MSc Global Health 2010-2011
Research Project: Assessment of the Advocacy Campaign of the Egyptian Government and NGOs to Eradicate FGC Practice in Egypt from 1994 to 2010
Objectives: The objective of this study is to assess the strategy and methodology used by the Egyptian government and NGOs in the period 1994 – 2010 to eradicate FGC through their advocacy campaigns.
Methods: The research approach and orientation depend on study and analysis of advocacy campaign documents and documentation pertaining to FGC in Egypt. A survey was carried to assess the effect of the campaigns and to estimate any level of attitude or behaviour change in the community as a result of it.
Results: The study concludes that the sum total of the anti-Female Genital Cutting advocacy campaign operations by the Egyptian Government and NGOs, has not managed to abolish FGC or decrease it significantly. The findings of the Egyptian Demographic Health Surveys, verified by the study’s independently conducted statistical research, confirm this conclusion.
Key Words: Female Genital Cutting, Eradication, Advocacy Campaign, Assessment, Egyptian Government/NGOs.
Dissertation Word Count: 14,983
Background: Biological Sciences
Research Project: Research Protocol for Exploring the Local Women’s Beliefs about the Piave Maternity Ward and Counselling Centre and Traditional Services in Nakuru, Kenya
In the Rift Valley Province in Kenya, it has been reported that over 66% of women give birth at home and over 30% of women use a traditional birth attendant at birth (Kenya DHS 2008). More specifically, in the Nakuru district, the hospitals and public health centres were insufficiently equipped in addition to only about 40% of births being attended by qualified health workers (Reach Out to Humanity 2006). Because of these facts and the high prevalence of HIV and AIDS in the area, in 2006 the Reach Out to Humanity for Health organisation decided that a maternity ward with an HIV and AIDS counselling centre and dispensary was a necessity in the community and needed to be built. An update of the status of the Piave Maternity Ward and Counselling Centre was given in 2010, three years after the opening of the facility but no formal research conducted on its progress and perceived underuse.
Therefore purpose of this investigation will be to evaluate the reasons for the underuse of the Piave Maternity Ward and Counselling Centre. In addition to evaluating the underuse of the facility by the surrounding community, the study will also investigate how the view of traditional medicine, more specifically traditional birth attendants, has been impacted.
This study aims to aid the Piave Maternity Ward and Counselling Centre to align their objectives and services more accurately with the surrounding community’s health priorities.
The study will also investigate how traditional birth attendants’ “business” has been impacted as well as attempt to assess if combining their traditional medical culture with the Western biomedical culture would be possible to be able to reach out to as many people in the community as possible. If the combining of the two medical cultures is in fact possible and both sets of health workers could respectfully work together, the number of human resources for health in that community would increase substantially.
The study is qualitative in nature and will interview women who use the maternity ward and counselling centre, key informants including Ministry of Health staff, health care facility workers, community leaders and traditional birth attendants. NVivo9 will be used to draw themes from the interviews after translating and back translating the interviews. The results will be disseminated by compiling the data into a report for the health workers to analyse and use to help improve their facility.
Keywords: traditional birth attendants, biomedicine, maternal health
Word count: 10067
Donna Kay Corcoran
Background: International Development and Food Policy
Research Project: Add Men and Stir: A Case Study Investigating Teenage Pregnancy and Male Inclusion in Teenage Pregnancy Prevention
Sierra Leone has an estimated population of 5.6 million, approximately one third of which live in urban areas and more than 50% are below age 19. Teenage pregnancy has recently emerged as a societal issue. Each year global statistics estimate that 16 million girls aged 15 to 19 give birth and an uncounted number of births are to girls even younger (WHO, 2008a). Approximately 95% of these births occur in low and middle income countries, where early marriage is common (WHO, 2008b). There is sparse literature associated with the topic of male inclusion in teenage pregnancy prevention in Sub-Saharan Africa. This study aimed to explore the socio-cultural factors associated with male inclusion in teenage pregnancy prevention in Freetown, Sierra Leone. The study was based on primary investigations and draws on a pilot project as a case study. Qualitative methods included focus group discussions and semi-structured interviews with project participants and key stakeholders including teenage boys and girls, adult community members, health workers and project staff. Findings highlight the importance of analysing the axes of power and culture in the GAD approach. Findings indicate that patriarchal structures and gender norms can disempower women, men, boys and girls and inhibit better reproductive health. Understanding these and the possible changes, provide valuable insights with which to inform programmes. Therefore including males is important to support adolescent rights and improve adolescent sexual and reproductive health. However, sexual and reproductive health information alone is insufficient to address the barriers to better reproductive health. It is recommended that programmes seek to include gender transformative strategies, partnerships and advocacy efforts to improve address root causes and improve adolescent reproductive health.
Key words: Teenage Pregnancy, patriarchy, gender, masculinity, Sierra Leone
Word Count: 14,455
Background: Bachelor of Science
Research Project: The Politics of Global Health in U.S. Foreign Policy: 2000 - 2010. Rhetorical Framing of Global Health-Related Multilateral Agreements
Background: Bachelor of Arts
Research Project: Attitudes, Knowledge, Behaviour and Beliefs regarding Second Hand Smoke and Cigarette Smoke among Cardiovascular Patients in Ireland
Principal Argument and Objectives: The tobacco epidemic and the cardiovascular disease epidemic are global issues annually affecting the lives of millions of people. Targeting the tobacco epidemic and targeting the associated exposure to second hand smoke has been shown to produce positive results on attempts to eradicate the cardiovascular disease epidemic. However, the increasing death rates due to both tobacco and second hand smoke indicate the paramount need to improve interventions aimed at reducing smoking rates and second hand smoke exposure. Utilizing health related knowledge has emerged as an approach to successfully alter behavior. The aim of this study was to assess knowledge about second hand smoke among a group of cardiovascular patients, and investigate the relationship between smoking-related behaviors and knowledge about second hand smoke.
Methods: Quantitative research utilizing hypothesis testing, referral sampling and questionnaire tools was conducted to explore levels of knowledge about and attitudes toward second hand smoke among cardiovascular patients at St. James’s Hospital. Data on age, sex, and smoking status was collected to evaluate for factors influencing patients’ knowledge, and to identify a possible trend between smoking behavior and knowledge about second hand smoke. A knowledge index scale was formed from responses to four questions on specific health effects associated with second hand smoke. Analysis was conducted using the Statistical Package for the Social Sciences (SPSS 18.0).
Results: The research identified an overall low level of knowledge about the health effects associated with second hand smoke among cardiovascular patients. Analysis of the results revealed the presence of a relationship between smoking status and knowledge about second hand smoke, and a relationship between smoking status and attitudes towards the health effects associated with second hand smoke and cigarette smoking. Knowledge with respect to second hand smoke was lowest among current smokers who likewise identified less strong attitudes and weaker acceptance for statements on cigarette smoke and second hand smoke.
Conclusions: Results suggest that current efforts aimed at informing patients of the health risks due to second hand smoke are inadequate. At-risk patients, such as individuals with cardiovascular, need to be better informed of specific health consequences linked with their disease. Increasing detailed knowledge regarding the effects of smoking and second hand smoke exposure could lead to stronger risk perceptions and thus, reductions in smoking rates. Utilizing improved informational interventions to increase levels of knowledge and strengthen concomitant attitudes could aid in both the global tobacco epidemic and the global cardiovascular epidemic.
Key Words: Second Hand Smoke, Cigarette Smoke, Cardiovascular Disease, Knowledge
Word Count: 14,956
Research Project: Patient Physician Communication: A comparison of how patient socioeconomic status and physician empathy affect the interaction.
There is a need to address inequalities in healthcare relevant to socioeconomic status. Understanding physician communication and empathy can play an important role in improving the quality of care and reducing inequalities in deprived areas.
This study used an exploratory quantitative analysis of video consultations in a primary care setting to assess the relationship between communication patterns, physician empathy and deprivation. This research used a sample of secondary data that included eight GPs working in the West of Scotland that were selected for variance in deprivation scores of their practice and their patient-rated empathy scores, as defined by the Consultation and Relational Empathy (CARE) measure. The two GPs with the highest CARE scores and the two GPs with the lowest CARE scores were selected from GPs that work with patients in areas of high deprivation. The same selection process was used for the GPs working in affluent areas. The Roter Interaction Analysis System (RIAS) was utilized to code and identify differences is sociolinguistic patterns and compare verbal utterances with the CARE and Scottish Index of Multiple Deprivation (SIMD) scores. Approximately ten consultations per GP were coded.
Results showed that high CARE GPs (i.e. those physicians who indicate a high level of empathy) demonstrated more utterances in categories associated with positive and socio-emotional talk. Yet, interestingly enough, negative rapport building utterances were increased in the high CARE group. Furthermore, the total number of patient utterances were increased in the high CARE group. When assessing high and low deprivation, the results showed that doctors asked more medical questions and gave more medical advice to those in affluent areas, while they spent more time with procedural comments such as transitions, asking the patient to repeat himself/herself, or giving ‘other’ information in high deprivation areas. Finally, when CARE scores were assessed as a factor of deprivation, the results showed an interesting correlation between dominance and the affluent/high CARE group. Also, in high deprivation areas open-ended and closed-ended psychosocial questions asked by the physician were associated with low CARE scores. On the contrary, in the affluent areas they were associated with high CARE scores. Similarly, GPs in affluent areas gave more information regarding psychosocial questions whereas there was no correlation in high deprivation areas, despite the increased number of patients presenting with psychosocial problems. As expected, positive and emotional utterances correlated with higher CARE scores.
It has been previously established by a multitude of studies that there are significant differences in physician communication in relation to patient socio-economic status. However, the results from this study contribute to this field of research by revealing specific verbal utterances that correlate with patient-rated empathy scores. It also takes a unique approach to the social exchange theory and perspective on physician dominance by recognizing the need for balance in the ratio of physician to patient utterances and on the choice of verbal utterances used to progress through the clinical encounter. The results of this study indicate that when the patient and physician share common goals and communication behaviours, a balanced level of physician dominance is not only expected but considered empathic. Recognizing and identifying specific areas of communication allows for strategic approaches in tackling and improving health inequalities in deprived areas.
Word Count: 12,423
Key Words: Patient-physician communication, General Practice, RIAS, Empathy, Socioeconomic status
Anna Mc Nally
Research Project: Examining the experiences of carers and parents of children with disabilities in Moshi town, Tanzania; a qualitative study.
Objectives: Gain an insight into how having a disabled child has impacted upon participants lives; examine if participants have experienced any negative stigma or discrimination as a result of having a disabled child, investigate if participants experience carer burden and examine their positive experiences of caring for a child with a disability.
Method: The study is qualitative and exploratory in nature and followed a phenomenological method. Convenience sampling methods were used to recruit fourteen carers of children with disabilities in Moshi town, Tanzania. Qualitative interviews were undertaken with all participants. The interviews ranged in length from 25-50 minutes and were conducted through a translator.
Findings: Data was inductively analysed manually by the researcher. A number of themes emerged which shed light on the experiences of carers; objective challenges in terms of financial and employment issues as well as the demands of care, along with subjective challenges in the form of stigma, isolation and pity. The child’s progress, respect and happiness were all seen as positive experiences by participants. Participants identified both material and financial needs. In order to deal with the challenges participants use a range of coping mechanisms these include their beliefs, support from different sources and various attitudes.
Conclusions: The findings of this research suggest that objective challenges are common and more significant than subjective challenges. Positive experiences are not as easily identified by the participants as the challenges, but having analysed the data it is felt that the carers do not see their job as entirely negative. This study concludes with recommendations for the setting up of peer support networks for parents so that they can deal better with the subjective burden. Emotional support through peer support networks could improve stress levels among carers. An extension of the hours of care provided by the day care centres run by BCC would enable better opportunities for carers to work and earn a living thus reducing their needs, the financial challenges they face and the objective burden.
Key Words: disability, caregiving, Tanzania, burden, coping strategies.
Word Count: 14,921
Background: Education and Mathematics
Research Project: Social Inclusion of Children with Disability
Background: Social inclusion of physically disabled children with amputations is essential for their mental health wellbeing as well as their personal identity. Since 1948, Palestine has been suffering from a long standing conflict and political instability, which resulted in unprecedented number of children with disability compared to any other country in the world. Those children are suffering from poor social inclusion and mental health status and their problem needs to be addressed. Moreover, local disability organizations are not able to secure the children’s basic needs due to the poor health and social services.
Methods: A hybrid method that combined both quantitative and qualitative techniques was adapted. Two structured questionnaires were administered to 100 children with amputations aged 12-18 years representing the main five governorates in the Gaza Strip. In addition to that children were randomly selected to represent diverse socioeconomic areas such as cities, villages, refugee camps and Bedouin communities. The quantitative data was collected using two questionnaires; GHQ12 and social inclusion questionnaire, while qualitative data was collected by 10 semi-structured interviews with experts working in the field of disability and rehabilitation.
Results: The study showed that 88% of the children’s disabilities were caused by war related incidents. On the other hand, all children both males and females are suffering from poor social inclusion and mental health wellbeing. However, males are more included and have better mental health wellbeing than females (M=3.25 for male and M= 3.61 for females). Significant sex related statistical differences were found in social inclusion (P=.000 ˂.05, 95% C.I -.499 - -.206) and mental health wellbeing (P=.000 ˂.05, 59% C.I -.354 --.1335) respectively. It was also found that the mean value of children live in refugee camps are far less included and have mental health problems compared to those live in the city and other places; they also suffer psychological distresses and poor efficacy. Finally the qualitative data showed that different factors that hinder social inclusion and mental health were identified, mainly political instability, under resourced disability organizations, lack of coordinated efforts, and negative societal attitudes towards disability.
Conclusions: From these results, it is clear that children with disability in the Gaza Strip have poor levels of social inclusion and mental health wellbeing. It was also found that females are less socially included compared to males and their needs should be addressed. Many barriers are hindering social inclusion of children with disability in Palestine were identified and therefore a high level decision making is needed to improve their situation. Finally, a new questionnaire for social inclusion was developed for the Gaza Strip which can now be used as a tool to assess social inclusion of similar contexts as well as a culturally adapted and standardized GHQ to assess mental health wellbeing.
Key words: Social Inclusion, Mental Health, Efficacy, Psychological distress, and Amputations.
Word Count: 14990
Background: International Development and Food Policy
Research Project: An Evaluation of the Relevance, Effectiveness, Efficiency, Impact and Sustainability of the Community-led Total Sanitation (CLTS) Approach in Liberia
Sanitation is a basic human need, a Human Right and the greatest medical achievement in nearly two centuries; however, sanitation continues to be relatively unappreciated in the plethora of issues facing low-income countries and continues to be under-resourced by donors and governments. Liberia, one of the poorest countries in the world, has recently endorsed Community-Led Total Sanitation as an approach to increasing sanitation coverage and reducing health burdens in rural areas. Through the use of this innovative low-cost approach facilitators ignite communities to take action; to overcome sanitation issues; and ultimately take development into their own hands. Liberia, however, is a unique context – recently out of war with a heavily donor dependent population.
This evaluation, using a descriptive, qualitative, cross-sectional study design, sought to establish the overall effectiveness, impact and sustainability of CLTS within the Liberian context, through OECD/DAC criteria for evaluating development assistance. The evaluation identified numerous issues that are affecting the ability to achieve sustained open defecation free communities, none more so than the facilitators involved and the monitoring of communities. CLTS, in Liberia, can be an effective tool, not only to increase sanitation demand and use of facilities but also to overcome the dependency of the population on external actors, enabling communities to identify their own needs and collectively take action to better their lives. However, without ensuring technically skilled and trained facilitators and continuous monitoring and support to communities, this process is unlikely to achieve established goals, let alone enable communities to move up the sanitation ladder.
Key Words: CLTS; Liberia; Community-Led Total Sanitation
Word Count: 14,876
Background: Political Science
Research Project: Infant Feeding Methods and Children’s Chronic Respiratory Illness Outcomes in Ireland: Is there an Association?
Objectives: The purpose of this study was to investigate whether or not there is an association between infant feeding methods and chronic respiratory illness in children in Ireland. The study also aimed to find if an association was dose-dependent (i.e. influenced by breastfeeding duration).
Methods: A quantitative method was used to examine secondary data from the Growing Up in Ireland (GUI) study. SPSS (PAWS) version 18 was employed to analyze the variables of breastfeeding and breastfeeding duration in relation to chronic illness and chronic respiratory illness in the 9-year-old GUI cohort. Data was analyzed using descriptive statistics and Chi-square independence tests.
Results/Conclusions: The study concluded that a statistically significant association between infant feeding method (breastfeeding) and chronic respiratory illness did not exist. The study failed to reject the null hypothesis that breastfeeding and chronic respiratory illness are independent. In turn, dose-response analysis was not conducted, as this second hypothesis was dependent on the first holding true.
Word Count: 10,390
Keywords: infant feeding, breastfeeding, chronic respiratory illness, asthma, Growing Up in Ireland Study
Sitting Allowances and Risk Perceptions and Prioritizations: An Exploration of the Effectiveness of Development Programs in the context of Sitting Allowances in Balaka, Malawi.
Objectives: The purpose of this research project was to investigate everyday risk and worry perceptions among adults living in the Balaka district of Malawi. By prioritizing their everyday worries and risks, this study aimed to identify worrisome issues other than HIV that could act as a barrier to preventing the virus or voluntary participation in an HIV prevention program. This study aims to investigate the use of sitting allowances in relation to participant’s willingness to attend such capacity and developmental programs. From such, it aims to examine the consequences sitting allowances have on overall development both a national and international level.
Methods: A qualitative interpretivist research method was used in this study. Using a convenience sampling method, focus group discussions with local participants and key informant interviews with NGO workers were conducted to obtain data.
Results: In an area where HIV prevalence is 16.2 percent, the top three concerns listed by respondents were financial concerns, food insecurity and a lack of both proper shelter and education. These worries were mentioned up to three times more than worries about the risks of HIV. Despite this, each participant agreed that they would be willing to attend an HIV prevention program. This apparent anomaly led the researcher to consider ‘sitting allowances’ – financial incentives received by attendees at such programs. Further research into sitting allowances found that the use of sitting allowances by NGO capacity and developmental programs are now an expectation rather than an incentive for participation. Sitting allowances are replacing the focus of meetings and trainings as the primary motivation for attendance. This motivation has and continues to create developmental implications such as competition between NGOs and overall issues of sustainability.
Conclusions: Sitting allowances are replacing the focus of meetings and trainings as the primary motivation for attendance. This motivation has and continues to create developmental implications such as competition between NGOs and overall issues of sustainability.
Keywords: HIV; risk perception; risk prioritization; Hierarchy of Need theory; sitting allowances
Word Count: 14, 961
Background: Public Health
Research Project: An Assessment of the Quality and Appropriateness of the Maternal Health Services Provided by the Majengo Health Centre in Moshi, Tanzania.
Objectives: To assess the quality and appropriateness of the maternal health services provided by the Majengo Health Centre.
Methods: A convenience sampling method was used to recruit participants from the Majengo Health Centre. The principal investigator conducted key-informant interviews with 10 health care professionals employed by the clinic and 14 patients utilizing or have utilized the clinic’s maternal health services.
Results: Findings of this study suggest an overall ability of Majengo Health Centre to attain the appropriate basic maternal health routine services. However, the analysis of findings promoted questions of the clinic’s ability of overall sustainability due to the lack of resources, which allows enhancement of the clinic’s capacity of quality. Essential resources required for maternal health includes the access and availability of funding, equipment, health education, medical supplies, technology, medicines and the direct access to emergency obstetric care. Although all these were at some given time present, Majengo Health Clinic is not capable of sustaining and maintaining their presence.
Conclusions: Despite the localized success of preventing maternal mortality, the Majengo Health Centre suffers from overarching issues of sustainability. Due to its inconsistent access to necessary resources, the clinic is contributing to the lack of likelihood of achieving the fifth Millennium Development Goal. Thus, in addition to enhancing the availability of resources and sustainability, developing countries, especially in sub-Saharan Africa, must efficiently identify service gaps in order to make progress towards the reduction of maternal mortality.
maternal health services, appropriateness, quality, provision of care, experience of care
Word Count: 13,799
Research Project: An investigation into the economic empowerment strategies employed by Zambia National AIDS Network, targeting women in Lusaka Province of Zambia.
The Zambia National AIDS Network, introduced grants for income generating activities to Civil society organizations as a means for sustainability. Taking into account contributions from community led efforts and initiatives in the fight against HIV /AIDS, ZNAN projected that it will be worthwhile for community organizations to continue implementing HIV prevention, treatment and care and support programmes rather than depending on donor funding. In light of this the initiative to fund sub projects for income generating activities was born.
This study an investigation into the economic empowerment strategies employed by Zambia National AIDS Network (ZNAN) targeting women in Lusaka Province of Zambia employed mixed methods approach to explore the strengths and weakness or challenges encountered by ZNAN and the women implementing the income generating activities.
Participants were sub divided into three levels: national level programme officers responsible for coordinating the IGA programmes, district level project coordinators responsible for supporting and overseeing the women groups and community based organizations managing businesses for income generating.
Using focus group discussions and interviews, the following were identified as barriers to sustainability of group owned businesses: high poverty levels, lack of access to financial resources, lack of infrastructure and equipment, gaps in training, in adequate personnel, lack of an impact evaluation framework, weak monitoring and evaluation system, succumbing to donor pressure to disburse funds in short time frame and lack of opportunity for exposure tours on business management trainings. A survey (quantitative) was undertaken to ascertain whether the interventions actually empower women or not.
Findings from the survey indicated that interventions by ZNAN empowered the women both at society (local level) and market (intermediary level) domains. Women empowerment on both domains is discussed in detail in the results and conclusion.
Word count 14, 864
Background: Veterinary Science
Research Project: The role of community based veterinarians in adopting a “One Health” approach to address neglected endemic disease in Eastern Province, Rwanda
Zoonotic pathogens account for two thirds of infectious diseases in people while more than 75% of emerging zoonoses are the result of wildlife-origin pathogens. A recent surge of interest in zoonoses has evolved with an emphasis on the new and emerging disease pandemics. This interest has evolved as a result of the global challenges of transboundry disease threats. Many international supported projects are starting up in developing countries funding major global programs to support research and building capacity for rapid surveillance and response systems to prevent such zoonotic pathogens escaping beyond their host populations. However within the rural based communities of these same countries a number of endemic diseases affecting people and livestock continue adding to the disease burden. Such diseases including rabies, bovine tuberculosis, brucellosis, cystic echinococcus and anthrax remain neglected.
This research aims to investigate if veterinarians working within their local communities could broaden their role by adopting a One Health approach to address these neglected endemic diseases. The researcher, a practicing veterinarian used a One Health approach to collect primary data by observations and cross-sectional interviews on 100 farms. The data collected was inputted into SPSS for exploratory data analysis and frequency tables and cross tabulations were used to describe it. Inferential statistics were also used out to test the significance of various factors against human and livestock health status.
This research identifies areas where there are weaknesses in farm biosecurity and potential factors that may affect transmission of zoonoses. By identifying factors involved in predisposing people and animals to zoonotic diseases, practical interventions can be taken to control the spread of these diseases across the farm fence or the farmhouse threshold. Due to the frequency of contact and the close relationship with livestock owners within their communities a full appreciation of the potential role of community veterinarians in One Health needs to be fully realised.
Word count: 14,064
Key word: Community Veterinarians, One Health, Neglected Endemic Diseases, Rwanda, Livestock
Background: Occupational Therapy
Research Project: An Exploration of the QOL of Parent Carers of Children With Intellectual Disability in West Dublin, Ireland
Due to technological advancement the number of children with intellectual and other forms of disabilities in Ireland and globally are increasing. The number of children with Intellectual Disability (ID) and other disabilities in Ireland being cared for at home are also increasing due to the recent emphases on the caring of people with disabilities in their homes. As these numbers are increasing the numbers of those who care for them in the homes are also increasing.
For all parents caring for one’s child (ren) brings joy and achievement but also has challenges and stress. However parent carers of children with ID have been regarded as a unique group of caregivers as they face unique circumstances and challenges and these affect the Quality of life (QOL) of these parent carers. This studies was therefore done to explore the perceptions of parent carers of children with Intellectual Disability in relation to their Quality of Life. Purposive sampling was used to recruit participants and in - depth interviews were used to explore experiences and factors that affected the QOL of 6 parents of children with ID who participated in this study and that of their families.
The results of the study revealed that there were both negative and positive factors that affected the QOL of the participants involved in this study. The negative factors included stress, isolation, health problems, financial difficulties, lack of support from family, friends and relevant services providers. On the positive side all the participants in this study said they had gained from looking after their child with ID. Some parents learnt to love and give, others learnt to put others first and some have become more confident through the need to fight for the needs of their children.
Another notable finding was that even though these parents were experiencing some challenges they were still happy with their lives and that of their children despite the amount and complexity of the caring involved, what they needed was support from relations and relevant services providers to afford them breaks and to further enhance their QOL and that of the whole family.
Keywords: Parent carer, Quality of Life, intellectual disability, Irish, child, family, perception.
Word count: 16 000