This study explored the experiences of members of an OCD support group, utilising a qualitative design, social constructionist approach, and a systemic framework. Participants were obtained through purposive sampling; data was collected via faceto- face semi-structured interviews with four participants. It emerged that these participants attended two OCD support groups (initial support group and sub-support group). The participants’ experiences were analysed using thematic analysis. Major findings: the participants’ motivation to attend both support groups was to reduce their OCD symptoms and improve functioning. The initial support group was a professional-led psychoeducational support group while the sub-support group was a self-help psychotherapeutic group. The groups also complemented each other with information from the initial support group being implemented in the sub-support group. The participants reported to have benefitted from participation in both support groups as their OCD symptoms reduced and their daily functioning improved. Recommendations for future research were discussed. / Psychology / M.A. (Clinical Psychology)

Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The concern of this study is primarily with insights, either acquired or original, which may be gleaned from the works of Michael Quinn Patton, especially his seminal book, “Utilization-Focused Evaluation” with regards to utilisation of evaluation. The importance of utilisation of evaluation processes and findings cannot be overemphasised. Use is critical to the success of multiple development programmes in South Africa which collectively will ultimately determine the country’s accomplishment of its developmental goals. The study is an analysis of the relevant literature on utilisation of evaluation; comparing and contrasting Patton’s writings with those of other scholars on this topic of utilisation. The process of understanding these insights involves a brief biography of Patton to get a glimpse into the factors which influenced the development of his ideas and to learn from them as well as from his innovative ideas. The major theme of utilization-focused approach to evaluation is utility and actual use of evaluations. The study therefore devotes special attention to these concepts in order to find out how he defines them, his motivation to focus on them and his perceptions of the purposes of evaluation. These determine his conception of the evaluation field; and his success in promoting evaluation utilisation is measured against them. The study also contains a detailed discussion of the so-called “paradigms debate” between the quantitative and qualitative paradigms in the educational and social sciences in the 1960s and 1970s. This debate was necessary to quell the division triggered by the domination of the quantitative paradigm over qualitative one in these fields and to promote understanding of the need to prioritise research questions by designing studies to answer to them instead of research problems being fitted into “onesize- fits-all” readymade designs, the study argues. The role played by Patton in turning evaluation into a profession is also discussed at length. His works on this subject include a contribution towards enhancing quality and credibility of evaluation, major input on the Standards of Excellence for Evaluation as well as assisting in the development of methods for evaluation. The inevitability of politics in evaluation is highlighted together with the importance of their ethical conduct. The debates in the American Evaluation Association are very illuminating and Patton’s involvement in them is detailed in the study. They cover a range of issues which are useful to deepening of understanding of evaluation conduct and particular factors which affect use. The study ends with a critical analysis of Patton’s contribution to utilisation of evaluations by programme decision makers and its significance to South Africa. / AFRIKAANSE OPSOMMING: Die doel van dié studie het hoofsaaklik te doen met insigte, hetsy oorspronklik of ontleen aan ander bronne, wat afgelei kan word van die werk van Michael Quinn Patton, veral van sy invloedryke boek, “Utilization-Focused Evaluation,” ten opsigte van die toepassing van program-evaluasie. Die belangrikheid van die toepassing van evalueringsprosesse en -bevindings, kan nie oorbeklemtoon word nie. Toepassing is krities tot die sukses van veelvuldige ontwikkelingsprogramme in Suid-Afrika wat gesamentlik uiteindelik sal bepaal of die land sy ontwikkelingsdoelwitte sal bereik. Die studie is ’n analise van die tersaaklike literatuur oor die toepassing van evaluering; wat Patton se werk met dié van ander skrywers oor die onderwerp van toepassing vergelyk. Die proses om dié insigte te verstaan, behels ’n kort biografie van Patton ten einde ’n vlugtige blik te kry oor die faktore wat tot die ontwikkeling van sy idees aanleiding gegee het en om van hulle, sowel as van sy innoverende idees, te leer. Die hooftema van die toespitsing op die toepassingsbenadering vir evaluering, is sy veelsydigheid en die werklike gebruik van evaluasies. Derhalwe le die studie hom dus veral op dié konsepte toe ten einde vas te stel hoe hy hulle gebruik het, wat sy motivering was om daarop te fokus en sy siening rondom die doelwitte van evaluasie. Dít bepaal sy begrip van die gebied van evaluasie, en sy sukses ten einde die toepassing van evaluasie te bevorder, word hierteenoor gemeet. ’n Uitvoerige bespreking oor die sogenaamde “ paradigma-debat’’ tussen die kwantatiewe en kwalitatiewe paradigmas in die opvoedkundige en sosiale wetenskappe van die 1960’s en 1970’s word ook hierin saamgevat. Verder voer die studie aan dat die debat noodsaaklik was ten einde die verdeeldheid te oorkom wat deur die oorheersing van die kwantitatiewe oor die kwalitatiewe paradigmas op dié terreine veroorsaak is, en om begrip te bevorder betreffende die behoefte om navorsingsvrae voorrang te gee deur studies te ontwerp wat dié vrae beantwoord, in plaas daarvan om navorsingsprobleme in ’n klaargemaakte een-grootte-pas-almal ontwerp te plaas. Patton se rol om program-evaluasie in’n professie te omskep, word breedvoerig bespreek. Sy werk oor die onderwerp sluit ’n bydrae in om die gehalte en geloofwaardigheid van evaluasie te verhef, belangrike insette ten opsigte van die Standaarde van Uitnemenheid vir Evaluasie, sowel as om met die ontwikkeling van evaluasiemetodes te help.

BACKGROUND:Some researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. However, there is a paucity of research on CAM providers' views of their patients' expectations regarding CAM therapy and the role of these expectations in patient outcomes.METHODS:To better understand how CAM providers view and respond to their patients' expectations of a particular therapy, we conducted 32 semi-structured, qualitative interviews with acupuncturists, chiropractors, massage therapists and yoga instructors identified through convenience sampling. Interviews were recorded, transcribed and analyzed thematically using Atlas ti version 6.1.RESULTS:CAM providers reported that they attempt to ensure that their patients' expectations are realistic. Providers indicated they manage their patients' expectations in a number of domains-- roles and responsibilities of providers and patients, treatment outcomes, timeframe for improvement, and treatment experience. Providers reported that patients' expectations change over time and that they need to continually manage these expectations to enhance patient engagement and satisfaction with treatment.CONCLUSIONS:Providers of four types of CAM therapies viewed patients' expectations as an important component of their experiences with CAM therapy and indicated that they try to align patient expectations with reality. These findings suggest that CAM providers are similar in this respect to conventional medical providers.

Syftet med den här studien är att jämföra två grundskollärarens förhållningssätt till skönlitterärt läsande för att visa dess betydelse för hur elever i mellanstadiet kan uppmuntras till att läsa skönlitterära texter i skolan. Därför har semistrukturerade intervjuer använts enligt Bryman (2011) samt kvalitativa forskningsintervjuer. Resultaten av undersökningen är tvådelade. Det ena visar på att om läraren utåt sett visar eleverna ett positivt förhållningssätt till skönlitteratur kan det ha en positiv inverkan på elevens läslust. Om läraren istället visar ett negativt förhållningssätt till skönlitteratur för eleverna kan detta ha en negativ inverkan på elevens läslust. Det som inte har någon betydelse är om lärarens positiva förhållningssätt till skönlitteratur är äkta eller inte, såvida inte eleverna märker att lärarens positiva förhållningssätt inte är äkta utan lärarens personliga tycke om skönlitteratur lyser igenom. / The purpose of this study is to examine and compare two primary school teachers approach to fictional reading and to show its significance regarding how pupils in middle school can be encouraged to read fictional texts in classroom activities. Therefore semi structured research interviews have been used, according to Bryman (2011) which was used was qualitative research interviews. The results of the research are twofold. One the one hand if the teacher shows the pupils a positive approach to fictional reading the impact on pupils’ love of reading might be positive. If the teacher instead show the pupils a negative approach to fictional reading the effects can be negative. On the other hand, it does not seem important if the teachers’ positive approach to fictional reading is authentic or not, unless the pupils notice that the teachers just pretend having a positive approach and their real thoughts shine through.

Over the past 20 years there has been a clear shift in Peru’s mortality profile towards non-communicable diseases. As part of this transition, childhood overweight and obesity (O&O) has become a growing public health concern. In order to address this challenge, context-specific information is needed concerning prevalence, associated factors and culturally appropriate interventions. To this end, I conducted a mixed methods study using a socio-ecological framework to investigate childhood overweight and obesity in Peru. This study found a prevalence of 19.2% overweight and 8.6% obesity among children aged seven to eight in a pro-poor cohort in Peru. Factors associated with being overweight in this cohort included: a high socioeconomic status, living in metropolitan Lima, an O&O mother, being male and being an only child or having only one sibling. The quantitative analysis highlighted the prevalence in O&O in this population and revealed a number of relationships explored in more depth via interviews and focus group discussions. The qualitative component of this research explored these associations amongst a sub-sample of children, parents and teachers in three distinct geographical regions in Peru. My qualitative research showed that parents, teachers and children are aware of the health implications of childhood overweight and obesity and that they have a sophisticated understanding of the many factors that influence its aetiology. Participants also had many suggestions for ways to address this issue in their community. This information was complemented by a systematic review and meta-analysis of the evidence of childhood O&O interventions that took place in Latin America published between 1990 and 2011. A combination of diet, physical activity and pharmaceutical strategies have shown modest effect on BMI reduction in O&O children, but more evidence is needed for effective population-level prevention strategies. The findings highlight the need for comprehensive, multi-level interventions. Notable intervention components include: kiosco reform, junk food taxation, creation of recreational space and enhancement of school-based physical activity programmes. To accomplish this, communities need to be mobilised and work together with school administration, municipal and national government.

Popular discourses and current government policy focus on the need for individuals and families to make healthy food choices, without acknowledging the social and cultural milieu in which these are embedded. A neo-liberal focus on responsible individualism is part of a middle class habitus that ensures foodwork and foodplay are located within distinct heteronormative cultural fields. In my thesis I explore narratives from seventy-five mainly middle class respondents who engaged in a series of asynchronous online interviews over nine months beginning in November 2010. The themes that emerged aligned with public policy debates on the family, healthy eating, eating disorders, ‘fat’ bodies and elite foodways. Hence, feeding the family ‘healthy’ meals ‘prepared from scratch’ was considered a means of acquiring social, symbolic and cultural capital. ‘Fat’ talk and ‘lipoliteracy’ or learning to read the body were ways of performing femininity, whilst elite foodways were utilised as forms of hegemonic masculinities. Hence, in a challenge to the individualisation thesis my research demonstrates the complexity of food relationships beyond individual consumer choice. Throughout I adopt an auto/biographical approach that stresses the interconnectedness of biography and autobiography, focuses on researcher reflexivity and is sensitive to respondent subjectivities. Respondents used a common vocabulary of individuality, whilst simultaneously embedding themselves in family and kinship relations. Indeed, family, gender, and class, were the means of anchorage in a sea of remembering that engendered a sense of ontological security. Foodways are, thus, part of a habitus that is gendered, classed, temporal and historical. Women in the study conformed to cultural scripts of heteronormative femininity, whilst men resorted to hegemonic masculinities to distance themselves from feminised foodways and care work. These identities were not part of a negotiated family model, but located in cultural fields that reinforced and naturalised gendered divisions, they were bound by gender and class.

The communication of anthropogenic climate change presents many challenges, for communicators, scientists, policymakers and publics alike. Particularly difficult is the issue of uncertainty, which can include ambiguity around the phenomenon of climate change, the possible impacts of this, and the timeframe within which such impacts will be seen. Previous research has established that audiences are often averse to uncertainty, and will disregard or ignore messages that contain it. This raises a theoretical and practical question of how best to manage uncertainty in climate change communication in order to maintain audience engagement. This question was the focus of this PhD research. Specifically, the aim of this thesis was to explore the process of climate change communication from the perspectives of the scientists, communicators, and the recipient. I achieved this research goal by utilising a mixed methods design. I firstly interviewed the originators (i.e., scientists) and professional communicators of climate change information to explore the process from their side (Chapter 2). This revealed a number of themes connecting to the different ways scientists and communicators understand the process of communication (e.g., as information exchange versus relationship building), the challenges of climate change communication and uncertainty in particular, and the (appropriate) role of scientists when communicating with the public about climate change. Next, in a series of studies I experimentally explored how audiences respond to variations in the informational content of climate change messages (such as the level of uncertainty) and the role of different communicative styles in further shaping audience engagement (Chapter 3). Broadly, the results of these studies suggest that while uncertainty can undermine audience engagement with climate change communications, the negative effects of uncertainty are buffered when the communicator is perceived to be high in morality and/ or when they use an open communication style. Interestingly, these effects of communication style were particularly evident among women, whereas men tended to react against this. Together, these studies show how relational factors (e.g., communication styles and perceptions of communication sources) can moderate the impact of informational content on audience responses. Finally, I ended this programme of research by looking in more detail at how audiences perceive a real scientific organisation engaged in climate change communication and the bases of their beliefs about organisation competence and morality (Chapter 4). This study combined qualitative and quantitative data to delve deeper into some of the insights gained in the experimental work, and to reconnect this to the real-world organisation context I began with. This study again showed how perceptions of communicator morality moderate responses to uncertainty, but also provide useful insights into the different origins of perceptions of morality and competence. Chapter 5 concludes by summarising the research presented in this thesis, discussing its strengths, limitations and ways forward. Here, I also consider the theoretical, methodological and practical implications of the thesis’ research findings. Briefly, it is argued that addressing the scientific uncertainties of climate change may not necessarily mean altering the form of information itself. Rather, modifying the language peripheral to the information that contains uncertainty, attending to the ways in which audiences perceive the sources of uncertainty, and considering variations amongst publics, may help to engage in effective communication around the complex issue of climate change.

Coupons are a marketing tool used to entice consumers to try a new brand or product in the hopes that they will then become loyal users after trial (Boundless, n.d.). Issuing coupons is a common practice for many businesses because it is relatively inexpensive to begin, and can be used for general advertising purposes in addition to attracting new customers. Digital coupons have been introduced in the last few years and their acceptance is growing, with redemptions in 2010 increasing by 10 times the 2009 rates and projected to increase exponentially with each year (Savings.com, n.d.). Despite the higher acceptance and redemption rates for digital coupon formats over the past 5 years, the overall coupon redemption rate has remained at around 2%. Early coupon academic studies in the promotional literature examine profitability maximization through manipulating coupon characteristics or the coupon process such as the timing of release, length of expiration dates, amount of the cents-off, and other related monetary factors. Despite the ability to adjust coupon features to maximize revenue and redemption, the effect is not strong enough to generate the motivation required to elicit new use from non-users being targeted nor improve the overall low redemption rates. Basic characteristics such as demographic and socioeconomic variables as well as some predisposing motivational characteristics have also been studied to predict coupon use. While some of these characteristics demonstrate differences between consumers who do and do not use coupons, characteristics provide little insight into why non-users choose not to coupon. Furthermore, the findings cannot be generalizable to the population as a whole when the redemption rate persists at 2%. With digital coupons a rapidly growing practice, it is important to determine whether or not this new coupon format might contribute to behavior change in current non- or infrequent users of coupons. The overarching goal of this research was to better understand the motivational processes driving the decisions to not use coupons in the context of consumer packaged goods (grocery). While most previous research has concentrated on characteristics of the consumer, characteristics of the coupon, and predisposing motivational constructs, this study examined why consumers rejected coupons by examining their narratives on the various stages of the coupon process to narrow down the factors contributing the most to deterring coupon use. A two-phase qualitative approach was selected to determine how digital coupons were perceived by both frequent and infrequent users followed by a more in-depth investigation into the timing, motivation and cognitive processes occurring behind the decision not to coupon. The Phase 1 study included 58 participants, 29 frequent users and 29 infrequent users. Participants completed a set of questionnaires measuring previously identified predisposing characteristics, given guidance on the selection of digital coupons loaded onto shopper loyalty cards and were provided with Sunday circulars. Each participant had 1 week to try and redeem the digital coupons and complete follow up questionnaires to determine any changes post-trial. Participants were invited to participate in 1 of 6 focus groups to determine themes related to the digital coupon trial. The Phase 2 study included 10 individuals who participated in depth interviews focusing on the processes, motivations and decisions related to coupon use during grocery shopping. The interview was broken out into 5 stages: 1 is an ice-breaker introduction to the study; 2 involves rapport building and setting the tone; 3 is the depth interview that attempts to elicit understanding into the motivation, timing, and rationale behind rejection of coupon use; 4 presents some popular emerging technologies based on emerging applications of interest to the Association of Coupon Professional Board; and 5 includes a brief discussion of different type of coupon and verification. Overall, the consumer's perceived purpose of the coupon is to save money through item cost reduction whereas from a marketing perspective the coupon is intended to entice consumers new to the brand or to encourage trial of a new product (Boundless, n.d.). This difference in perception could be a major contributor to the valuation process and resistance/rejection themes of infrequent users. Interestingly, very few infrequent users rejected the practice of coupons outright and were far more likely to resist or postpone the practice. More research should be conducted to identify when, how and why infrequent users re-evaluate coupons or try the process again. Coupon industry members should review the coupon practice and make a decision to either abandon or overhaul the process as it currently does not provide value to either the manufacturers issuing the coupons or the consumers, even those actively using coupons. If the decision is to overhaul the practice then a decision should be made whether or not to adapt to the current perceptions that coupons are a means to reduce product price or re-educate consumers and industry members alike on the coupon as a means to solicit trial. Lastly, many of the existing apps do not address any of the coupon-related barriers, incongruities, or infrequent user needs. A disruptive technology is needed to change consumer perceptions, encourage coupon use and provide value added utility beyond just bypassing the coupon process to make the practice relevant in today's mobile culture.

Bakgrund: Stroke är en folksjukdom som drabbar ungefär 30 000 personer i Sverige varje år och beräknas kosta samhället runt 18 miljarder kronor. Rehabiliteringen efter stroke är ofta intensiv, mångfacetterad och långvarig. Syfte: Syftet var att beskriva patienters upplevelser i samband med rehabiliteringen efter stroke samt att beskriva undersökningsgruppen i de ingående artiklarna. Metod: En beskrivande litteraturstudie som grundar sig på 12 kvalitativa artiklars resultat. Resultat: Stroke upplevdes som en omvälvande livshändelse och huvudmålet med all rehabilitering var att få återgå till det liv som patienterna levt innan stroken. Hoppet om att återfå förlorade funktioner upplevdes som viktigt och varje tecken på förbättring gav motivation till fortsatt rehabilitering. Det var stor kontrast mellan de patienter som upplevde delaktighet i rehabiliteringsprocessen och de som önskade att de hade haft ett större inflytande. Kvinnor upplevde sig mindre delaktiga än män. Det framkom att patienter upplevde att de hade skrivits ut för tidigt från strokeenheten och inte förberetts tillräckligt inför hemkomsten. Den nedsatta funktionsnivån blev mycket tydligare när de kom tillbaka till sin vardag hemma och de saknade den nära kontakten och erfarenhetsutbytet som de hade haft med andra patienter på sjukhuset. Slutsats: Det framkom att patienter med stroke har skilda upplevelser beträffande mål, stöd, information och delaktighet i rehabiliteringen. Ett individanpassat förhållningsätt till patienters målsättningar är betydelsefullt och adekvat information viktigt. Ändamålsenligt stöd från vårdpersonal bidrar till ökad delaktighet samt ökar patientens förmåga att utföra och klara av aktiviteter i rehabiliteringen. / Background: Stroke is a disease that affects approximately 30,000 people in Sweden each year, and is estimated to cost society around SEK 18 billion. Rehabilitation after stroke is often intense, multi-faceted and long lasting. Aim: The aim of the present study was to describe patients' experiences of rehabilitation after stroke and to describe the study group in the included articles. Methods: A descriptive literature review based on 12 qualitative studies. Results: Stroke was perceived as a disruptive life events and the main goal of all rehabilitation was to return to the life that patients lived before the stroke.The hope of regaining lost functions were perceived as important and any signs of improvement gave motivation to continue rehabilitation.The contrast was considerable between those patients who experienced participation in the rehabilitation process, and those who wished they had a bigger influence.Women felt less involved than men. It was revealed that the patients felt that they had been discharged prematurely from the stroke unit and were not prepared for the homecoming. Their reduced abilities became much clearer when they returned to their everyday lives at home and they lacked the close contact and the exchange of experiences they had had with other patients in the hospital. Conclusion: It was found that patients with stroke have different experiences regarding goals, support, information and participation in rehabilitation. An individualized approach to patient goals is significant and adequate information is important. Effective support from health professionals contribute to increased participation and increase the patient's ability to perform and manage activities in the rehabilitation.

Abstrakt (svenska) Titel: Infertilitet – vems rätt att bestämma? En kvalitativ intervjustudie kring barnmorskors erfarenheter av att arbeta med infertilitet. Författare: Rebecka Kristensen Berlin, Umeå Universitet -Institutionen för Omvårdnad   Syfte: Att undersöka hur barnmorskans erfarenheter av parens reaktioner uppfattas i samband med infertilitetsproblematik. Studiedesign: En kvalitativ intervjustudie innefattande fyra barnmorskor har genomförts på en barnmorskemottagning. Intervjumaterialet analyserades utifrån kvalitativ innehållsanalys, vilket i korthet innebar följande steg: Materialet transkriberades ordagrant och bröts därefter ned i meningsbärande enheter, för att kunna sortera data utifrån innehåll. Kondensering utfördes i syfte att lyfta fram kärninnehållet. Abstraktion utfördes för att få fram koder, i syfte att reducera mängden text men även för att därefter kunna sammanfoga snarlika ämnen till underkategorier, vilka sedan grupperades i huvudkategorier tillhörande ett gemensamt tema. Resultat: De fyra huvudkategorier som uppkom var känslor, kommunikation, rättighet och prevention. Känslor: Oro, stress samt nedstämdhet var vanligt förekommande. Mäns känslor var svårare att identifiera då kvinnor ibland kom ensamma till besöken, samt män ibland dolde känslor bakom aggressivitet. Kommunikation: God information skapade förtroende. Råd om livsstilsförändringar samt vidareremittering var en viktig form av stöd. Rättighet: Ingen har rätt till barn, men alla ansågs ha rätt att försöka få barn. Privatekonomi samt samhällets krav påverkar dock i stor utsträckning paren vid misslyckade försök eller önskan om ytterligare barn. Prevention: Vikten av information kring infertilitet vid undervisning i skolan, vid preventivmedelsamtal och vid cellprovtagning poängterades. Slutsats: Att vara väl införstådd med de känslor som kan uppstå i samband med infertilitet möjliggör att ge tillfredställande stöd. Särskilda ansträngningar behöver göras för att nå män, såväl emotionellt som preventivt. Stort utrymme för förbättring finns gällande preventiva åtgärder, i syfte att fördjupa allmänhetens kunskaper kring infertilitet. Nyckelord: kvinnlig infertilitet; manlig infertilitet; känslor; barnmorska; kvalitativ forskning / Abstract (English)     Title: Infertility. Who´s right to decide? A qualitative interview study regarding midwives experiences to work with infertility. Author: Rebecka Kristensen Berlin, Umeå University- Department of nursing   Objective: To investigate midwives thoughts and experiences regarding couples reactions in connection with infertility.  Study design: A qualitative interview study comprising four midwives have been conducted. The resulting data was analyzed using qualitative content analysis, consisting of the following steps: The material was transcribed verbatim and then broken down into sentences, to aid in sorting the data based on content. Condensation was carried out in order to highlight the core content. Abstraction was performed to obtain codes, in order to reduce the amount of text , but also to subsequently merge similar content into subcategories , which were then grouped into categories. Results: Four main categories emerged. Feelings: anxiety, stress and depression were common. Men’s feelings were more difficult to identify since women sometimes came alone to appointments, and men sometimes concealed their feelings behind aggression. Communication: Good information created trust. Advice on lifestyle changes and referrals were important forms of support. Empowerment: No-one has the right to a child, but the right to try to have a child. Personal and societal demands, however, affect the couples at failure to conceive or desire for additional children. Prevention: The importance of information about fertility in school, at contraception counselling and routine smear exams was emphasized. Conclusion: Awareness of the feelings that infertility may give rise to, enables providing satisfactory support. Further efforts need to be made to reach males emotionally as well as preventatively. There is great possibility for improvement in regards to public awareness about infertility. Keywords: female infertility; male infertility; emotions; midwife; qualitative research