• Addressing Gaps in Cognitive Dissonance Theory and Relational Frame Theory – Research on Coherence and Ambiguity

      Hulbert-Williams, Lee; Hulbert-Williams, Nick; Lafferty, Moira; Ashcroft, Samuel P. (University of Chester, 2021-03)
      The aim of this thesis was to build a body of evidence to address several gaps in Cognitive Dissonance Theory (Harmon-Jones, E. & Harmon-Jones, C., 2007) and Relational Frame Theory (Hayes et al., 2001), relating to relational coherence, incoherence, and particularly ambiguity. These gaps included a lack of: theory and research on ambiguity; robust definitions of coherence, incoherence and ambiguity; research on the relative appetitiveness of coherence versus incoherence and ambiguity; multiple-stimulus research in Cognitive Dissonance Theory; technical experimentation in Cognitive Dissonance Theory; and clarity about the stimulus-specific lower boundary conditions of coherence-related phenomena. An overview of theory and research pertaining to coherence, incoherence and ambiguity was given (Chapter 1), including discussion regarding the gaps highlighted. Then, working definitions of coherence, incoherence and ambiguity were offered (Chapter 2). The ambiguity-coherence study by Quinones and Hayes (2014) was conceptually replicated and expanded (Chapter 3), discovering that participants spontaneously generate A-C relationships on ambiguous A-C blocks involving nonsense stimuli. A design issue regarding patterns of reinforcement was identified in Chapter 3, and this was discussed and resolved (Chapter 4), alongside an assessment of the appetitive properties of coherence. Participants displayed no preference towards completing a coherent versus an ambiguous A-C block again. Physiological measures of Heart Rate and Galvanic Skin Response were measured in response to coherence and ambiguity (Chapter 5), further evidencing spontaneous generation of relationships in response to ambiguity. No difference in physiological measures was found between coherent and ambiguous A-C blocks. Incoherence was incorporated into the design (Chapter 6), which provided corroborative evidence of the spontaneous generation effect and also demonstrated the validity of the experimental design by matching predictions from Relational Frame Theory. An updated assessment of the appetitive properties of coherence was completed (Chapter 7), with real words as stimuli and discriminatives. Spontaneous generation of relationships in response to ambiguity also occurred using these alternative stimuli. Differences were broadly not found between coherent and ambiguous A-C block types, indicating that there appears to be a stimulus-specific lower boundary condition for various coherence phenomena such as changes in affect and arousal. However, the spontaneous generation of A-C relationships indicates no stimulus-specific lower boundary condition for coherence-related behavioural responses. Finally, the effect of experimental design on spontaneous generation of relationships was assessed (Chapter 8), identifying that spontaneous generation of relationships is moderated by the complexity of the cognitive task at hand. Findings from this thesis were synthesised with literature on coherence, particularly that of Cognitive Dissonance Theory and Relational Frame Theory (Chapter 9), with limitations, implications and future research directions given. This thesis: evidences the importance of ambiguity in any theory relating to coherence; identifies a possible stimulus-specific lower boundary condition for affective but not behavioural coherence-related responses; shows that the spontaneous generation of relationships effect could potentially be considered a fundamental aspect of human relational behaviour; and demonstrates that such spontaneous generation effects appear moderated by the complexity of the cognitive task at hand.
    • Anxiety and depression symptomatology in adult siblings of disabled individuals: The role of perceived parenting, attachment, personality traits and disability types

      Murray, Lindsay; Scott, David; O'Neill, Linda P. (University of Liverpool (University of Chester)University of Chester, 2011-11)
      Objectives: (1) To ascertain whether adult siblings of disabled individuals are more prone to anxiety and depression symptomatology than a closely matched control group. (2) To examine the contribution that perceived parenting styles, attachment styles and personality traits play in the long-term affective outcome of these siblings. (3) To consider if the type of disability has a role in sibling affective outcome. Design: A cross-sectional, closely matched study design, with data collected through self-report. One-way ANOVAs, correlational analyses, moderation and mediation analyses were applied. Participants: Adult siblings of disabled individuals (SDI), were initially contacted through support groups, such as SIBS, the Down’s Syndrome Association, the National Autistic Society and the Prader-Willi Association (UK) and responded to a postal or e-mailed questionnaire; 150 participants returned the completed questionnaire. The 150 control group participants were closely matched on the variables of gender, age, marital status and when possible socio-economic status, in order to compare like with like. This group was contacted through friends, family, work colleagues and local businesses. Measures: All the participants completed a range of demographic questions; the SDI were additionally asked questions regarding their disabled sibling. The established measures used included the Hospital and Anxiety Depression Scale (Zigmond & Snaith, 1983), Experiences in Close Relationships (Brennan, Clark & Shaver, 1998), an adapted measure of the Descriptions of Parental Caregiving Style (DPCS, Hazan & Shaver, 1986) and the International Personality Item Pool (Goldberg, 1999). Results: The majority of SDI reported no increased anxiety or depression symptomatology, however, when compared the SDI did report higher levels of anxiety and depression symptomatology than the control group; also higher levels of perceived inconsistent mothering, attachment-related anxiety and neuroticism, with lower levels of extraversion than the control group. These variables mediated the path between having a disabled sibling and anxiety and depression, with the notable exception of perceived inconsistent mothering. This variable showed no association with any of the established measures for the SDI group; however, there were associations consistent with previous research for the control group. There was no moderation effect on anxiety or depression between the demographic variables and SDI. The autistic spectrum disorder siblings reported similar levels of anxiety symptomatology to Prader-Willi siblings but higher than Down’s syndrome siblings and the control group and they also reported the highest levels of depression symptomatology. Conclusions: The adult SDI’s higher propensity towards anxiety and depression is a cause for concern; particularly when explained through heightened levels of attachment-related anxiety, high levels of neuroticism and low levels of extraversion. The lack of association with perceived inconsistent mothering requires further investigation. These results can help guide interventions or clinical therapies; the emotional well-being of SDI is paramount as they will possibly be among the first group to assume responsibility for their disabled siblings.
    • Benefits of musical training on implicit memory and learning in healthy older adults and individuals with dementia

      Cousins, Margaret; Bramwell, Ros; Thorpe, Lisa (University of Chester, 2021-03)
      Ageing is linked to a variety of health issues, but perhaps the most well documented feature of growing older is that it is associated with memory decline (Ward, Berry & Shanks, 2013). It is well established that explicit memory declines with age, with the rate of decline being an important predictor of the diagnosis of dementia (Ward et al., 2013). Implicit memory is involved in everyday tasks that, with practice, become largely automatic. The process of implicit learning is generally defined as the ability to acquire knowledge unconsciously. An effective way of improving health in older adults is through music. Making music is one of the essential skills that requires the use of implicit knowledge. Procedural learning is one type of implicit knowledge that focuses on the learning of a skill through repeated performance and practise. To become a professional musician takes years of skill training, for example, practising scales improves finger patterns in pianists, which over time becomes an implicit motor skill that helps with musical performance. Previous research that has looked at implicit memory in musicians, has focused on young adults and found that both musicians and non-musicians performed equally on implicit knowledge tasks (Bigand et al. 2001). This thesis aimed to look at whether musical training is associated with better performance in implicit memory in healthy older adults and individual with dementia. To do this implicit memory tasks including an adaptation of the Phoneme Monitoring Task (Bigand et al., 2001), Serial Reaction Time Task (Nissen & Bullemer, 1987) and The Word Completion tasks (Tulving, Schacter & Stark, 1982), were completed by healthy older adults and individuals with dementia both musicians and non-musicians. Overall, results showed that musicians, both older adults and individuals with dementia, performed better than non-musicians on procedural learning tasks (Serial Reaction Time Task) but there was no difference on implicit tasks such as priming. Although both musicians and non-musicians with dementia showed reaction times that would suggest procedural learning for repeated sequences, only musicians showed a significant difference between repeated and novel sequences, suggesting that musical training benefits procedural learning. Overall, both health older adult musicians and musicians with dementia performed faster than non-musicians on both the Serial Reaction Time Task and the Adapted Phoneme Monitoring task. However, results did not reach significance on the Adapted Phoneme Monitoring Task. The results suggest that musical training benefits procedural learning in musicians, which could have positive implications for future learning in older adults and individuals with dementia.
    • Cancer Experiences in People with Intellectual Disabilities

      Hulbert-Williams, Nick; Hulbert-Williams, Lee; Bramwell, Ros; Flynn, Samantha (University of Chester, 2018-12-20)
      People with intellectual disabilities are increasingly being diagnosed with cancer due, in part, to increases in life expectancy for this population. Despite the growing number of people with cancer and intellectual disabilities, the cancer-related experiences of people with intellectual disabilities are under-researched. Person-centred approaches to research are needed to better understand the needs and psychosocial outcomes of people with cancer and intellectual disabilities. This thesis aims to better understand the cancer-related experiences of people with intellectual disabilities, and the impact on the people who support them. The thesis comprises four related studies: (1) a systematic review of psychosocial experiences of cancer in people with intellectual disabilities; (2) a qualitative study of cancer experiences in people with intellectual disabilities using thematic analysis informed by grounded theory; (3) a survey of UK oncology nurses’ attitudes and care perceptions towards people with intellectual disabilities; and (4) a feasibility study of an intervention to improve healthcare professionals’ perceptions of communicating with people with cancer and intellectual disabilities. Five themes emerged from the ten papers included in the systematic review: delayed diagnosis; information, communication, and understanding; negative psychological consequences; negative physical consequences; and social support. Six of the ten papers included data from the same ethnographic study of 13 people, highlighting a paucity of empirical research regarding the psychosocial cancer experiences of people with intellectual disabilities. The qualitative study indicated that people with intellectual disabilities were often excluded from conversations about their diagnosis, treatment, and ongoing care, and expressed confusion and anxiety about their cancer. Attempts to protect them from distress inhibited communication, but where additional support was offered, participants engaged more meaningfully in their experience and this should, therefore, be encouraged. In the qualitative study, oncology nurses were reported to be important figures in the care of patients with intellectual disabilities. The survey of oncology nurses highlighted that caring for cancer patients with intellectual disabilities may intensify their already difficult role; however, previous experience may ameliorate negative consequences. This sample identified their need for training about communicating with people with intellectual disabilities. The first three studies informed the development of a novel, brief, online, video-based intervention for healthcare professionals working with people with intellectual disabilities and cancer. The feasibility trial of this intervention indicated that there were problems with recruitment, high attrition, and intervention adherence. These problems were, most likely due to participants finding the content and delivery method to be unacceptable. It is clear that the intervention is not feasible in its current format, and that further theoretical and modelling work is needed before the intervention is feasibility tested again ahead of a definitive trial. This body of work has demonstrated that people with intellectual disabilities and cancer face multiple barriers to accessing cancer care, including informative and understandable communication with healthcare professionals. With appropriate support, psychological and physical outcomes can be improved for people with intellectual disabilities and cancer, but caring for people with cancer and intellectual disabilities can be challenging for paid and informal carers, and oncology staff. Difficulties with communication are bi-directional, and improving communication might be an appropriate first step to improving cancer experiences for this population, but developing effective interventions presents numerous feasibility challenges.
    • Children’s Decisions to Support Victims of Bullying: Friend and Peer Influences and the Effects of a Cross-Age Teaching of Social Issues Intervention

      Boulton, Michael J.; Lloyd, Julian; Rodway, Paul; Marx, Hedda (University of Chester, 2018-12-17)
      Bullying among school children is a social phenomenon that is now recognised as a widespread and serious problem across the globe. While decades of research have generated valuable insights as regards prevalence, main correlates and detrimental health consequences, many questions and gaps remain. For instance, it is unclear why the great majority of peer bystanders not intervene to support victims in a bullying conflict despite holding anti-bullying beliefs. Furthermore, great efforts have been made in the area of peer support and anti-bullying initiatives however there is still no intervention that has shown to be effective long term and cross-culturally. This thesis consists of two empirical studies. To advance knowledge of factors that influence pupils’ victim support behaviour, the first study examined the role of perceived friend and peer consequences in predicting intentions to three types of help: provide emotional support, help to stop the bully and get adult support. Structural equation modelling revealed that perceived friend consequences were significantly associated with each of the victim support behaviours studied. Additionally, perceived peer reactions predicted intentions to get adult help. These findings suggest that friends play a more important role than peers in affecting victim support. Some significant gender effects emerged, showing that the overall pattern of associations held for boys, but not for girls. The findings highlight the concerns children hold with regard to their (dis)approving views related to victim support. Outcomes further suggest that victim defending should not be regarded as a broad homogeneous construct. The second study assessed the effectiveness of a cross-age teaching of social issues intervention (CATS) on enhancing pupils’ knowledge on three victim support behaviours, and their awareness of the value of helping. In small cooperative groups older pupils were invited to step into the tutor role to prepare a lesson and teach it to two years younger tutees. An experimental-control group design was employed to test participants’ performance at three time points over a six to eight week period. CATS tutors significantly improved their knowledge and awareness of the provictim behaviours studied while no positive changes were evident for participants in the control group. Furthermore, children who participated in the project expressed high satisfaction with the intervention. Based on the positive findings it was concluded that CATS is a viable technique for enhancing pupils’ knowledge and awareness on prosocial topics. Helping children to see the value of supporting victims of bullying, in any of the ways studied, could help them avoid anticipating negative reactions from friends and peers, and in turn make it more likely that they would choose to help if the need arose.
    • Choices for childbirth: The role of psychological and social factors in the nature and extent of women's decisions for labour and delivery and their influence on post-natal outcomes

      Hayes, Liane (University of Liverpool, 2014-01)
      Research into birth plans has considered women’s experiences of their usefulness as an aid to communicating preferences for childbirth. It has also evaluated implications for post-natal well-being based on the realisation of expressed preferences in labour and delivery. The current study aimed to identify the psychosocial profile of birth planners and to explore the outcomes for these women as compared with non-planners post-natally. It also compared the psychological constructs measured in the sample with a non-pregnant population to see differences between pregnant, post-natal and non-pregnant women on these dimensions. A sample of 140 women who had not been pregnant in the past year completed a questionnaire measuring: Age, occupational group; ethnic group; general health status, health knowledge, attitudes towards doctors and medicines; locus of control; coping style; perceived social support; and beliefs about pain control. A questionnaire was also given to 120 women in four antenatal clinics across a primary care trust in the North West of England. This questionnaire produced data on all of the variables in the comparison questionnaire, plus: Parity; antenatal education; birth plan use; medical conditions; information seeking; and childbirth self-efficacy. Women also described in text their preferences for birth. At least four weeks after delivery these women completed a further questionnaire consisting of the seven measures used in both the previous two questionnaires, plus: experience of birth; usefulness of birth plan; and post-natal depression. They also described in text their experience of birth. Results showed that birth planners were younger and had lower levels of internal health control than non-birth planners. Birth planners tended to use problem focussed coping styles, perceived less support from their significant other and perceived doctors as more powerful in pain control than non-birth planners. More positive psychological post-natal outcomes were experienced by women who valued their birth plans if they had one but overall birth planners experienced more negative psychological post-natal outcomes than non-birth planners. The non-pregnant sample was comparable in demographic terms to the pregnant sample but differed in most subscales across all measures to the pregnant sample pre-natally and to a lesser extent post-natally. The factors implicated in birth planning and psychological post-natal outcomes are discussed both in terms of the literature and possible implications for the training and practice of midwives.
    • Dyslexia and time: A comparison of speed and accuracy of young dyslexics and non-dyslexics on time recognition and time management by adult dyslexics

      Wheeler, Timothy J.; Reynolds, David; Ellis, Antony R. (University of Chester, 2013-08)
      This research describes two invesitgations into temporal processing by dyslexics. Firstly, the accuracy and speed of response that dyslexic children and matched controls demonstrate on three types of time comparison task was explored. The participants were 96 boys and 24 girls, divided into three age bands: 7:0 - 7:11; 11:0 - 11:11 and 14:0 - 14:11 years of age of whom 60 were dyslexic and 60 non-dyslexic. Dyslexics in all age bads took longer and made fewer correct responses than non-dyslexics in time telling. Younger dyslexics were differentially disadvantaged when compared to older dyslexics in speed and correctness. Both groups showed improved accuracy and speed with age. The dyslexic cohort aged 14 years improved in accuracy from age 11, though with only marginal improvement in reaction time speed. Complex time perception proved most difficult for both groups. Reason for these differences are discussed with reference to limited sort-term memory problems affecting performance especially for dyslexics. The research substantiates particular theories of dyslexia and a new model helps to explain the process. Practical implications are suggested for parents, teachers and examiners concerned with dyslexic children. Secondly, the time management skills of dyslexic and non-dyslexic adults were examined for 43 dyslexic and 41 non-dyslexic particpants who answered an online questionnaire about their time management skills. The adult questionnaires revealed that dyslexics find time management, estimation, planning and sticking to a schedule particualrly difficult, resulting in task delay or incompletion, and heightened levels of stress as time pressures increase. Questions revealed lack of confidence in time management techniques amongst dyslexics. Many dyslexics had found these difficulties placed severe contraints on career choices, areas of employment and lifestyle. Possible reasons for these diffierenecs are discussed with an accompanying model that stresses the contraints caused by poor working memory.
    • An investigation into the development of ACT-based approaches to increase physical activity

      Lafferty, Moira; Whalley, Anthony P. (University of Chester, 2021-01)
      It is well documented that regular physical exercise supports physical and mental wellbeing. Despite the promotion of physical activity by world health experts and governments, physical inactivity within the population remains a cause for concern and disorders associated with sedentary lifestyles have continued to increase. Evidence suggests that the uncomfortable private-events people experience during physical exertion can become psychological barriers to participation in physical activity and thus result in avoidant behaviours. Acceptance and commitment therapy (ACT) has been used to promote increased physical exercise by enhancing psychological flexibility in relation to private-events that are perceived as unpleasant. However, relationships between the individual ACT processes and the theories which underpin their use in interventions designed to promote physical activity have yet to be fully explored. Understanding the relationship between ACT processes and physical exercise is key for appropriate and robust intervention development. This thesis aimed to explore the theoretical and practical application of ACT processes in relation to exercise and inform further development of effective brief interventions designed to increase activity levels. The programme of work within this thesis had two phases. The first phase included two studies: a systematic review to explore the existing evidence; and a quantitative survey study to determine if associations exist between physical activity levels and the individual core processes of ACT. Results from phase one found that the reviewed literature failed to explore the use of Relational Frame Theory (RFT) critical to ACT, and a survey suggested that ACT processes of defusion, self-as-context and personal values were likely to play a significant part in activity levels. The second phase comprised of three interrelated quantitative intervention studies designed using RFT. Each explored the ACT processes by measuring task duration and the intensity of private-events experienced during exercise. The first intervention study combined defusion and self-as-context with no significant effects on an exercise task. The second combined defusion, self-as-context and value orientated cues to behaviour change. Exercise duration was significantly increased in the ACT intervention, while there was no decrease in the intensity of private-events. The final study tested a values clarification task with cues to behaviour change and reported significantly increased exercise duration. The thesis demonstrates that relational frame theory applied to ACT processes can influence the duration of exercise although the relationship with private-events remains uncertain. The robust, theory focused approach to this work represents a small but valuable contribution to the development of intervention strategies and has implications for future research. Strategies worked best using a combination of both deictic and hierarchical relations for training cognitive defuison and self-as-context, and especially for the clarification of personal values used as cues to behaviour change. Further research is needed to establish both the external validity and longevity of observed effects.
    • Laterality in Chimpanzees: Links with Behavioural Style and Social Networks

      Murray, Lindsay; Rodway, Paul; Díaz González, Sergio (University of Chester, 2021-01)
      This thesis presents a series of studies investigating laterality in chimpanzees and its links with personality examined as behavioural style and social networks. The studies presented in this work were conducted by observing a group of 19 chimpanzees in captivity and present new findings in this species. However, this thesis has a broad evolutionary perspective, addressing important questions regarding personality and laterality that could prove helpful to the understanding of the evolution of laterality in vertebrates. Chapter 1 offers a general review of the three main areas of knowledge investigated: laterality, animal personality and primate social networks. Then, the first study of this project, presented in Chapter 2, began by exploring hand preference in the chimpanzee group, investigating spontaneous actions and unimanual tasks and expanding previous research by studying posture, between-task consistency and temporal stability. Chapter 3 investigated additional measures of motor laterality and proposed a novel way of measuring laterality in primates. Together, Chapters 2 and 3 directly examine laterality in chimpanzees and serve as the base from which to explore the links between laterality, personality and social networks in the subsequent studies. If lateralization is rooted in emotional processing and hemispheric lateralization, then individual differences in behaviour (particularly those that reflect emotional expression) would show a relationship with individual laterality. In order to address this question, Chapter 4 studies behavioural style in chimpanzees and its possible link with laterality. Simultaneously, if intraspecific coordination plays a role in the development of population level laterality, similarly lateralised individuals would likely have strong bonds to coordinate with each other. Chapter 5 introduces the approach and techniques of social network analysis and uses them to explore and describe the social structure of the group while describing the integration of a new adult chimpanzee. Chapter 6 applies social network analysis to explore if laterality plays a role in the way the group is structured. Lastly, Chapter 7 integrates all empirical chapters and presents the final discussion and conclusions of the thesis.
    • Measuring and Exploring LGBTQ+ Stigma Reduction from a Contextual Behavioural Science Perspective

      Hulbert-Williams, Lee; Hulbert-Williams, Nick; Mattison, Michelle; Carol, Janine; Norwood, Sabrina (University of Chester, 2022-02)
      This thesis is comprised of five empirical studies which were designed to measure and explore lesbian, gay, bisexual, transgender, and queer/questioning+ (LGBTQ+) stigma reduction, through a Contextual Behavioural Science (CBS) lens. This thesis offered unique contributions to the field via its introduction of a novel stigma measure, its empirical testing of the euphemism treadmill effect, and its introduction of a novel form of perspective-taking. The thesis begins with a literature review chapter, followed by the first phase of experimentation. This involved the creation of a new psychometric scale to measure others’ stigmatising attitudes. Data were collected from a total of 429 participants, measuring attitudes toward two different populations. Exploratory factor analysis and item-reduction was undertaken using data from one sub-set of participants resulting in a unidimensional scale. Parallel forms were created using an odd-even split. The resultant factor was compared against the second sub-set of participants using a confirmatory factor analysis. The one factor, 24-item structure was confirmed and retained. The second phase of experimentation involved exploring a previously employed reduction technique (i.e., language and the euphemism treadmill effect) using both a methodologically robust approach and ecologically valid approach, across two studies. The first study used a technique familiar to CBS, match-to-sample, while the second used a more ecologically valid approach, a vignette. Both contained the same three hypotheses. Results from the first study indicated some significant correlation between pre-intervention and post-intervention scores, but no significant effect within the gay condition specifically. Results also showed that word valence was a significant moderator between pre- and post-intervention scores. Results from the second study indicated no significant change in scores from pre- to post-intervention labels, with pre-intervention scores and post-intervention scores showing a strong positive correlation. Word valence was not a significant moderator between pre- and post- scores. The third phase of experimentation involved exploring both a previously utilised perspective-taking intervention, and the creation of a novel form of perspective-taking, across two studies. For the first study, 280 participants were randomly assigned to one of six different conditions varying in requirements expected and type of perspective-taking. Each ix condition also varied in participant burden, across three levels ranging from least burdensome to most burdensome. The second study utilised 235 participants who were randomly assigned to one of three different perspective-taking conditions. Attitudes toward gay people were measured pre- and post-intervention as well as after a two-week follow-up period and compared both within and between subjects. Results from the first study showed no significant effect of change scores nor of type of intervention, as well as level of participant burden, on two of the three measures utilised. Results for the second study found no significant effect of condition on change scores. However, attitudes were shown to have significantly changed from pre-intervention to post-intervention on all three measures, and this significant change remained between pre-intervention to follow-up on two of the three measures utilised. The general discussion chapter gives an overview of the key findings that emerged from this thesis as well as a discussion of implications, limitations, and future directions as a whole and complete work.
    • Sport coaching in a community setting: How do community youth sport coaches’ frame their role?

      Wheeler, Timothy J.; Lafferty, Moira E.; Ryrie, Angus (University of Chester, 2016-12)
      Community youth sport coaching is identified as a coaching domain tasked with delivering complex social outcomes. When coaching in this context, individuals can be expected to operate in multiple settings, as well as engage with, and support numerous participant types. To meet participant needs coaches are required to have a wide range of skills and competencies. Current research suggests how coaching roles emerge and competencies develop are not always clear. Therefore, to understand coach identity fully; there is a requirement to explore the meanings, values and importance placed upon coach roles. Past research illustrates that the manner in which coaches’ frame their role is instrumental to how they prioritise and organise critical moments of practice that warrant further reflection; thus allowing individuals to “construct the reality in which they function". This thesis intends to extend current knowledge on how sport coaches’ define, shape and “frame” their role in community youth sport settings. The research objectives are to: (a) examine the environmental conditions and personal views coaches’ hold with regard to community youth sport in the UK and, (b) evaluate elements that influence their role and individual approach towards coaching. In essence, (c) evaluate how community youth sport coaches’ shape and frame their role.
    • The Unmet Psychosocial Needs of Haematological Cancer Patients and their Impact upon Psychological Wellbeing

      Swash, Brooke (University of Chester, 2015-01)
      Unmet psychosocial needs indicate a desire for additional support in cancer patients, having a direct clinical utility in directing the provision of supportive care. There is evidence in wider cancer groups that unmet needs relate to psychological wellbeing but this relationship has yet to be fully explored and factors that may explain or moderate this relationship yet to be examined. There has been little investigation of type or prevalence of unmet need in haematological cancer patients, however, haematological cancers are noteworthy for their high levels of associated distress. Understanding causality of distress is key to the effective implementation of supportive care services. This thesis aimed to highlight the unmet needs most relevant to haematological cancer patients and to explore their impact upon psychological wellbeing. This thesis comprises four interconnected research studies: a systematic review exploring existing knowledge of unmet needs; a qualitative exploration of patient experiences of unmet needs and their impact; a quantitative questionnaire study of unmet need and psychological wellbeing in newly diagnosed haematological cancer patients, placing a special emphasis on the difference between active treatment and watch and wait regimes; and, a second quantitative questionnaire study that explores unmet need, psychological wellbeing, and psychological flexibility as a potential moderator in their relationship in a sample of haematological cancer survivors. This thesis demonstrates a relationship between unmet need and psychological wellbeing in haematological cancer patients. Fear of recurrence, concerns about loved ones, being able to do the things you used to, and a need for information were all found to be of relevance. The qualitative study highlighted that patients feel that, as haematology patients, they are distinct from other cancer patients which impacts upon the perceived acceptability of support services and specific barriers to the accessing of support services are presented. Significant correlations between unmet need and key psychological outcomes such as anxiety, depression and quality of life were observed in both quantitative studies. In addition, the concept of psychological flexibility was found to moderate the relationship between unmet need and psychological wellbeing in haematological cancer survivors. This work has clear implications for both future research and clinical practice. Unmet needs assessment has the potential to be used as a screening tool for overall psychological wellbeing, a way to stratify and understand the specific causes of distress and poor quality of life for this patient group. In the UK, on-going support for cancer patients diminishes at the end of treatment, these findings suggest that further support is needed in order to meet the psychological needs of cancer survivors. Further research is needed to further explore the role of psychological flexibility in cancer-related distress: interventions that target psychological flexibility have the potential to improve both unmet need and distress.