PhD opportunities

Potential PhD studies

The following are a list of potential PhD studies which we would welcome applications for. However, it is important to note that we are not able to offer any financial assistance to students wishing to undertake a PhD programme.

Developing culturally competent end-of-life care for South Asian renal patients – perspectives of the family/carers

Supervisor: Professor Gurch Randhawa

Investigating the relationship between social class, age, gender, ethnicity and education of transplant donors and recipients

Supervisor: Professor Gurch Randhawa

Informal caregivers for people with multiple sclerosis: Who are they, what is their level of mental health, and how are they supported?

Supervisor: Dr Chris Papadopoulos

Background: Caregiver burden is a multidimensional response to many factors associated with providing assistance to people with Multiple Sclerosis (MS), including physical, psychological, emotional, and social stressors. This has been highlighted by the 2001 UK Census, in which carers who provide high levels of care for sick or disabled relatives and friends were shown to be more than twice as likely to suffer from poor health compared to people without caring responsibilities. The importance of the role which carers play has been recognised in the recent ‘Healthy Lives, Healthy People’ white paper for Public Health with the Government pledging to provide an additional £400 million available through the NHS over the next four years to support carers.

Aims: The aims of this PhD are to (1) identify the characteristics of UK-based informal caregivers; (2) identify the level and type of assistance they provide; (3) investigate the type of services and support structures available to carers; (4) investigate the barriers of service up-take; (5) assess the level of mental health of carers over time; (6) evaluate the effectiveness of the UK Government's spending on support for carers in terms of mental health; and (7) to provide evidence-based recommendations of how to improve the health of carers.

Methods: A two-point quantitative cross-sectional survey approach will be utilised. These surveys will collect data on carer characteristics, service uptake, and mental health levels. One of these surveys will be conducted as soon as possible, and another will be conducted after 18 months later in order to evaluate whether the Government’s strategy has produced a positive change in mental health level.

Can the ‘individualism/collectivism’ paradigm help to explain cross-cultural alcohol use behaviour?

Supervisor: Dr Chris Papadopoulos

Background: The ‘individualism/collectivism’ (I/C) dimension is one of the most explanatorily useful cross-cultural value paradigms (Triandis, 2006). The paradigm has been extensively examined in relation to a range of cross-cultural psychological phenomena (Berry et al, 2007), although only to a minor degree in relation to alcohol use. This is surprising given that alcohol has been shown to substantially vary in level and meaning across cultures (Johnson, 2007; Foster et al, 2007). Thus, there is a need for research that directly and rigorously investigates this association, as this may help explain some of the cross-cultural variation reported in substance use research.

Aims: The aim of this PhD are to (1) To investigate whether the I/C paradigm helps to explain adolescent alcohol use behaviour variation across UK-based cultural groups; (2) To investigate whether the I/C paradigm helps to explain adolescent alcohol use motivation variation across UK-based cultural groups; (3) to provide a contemporary snapshot of UK-based cultural groups’ alcohol use behaviour and level; and (4) to investigate where the cultures studied fit along the I/C dimension.

Methods: A cross-sectional, questionnaire survey will be employed via the internet using the online survey software. The questionnaire will include the validated ‘Drinking Motivation Questionnaire Revised’ (Cooper et al, 1994) and the ‘Vertical-Horizontal Individualism-Collectivism Scale’ (Triandis, 1995). Furthermore, a set of questions relating to alcohol use behaviour and socio-demographics (including cultural identity questions) will be integrated into the questionnaire.

The use of Skype as an innovative platform for delivering Cognitive-Behavioural Therapy for people suffering from Multiple Sclerosis and depression.

Supervisor: Dr Chris Papadopoulos

Background: It has been well established that there are inequalities in the level and type of access for psychological services. A recent mental health strategy has been to increase accessible treatments, including innovations in Cognitive Behavioural Therapy (CBT) delivery. One innovative platform for CBT delivery has been telephone CBT which several studies have shown good outcomes with (Mohr et al, 2005; Mohr et al, 2007; Beckner et al, 2007; Cosio et al, 2011). Another potentially clinically effective (and cost-effective) innovative platform for CBT delivery could be the use of internet-based video conferencing software such as Skype.

Aims: The aim of this PhD are to (1) examine the clinical effectiveness associated with Skype-based CBT with participants suffering from multiple sclerosis and depression; (2) to determine its relative cost-effectiveness; and (3) to evaluate the acceptability of this treatment platform.

Methods: A randomised controlled trial in which participants with Multiple Sclerosis and depression on a waiting-list for treatment (control group), who are receiving treatment-as-usual (control group), or are randomly assigned to an intervention group (who will receive Skype-based CBT from trained professionals) are compared in terms of clinical- and cost-effectiveness. Acceptability of the Skype-based CBT approach will be assessed by semi-structured qualitative interviews with the intervention participants.

Dying well with childhood cancer

Supervisor: Dr Dong Pang

Decision making in patients, families, physicians, and policy makers in the end-of-life (EOF) care needs reliable epidemiological data. To provide baseline information for palliative care in children with cancer, the Ph.D will explore secondary data from hospitals or other organisations: a) To describe how children with cancer are dying in England, including the direct causes of death, diseases and co-morbilities, place of death, and the remaining life span; b) To make comparisons by socio-demographic characteristics; c) To make cross-culture comparisons among different ethnic groups. In addition, determinants of quality of EOF care will be investigated. The quality of EOF care will be described by experiences of physicians, patients and their families.

References

• Pamela S. Hinds, Jennifer Brandon,Caitlin Allen, Nobuko Hijiya, Rachel Newsome, Javier R. Kane. Patient-reported Outcomes in End-of-Life Research in Pediatric Oncology J Pediatr Psychol. 2007;32(9):1079-1088.
• L Brook, R Hain. Predicting death in children Arch. Dis. Child.. 2008;93(12):1067-1070.
• Johnston DL, Nagel K, Friedman DL, Meza JL, Hurwitz CA, Friebert S. Availability and use of palliative care and end-of-life services for pediatric oncology patients. J Clin Oncol. 2008;26(28):4646-50.
• Hayley Hunt, Unnur Valdimarsdottir, Lorelei Mucci, Ulrika Kreicbergs and Gunnar Steineck. When death appears best for the child with severe malignancy: a nationwide parental follow-up. Palliat Med. 2006;20(6):567-577
• Bronna D. Romanoff. Meaning Construction in Palliative Care: The Use of Narrative, Ritual, and the Expressive Arts Am J Hosp Palliat Care. 2006;23(4):309-316.
• Craig A. Hurwitz, Janet Duncan, and Joanne Wolfe. Caring for the Child With Cancer at the Close of Life. JAMA. 2004;292(17):2141-2149

Palliative care: a cross-cultural comparison between the UK and China

Supervisor: Dr Dong Pang

Culture plays an important role to determine how individuals make meaning out of dying and relevant suffering. With increasing diversity in the UK, it is required to know the cultural differences to avoid cross-cultural misunderstandings at the end of life. In this PhD research project, you will carry out a study to compare palliative care in the UK and in China, and explore issues involved in cross -cultural care in the UK, including cultural beliefs, values, practices, and communication techniques etc.

References

• Kagawa-Singer M, Blackhall LJ. Negotiating cross-cultural issues at the end of life: "You got to go where he lives". JAMA. 2001;286(23):2993-3001.
• Wei-Chen Tung, Hospice Care in Chinese Culture: A Challenge to Home Care
• Professionals Home Health Care Management & Practice 2011: 23(1) 67–68

Application of statistical methods for missing data in epidemiological research

Supervisor: Dr Dong Pang

Missing data are very common in epidemiologic research and are often poorly handled. Although there is plenty theoretical research on the topic (Rubin 1976 and 1988; Little 1976), a number of new statistical approaches, such as multiple imputation, have been developed (Sterne et al, 2009) and used in some epidemiologic studies (Pang et al 2010). In a recent review of 1,105 original studies published during two calendar years in epidemiology journals (the American Journal of Epidemiology, the Annals of Epidemiology, Epidemiology, and the International Journal of Epidemiology), there were only 16 studies (<2%) that used multiple imputation, inverse probability weighting, or the expectation-maximisation algorithm (Klebanoff 2008).

There is a growing need to identify and evaluate current methods, and develop the best methods for analysing epidemiological studies with missing data.

The Ph.D. will focus on the following: a) To review current general methods in the literature of biostatistics, in particular mainstream methods, such as weighting methods and multiple imputation; b) To develop or tailor tools in the analysis of missing data for epidemiologic studies, such as case-control, cohort and cross-sectional studies.; c) To test the tools by means of comparisons of different imputation methods and sensitivity analyses with conventional methods in real epidemiologic studies.

References

• Rubin DB. Inference and missing data. Biometrika 1976;63:581–92.
• Little RJA. Inference about means for incomplete multivariate data. Biometrika 1976;63:593–604.
• Rubin DB. An overview of multiple imputation. Proceedings of the Survey Research Methods Section of the American Statistical Association. 1988:79–84.
• Klebanoff MA and Cole SR. Use of multiple imputation in the epidemiologic literature. American Journal of Epidemiology. 2008: 168 (4): 355-357.
• Sterne JAC, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. British Medical Journal, 2009: 339:157-160.
• Pang D, Jones G, Power C, and MacFarlane GJ. Influence of childhood behaviour on the reporting of chronic widespread pain in adulthood: results from the 1958 British Birth Cohort Study. Rheumatology, 49(10): 2010: 1882-8.

Modelling chronic disease prevention in life-course approach

Supervisor: Dr Dong Pang

To estimate and evaluate the potential effectiveness of strategies, such as high risk and population approaches etc. to the primary prevention of chronic diseases in life-course setting.

The Ph.D will apply epidemiological perspectives to the study of relationships between biological, psychological and social factors as they develop over the life course and how they contribute to chronic diseases by reviewing evidence of cohort and randomised controlled trials as well as other observational studies.

You will conduct secondary analysis of longitudinal birth cohort and panel studies and build disease models using modern sophisticated analytic approaches, such as multiple equation model, Bayesian method, multiple imputation of missing data and machine learning in addition to classical statistical methods.

The strategies to the prevention of rare diseases or of common diseases but in a minority group (socially advantage group) or at the individual will be explored. It is unique that you combine conceptual issues linking risk factors to chronic diseases, the modern methodological base of epidemiology, statistical analysis, and policy.

References

• Rose G. The strategy of preventive medicine. Oxford: Oxford University Press; 1992.
• Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997 17;349(9063):1436-42.

Factors influencing participation in recruitment of normal control research participants in epidemiologic studies

Supervisor: Dr Dong Pang

Participation rates of epidemiologic studies have been declining during the past 30 years, with particularly steep declining in normal control participants (Morton et al 2006; Galea and Tracy, 2007). Studies with substantially differential participation between patient and normal control participants are likely subject to the self-selection bias, which might threaten the generalisation of studies. There is a growing need to know factors /strategies with good recruitment in normal control participants when planning and conducting epidemiologic or clinical research.

To understand good factors and barriers in recruitment of healthy participants in the general population, the Ph.D will explore participant-related factors, investigator-related factors, sampling frames, mode (mail, email, in-person, internet), and monetary incentives etc. in relation to participation. The specific tasks include systematic review and meta-analysis of relevant studies and testing good factors in general population.

References

• Morton LM, Cahill J, Hartge P. Reporting participation in epidemiologic studies: a survey of practice. Am J Epidemiol 2006; 163:197-203.
• Galea S, Tracy M. Participation rates in epidemiologic studies. Ann Epidemiol 2007; 17:643-53.

Understanding the role of ethnicity and masculinity in men's health seeking behaviour

Supervisor: Dr Nasreen Ali

Evidence highlights inequalities in health between men from differing socio-economic and ethnic backgrounds. Cultural beliefs and practices affect men's decisions to seek medical help. Men's health-seeking behaviour (the recognition of a health concern and the consequent service utilisation (Smith, Braunack-Mayer and Wittert, 2006) is affected by specific cultural notions of masculinity which prevent them seeking help (Galdas, Cheater and Marshall, 2005). In other words what masculinity means varies by ethnicity. Notions of masculinity may be an important factor in delays in seeking help among this group. Early diagnosis is vital for successful treatment and it is therefore important to understand reasons why men may not access services in a timely fashion. This qualitative study will look at the impact of cultural beliefs and practices on ethnic minority men's health seeking behaviour for a number of/or one health problem/s: mental health, cancer, diabetes and CHD. This research has the potential to highlight culturally appropriate interventions thus encouraging timely service utilisation, ensuring better disease management, increasing survival, and reducing NHS costs.

• Galdas, P.M., Cheater, F. and Marshall, P. (2005) Men and health help-seeking behaviour: literature review, Journal of Advanced Nursing 49, 6, 616-633
• Smith, J.A., Braunack-Mayer, A. and Wittert, G. (2006) What do we know about men's help-seeking and health service use? MJA, 184, 81-83

The cultural dynamics of sex and sexual health and wellbeing among Black, South Asian and White young people

Supervisor: Dr Nasreen Ali

Young people from ethnic minority backgrounds have often been underserved by mainstream sexual health and well-being services with economic disadvantage, marginalisation and racism contributing to inequalities (Fenton, 2001). It is argued that despite the increased awareness of perceived risk safe sex practices among ethnic minority youth are undermined by negative symbolism, gender imbalance in sexual-decision making and peer pressure (Varga, 1999). This comparative qualitative study will explore how sexual dynamics, encompassing cultural notions of masculinity and patriarchy impact on the sexual behaviour and sexual health and well-being of Black, South Asian and White young people. There will be two main strands to this research. The first will involve a consideration into the way in which issues around sex and sexual practices are talked about by young people from ethnic minority backgrounds, and how these conversations influence their understanding of appropriate sexual behaviour and safe sex practices. The second strand will focus on the analysis of existing health behaviour models and how they can be fine-tuned to have a greater relevance to ethnic minority youth. The study will be informed by critical theory approaches which rigorously interrogate conventional frameworks for understanding sexual behaviour among young people of ethnic minority and culturally diverse backgrounds.

• Fenton, K.A. (2001) Strategies for improving sexual health in ethnic minorities in Current Opinion in Infectious Diseases 14, 1, 63-69
• Foucault, M. (1990) The History of Sexuality Volume 1: An Introduction, Pantheon Books, New York
• Varga, C.A. (1999) Sexual decision-making and negotiation in the midst of AIDS: youth in KwaZulu-Natal, South Africa, Health Transition Review, 7, 3,45-6

Dignity in healthcare

Supervisor: Dr Lesley Baillie

Dignity in healthcare is a core principle, espoused in the NHS Constitution and in healthcare professionals’ codes of conduct. In 2006 the Department of Health launched a dignity in care campaign and this work is now mainstreamed within healthcare policy. However, there continues to be reports of patients, particularly in acute hospitals, experiencing indignity causing distress to patients and their families. This Phd work will be centred on dignity in healthcare and the focus will be on improving dignity for patients in acute hospital settings. The work could be focused in a variety of ways, for example:

• Dignity for a particular patient group in hospital, for example older people, patients at end of life, patients with dementia or a particular condition, such as stroke or trauma; 
• Dignity related to specific care activities or treatments which patients experience in hospital. This might relate to the care or treatments particular health care professionals are involved with.
• Dignity related to a specific care environment in hospital, e.g. Accident and Emergency, Day surgery, intensive care unit, rehabilitation ward
• Dignity experienced across a patient pathway through different units in the hospital.

The study is likely to take a qualitative approach but could take an action research approach.