• Finite difference approximation for stochastic parabolic partial differential equations

      Yan, Yubin; Patel, Babubhai M. (University of Chester, 2009-09)
      Differential equations, especially partial differential equations (PDES) have wide range of applications in sciences, finance (economics), Engineering and so forth. In last decade, substantial amount of work has been done in studying stochastic partial differential equations (SPDES). A SPDE is a PDE containing a random ‘noise’ term. SPDES have no analytical solutions. Various numerical methods have been developed from time to time and tested for their validity using Matlab program. In this thesis, the author will discuss the finite difference method for stochastic parabolic partial differential equations. Matlab software is used for simulation of the solution of this equation. The main objective of this thesis is to investigate the finite difference approximation of a stochastic parabolic partial differential equation with white noise. The author discusses alternative proof for error bounds using Green function in support of this method.
    • A finite element method for time fractional partial differential equations

      Yan, Yubin; Atallah, Samia A. (University of Chester, 2011-09)
      Fractional differential equations, particularly fractional partial differential equations (FPDEs) have many applications in areas such as diffusion processes, electromagnetics, electrochemistry, material science and turbulent flow. There are lots of work for the existence and uniqueness of the solutions for fractional partial differential equations. In recent years, people start to consider the numerical methods for solving fractional partial differential equation. The numerical methods include finite difference method, finite element method and the spectral method. In this dissertation, we mainly consider the finite element method, for the time fractional partial differential equation. We consider both time discretization and space discretization. We obtain the optimal error estimates both in time and space. The numerical examples demonstrate that the numerical results are consistent with the theoretical results.
    • Fit for public consumption: An exploratory study of the reporting of nutrition research in UK tabloids and public attitudes towards it

      Hogard, Elaine; Basu, Andrea J. (University of Liverpool (University College Chester)North East Wales NHS Trust, 2005-11)
      Newspapers constitute a popular form of mass media within the UK; presenting a valuable opportunity for disseminating key nutrition and health messages. This qualitative, exploratory study examined tabloid articles reporting on nutrition research, and public attitudes towards them. All popular tabloids were included and articles were sampled over a full calendar month. A tool was designed to test for accuracy with respect to the original research, balance, and presence of appropriate contextualised information. Thirty-nine features were systematically assessed using the tool. Two focus groups were conducted to explore public attitudes towards specific tabloid articles. Questions were centred on the cognitive, affective and behavioural elements of attitude formation. The groups were audio recorded, transcribed, and emerging themes were established. Findings indicated that tabloid articles were essentially inaccurate, biased, and not effectively contextualised. Attitudes expressed within the focus groups were largely negative and suggested that tabloid articles could confuse members of the public. Articles were more likely to be disregarded than acted upon, however there was some value attached to newspapers providing nutrition information, inferring that opportunities to effectively use this media are not completely lost.
    • A focused qualitative assessment of primary school education needs to inform tailored resources supporting childhood obesity

      McNamara, Sorcha (University of Chester, 2017-09)
      Objective: To examine primary school education-needs to inform tailored resources supporting childhood obesity. Design: A qualitative study based on 8 semi-structured interviews. Questions addressed schools' approach to childhood obesity, resources, barriers, and possible enablers. Setting: Primary schools from the Manchester City Council jurisdiction. Participants: A purposive sample of 8 senior leadership school staff members (100% female). Phenomenon Of Interest: Types of perceived barriers and supportive tools to empower obesity discussions with parents. Analysis: Transcriptions were coded and analysed based on a socioecological framework using thematic analysis. Results: Five key themes emerged: complex families, primary schools as a key setting, the food environment, difficulties raising obesity and empowerment. The enabler training pack developed in response to these themes was received positively by school staff and initial feedback indicated it helped bridge perceived knowledge and skill gaps. Conclusions and Implications: Significant barriers exist to health behaviour change for families of a lower socio-economic status. Each school’s approach to childhood obesity varied greatly but all expressed a need for more healthcare professional guidance. Implications include training and tailored resources that can be applied to all primary schools and their staff.
    • Food security among first-year international students studying at the University of Chester (UoC) and the relevance of dietary acculturation as a determining factor

      Kennedy, Lynne; Abe, Opeyemi (University of Chester, 2016-09)
      Food security is an important nutrition issue among vulnerable population groups such as; international university students. When physical, social and economic access to sufficient, safe and nutritious food which meets dietary needs and food preferences for a healthy life is limited or uncertain, food insecurity exists. This study aimed to investigate the extent of food security among first-year international students at the University of Chester (UoC) and to assess factors affecting their ability to obtain their preferred traditional foods. Method: A cross-sectional survey of 124 first-year international students at the UoC, using self-reported validated questionnaires. Food security was measured using the Australian National Nutrition Survey (single item measure) and US Adult Food Security Survey Module from the United States Department of Agriculture Community Food Security Assessment Tool Kit (10-item measure). Socio-economic and demographic variables, and food access and availability questions were also included. Results: Food insecurity was evident in the student sample. The prevalence of food insecurity using the single item and multi-item measures were 21.8% (n=25) and 79.8% (n=99) (54.8% reported severe food insecurity and 25% reported some degree of food insecurity) respectively. Students’ food insecurity was associated with cost and quality of food, location and transport to food stores, low income, no employment, no scholarships and renting. Conclusion: Food insecurity is a significant problem among international students at the UoC. There is a need to increase the accessibility, availability and affordability of international students’ preferred traditional foods. It is necessary to broaden research on different university settings and further strengthen support systems to increase access to nutritious, preferred traditional foods for this population.
    • Food, physical activity and climate change perspectives in relationship to allotment ownership

      Burek, Cynthia V.; Ellahi, Basma; Hunt, Ann (University of Chester, 2010)
      Obesity and climate change are two of the biggest public health crises that the world currently faces and will face for many years to come, unless action is taken to halt the causes. The link between diet, physical activity and obesity has been firmly established. The causes of obesity are however, a multi-faceted problem, as are the causes of climate change. Current food production has been linked to increasing levels of CO2, and current eating habits can be responsible for a large carbon footprint. Growing your own food has been suggested as a method of reducing one’s carbon footprint, increasing physical activity levels and improving diet, little evidence exists to support this theory. This study looks at the fruit and vegetable consumption, physical activity levels and climate change awareness of allotment holders in two wards of Stockport. Qualitative and quantitative data was collected via face to face questionnaires (n=28) at both allotments sites. Fruit and vegetable intakes of allotment holders were above those of the U.K. general public and intake increased after allotment ownership. Physical activity levels were on average, higher than the recommendation of thirty minutes a day for at least five days per week and generally increased after uptake of the allotment. Allotment owners rent their plots for a combination of reasons, the majority wanting to grow their own food, and get exercise and most also cite some form of environmental issue. All participants were aware of climate change and although not all thought it would affect allotments; most had ideas of what they would do to adapt to changes. There are synergies between solving climate change issues, such as Green House Gas emissions and improving our health, both physically and nutritionally. Growing your own fruit and vegetables on an allotment can increase your consumption of fruit and vegetables significantly, increase your exercise levels and reduce your CO2 emissions.
    • Forecast model for radon concentrations in visitor caves

      Mitchell, Kirsty A. (University of Chester, 2012-09-20)
      The aim of this project is to develop a mathematical forecast model which can be used to forecase the radon ceontrations in visitor caves and to assess its validity using statistical analysis of its outputs and datasets from other caves. The project consists of a literature review, the creation of a forecast model and a statistical analysis of the results of the model with comparison data. The aim of the literaure review is to identify any mathematical models involving radon concentrations and to find any datasets that could be used to develop a forecast model of the seasonal variations in radon concentrations. Having identified a suitable dataset for development of the model a model specific to that cave will be carried out. The results of this model will then be statistically anlysed using the original dataset and a second dataset for comparison purposes, following any necessary adjustments. This will identify whether a forecast model based on observed seasonal variations could be used to predict accurately the radon concetrations in a visitor cave. The use of a second dataset will indicate whether this model has the potential to be applied to other caves or whether predictive models would have to specifically developed for each cave system.
    • Fractional differential equations and numerical methods

      Ford, Neville J.; Landy, Alan J. (University of Chester, 2009-06-22)
      The increasing use of Fractional Calculus demands more accurate arid efficient methods for the numerical solution of fractional differential equations. We introduce the concepts of Fractional Calculus and give the definitions of fractional integrals and derivatives in the Riemann-Liouville and Caputo forms. We explore three existing Numerical Methods of solution of Fractional Differential Equations. 1. Diethelm's Backward Difference Form (BDF) method. 2. Lubich's Convolution Quadrature method. 3. Luchko and Diethelm's Operational Calculus (using the Mittag-Lefner function) method. We present useful recursive expressions we developed to compute the Taylor Series coefficients in the Operational Calculus method. These expressions are used in the calculation of the convolution and starting weights. We compare their accuracy and performance of the numerical methods, and conclude that the more complex methods produce the more accurate results.
    • ‘Fragile Worlds’: A literature-based heuristic exploration of the experiencing of presence within the person-centred therapeutic encounter

      Gubi, Peter M.; Bridges, Ruth M. (University of Chester, 2007-11)
      The quality of presence has been widely researched within the realms of both nursing and psychotherapy during the last two decades and yet would appear to continue to challenge our contemporaneous predilection for the more measurable and contained. Through heuristically informed literature-based research, the author examines facets of the personal, professional and spiritual dimensions of presence, offering an investigation of its experience and influence within the psychotherapeutic encounter. The study identifies five key aspects of presence and offers a discrete analysis of these, whilst simultaneously acknowledging the essential fluidity of the phenomenon. Co-creative elements of presence are emphasised incorporating recognition of the mutuality of encounter, alongside a consideration of presence as offering. The significance of the self is identified and the study concludes with a reflection on existential and spiritual dimensions. Within much of the literature presence is perceived as deeply therapeutic. Conversely, this research suggests that, whilst presence may clearly retain the capacity to support emotional and psychological growth, it may also possess the potential for harm. It is argued that, as therapists, we might offer our presence with care, guarding against a somewhat indiscriminate ‘holding’ and accompaniment of clients. The main implication is to training wherein the author argues that further attention might be paid to understanding the impact of the ‘self’ within the moment of meeting. Written from an existential-humanistic stance, this study concludes that however elusive presence may initially appear, it offers itself for a considerable degree of analysis and thus proves itself worthy of more focused attention during initial training and beyond.
    • Friends’ Experiences and Sense-Making of Providing Support for a Socially Anxious Young Person: An Interpretative Phenomenological Analysis

      Heath, Hannah; Nielsen, Amanda K. (University of Chester, 2016)
      This study investigates how friends experience and make sense of providing support for a socially anxious young person. The experiences of friends who provide support for people with mental illnesses are rarely studied in their own right; studies tend to group friends with the experiences of partners or parents. This study aimed at analysing the overlooked perspective of the friends. Friends’ experiences were attained through semi-structured interviews with five self-identified friends of a young person with social anxiety. Through an Interpretative Phenomenological Analysis, three super-ordinate themes were generated: experiencing responsibility, the challenges in providing support, and the meaning of providing support. The analysis demonstrated that friends are a great source of support for socially anxious young people. Participants experienced a great responsibility because the socially anxious friends were dependent upon the support provided. Providing support was challenging; participants dealt with self-blame, worries about providing the right support and being a good supporter. However, participants valued their friendships, and providing support was also linked to feelings of reward, pride, success and achievement. The discussion indicated that great responsibility and dependency is commonly experienced among carers of people with mental illnesses, and that friends could benefit from sharing the responsibility with more people to reduce the challenges associated with providing support. Future research was recommended to examine the consequences of providing support alone versus in a group, and engage with the self-blame experienced among friends providing support. Last, more qualitative research on the experiences of friends was recommended for future studies.
    • From breaking news to broken communities: How does the representation of religion in local media contribute to maintaining or extending social cohesion in segregated communities?

      Graham, Elaine L.; Lees, Rebecca (University of Chester, 2017-01)
      Research suggests that Muslims in Britain have been, and continue to be represented and portrayed less favourably to other religions in mainstream media particularly within the print press, on a local and national scale (Knott, Poole, Tairu, 2013, Poole, 2009). This dissertation critically analyses how religion, specifically Christianity and Islam have been represented in the local media and to what extent this representation has had an impact on the maintaining or extending of social cohesion within Burnley; a town where segregation is apparent and integration is a challenge. Data collected through the application of content analysis and critical discourse analysis to two newspapers from 2001 to 2015 shows the patterns and trends in representation over a substantial period of time, whereby the community they serve became increasingly diverse with each Census. Findings from the research suggest that Christianity was referenced more times than Islam and more positively. However, significant changes to the practice of the press over the fourteen years resulted in the inclusion of more Muslim voices contributing to the enhanced religious literacy of the press. Recommendations for further research to add to this dissertation have been made in addition to enhancements to the practice of the local print media.
    • From Israel to Epworth: An assessment of the Psalms in the life of Methodist worship

      Christianson, Eric; Houghton, Gillian M. (University of Liverpool (Chester College of Higher Education), 2003-07)
      This dissertation looks at contemporary use of the Psalms in Methodist public worship, showing how Methodism is abandoning the tradition of using the Psalms and losing touch with both Christian tradition and the wishes of its founding father, John Wesley. The literature review considers the history of the Psalms in worship and then looks at their contemporary importance for worship. This includes an assessment of the universality both of the emotions expressed in the Psalms and of the language used. The importance of the Psalms to early Methodism is also considered. By means of two questionnaires issued to preachers and worshippers in the Lytham St Annes' Circuit of the Methodist Church, the dissertation goes on to show the limited use made of the Psalms in Methodist worship and the detrimental effect of this limited use. Finally the dissertation outlines somes means by which the Psalms might be reincorporated into Methodist worship and offers reasons, drawn from the literature review, about why this is so important for the spiritual well-being of individual worshippers.
    • ‘From mechanisation may be born a David to slay a Goliath’ an assessment of the impact of Sir Basil Henry Liddell Hart’s indirect approach on Operation Compass 1940 – 1941

      Hughes, Alexander J. (University of Chester, 2013)
      In the Second World War the Germans introduced a new form of warfare: Blitzkrieg, whereby rapid mechanised assaults supported by aircraft swept all before the advancing Wehrmacht. The topic chosen for discussion focuses on an often overlooked and indeed forgotten victory in the North African Campaign in the Second World War. History documentaries, Hollywood films and vast numbers of books have focused on the duel in the desert between Montgomery and Rommel, culminating in the Second Battle of El Alamein, almost endlessly. Prior to Rommel’s arrival in the desert, however, a series of battles took place as a part of a far larger operation, Operation Compass, where some 30,000 British and Empire Forces eventually destroyed the 250,000 strong Italian 10th Army. . It shall be the purpose of this dissertation to assess whether through Sir Basil Henry Liddell Hart’s strategy of the ‘Indirect Approach’ the British mechanised forces were indeed the deciding factor in the outcome of Operation Compass during the opening phase of the North African campaign 1940-1941.
    • 'From service to Civvy street’: An exploration of therapists' experiences who support veterans facing a difficult transition from military to civilian life

      Parnell, Tony; Jones, Gemma L. (University of Chester, 2013)
      Approximately twenty thousand Army, Royal Air Force and Royal Navy personnel leave the U.K forces each year. For many, the transition from service to civilian life is an uncomplicated one. However, for some, numerous and significant problems can arise brought on by mental health issues which range in severity and complexity. The present phenomenological qualitative study aimed to explore counsellors' experiences of ex-service personnel facing difficult challenges upon transitioning to civilian life from the forces and within that, identify some of the barriers and facilitators which may inhibit/promote a successful transition. In-depth, semi-structured interviews were conducted as a method of data collection. Use of the constant comparative method allowed an exploration of the data for analysis. Participants described their perceptions in terms of characteristics of a military life, including how identities may have been shaped; psychological & health issues upon return from deployment; social issues and the impacts difficult adjustments ensued; loss as experienced upon return to civilian life; the attempt to bridge the gap between the two lives including seeking help, coping strategies and mental adjustment; counsellor attributes and the role that therapy can play in assisting difficult transitions. Identity was recognised as a major significance throughout the findings, along with a shift in identity from soldier to civilian, assisted by challenges to maintain a service identity before a continuous transition could be attempted.
    • Front line fatigue or capacity building - what's really going on? A case study of Liverpool City Council front line services

      Scanlon, Tom; Aspinall, Dyane (University of ChesterLiverpool City Council, 2005-05)
      Liverpool City Council has undergone a huge transformation, perhaps most notably in its front line services. Many of the staff working within the new functionally centralised environments has been exposed to a prolonged period of transformational and ongoing transactional change. This study has attempted to analyse the effects such a change journey has on individuals, looking particularly at the notion of capacity building and change fatigue. The case study utilised interviews with Managers and staff focus groups which were supplemented by surveys of 60 staff within Liverpool City Councils front line services, i.e. Call Centre and One- Stop Shops. The data confirmed that staff within these environments have undergone a unique change journey over the last four years and found that exposure to extensive and prolonged change does increase an individual capacity to undertake further changes in the future. The extent of the presence of capacity building within individuals was found to be similar in both Call Centre and One- Stop Shops. The evidence also suggests the presence of change fatigue within both working environments and particularly so within the One- Stop Shops where more change fatigue was found to be present. The findings from this research suggest that staff within these working environments would benefit from greater involvement in setting the pace of the change, more effective communication about future change and require greater support from managers as the cumulative effects of change builds to a critical point. This case study is largely theoretical with some application in practise.
    • The function of the multidisciplinary team meeting for head and neck cancer: A qualitative analysis

      Perry, Catherine; Arya, Arvind K. (University of Liverpool (University of Chester), 2007-10)
      Multidisciplinary team meetings (MDMs) have been shown to be beneficial in the management of patients with cancer. Government recommendations introduced in 2002 suggested that more meetings were needed to take place to optimize cancer care in the UK. Head and neck cancer is a typically heterogeneous disease, and the input of a multidisciplinary team was considered to be vital in order to manage patients properly. This study was aimed at exploring the working of such MDMs through a series of interviews with healthcare professionals who regularly attended them. A large tertiary referral centre for head and neck cancer was the setting of the study. A total of 12 interviews were undertaken. Themes emerged from the data suggesting that there were benefits and problems with the MDM. There were benefits to team working, communication, information gathering, patient care, planning and decision reassurance. The problems identified included time constraints, excessive radiological workload, cost implications and loss of nurse led meetings. There was little contribution by certain allied heath professionals (AHPs) who found the atmosphere generated by medical staff combative. There was little time available to discuss non-medical issues. Patient care was not affected because social issues were discussed at a clinic following on from the MDM. Some Consultants questioned the ability of the MDM to come up with suitable treatment plans for patients, and preferred to make decisions in the clinic. The study's findings could help improve the working of the MDM in head and neck cancer. The issues of non-contribution should be addressed as should time and financial resources. A different set up of the MDM may be beneficial or by having an addition MDM per week. Further studies are needed to fully explore these issues, and to implement changes to improve head and neck cancer services in the UK.
    • General public's attitudes towards people who self-harm: Perceived dangerousness and desired social distance

      Hochard, Kevin D.; Ellis, Jacob (University of Chester, 2017-09)
      Public attitudes towards self-harm are critically important, yet relatively unexplored. They can moderate or further exacerbate social and emotional difficulties that instigated initial self-harming episodes and considerably influence help-seeking behaviour. Participants from the general public (N = 109) answered a repeated measures self-report questionnaire that assessed desired social distance and perceived dangerousness towards individuals depicted in eight hypothetical vignettes, which varied between gender (male, female), presence of self-harm (no, yes) and self-harm intent (without suicidal intent, suicidal intent, ambivalent intent). Regarding desired social distance, evidence was identified to suggest that people who engage in self-harm without suicidal intent are perceived more negatively than individuals who do not have a history of self-harm (p < .001, d = 1.55). Numerous factors were identified to further adversely affect desired social distance from individuals who engage in self-harming behaviour. Males tended to have more negative attitudes towards people who self-harmed (p = .015, d = .48) and both genders displayed more negative attitudes towards male self-harmers (p < .001, d = .55). Both males (p = .004, d = .57) and females (p < .001, d = 1.31) who indicated suicidal intent received more negative responses than those who self-harmed without suicidal intent. Overall, perceptions of dangerousness were positively correlated with desired social distance (r = .36, p = < .001), however, gender and intent-specific attitudes contributed conflicting evidence to this relationship. These findings provide foundations for research into public attitudes towards individuals who self-harm, which could potentially inform public awareness campaigns.
    • Genii of the Moors: Exploring the Imaginary and Imaginative Spaces in the Brontës juvenilia’s geographical fantasy worlds of Glass Town, Angria and Gondal, and its domestic resurgence in Charlotte Brontë’s Jane Eyre

      Pickett, Danielle J. (University of Chester, 2017)
      The story of the Reverend Patrick Brontë’s gift of twelve wooden soldiers to his twelve-year-old son Branwell in June 1829 is a much repeated one among scholars of the Brontë juvenilia. Renamed affectionately The Twelves, the toy soldiers provided the catalyst for the Young Men’s plays that grew into the Glass Town, Angria and Gondol sagas, and would continue to fuel the four youngest Brontë siblings’ imagination for the next twenty years. And yet, despite this early education of authorship and world play, Elizabeth Gaskell in The Life of Charlotte Brontë gave little attention to the ‘wild weird writing’ of her subject’s formative years,1 instead enshrining Charlotte in a domestic home ‘of the most dainty order, [and] the most exquisite cleanliness’.2 Resorting to same superlatives that she does in her treatment of the juvenilia, Christine Alexander’s assertion that ‘Nineteenth-century biographers…generally gave no more than a cursory glance at an author’s juvenilia, if indeed they acknowledged it at all’ fails to account for Gaskell’s censorship, and implies a more deliberate motive for the (dis)use of her language.3 This study locates Gaskell’s uneasiness in the conflict between Charlotte the writer, and Charlotte the woman. Accepted as her writing was in adulthood, it is Charlotte’s juvenilia and the imaginary worlds of Glass Town and Angria she created in childhood but continued well into adulthood, that disrupts the demarcation between what was acceptable as a professional woman author, and what was not. If the nature of the freedom of play in childhood is meant to be temporary, the transgressive nature of the Brontës’ was that it was not. For Charlotte, prolonged immersion in her fantasy world began to affect her reality, and it is the conflict between reality and her imaginary world that is evident in Jane Eyre, which this study examines as a full-length version of her last contribution to her juvenilia and read as ‘A [Final] Farwell to Angria’.
    • Giving a Voice, Healing Trauma: Exploring the Usefulness of Art Therapy with Refugee Children

      Lovell, Andy; Lowndes; Akthar, Zahra (University of Chester, 2017-10)
      Children who seek refuge to the United Kingdom have experienced a journey witnessing many traumatic events, separation and losses. These experiences can have a profound effect on a child’s well-being and resettlement in the host country. Art therapy is an avenue which can help these children to heal their trauma, and explore the feelings and changes that arise with becoming a refugee. This research set in an interpretive paradigm, informed by hermeneutic phenomenology explores the usefulness of art therapy with refugee children. It aims to investigate this enquiry through the lens of art therapists to gain insights from lived experiences and stories. Three semi-structured interviews were conducted, which were explored and analysed through using thematic analysis, which discovered five key themes these were identified as: (1) Giving Voice, (2) Rebuilding Trust, Opening Wounds, (3) Sharing Stories, Healing Pain, (4) Exploring Identity, Discovering New- Self, and (5) Understanding Art Therapy. Upon reflection, the four initial findings merged together highlighting the two key usefulness of art therapy, these were established as: (a) providing refugee children with a safe space to heal and discover new-self, and (b) giving refugee children a voice to express, and share their stories. Despite the last theme (understanding art therapy) being established as a limitation, this created an area for future research to help inform art therapy practice. From the findings discovered, it was concluded that art therapy is a useful form of psychotherapy for refugee children. Art therapy provides these children with a safe space to heal, and gives them a voice to express and be heard.
    • A gluten-free diet as a normal way of life: Adherence to gluten-free diet among people with coeliac disease and the role of specialist follow up

      Ford, David; Pender, Fred; Fallows, Stephen; Britcut, Elizabeth K. (University of Liverpool (University of Chester)Wirral University Teaching Hospital NHS Foundation Trust, 2009-08)
      Strict adherence to a gluten-free diet is the only known treatment for coeliac disease and is believed to reduce the risk of serious complications such as malignancy. Regular follow up has been associated with better dietary adherence in this group. This thesis examines adherence to a gluten-free diet among people with coeliac disease with a particular emphasis on specialist follow up. The research presented in the thesis comprises a qualitative study, conducted using a grounded theory method, and a questionnaire study. The questionnaire focussed particularly on specialist follow up and aimed to compare people who attended follow up with those who had defaulted. Data for the qualitative study was collected by means of semi-structured interviews. Thirty interviews were carried out. Interview transcripts were analysed and the findings used to develop a model of dietary adherence. The experience of coeliac disease and of implementing a gluten-free diet was seen to be a social one. At the centre of the model was the concept of dietary adherence as the incorporation of the gluten-free diet into normal life. The model illustrates the factors which were found to facilitate or inhibit the adoption of a strict gluten-free diet as part of normal life. Findings from the qualitative study were used to inform a postal questionnaire. Three hundred and four questionnaires were distributed and 214 returned giving a response rate of 70%. A higher response rate (78%) was obtained from regular clinic attenders than non-attenders (43%). Non-attenders (n=29) were less likely than attenders (n=185) to report their needs had been met at their out-patient appointments. This suggests that a service which better meets the needs of this group may result in better attendance and this may in turn improve dietary adherence and possibly influence long term health. This research suggests a number of ways in which health professionals may better support people with coeliac disease. These include understanding the social aspects of coeliac disease, providing practical and factual information that is useful to the individual and allowing adequate time for patients to discuss their concerns.