencing intervention strategies/policies and activities, however, need attention. AIM: The study aims to examine the factors that influence nutrition interventions within the United Arab Emirates’ healthcare system. METHOD: This research adapts an interdisciplinary approach where a triangulation mixed methodology is applied. Both qualitative and quantitative methods are used, through the analysis of ten interviews with policy makers, four case studies and 161 questionnaires. Furthermore, the research framework, which emerged from the literature search and qualitative analysis, is tested and validated by rigorous quantitative analysis using SPSS. The statistical analysis, using factor analysis, MANCOVA and ranking analysis aims to provide solid support for the resulting factors. MAIN FINDING: The study identifies five factors that influence nutrition interventions in a healthcare system, and could enhance the effectiveness of nutrition interventions. The factors are 1) quality and processes, 2) training and use of technology, 3) senior management involvement and responsibility, 4) patient diversity, and 5) multidisciplinary teams. CONCLUSION: This study contributes to the emerging literature on management in nutrition interventions and the theory and importance of preventative measures in relation to nutrition. This study provides a roadmap for policy makers to adopt in order to enhance the role of nutrition interventions in healthcare settings.
Culture Department of the Emirates’ Embassy and Ministry of Higher Education (UAE)

Non-communicable diseases are on the increase worldwide, causing more than 36 million deaths each year. Evidence of the link between the role of nutrition and reducing non-communicable diseases is predominant in the literature. The factors influencing intervention strategies/policies and activities, however, need attention. AIM: The study aims to examine the factors that influence nutrition interventions within the United Arab Emirates’ healthcare system. METHOD: This research adapts an interdisciplinary approach where a triangulation mixed methodology is applied. Both qualitative and quantitative methods are used, through the analysis of ten interviews with policy makers, four case studies and 161 questionnaires. Furthermore, the research framework, which emerged from the literature search and qualitative analysis, is tested and validated by rigorous quantitative analysis using SPSS. The statistical analysis, using factor analysis, MANCOVA and ranking analysis aims to provide solid support for the resulting factors. MAIN FINDING: The study identifies five factors that influence nutrition interventions in a healthcare system, and could enhance the effectiveness of nutrition interventions. The factors are 1) quality and processes, 2) training and use of technology, 3) senior management involvement and responsibility, 4) patient diversity, and 5) multidisciplinary teams. CONCLUSION: This study contributes to the emerging literature on management in nutrition interventions and the theory and importance of preventative measures in relation to nutrition. This study provides a roadmap for policy makers to adopt in order to enhance the role of nutrition interventions in healthcare settings.

Problematisk skolfrånvaro har uppmärksammats efter att en statlig utredning 2016 kom fram till att det finns bristande kunskap inom området i Sverige. Studiens syfte är att undersöka hur specialpedagogen används i det främjande arbetet för skolnärvaro och det förebyggande och åtgärdande arbetet vid problematisk skolfrånvaro utifrån 20 kommunala handlingsplaner. Frågorna är: Vilka insatser för närvaro och problematisk skolfrånvaro, som beskrivs i de kommunala handlingsplanerna, kan kopplas till specialpedagogen? På vilka nivåer (individ-, grupp- och organisationsnivå) används specialpedagogen i arbetet med att främja närvaro och att förebygga och åtgärda problematisk skolfrånvaro? En kvalitativ dokumentanalys gjordes utifrån sex kategorier. Systemteori och specialpedagogiska perspektiv användes i analysen för att belysa studiens frågor. Sammanfattningsvis visar studien att specialpedagogen kopplas explicit till uppgifter som till exempel fördjupad kartläggning vid skolfrånvaro och specialpedagogiskt stöd till enskild elev på individnivå. Specialpedagogen nämns implicit genom elevhälsans arbete på organisationsnivå i ett fåtal handlingsplaner.  I diskussionen lyfts varför handlingsplanerna bör uttrycka det främjande och förebyggande arbetet och hur det förebyggande och åtgärdande arbetet kan utvecklas i det systematiska kvalitetsarbetet kopplat till specialpedagogens kompetens. Därutöver diskuteras även den specialpedagogiska kompetensen och dess roll i elevhälsan, riskerna med frånvaroteam och behovet av att utveckla ämnet problematisk skolfrånvaro i den specialpedagogiska utbildningen.
Problematic school absenteeism as first identified as a problem in 2016 when a government inquiry concluded that there was a lack of proper knowledge on the subject in Sweden. The purpose of this paper is to explore how 20 municipalities, via their schools’ action plans and policies, utilize special educators with regard to students’ problematic school absenteeism through the use of early intervention, and preventative and supportive measures. Examined will be: How is the special educator involved in the efforts to curb problematic school absenteeism? On what levels (individual, group or organizational) is the special educator engaged to promote attendance and to prevent and remedy problematic school absenteeism? The observational basis for this paper is a qualitative analysis of action plans from twenty different municipalities. This analysis was made based on six categories. Systems theory and special needs perspectives were used in the analysis to highlight the questions posed in this paper. In summary, the special educator is explicitly connected to certain tasks such as the in-depth tracking of absenteeism and the support for students with special needs. More often, the responsibilities included under the special educator’s purview are implicitly included in the framework for the team responsible for student well-being. The discussion addresses why action plans must describe supportive and preventative measures and ways in which preventive and remedial activities can be developed during systematic quality processes linked to the special educator's skills set. Additionally, discussed were the special educator’s roll in the team responsible for student well-being, the pros and cons with the absenteeism-teams and even the need to develop understanding for this subject in training for the special educator.

Yes
Objectives To test whether an occupation based lifestyle intervention can sustain and improve the mental wellbeing of adults aged 65 years or over compared to usual care, using an individually randomised controlled trial. Participants 288 independently living adults aged 65 years or over, with normal cognition were recruited from two UK sites between December 2011 and November 2015. Interventions Lifestyle Matters is a NICE recommended multi-component preventive intervention designed to improve the mental wellbeing of community living older people at risk of decline. It involves weekly group sessions over four months and one to one sessions. Main outcome measures The primary outcome was mental wellbeing at 6 months (mental health dimension of the SF-36).Secondary outcomes included physical health dimensions of the SF-36, extent of depression (PHQ-9), quality of life (EQ-5D) and loneliness(de Jong Gierveld Loneliness Scale),assessed at 6 and 24 months. Results Data on 262 (intervention =136; usual care =126) participants were analysed using intention to treat analysis. Mean SF-36 mental health scores at six months differed by 2·3 points (95 CI -1·3 to 5·9; P=0·209) after adjustments. Conclusions Analysis shows little evidence of clinical or cost effectiveness in the recruited population with analysis of the primary outcome revealing that the study participants were mentally well at baseline. The results pose questions regarding how preventive interventions to promote wellbeing in older adults can be effectively targeted in the absence of proactive mechanisms to identify those who at risk of decline.
Primary Care Research Network (PCRN) funding was accessed to support recruitment activity in GP surgeries in Sheffield and NISCHR provided support in North Wales.

A dissertation submitted to the Faculty of Education in fulfilment requirement for the Degree of Master of Education in the Department of Educational Psychology and Special Education at the University of Zululand, South Africa, 2005.
The aim of the study was to conduct a formative investigation into the effectiveness of "Wildfire" as a preventative intervention for HIV/AIDS. "Wildfire" is an experiential activity-based psycho-educational workshop/game that guides participants through the process of 'exposure' to HIV/AIDS, voluntary counseling and testing (VCT). It stimulates discussions and active reflections while imparting knowledge and information that goes beyond preventative awareness campaigns. The target population was Grade 9 learners. A representative sample of rural and township school contexts in the East London area of the Eastern Cape constituted the sites for intervention. The schools selected constituted a convenience sample and learner participation was voluntary, depending on parental permission. A total of 104 learners participated, 95 in the "Wildfire" intervention and 9 in the control group. The methodology applied included a pre- and post-test questionnaire, behavioural observations and verbal responses during the intervention, as well as focus-group notes arising from the debriefing after "Wildfire". The findings indicated that "Wildfire" was an effective and powerful psycho-educational tool for mediating an in-depth understanding of issues around HIV/AIDS and personal vulnerability for adolescents. The triangulation of methods provided evidence that the intended learnings of "Wildfire" were internalized to both group and individual levels. Furthermore, these points of planned learning were sustained over time. "Wildfire" provided psycho-social, emotional and cognitive 'maps' for individuals about how quickly HIV/AIDS can be spread, how to manage 'exposure* and how to treat those infected with the virus. The study was situated within practices of primary health care and prevention of HIV/AIDS. Its relevance to answering research needs and corroborating current research findings has been discussed. The utility of the study for practical purposes, was that it informed the current and future practices of an NGO and provided information for the Education Department which could enrich the effectiveness of its current HIV/AIDS education in a cost-effective way.

ABSTRACT Specific Exercises as a Secondary Preventative Intervention Programme for Low Back Pain in 12-13 year old Children Gina Lucia Fanucchi Supervisors: Dr Ronél Jordaan, Prof Aimee Stewart Many recent large epidemiological studies have shown that the incidence of non-specific low back pain (LBP) in adolescents is very similar to that in adults, and that LBP in children is predictive of LBP in adults. As a result, it has been suggested that programmes targeting the prevention of LBP should be implemented early. However, there is currently very limited literature available on LBP preventative interventions during childhood. Therefore, this study aimed to determine the efficacy of an eight-week specific exercise programme in reducing self-reported episodes and intensity of LBP, as well as modifying some of the identified risk factors for LBP in children. A randomised control trial was used. Seventy-two 12-13 year old children, who had complained of LBP in the past three months, were included in the study. The intervention group completed an eight week school-based specific exercise programme, whilst the control group continued with normal school activity during this time. Data were collected at baseline, immediately post-intervention and at three months post-intervention, using a valid, reliable questionnaire and physical measurements. Treatment groups were compared with respect to change from baseline to postintervention, using an analysis of covariance (ANCOVA) with baseline values as covariates. Testing was done at the 0.05 level of significance. Significant improvements were observed in the exercise group for LBP prevalence (p=0.02), pain intensity VAS (3 months) (p<0.01) and VAS (1 month) (p=0.01), neural mobility (p<0.00001), hamstring flexibility (p<0.00001), iliopsoas flexibility (p<0.001) and lumbosacral position sense (p=0.01), immediately post-intervention, as well as three months post-intervention. Therefore, it can be concluded that specific exercises are beneficial in the prevention of LBP in 12-13 year old children. In addition, specific exercise programmes should be implemented early, ideally as an integral component of school physical education programmes.

abstract: An ever expanding body of research has shown that children of divorce are at increased risk for a range of maladaptive outcomes including academic failure, behavior problems, poor psychological adjustment, reduced self-concept, and reduced social competence (Amato, 2001). Furthermore, the widespread prevalence of divorce makes preventing these poor outcomes a pressing public health concern. The Children of Divorce-Coping with Divorce (CoD-CoD) program is an internet-based selective prevention that was derived from recent research identifying modifiable protective factors in children of divorce including active and avoidant coping, divorce appraisals, and coping efficacy. CoD-CoD addresses these putative mediators through careful adaptation of intervention components previously demonstrated to be effective for children from disrupted families (Pedro-Carroll & Alpert-Gillis, 1997; Stolberg & Mahler, 1994; Sandler, et al., 2003). In the CoD-CoD efficacy trial, 147 children ages 11-16 whose family had received a divorce decree within 48 months of the intervention start date served as participants. Participants were assessed in two waves in order to test the small theory of the intervention as well as the interventions effects on internalizing and externalizing behaviors. Analyses indicated that the program effectively reduced the participants total mental health problems and emotional problems as reported on the Strengths and Difficulties Questionnaire (SDQ) (d = .37) and for total mental health problems this effect was stronger for children with greater baseline mental health problems (d = .46). The program also had mediated effects on both child and parent-reported total mental health problems whereby the program improved coping efficacy for children with low baseline coping efficacy which led to reduced parent-reported mental health problems. To the author's knowledge this is the first randomized controlled trail of internet-based mental health program for children or adolescents which utilizes an active control condition.
Dissertation/Thesis
Ph.D. Psychology 2011

Yes
Background: Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). Methods: During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. Results: Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. Conclusions: Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research.
The Lifestyle Matters RCT was funded by the Medical Research Council (grant number G1001406); Sheffield Health and Social Research Consortium; National Institute for Health Research Public Health Research programme (project number 09/ 3004/01)

This study explores the possible efficacy of a low carbohydrate and high fat nutritional intervention (LCHF) as a treatment possibility aiming to improve the ability of self-control and regulation in the context of carbohydrate-addiction. The study first outlines why increased simple carbohydrate consumption has been implicated as a risk-factor in numerous chronic conditions, and then explores the possibility that a reduction of such consumption could lower general medical expenditure in the healthcare sector of already overburdened institutions, especially in developing countries like South Africa. Since the neurobiological evidence for food addiction is compelling, this study investigates the impact of a low carbohydrate and high fat eating (LCHF) regimen by measuring the change in the severity of addictive behaviour in relation to a reduced carbohydrate consumption. Results indicate that a LCHF nutritional intervention lessened addictive behaviour after just 30 days, resulting in a statistically significant decrease in addiction symptoms from day 1 to day 30. The weight and BMI values of the participants recorded at the end of the study showed a reduction from those obtained during the pre- treatment stage, and the self-perceived ‘feeling in control’ also improved in all participants after the intervention. The introduction of a LCHF nutritional intervention presents a relatively cost-effective treatment and preventative measure to combat carbohydrate over-consumption and its numerous health complications, and it is therefore hoped that the positive findings of this study will foster further research, using larger samples, into this type of nutritional intervention against addictive eating behaviour.
Psychology
M.A. (Psychology)