Psychological understanding of the impact of health interventions in relation to chronic conditions

Harding, Sam (2019) Psychological understanding of the impact of health interventions in relation to chronic conditions. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

This thesis describes original research by the author into the quality of life impact of significant health interventions on patients’ psychology. Nine publications spanning 10 years of research, multiple medical specialities, and study methodologies, are presented. A unifying factor across this research is that all participants have been in receipt of an evidence-based intervention to address their specific challenges. Six papers describe primary data collection and analysis to gain an understanding of prevalence or change over time of a health psychology phenomenon. Following on from these papers, three systematic reviews are included. These present the evidence base for psychological phenomena in a population, or the effectiveness of an intervention. The thesis is structured around the design of the studies included. Three distinct study designs are employed; 2 single time point or ‘snapshot’ paper, 3 two-time point or ‘Pre- & Post’ studies, and a longitudinal study. All adopted a cohort approach for both methodological and practical reasons. Each produced findings that contribute to our knowledge of the phenomenon under investigation, as outlined in the following chapters. The longitudinal cohort study, additionally contributed methodologically to the field of health psychology research. By using a novel adaptation of cross-sequential design, and Linear Mixed-effect Modelling for analysis, this research demonstrated how long term conditions in relatively small populations can be rigorously investigated. All six primary research papers recognise the importance of Public Patient Involvement. I have always taken a strong moral stance on the inclusion of the patient perspective in study design and data interpretation, and it is now being formally included as a core part of health psychology research design and funding. As a Health Psychologist and methodologist, this thesis reflects on how working with research participants across projects has influenced my clinical and research practice, and how I have tried to explore the impact of their treatments on psychological wellbeing. I present how each paper has contributed to new knowledge and how it has informed my development as an independent researcher. Lastly, I propose a 10 research agenda, informed by the research in this thesis, with suggestions of how this may fit with my research interests, the changing face of research and service provision within the NHS and social care.