DSpace Collection:
http://theses.ncl.ac.uk/jspui/handle/10443/5255
2024-03-28T13:04:46ZPerinatal mental health in rural Bangladesh : a mixed methods exploration of the social determinants and perspectives of pregnant women and healthcare providers
http://theses.ncl.ac.uk/jspui/handle/10443/6088
Title: Perinatal mental health in rural Bangladesh : a mixed methods exploration of the social determinants and perspectives of pregnant women and healthcare providers
Authors: Insan, Nafisa Lubaba.
Abstract: Background: Pregnancy is a time of major psychological changes making pregnant
women more susceptible to Perinatal Mental Health (PMH) conditions, especially
antenatal depression with comorbid anxiety. Prevalence of antenatal depression in
Bangladesh ranges from 18-33% compared to 7-15% in high-income countries like the
UK. These disparities stem in part from poor understanding of, and stigma surrounding,
PMH, which hinder pregnant women from seeking mental health care. In addition,
there is limited research exploring social determinants and perspectives around PMH
in rural Sylhet, Bangladesh.
Aim: This PhD research aimed to explore the social determinants and perspectives
(women and healthcare providers (HCPs)) around antenatal depression in rural Sylhet,
Bangladesh, to enable development of better care for underserved women in rural
Bangladesh in collaboration with Maternal Aid Association (MAA).
Methods: 1) Two systematic reviews of the social determinants and perspectives
surrounding PMH in South Asia; 2) Cross-sectional survey of 235 pregnant women in
rural Sylhet; 3) Cross-sectional survey of 139 HCPs in Bangladesh; 4) Semi-structured
interviews with 14 HCPs, and 5) mixed methods triangulation.
Results: The point-prevalence of antenatal depression was 56%. Intimate Partner
Violence (adjusted odds ratio (AOR) 10.4 [95% confidence intervals (95%CI) 2.7-39.7])
and perceived husband’s male gender preference (AOR 9.9 [95%CI 1.6-59.6]), were
significantly associated with increased odds of antenatal depression among pregnant
women. Increased family support was a significant protective factor for antenatal
depression (AOR 0.94 [95%CI 0.91-0.97]). HCPs displayed non-stigmatising attitudes
towards PMH, but limited knowledge regarding screening and management, and
desired further training and education.
Conclusion: Antenatal depression commonly occurs in rural Sylhet, Bangladesh,
highlighting the need for improved screening and management within this region. The
findings recommend the integration of PMH into the MAA antenatal care services. Key
activities could involve screening of antenatal depression, psychoeducation for women
and families, and training and education for HCPs.
Description: PhD Thesis2023-01-01T00:00:00ZRecovery from resistance exercise in later life : why does it matter, what do we know about it, and can we do anything about it?
http://theses.ncl.ac.uk/jspui/handle/10443/6074
Title: Recovery from resistance exercise in later life : why does it matter, what do we know about it, and can we do anything about it?
Authors: Hayes, Eleanor Jayne
Abstract: Resistance exercise is highly recommended for the maintenance of muscle mass and
strength in older adults. Performing unaccustomed resistance exercise often leads to
temporary reductions in physical functioning and sensations of muscle soreness in the days
following the exercise bout. Optimising the recovery process after such exercise bouts is an
important aim to maximise adaptation and limit side-effects, but the exercise recovery
process in older adults is not well understood. Certain whole foods, such as cow’s milk, have
previously been suggested as effective recovery aids in this population but evidence for this is
limited. Therefore, this thesis aimed to systematically map the current literature surrounding
exercise recovery in older adults and identify suitable whole food interventions to aid
recovery, alongside investigating older adults’ knowledge and attitudes towards resistance
exercise, exercise recovery, and exercise recovery strategies.
Chapter 3 presents a summary of the current literature following a systematic
literature search and determines that there is limited research assessing recovery from
resistance exercise in older adults, particularly in older women, and that literature in this area
is inconsistent in both study protocol and findings. Chapter 4 details the results of a large-scale
online survey, that show that there is a need to educate older adults on the benefits of
resistance exercise, and the process of exercise recovery, in order to improve uptake and
adherence to resistance exercise programmes. It also discusses older adults’ lack of knowledge
surrounding exercise recovery strategies, and their preference for whole food strategies over
supplements. Lastly, Chapter 5 aimed to examine the effectiveness of a whole food product,
cow’s milk, for aiding exercise recovery in older adults. Due to difficult recruitment, the study
was not adequately powered to detect any effect of condition. Various methodological
considerations are presented for future research surrounding exercise recovery in older
adults, including the suitability (or lack thereof) of traditional indirect markers of exerciseinduced muscle damage.
In conclusion, the findings of this thesis demonstrate that the literature describing
exercise recovery in older adults is lacking in strength and coherence. This thesis provides
novel insights in to the knowledge and views of older adults of the exercise recovery process,
and provides initial evidence-based recommendations for the progression of methodological
approaches within this area of research.
Description: PhD Thesis2023-01-01T00:00:00ZSupporting dental treatment decisions for people living with dementia
http://theses.ncl.ac.uk/jspui/handle/10443/6055
Title: Supporting dental treatment decisions for people living with dementia
Authors: Geddis-Regan, Andrew Robert
Abstract: Background: Making dental treatment decisions can be complex for people living with dementia
(PLwD), their carers and dentists. There is limited research exploring how PLwD, their carers or
dentists may be supported with dental treatment decision-making.
Aim: The work presented in this thesis aimed to support the collaborative production of an
intervention to support PLwD, their carers, and dentists with dental treatment decision-making.
Methods: Four related projects comprise this thesis: Project 1 was a systematic review that explored
the effectiveness of existing interventions supporting healthcare decision-making for PLwD. Projects
2 and 3 used qualitative interviews to explore the experiences of dentists, PLwD and carers regarding
dental treatment decision-making. Constructivist grounded theory methods, where data were
simultaneously generated and analysed, were used to develop an understanding of each group's
experiences and how dentists approach treatment decision-making for PLwD. Project 4 used co production where PLwD, carers, dental team members and other stakeholders worked together to
develop a prototype intervention to support PLwD, carers and dentists with dental care decision making.
Results: No interventions were identified that were effective in supporting PLwD with healthcare
decisions, including dental care (Project 1). Despite seeking to provide individualised care, dentists
reported specific approaches to decision-making for PLwD which focused heavily on biomedical
aspects of care, such as medical risk or benefit (Project 2). PLwD and carers explained they wished to
be understood and more involved in dental treatment decision-making (Project 3). A series of
workshops and separate interactions with PLwD and a dental team led to the co-production of the
Dental Decisions Tool, which may support patient and carer involvement in dental treatment
decisions (Project 4).
Summary: Informed by qualitative research, the Dental Decisions Tool was co-produced to gather
information on PLwD’s preferences and values for care, and to support PLwD, carers and dentists
with dental treatment decision-making. Once completed, the Dental Decisions Tool may also support
best interest decision-making for people lacking the capacity to consent for dental treatment. Further
research is needed to explore the acceptability, suitability, and effectiveness of this tool.
Description: PhD Thesis2023-01-01T00:00:00ZImproving mealtime care for people with dementia : a training intervention for care homes
http://theses.ncl.ac.uk/jspui/handle/10443/6051
Title: Improving mealtime care for people with dementia : a training intervention for care homes
Authors: Faraday, James Heath
Abstract: Background
Many people living with dementia have difficulties at mealtimes, which can result in serious
complications including ill-health, stress, hospital admissions and even death. However,
current training in mealtime care for staff working with this population has been found to be
poorly reported, with variable effectiveness. This thesis describes work to develop an
evidence-based training intervention to improve mealtime care for people with dementia in
care homes.
Method
There were three phases to the study. The first phase was a literature review of relevant
scientific papers and published guidelines. Evidence was synthesised from diverse sources to
identify themes in mealtime care for residents with dementia. The second phase was an
ethnography conducted in UK care homes, to explore current practice in mealtime care, and
identify good practice. This included mealtime observations, and semi-structured interviews
with care home staff, family carers, and visiting health and social care professionals. The
third phase was a series of co-development workshops, in which key stakeholders worked
together to create a prototype training intervention, using evidence from phases one and two.
Results
The study found that priorities in mealtime care, such as providing choice, facilitating
independence, and promoting adequate nutrition/hydration, were often in tension with one
another. In addition, mealtimes operated within a complex system which constrained care. A
person-centred approach, focusing on residents’ history, capabilities, preferences and
prognosis, helped to resolve tensions between competing priorities in mealtime care.
Teamwork between care staff, kitchen staff, management, external health and care
professionals, and family carers was key in overcoming contextual constraints. These
findings informed the development of a prototype training intervention, in which
collaborative learning was emphasised.
ii
Conclusion
This thesis contributes to the field through the co-development of a new prototype
intervention to improve mealtime care for people with dementia in care homes. The
intervention is informed by new knowledge about good practice in mealtime care for this
population, and about how care home staff can overcome contextual constraints on practice.
Future work will test the feasibility and acceptability of the prototype training intervention.
Description: PhD Thesis2023-01-01T00:00:00Z