Many people with dementia and carers receive support through the third sector, including through cultural arts interventions which aim to provide a meaningful, shared experience. Museums are one venue offering these interventions, including non-reminiscence-based programmes. Although there has been some research on the impact of museum programmes, it has tended to focus on positive outcomes. The impact of including carers in these programmes is also not well understood, which means it is not possible to say for which dyads they work, or do not work, or how to best support dyads in this setting.
This thesis aimed to explore how including carers in museum programmes for people with dementia has an impact on the person with dementia, the carer, and the relationship between them, using a realist approach to develop theory. Theories were first developed through a realist review of the literature, and then tested in an evaluation at six museum sites, which included participant-observation of sessions and interviews. From these theories, a generalisable conceptual platform was developed on the core processes involved when carers are included.
This research highlighted that the inclusion of carers has positive impacts, such as shared respite and opening up the museum, and negative impacts, such as highlighting losses and excess disability. The developed programme theories and conceptual platform considered how these outcomes may be generated. This resulted in a number of implications for further research, policy, and practice. The findings may also be applicable beyond museum programmes, and further research could use the theories and platform to consider how including carers may have an impact in other kinds of programmes for people with dementia, and in programmes for other kinds of dyads.
This thesis suggests the inclusion of carers is not a neutral act, and careful consideration needs to go into how to support people with dementia and carers given the variety of positive and negative processes which can occur. Alongside making venues and programmes more dementia-friendly, there must also be a consideration of how they can become more carer-friendly.

Introduction: the focus of previous research on the Alexander Technique (AT), a psychophysical self-management approach, has mainly been in musical performance, physical change, and health outcomes such as pain. This rapid realist review aimed to understand psychological and non-physical outcomes of the AT, and how they may be generated. Methods: Using a rapid review approach, papers with relevance to non-physical outcomes were identified using backward and forward citation searching from two key systematic reviews and consultation with AT experts. Results:. Thirty six documents were included for analysis, which resulted in 8 evidence-informed theory statements on how and for whom non-physical outcomes can be generated by AT lessons. A variety of non-physical outcomes of the AT were found, including improved general wellbeing and increased confidence to address present and future challenges, as well as identifying that difficult emotions can arise in lessons. Two main causal pathways were identified – 1) improvements in physical wellbeing leading directly to psychological wellbeing; and 2) an experience of mind-body integration leading people to apply AT skills to non-physical situations. Conclusions:. The AT may be a useful approach in a range of settings for psychophysical, long-term outcomes, and further research is warranted. We suggest a number of recommendations for practice and further research, including for AT teacher training and the need for mixed-methods research in the AT, and factors which support a person to gain benefit, such as openness to self-management and support to attend regular lessons.

BACKGROUND: in the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. OBJECTIVE: to update and synthesize literature on barriers and facilitators to GP-patient communication about emotional concerns in UK primary care. DESIGN: Systematic review and qualitative synthesis. METHOD: We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. RESULTS: Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. CONCLUSION: the findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP-patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor's domain of expertise; and the value of exploring and shaping new understandings about patients' emotional concerns and their management.

With ageing comes an increased risk of poor health and social isolation, particularly in poorer populations. Older people are under-represented in research and as a result interventions may not take account of their context or barriers to participation. In co-creative work, future service users work with professionals on an equal basis to design, develop and produce a service or intervention. Our objectives were to (a) undertake a co-creation study with older people living in a northern city in the United Kingdom, (b) explore maintenance of health and well-being in older age, (c) explore the application of co-creation with an older community population and (d) evaluate the process and inform future work. The study was conducted during 2017 by a project team of 10 lay community dwelling older people and four university researchers. Findings demonstrate that state of mind and of health were key to well-being in older age. Feeling safe, comfortable and pain free were important along with being able to adapt to change, have choice and a sense of personal freedom. Social connectedness was seen as the keystone to support healthy behaviours. Rather than developing new interventions, there was a perceived need to connect people with existing resources and provide a human 'bridge' to address barriers to accessing these. In conclusion, the co-creation process proved productive, even when undertaken on a small scale. The scope of the project needs to be realistic, to use diverse methods of recruitment and skilled facilitators, and to prepare well in terms of accessibility, simple systems and appropriate information provision.