Dr Brenda Lynch, UCC 2014
Dr Paula Bryne, NUIG 2014
Dr Sarah-Jane Flaherty, UCC 2014
Disrupting Routines, Facilitating Control: Exploring a Change Towards Healthier Food Purchasing Behaviour Using a Health App
Supervisors: Prof Mary McCarthy (UCC), Dr Alan Collins (UCC), and Prof Fionnuala McAuliffe (UCD)
Unhealthier food consumption patterns constitute a leading risk factor for ill health. As an important step in the food consumption process, changing food purchasing may improve the healthfulness of dietary patterns. Changing behaviour towards healthier food purchasing may be viewed as effortful by consumers due to inadequate nutrition knowledge and skills which may inhibit their ability to make healthy choices within the supermarket. A dominance of routines and habits further impedes the use of deliberative decision-making, which makes information provision and goal-setting less effective. Behaviour change may be supported by disrupting undesirable behavioural patterns, building of personal resources, and reframing behavioural outcomes. This should prompt a greater use of reflective cognitive processes during food purchasing and aid healthier behaviour. However, there is limited evidence in relation to food purchasing. Given recent technological advances, apps offer a potential tool to facilitate such change. The high use of apps across social groups suggests that they may be appropriate for supporting behaviour change in lower socioeconomic groups. It is unclear if existing apps are appropriately designed or acceptable for use for the necessary time period, particularly for individuals from a lower socioeconomic background. Such knowledge gaps must be addressed to inform intervention design. This thesis aims to contribute to the theoretical understanding of the interplay between mobile app technology and behaviour change with food purchasing as the behaviour of interest, and a particular focus on women from a lower socioeconomic background.
This thesis was grounded in a pragmatic philosophical perspective and consisted of four phases. In phase one, structural equation modelling was undertaken to examine the individual-level determinants of a healthy eating habit and the extent to which personal goals and self-control are linked to a healthy eating habit. A content analysis of existing apps was undertaken in phase two to examine their capacity to support healthier food purchasing behaviour. A structured analytical matrix was employed where relevant literature and theory was drawn upon. A phenomological methodology was used for the remaining two research phases. In phase three, the researcher explored the experience of using a health app to support healthier food purchasing behaviour. Women from a lower socioeconomic background were recruited and asked to use two, of three possible, apps over a two-week period. Subsequent semi-structured interviews explored the experience of using an app including those personal and app-related factors of importance. Inductive thematic analysis was conducted to explore common patterns across participants’ experiences.
In the fourth research phase, the lived experience of changing purchasing behaviour was explored in women from a lower socioeconomic background using a health app over an 8-11 week period. Participants were asked to use one, of two possible, apps. Multiple data collection methods were employed to capture the lived experience of behaviour change and app use. At baseline, an accompanied shop, incorporating the use of think-aloud protocol and researcher observations, was conducted, followed by an in-depth interview and questionnaire completion. At the midway point, participants were asked to complete a reflective account of their
experience thus far. They were also asked to share their till receipts for the study duration. At follow-up, an accompanied shop, in-depth interview, and questionnaire completion was again employed. The interpretative phenomenological analysis was conducted to gain insight into the behaviour change experience. Theoretical thematic analysis was employed to examine app use through the lens of engagement theory.
Self-control and deliberative cognitive processes were central to maintaining a healthy eating habit. This challenges the current conceptualisation and suggests the need to view complex food behaviours as highly routinised; this is an important consideration for behaviour change. Food purchasing behaviour was not a primary focus of existing apps with behavioural outcomes, such as weight-loss, as their main goal. While existing apps have the potential to support healthier purchasing behaviour, there is an opportunity to broaden their capacity. Health apps, through the process of self-monitoring, problem solving, and behavioural prompts disrupted existing purchasing patterns. This prompted the use of reflective cognitive processes such that purchasing behaviour was directed by personal resources and healthy food goals. However, the extent to which reflective cognition continued to be employed during behaviour change was influenced by the broader goal system in which healthy food goals resided.
The importance of user engagement was highlighted through this exploratory research. Engagement was expressed at an intrinsic level as a sense of personal autonomy, an increased perceived capacity to change, and viewing the app as a confidential and empathetically. App features that facilitated their expression were considered to result in optimal engagement. Findings suggest that an individual’s involvement, in relation to healthy food, may act as a trigger for different phases of engagement as variations in goal saliency lead to flux in involvement levels. The importance of individual characteristics on app engagement was evident which emphasises the need to integrate tailored features into health apps to ensure that it is congruent with personal goals.
The present findings add to the existing understanding of the interplay between app technology and behaviour change. If appropriately designed health apps may facilitate a more conscious approach to food purchasing and support healthier purchasing behaviour. An individual’s goal system architecture may influence the extent to which the reflective cognitive system is employed during behaviour change, which progresses existing knowledge of the influence of goal systems on behaviour change. The present research contributes to the extant literature in relation to user engagement. The intrinsic expressions of engagement are proposed to result from different configurations of engagement dimensions which suggests an interaction between these dimensions rather than an isolated existence. The potential role of involvement as a trigger of engagement phases further challenges the current conceptualisation of engagement. Such findings add to the call for the use of alternative non-quantitative, context specific means of measurement to adequately capture the engagement process. In conclusion, findings suggest the potential to expand existing behaviour change theory, to integrate components of engagement, for improved relevance in the app technology space. Future health app design must consider the individual user and incorporate tailored features to ensure user self-congruence and support continued engagement to facilitate change. Health apps may be an effective tool to support healthier food behaviours in women from a lower socioeconomic background but they may be most effective when implemented as part of a range of individual,
community, and broader structural measures.
Dr Daniela Rohde, RCSI 2014
Cognitive impairment and medication adherence in stroke
Institution: Royal College of Surgeons Ireland (RCSI)
Supervisors: Prof. Anne Hickey, Prof. Kathleen Bennett, Prof. David Williams
The overarching aim of this thesis was to explore the bidirectional association between adherence to secondary prevention medications and cognitive impairment in stroke survivors. A secondary aim was to provide an updated account of the longer-term outcomes of cognitive impairment post-stroke.
Methods and results
Five interrelated studies were conducted to address these aims. Study 1 explored the association between cognitive impairment and cardiovascular medication use in an Irish sample of the general population aged 50+, finding no evidence of an independent association between the use of cardiovascular medications and cognitive impairment. Study 2 systematically reviewed the existing literature on the association between cognitive impairment and medication adherence in stroke survivors, and found no significant association when all included studies were pooled, although heterogeneity was significant and the overall evidence quality poor. Studies 3, 4 and 5 were based on a 5-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort study. Study 3 explored the impact of cognitive impairment on subsequent medication adherence, as well as the impact of medication non-adherence on later cognitive impairment. While this study found no statistically significant associations between cognitive impairment and medication adherence, stroke survivors with cognitive impairment were significantly more likely to receive help with medication taking. Study 4 considered the impact of cognitive impairment on outcomes, finding that cognitive impairment at 6 months post-stroke was associated with significantly increased risk of mortality, further cognitive decline, worse quality of life, lower levels of independence, and increased likelihood of depressive symptoms at 5 years. Study 5 explored family caregiver psychological wellbeing and revealed that family caregivers of stroke survivors with cognitive decline were significantly more likely to experience anxiety and depression.
Taken together, the findings from this thesis do not indicate an association between cognitive impairment and medication adherence in stroke survivors. However, a number of factors could account for this lack of consistent association, including the moderating effect of help received with medication taking, as well as the range of definitions and assessments of non-adherence and cognitive function, which make it difficult to draw comparisons across studies. Given the prevalence of both of these phenomena in stroke survivors, and their associations with poorer outcomes, the design of effective interventions to address medication non-adherence and to reduce the burden of cognitive impairment post-stroke is paramount.
Dr Rebecca Dennehy, UCC 2014
Cyberbullying and Young People: Behaviours, Experiences and Resolutions
Institution: School of Public Health, UCC
Supervisors: Professor Ella Arensman, National Suicide Research Foundation, Ms Mary Cronin, School of Public Health, UCC and Dr Sarah Meaney, National Perinatal Epidemiology Centre, UCC
Cyberbullying is a complex and multifaceted public health issue among young people. Research indicates deleterious effect on the mental health and wellbeing of victims which warrants action to address this issue. Adults do not have first-hand experience of cyberbullying in their youth and so the development of prevention and intervention strategies can benefit from the engagement of young people’s perspectives. However, young people’s voices are largely absent from the current discourse. This thesis aims to explore the nature, causes, and consequences of cyberbullying from the perspective of young people with a view to informing the development of evidence-based prevention and intervention strategies.
The research was framed by the Medical Research Council guidelines for intervention development. Qualitative and participatory research methods were employed. In the first instance a systematic review and meta-ethnographic synthesis of qualitative studies related to young people’s conceptualisations of cyberbullying was conducted. Secondly, a rights-based model was developed to facilitate the active involvement of young people in the research process. A Young Person’s Advisory Group was purposefully formed to collaborate in the design, conduct, and interpretation of a qualitative study of young people’s perspectives on cyberbullying as well as in priority setting for intervention development. Young People’s involvement in the Advisory Group was evaluated to determine the effectiveness off the model in facilitating young people’s participation in the research process and the acceptability of the approach. The co-designed qualitative study comprised focus groups with secondary school students which were conducted in the school setting. Data were analysed thematically.
The meta-ethnography highlighted that the fundamental role of cyber technology in young people’s lives and the complexity and ambiguity of the cyber world in which they connect are inherent to young people’s conceptualisations of cyberbullying. The participatory evaluation
of young people’s involvement in the research process indicated that the elements necessary for the effective realisation of young people’s participation rights were present in this study. Based on their interpretation of preliminary findings from the qualitative study, Advisory Group Members identified the non-consensual distribution of nude images and the mental health impact of cybervictimisation as serious concerns for young people and priorities for intervention development. Findings indicate that non-consensual distribution involves a complex process that is produced by, and reinforces, gender power dynamics. Young males, under pressure to conform to societal constructs of masculinity, coerce females to send explicit images which are screenshot and intentionally distributed, without consent, to male peers in exchange for social kudos. Regarding the mental health impact, cyberbullying was described as more psychological in nature and impact than traditional bullying with increased deleterious effect on the mental health and wellbeing of victims. Analysis identified several barriers which prevent victims from seeking social support and participants’ perception that suicide is a viable escape route for young victims defeated and entrapped by cybervictimisation.
This research makes a valuable contribution to the existing knowledge base in that it privileges youth voice on the nature, causes, and consequences of the phenomenon and highlights young people’s priorities regarding intervention development. In response to research findings and suggestions from the Young Person’s Advisory Group several recommendations, which are grounded in young people’s experiences, values, and norms, are made in relation to research, policy, and practice.
Dr Ailbhe Spillane, UCC 2014
The impact of suicidal behaviour on family members in Ireland: a mixed methods study
Institution: UCC, 2014 cohort
Supervisors: Prof. Ella Arensman (UCC), Dr. Paul Corcoran (UCC), Dr. Karen Matvienko-Sikar (UCC)
Background: Suicidal behaviour is a complex and multifaceted problem encompassing individual, social and environmental components. There is a plethora of studies examining the adverse psychological health effects of suicide bereavement, but high quality research in this area is still limited. However, the physical health consequences of both suicide and self-harm on family members is lacking. There is also a paucity of research exploring the specific support needs of people bereaved by suicide and people experiencing a family member’s self-harm, regardless of severity, both in the short and long-term.
Methods: This doctoral work adopted a mixed methods approach and comprised four studies. Study 1 was a systematic review of the physical and psychosomatic health outcomes of family members bereaved by suicide. Study 2 (Inc. a published protocol) was a mixed methods examination of the physical and psychological health outcomes of family members bereaved by suicide that was conducted using qualitative interviews and quantitative scaled data. Study 3 was a qualitative study exploring how suicide-bereaved family members experienced the inquest process. Study 4 was a qualitative examination of individuals’ experiences of a family member’s high-risk self-harm.
Results: The systematic review found tentative evidence that suicide-bereaved family members have an increased risk of a number of adverse physical health outcomes, including cardiovascular disease, diabetes and hypertension, compared to people bereaved by non-suicide deaths. The qualitative component of the mixed methods study indicated that intense grief reactions, including guilt, blame, anger and shame manifested in exacerbating and prolonging physical, psychological and psychosomatic difficulties. The quantitative component of the mixed methods study demonstrated that suicide-bereaved family members have elevated depression, anxiety and stress levels. The qualitative study exploring the impact of the inquest process identified a number of distressing and challenging aspects for family members, including the timing and setting of the inquest and hearing graphic evidence about their own family member and that of other people who died by suicide. Finally, the qualitative study exploring experiences after a family member’s high-risk self-harm indicated that the health impacts of experiencing multiple high-risk self-harm acts is particularly marked compared to experiencing a single self-harm act.
Conclusion: The doctoral work presented in this thesis is innovative in examining the impact of a family member’s fatal or non-fatal suicidal behaviour from multiple research methods. The health impact of family members experiencing fatal or non-fatal suicidal behaviour are broadly similar and require proactive facilitation of support by clinicians. The inquest process was often viewed as distressing by suicide-bereaved family members. The support needs of people experiencing a family member’s suicide or high-risk self-harm are similar and both groups would benefit from a model of proactive facilitation of support by clinicians and other health professionals.
Dr Kieran Walsh, UCC 2014
Rationalising antipsychotic prescribing in dementia: a mixed-methods investigation
Institution: UCC, 2014 cohort
Supervisors: Dr. Suzanne Timmons (UCC), Prof. Stephen Byrne (UCC), Prof. John Browne (UCC), Dr. Jennifer McSharry (NUIG)
Dr. Caragh Flannery, UCC 2014
Developing a behavior change intervention for physical activity during pregnancy
Institution: NUIG, 2014 cohort
Supervisors: Prof. Molly Byrne (NUIG), Prof. Patricia Kearney (UCC) , Prof. Fionnuala McAuliffe (UCD)
Dr Amelia Smith, TCD 2014
Epidemiological studies in breast cancer: the association of commonly used medicines and specific biomarkers with patient outcomes
Supervisors: Prof. Kathleen Bennett (TCD), Dr. Ian Barron (TCD), Laura Murphy
*not available yet*
Dr Alan Maddock, MU 2014
A mixed methods study examining individual differences in well-being and symptom reduction, and the effectiveness of mindfulness based interventions in psoriasis patient treatment through the lens of the Buddhist Psychological Model (BPM)
Institution: TCD, 2014 cohort
Supervisors: Prof. David Hevey (TCD), Dr. Paul D’Alton (St Vincent’s University Hospital, Dublin)
*not available yet*