http://theses.ncl.ac.uk/jspui/handle/10443/5255 2026-04-21T16:48:43Z 2026-04-21T16:48:43Z Rimmer, Ben http://theses.ncl.ac.uk/jspui/handle/10443/6736 2026-04-15T12:07:18Z 2025-01-01T00:00:00Z

Title: Living with a lower-grade glioma : exploring the potential for supported self-management Authors: Rimmer, Ben Abstract: Background: Lower-grade gliomas (LGG) are a subgroup of primary malignant brain tumours. People with LGG may live long-term with tumour-specific symptoms and impairments (e.g. seizures, cognitive impairment), alongside the uncertainty of an incurable condition. Supported self-management can improve clinical and psychosocial outcomes, such as quality-of-life (QoL). However, the self-management experiences of people with LGG are unclear. This thesis aimed to understand the lived experiences of people with LGG and the potential for supported self-management, from multiple perspectives. Methods: A quantitative systematic review of health-related QoL in people with LGG was followed by three semistructured interview sets. These comprised purposive samples of people with LGG (n=28), informal caregivers (IC) (e.g. partners) (n=19), and healthcare professionals (HCP) who support adults with brain tumours (n=25). Participants were recruited across the United Kingdom, through four National Health Service hospitals and the Brain Tumour Charity. Interviews were audio-recorded, transcribed, then analysed using inductive thematic analysis, framework method, or directed content analysis. Results: Findings are reported across six publications. People with LGG experience extensive QoL impacts (e.g. seizures, fatigue), with considerable implications on day-to-day life (e.g. work, relationships). They show willingness to self-manage but several factors (e.g. knowledge, health status) influence their ability to self-manage effectively. ICs provide wide-ranging support (e.g. practical, healthcare advocacy) but experience difficulties with preserving the care recipient’s independence. HCPs can empower people with LGG and ICs with the necessary tools and information, though challenges (e.g. identifying support needs, HCP collaboration) hinder the implementation of self-management support. Conclusions: This thesis provides novel and comprehensive understanding of the need, and potential for, supported self-management in people with LGG. These insights could extend to other brain tumours or progressive neurological conditions. Overall, this represents critical groundwork for the development and implementation of person-centred self-management support, to improve the QoL of this underserved population. Description: D. App. Ed. Psy. Thesis

2025-01-01T00:00:00Z Barker, Robert Olive http://theses.ncl.ac.uk/jspui/handle/10443/6732 2026-04-10T15:16:12Z 2025-01-01T00:00:00Z

Title: Acute deterioration in care homes : exploring optimal approaches to the identification and management. Authors: Barker, Robert Olive Abstract: When care homes residents experience an acute deterioration in their health status, they may receive care that is reactive and not in line with their preferences. The aim of this work was to explore how acute deterioration is managed in care homes, and to identify strategies to improve care. To achieve this, a multiple methods approach was employed. A repeated cross-sectional study showed that the complexity of resident care need is increasing, meaning that they are often living with many of the functional and physiological characteristics which would be used to recognise or indicate acute deterioration in other populations. An ecological study highlighted the susceptibility of residents to COVID-related mortality, its association with vital sign abnormalities at a population level, and the widespread use of the National Early Warning Score (NEWS2) in care homes. This is consistent with the policy drive to use remote monitoring and deterioration tools, especially NEWS2, in care homes. Qualitative work showed that the NEWS2 may have a useful role in managing acute deterioration, especially supporting carer judgement. However, implementation challenges, inconsistent uptake, and unintended consequences in this setting remain significant concerns. A quantitative study demonstrated that higher NEWS2 measurements (on hospital admission) were associated with adverse health outcomes. NEWS2 may therefore aid care decision-making for hospitalised residents, but its use in the care home setting remains unclear. A scoping review about deterioration tools demonstrated that the majority of studies described an intervention in which SBAR (situation-background-action-recommendation), NEWS2 or STOP AND WATCH was a component. Overall, there was no robust evidence that deterioration tools improve resident care, but there was evidence that tools can increase the confidence of care home staff in managing acute deterioration. The body of evidence presented in this thesis identifies important evidence gaps, and features of deterioration tools that should be prioritised for future development, such as supporting care home staff judgement and intuition about acute deterioration. A common theme throughout this programme of work is the implementation challenges of introducing novel deterioration interventions into care homes. Future research should be underpinned by implementation science theory with care homes residents and staff at the centre of intervention co-production. Description: MD Thesis

2025-01-01T00:00:00Z Offu, Ogochukwu Fidelia http://theses.ncl.ac.uk/jspui/handle/10443/6702 2026-03-20T12:24:13Z 2025-01-01T00:00:00Z

Title: Enhancing the role of UK community pharmacy staff in the prevention of prescription and over-the-counter opioid misuse : developing intervention strategies using establishedbehaviour change models Authors: Offu, Ogochukwu Fidelia Abstract: Background: Opioids are associated with half of all registered drug poisoning deaths in the UK, yet the rate at which opioids are prescribed remains high. Furthermore, over-the-counter (OTC) opioids can be obtained from pharmacies without a prescription. Community pharmacists have a role to play in preventing opioid misuse since they are responsible for dispensing opioids to patients. This study was aimed at developing strategies for intervention to help enhance community pharmacists’ roles in the prevention of prescription and OTC opioid misuse. Methods: The research involved three studies- a systematic review and two qualitative research. The systematic review was carried out according to PRISMA guidelines and set out to review literature on the barriers and facilitators of community pharmacists’ involvement in prescription and OTC opioid misuse prevention. The Qualitative studies were carried out by conducting one-to-one interviews with 36 participants (Study 2: 28 community pharmacy staff, Study 3: eight policymakers) via Zoom. The Capability, Opportunity, Motivation, and Behaviour (COM-B) model which is used for identifying factors that influence behaviour, and the Behaviour Change Wheel (BCW) model used in developing strategies for intervention were used in classifying identified themes. For the systematic review, database search in Ovid MEDLINE, Embase, Scopus, Web of Science, CINAHL, and APA PsycINFO were carried out and narrative synthesis utilising the COM-B model was used for analysis. Data obtained from the qualitative studies were thematically analysed. Findings: Ten articles were included in the review. Barriers and facilitators identified were classified as capabilities (knowledge and skill), opportunities (such as relationship with prescribers, time) and motivation (pharmacists’ attitude). Themes identified from the pharmacy staff interviews were mapped to the COM-B model to identify 22 iii potential areas for intervention while 13 Behaviour Change Techniques (BCT) to target each of these areas were identified from all three studies using the BCW model. These enabled the development of strategies that could help enhance the potential targets, thus enhancing community pharmacists’ roles in the prevention of opioid misuse. These strategies are education and training, collaboration with GPs, change in OTC opioid regulatory practices, and support from commissioners. Conclusion: This research has identified strategies for intervention that could help to enhance community pharmacists’ roles in the prevention of opioid misuse. This finding has provided a baseline for future research on the development of feasible, effective, and cost-effective interventions following the Medical Research Council (MRC) framework. Description: PhD Thesis

2025-01-01T00:00:00Z MacGregor, Fiona http://theses.ncl.ac.uk/jspui/handle/10443/6700 2026-03-20T09:47:48Z 2025-01-01T00:00:00Z

Title: An evaluation of the multiple and interrelated factors shaping evidence-based practice implementation in forensic radiographic practice Authors: MacGregor, Fiona Abstract: Background: Forensic radiography is an indispensable but less well-known element of forensic science. This has the primary role of assisting the criminal justice system using medico-legal radiographic imaging. It must be underpinned by evidence-based best practices through the full implementation and application of guidelines and protocols. Essential to this process is the support of the organisations delivering forensic imaging services. Aim: To identify and explore the multiple and interrelated factors impacting guideline and best practice implementation in forensic radiography in international and United Kingdom contexts, from the perspectives of diagnostic radiographers. Methods: A multi methods study design comprising three phases was conducted. The data collected was analysed through inductive content analysis, inductive narrative and thematic approaches respectively. Results: Findings demonstrated a complex picture of current working practices with variation in levels of guideline implementation. Organisational, community and personal barriers underpinned implementation. Three synthesised themes comprising organisational awareness and support, radiographic community practice and perceptions, and research and best practice dissemination were developed from the data. These culminated in a conceptual model of the acceptance of adversity premised on the concepts of intractable organisational factors and the normalising of negative conformity. Discussion: Issues such as staffing and resource shortages lie outside the direct control of organisations, but this was not the case for all issues identified. Others may potentially be addressed through a change in organisational practice behaviours, personal mindsets, and the enhanced recognition of the diagnostic radiography profession and its forensic role. These can only be achieved through a fundamental shift in healthcare organisations and their leadership approaches to the role of evidence-based practices. Description: Ph. D. Thesis.

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