PhD Opportunities for 2008/2009
Applications are invited for a postgraduate award in Health Services Research funded by the Northern Ireland Research and Development office. The successful candidate will follow a three year full-time programme of research study on the topic “Risk of congenital anomaly among multiple births in Europe” for the degree of Doctor of Philosophy at the University of Ulster (www.ulster.ac.uk). This postgraduate studentship will be tenable in the Faculty of Life and Health Sciences, University of Ulster, and be based on the Jordanstown campus.
The award will comprise fees (at the Home rate only) and an annual stipend of £12,940.
Candidates should have UK residence and hold, or expect to obtain by 15 August 2008, a first or upper second class honours degree in biomedical sciences, psychology, nursing or an area related to health or health services, or in mathematics/statistics. Candidates should be able to demonstrate interest and aptitude for training in quantitative analysis of health data.
For further information please contact:
Research Office, University of Ulster, Cromore Road, Coleraine, BT52 1SA
E: hj.campbell@ulster.ac.uk T: 028 7032 4729 or 028 7032 4031. Application materials are available on the University web site at http://www.ulster.ac.uk/researchstudy.
The closing date for receipt of completed applications is 30 May 2008.
Interviews will be held in June 2008.
PhD project outline:
“Risk of congenital anomaly among multiple births in Europe”
In Northern Ireland and Europe, the rate of multiple births has been increasing steeply due to the combined effect of a rise in maternal age and increased use of assisted reproductive technology. Multiple births are well known to carry a higher risk of perinatal mortality, preterm birth and cerebral palsy. Risk of congenital anomaly is less well documented. This project will assess the risk of congenital anomaly among multiple births using the database of EUROCAT (European Surveillance of Congenital Anomalies www.eurocat.ulster.ac.uk) at the University of Ulster, a unique database derived from 39 population-based registers of congenital anomaly in Europe now covering one quarter of the European birth population, and more than 6 million births since 1980. Specifically, the project will a) determine the excess risk of all and selected congenital anomalies in multiple births compared to singleton births in Europe b) describe the excess perinatal mortality due to congenital anomalies among multiple births in Europe and explore possible interpretations and c) determine levels of concordance in twins. The research will provide an opportunity to work with public health professionals, academics and clinicians across Europe. The programme will provide epidemiological training.
Supervisor: Professor Helen Dolk (h.dolk@ulster.ac.uk, Tel 028 90368540) of the Faculty of Life and Health Sciences. Candidates are invited to make informal inquiries or requests for further information about the project.
Project Title:
Breastfeeding Support On-Line: Exploring, Designing and Testing a Motivational Intervention
Supervisors:
Professor Marlene Sinclair, Professor George Kernohan, Advisor: Dr. Janine Stockdale
Level: PhD
Background to the project:
The WHO recommends that women should exclusively breastfeed for six months. Relevant breastfeeding instruction is a critical component (Sikorski 2004) but women do not always find relevant instruction through direct interaction with health professionals (Hanns 2004, Dykes 2006).
The Internet is universally accessible to women in UK & Ireland and pregnant women are becoming increasingly efficient in terms of searching for, and appraising information received (Lagan et al, 2006). With over 15 million sites available for breastfeeding there is evidence to suggest women need breastfeeding information and they are motivated to satisfy their desire or goal by seeking information from the Internet. An examination of the motivational content of key breastfeeding web sites concluded that the Internet is an unknown but potentially rich resource for enhanced breastfeeding instruction (Stockdale et al (2007). Breastfeeding women are motivated to search for instruction when they require directional goals and assurance that their breastfeeding experience is progressing successfully. Women search for relevant information that either shows them how to increase their confidence (Butler 2000).
Objectives of the research:
• To explore women’s perceptions of the usefulness of on-line support instructional programmes for breast feeding
• To assess the motivational content of current on-line breastfeeding instruction
• To design a woman-friendly motivationally enhanced web-based programme for breastfeeding mothers that meets their perceived need
• Test the effectiveness of the developed e-learning breastfeeding instructional programme
The aim of this research is to develop and test an on-line, motivational instructional package for pregnant and lactating women.
Methods to be used:
This study requires an exploratory and experimental approach and will include the evaluation of current on-line breastfeeding programmes and breastfeeding support web sites using an evaluation motivational framework; the ARCS Model of Motivational Instructional Design (Keller 1979). The four phases of the ARCS Model concentrate on defining and meeting the perceived needs of the users.
Phase one and two focus on analysing current web based (“e-breastfeeding”) instruction and women’s perceived need for such instruction. Based on the findings, phase three will concentrate on the application of motivational strategies that will enable the development of a motivationally enhanced on-line instructional support programme. Phase four will test the effectiveness of the resultant e-learning programme through application of an on-line questionnaire to obtain data including the main outcome measure: evidence of persistence in breastfeeding behaviour.
References:
Butler R. (2000) What Learners want to Know: the role of achievement goals in shaping information seeking, learning and interest. In: Intrinsic and Extrinsic Motivation, The search for optimal Motivation and Performance. Academic Press USA pp 161
Keller JM. (1979) Motivation and Instructional Design: A Theoretical Perspective. Journal of Instructional Development 2(4): 26-34
Lagan B, Sinclair M, Kernohan G (2006) Pregnant Women’s use of the internet: a review of published and unpublished work. Evidence Based Midwifery 4(1): 17-23
“Breastfeeding in Hospital: Mothers, Midwives and the Production Line” (2006) Fiona Dykes; Routledge
Hanss K., (2004) Confidence and breast feeding: a view from the front-line. Journal of Family Health Care. Vol 14:1 21-24
Stockdale J, Sinclair M, Kernohan WG, Keller JM. (2007) Exploring the potential of the Internet to motivate breastfeeding. The Royal College of Midwives. Evidence Based Midwifery 5(1): 10-5
Sikorski J., Renfrew MJ., Pindoria S., Wade A., (2004) Support for breastfeeding mothers (Cochrane Review). In: The Cochrane Library, Issue 1,. Chichester, UK, John Wiley & Sons, Ltd.
Skills required of applicant:
In preference the applicant ought to have a Master’s degree and have undertaken relevant research in pregnancy and have good communication and written skills.
Experience of working as a midwife with pregnant women is advantageous. Some experience in interviewing, using data management packages such as SPSS and NVivo would also be helpful.
The individual would also need to be highly motivated and able to work independently.
Project Title:
Physical activity during pregnancy: an investigation of women’s preferences, experiences and perceptions
Supervisors:
Professor Marlene Sinclair (Chair in Midwifery Research and practising midwife)
Dr Dianne Liddle (Physiotherapist and exercise physiologist)
Advisors
Dr Marie Murphy (Accredited exercise physiologist and physical activity and health researcher)
Dr Eric Wallace (Director of Sports Research Institute)
Level: PhD
Background to the project:
Increasing proportions of the population are not meeting the recommended physical activity levels for maintaining good health resulting in rising obesity levels (Haskell et al., 2007). This trend extends to women of reproductive age, and has been found to result in the development of certain complications during pregnancy such as term stillbirth, pre-eclampsia, gestational diabetes and pregnancy-induced hypertension (Villamor and Cnattingus, 2006). In addition, depression and low back and/or pelvic pain are common complications of pregnancy (Gutke et al., 2007), which can contribute to weight gain, increased use of health care resources, work disability, and reduced quality of life (Olsson and Nilsson-Wikmar, 2004). A recent report in the British Medical Journal has highlighted the importance of maintaining a healthy weight before, during and after pregnancy in order to reduce the risk of developing such complications (Walsh and Murphy, 2007). Exercise is recognised as being a safe and effective means of controlling weight, balancing mood, improving self-esteem (Haskell et al., 2007) and the American College of Obstetricians and Gynaecologists (ACOG) currently recommend moderate exercise at least three times per week during pregnancy to enhance maternal fitness and well being (ACOG, 1994). Despite the above recommendations, the physical activity levels of pregnant women are reported to typically decrease during pregnancy, particularly from the second to third trimester (Rousham et al., 2006). Most pregnancy studies have relied on self-report to estimate habitual physical activity and there is a lack of rigour in many of the designs. Therefore, this study proposes to explore the factors influencing participation in regular physical activity during pregnancy
Objectives of the research:
To undertake a structured review of the literature to determine the range, and quality of evidence pertaining to the bio psychosocial and perceived health effects of moderate intensity exercise in pregnancy
To identify the factors influencing pregnant women’s decision making with regard to engagement in, and adherence to exercise / physical activity (preference, gestational factors, expectations and information available)
To make recommendations for the proposed development of evidence-informed guidelines for pregnant women with regard to exercise in pregnancy
Main research questions being addressed by the project
What evidence is currently available for the use of moderate intensity exercise in pregnancy?
How do pregnant women perceive the value of exercise in pregnancy?
What are users and educators opinions of current guidance on exercise in pregnancy?
Methods to be used:
The proposed research question is best answered using a mixed-method approach:
Structured literature review
Semi-structured interviews with pregnant women and new mothers to explore their perceptions of current advice (provided routinely on exercise in pregnancy) and to seek their willingness to engage in different levels of exercise
Survey of pregnant women’s current exercise and activity levels (design will be informed by the literature review and appropriately selected valid and reliable research instruments.
Focus Groups to determine appropriate and achievable recommendations for evidence-informed guideline development.
Sample
Interviews Primigravidae women will be recruited into the study at 6-12 weeks gestation and interviewed at 28 weeks, 36 weeks and three to six months post natal.
Survey Power analysis will be used to determine sample size for the survey
Focus groups The first focus group will be undertaken with 6-8 users of the service
The second focus group will take place with policy makers and educators and will include 6-8 participants
References:
Haskell WL, Lee. I-M, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. (2007). "Physical activity and Public Health. Updated recommendations from the Americian college of Sports Medicine and the American Heart Association." Circulation 2007; 116: 1-14
Olsson C, Nilsson-Wikmar L. Health related quality of life and physical ability among pregnant women with and without back pain in late pregnancy. Acta Obstetricia at Gynaecologica Scandinavica 2004; 83: 351-357.
American College of Ostetricians and Gynaecologists Technical Bulletin no. 189 Exercise during pregnancy and the postpartum period. International Journal of Gynaecology and Obstetrics 1994; 45: 65-70.
Gutke A, Josefsson A, Oberg B.Spine. Pelvic Girdle Pain and Lumbar Pain in Relation to Postpartum Depressive Symptoms. Spine 2007 32 (13):1430-1436
Rousham EK, Clarke PE, Gross H. Significant changes in physical activity among pregnant women in the UK as assessed by accelerometry and self-reported activity. Eur J Clin Nutr 2006; 60(3): 393-400.
Walsh JM, Murphy DJ. Weight and pregnancy. BMJ 2007; 335: 169.
Villamor E, Cnattingus S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population based study. Lancet 2006; 368: 1164-1170.
Skills required of applicant:
In preference the applicant ought to have a Master’s degree and have undertaken relevant research in pregnancy and or exercise physiology.
Experience of working with women who are pregnant would be advantageous. Some experience in interviewing people and using statistical packages such as SPSS would also be helpful.
The individual would also need to be highly motivated and able to work independently.
Project Title:
Exercise for Low Back Pain in Pregnancy: an exploration of current practice and recommendations for future management.
Supervisory team:
Dr. Dianne Liddle, Prof. Marlene Sinclair, Prof. Frank Dobbs
Statistical advisor: Ms Evie Gardner
Contact Details: sd.liddle@ulster.ac.uk; m.sinclair1@ulster.ac.uk; f.dobbs@ulster.ac.uk
Level: PhD (DEL / VCRS)
Background to the project:
Clinical guidelines are not available for the management of low back and / or pelvic pain (LBPP) in pregnancy, despite the fact that over 2/3 of women experience symptoms, which typically increase as pregnancy progresses (Pennick and Young, 2007). Its pathophysiology is poorly understood (Mogren and Pohjanen, 2005) which makes effective management problematic. Reductions in activity, to avoid pain, and increases in body mass index (BMI) have been identified as significant risk factors for sustained LBPP both during and after pregnancy (Mogren, 2006; Gutke et al., 2007), which along with other complications such as depression (Gutke et al., 2007) can result in reduced quality of life, increased health care use, and work disability (Olsson and Nilsson-Wikmar, 2004). Exercise is a safe and effective means of controlling weight, improving self-esteem, and reducing the disability often associated with back pain (Haskell et al., 2007; Hayden et al., 2005), and its use in the management of LBPP in pregnancy is supported (Pennick and Young, 2007). However, high quality research is needed to determine the value of exercise for LBPP in pregnancy, in particular whether a dose-response relationship exists, what type(s) of exercise, if any, pregnant women engage in, factors influencing adherence, and their perspective on current management strategies for LBPP in pregnancy.
Objectives of the research:
To determine the quality and methods of exercise prescribed within RCTs to pregnant women experiencing LBPP; to generate a profile of the activity and / or exercise levels of a cohort of pregnant women, their willingness to engage in wellness behaviours, and their experience of LBPP in pregnancy; to qualitatively explore women’s’ experience(s) of LBPP in pregnancy, their views on the effectiveness of treatment received, and recommendations for future management; to design and pilot test an exercise intervention for women presenting with LBPP in pregnancy.
Methods to be used:
A systematic review of RCTs using exercise for the management of LBPP in pregnancy, specifically the quality of exercise prescription, whether a dose / response relationship exists, adherence rates, and evidence of biopsychosocial effects; 2. A survey investigating the typical activity levels, and incidence of LBPP in a cohort of women who have recently given birth in Northern Ireland (n=200), and their willingness to engage in wellness behaviours; 3. Focus groups exploring women’s experiences of, and recommendations for the future management of LBPP in pregnancy; 4. Pilot RCT (n=30) to assess the value of a programme of exercise (based on the information collected from the above studies) for pregnant women experiencing LBPP when compared to current clinical practice.
The findings from this PhD thesis will help to generate recommendations for future practice.
Outcomes: Numerical rating scale (0-10) – pain frequency and intensity; quality of life; health care use; work disability; satisfaction with care; change in body mass index (BMI).
References:
Pennick WE, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. The Cochrane Database of Systematic Reviews 2007, Issue 2.
Olsson C, Nilsson-Wikmar L. Health related quality of life and physical ability among pregnant women with and without back pain in late pregnancy. Acta Obstetricia at Gynaecologica Scandinavica 2004; 83: 351-357.
Skills required of applicant:
This application is suitable for a postgraduate student with experience in exercise programme design from a physiotherapy, midwifery, exercise science background.
Project Title:
Complementary And Alternative Medicine (CAM) In Pregnancy and Birth
Proposed Supervisors:
Dr. Ciara Hughes and Prof. Marlene Sinclair
Level: suitable for a PhD or Clin M Res student
Background to the project:
Recent research by Hatamleh et al (2005) demonstrates clearly the pattern of morbidity associated with induction of labour including increased instrumental delivery, higher rates of admission to ICU and a higher incidence of perineal trauma. With the increasing use of technologies in childbirth (Sinclair & Crozier, 2004) the role of CAM in facilitating women to achieve a more ‘normal birth’ is being highlighted. The use of CAM during pregnancy is increasing. Allaire and colleagues (2000) found 94% of midwives surveyed recommended CAM to women in their care for nausea, vomiting, musculoskeletal pain, anxiety, stress, fatigue and indeed facilitating labour. The House of Lords (2000) has advised research into the efficacy and safety of individual CAMs. In addition The Royal College of Midwives Code of Professional Conduct (2004) calls for research to ensure that the use of complementary therapies is safe and in the interests of women during pregnancy.
Reflexology is currently provided within the Royal Jubilee Maternity Hospital for women in the third trimester of their pregnancy. A small retrospective cohort study comparing primparous women who had received reflexology to a randomly selected low risk primparous control group was recently conducted within this unit (McNeill et al 2006). The study indicated that reduced labour time and a reduction in the use of analgesia during delivery might be attributed to reflexology treatments received prior to labour. However there is little published data on effectiveness of reflexology for either managing symptoms associated with pregnancy or on birth outcomes.
Objectives of the research:
To provide baseline data on the effectiveness of CAMs for the management of symptoms associated with pregnancy and birth, and so influence the knowledge and attitudes of health professionals towards the use of CAM in pregnancy
Aim: To identify the current use of CAM in management of the symptoms associated with pregnancy and birth outcomes and to assess the impact of reflexology on birth outcomes.
Methods to be used:
A multi-method approach involving a structured literature review, surveys of pregnant women and health professionals, and a pilot clinical study.
A structured review of the literature and a critical appraisal of the evidence with regard to assessment, treatment and outcomes from commonly used CAMs.
A survey of pregnant women within N.I. to determine the current use of complementary therapies for pregnancy, birth and in the post partum period.
A survey of N.I. health professionals knowledge of and attitudes towards the use of CAM in pregnancy and the postpartum period
A pilot clinical study based at RJMH to investigate the effect of reflexology during the third trimester of pregnancy on birth outcomes (labour time and delivery mode).
References:
Allaire AD. Moos, MK, Wells, SR. Obstet Gynecol. 2000; 95, 19 – 23
Hatamleh R., Sinclair MK., et al (2005) Conference Proceedings TCD 2005
Sinclair, M.K., Crozier, K. (2004) British Journal of Midwifery 12 (8): 509-513
Mc Neill, J. Alderdice F. McMurry, F. (2006) Comp Ther Clin Pract. 2006 12 (2) 119-25.
Skills required of applicant:
This application is suitable for a student from any health care background. Knowledge in CAM and pregnancy is desirable.
For further information please contact Dr. Ciara Hughes or Prof. Marlene Sinclair
e-mail: cm.hughes@ulster.ac.uk Tel: 028 9036 6227
e-mail: m.sinclair1@ulster.ac.uk Tel: 028 90368118