"May 2015" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Max A. Ito Participation in social roles and daily activities is considered a primary outcome for children with cerebral palsy (CP) and thus is an important focus of pediatric therapy. The purpose of this study was to describe the participation patterns of children ages 2 to 6 years with CP, investigate how gross motor impairment affects participation, and identify those family and environmental factors that may influence participation in daily activities and social roles. A convenience sample of 51 children with CP between the ages of 2 and 6 years and their parents completed this study. Parents completed four standardized instruments: the Assessment of Life Habits (LIFE-H), the Impact on Family Scale, The Child and Adolescent Scale of Environment, and the Child Health Conditions Questionnaire, which measured participation, family burden, the environment, and associated conditions respectively. Hierarchical multiple regression analysis was used to determine the extent to which family and environmental factors explained participation in daily activities and social roles while controlling for gross motor impairment (GMFCS), associated conditions and age. The findings of this study suggest that very young children with CP experience substantial restrictions across 10 of 11 domains of participation. Parents report greater environmental barriers, associated health conditions and impact on family as GMFCS levels increase. Gross motor impairment, associated health conditions, and age accounted for 65% of the variance in participation. The environment and family factors did not contribute significantly to the model. For the children in this study, intrinsic factors accounted for most of the variance in participation.

In today’s health care environment of quick discharges and shortened hospital stays discharge planning has become increasingly important in acute care occupational therapy practice. Discharge planning is a complex process and an important aspect of patient care as poor discharge planning has been associated with poor patient outcomes and increased risk of adverse events and readmission. This study addressed the following research questions: (a) How do acute care occupational therapists describe their role in the discharge planning process? (b) What guides acute care occupational therapists discharge decisions and recommendations? (c) How do acute care occupational therapists define optimal discharge planning? and (d) What actions can acute care occupational therapists take to optimize the effectiveness of their discharge planning skills within the current health care system? Using an action research methodology, two groups of five occupational therapists met online to discuss acute care occupational therapy discharge planning practices, and actions that could be taken to strengthen their practice. Action plans generated, implemented, and evaluated focused on improving communication with discharge planners, language used in documentation, and incorporating the use of standardized assessments to assist with discharge planning. Schell’s ecological model of professional reasoning as the theoretical model underlying this study was used to examine factors that influence occupational therapy discharge decision making. Data were collected from audio chat transcripts, survey responses, and researcher notes, and analyzed using Stringer’s action research sequential data analysis and interpretation methodology. Five themes emerged including (a) the role of occupational therapy, (b) the complexity of discharge planning, (c) pragmatics of practice, (d) why don’t they pay attention, and (e) the importance of stakeholder communication. Participants felt that discharge planners were not reading occupational therapy documentation, occupational therapy consults were late so that occupational therapy discharge recommendations were just a formality, and physical therapy discharge recommendations had more weight than occupational therapy recommendations. Participants felt that if patients were discharged without benefit of occupational therapy recommendations they could be at increased risk for an adverse event and compromised safety. Good communication among stakeholders was seen as essential for optimal discharge planning.

The aim of this study was to contribute to the limited literature on Mixed-Race identity development in the post-apartheid context while providing a personal, evocative, and critical exploration of Mixed-Race identity. The objectives were to use self-reflection as a tool to think critically about how close relationships and other systemic factors (such as friendships, school environment and broader societal factors) that contributed to my Mixed-Race identity development, played a significant role. The autoethnographic methodology was used to harness the quality of evocative and personal writing in the process of knowledge creation and establishing a voice for the Mixed-Race experience through the narration of my personal experiences. Autoethnography is a methodology that situates the researcher as the ‘data’ by using first-person accounts of their experiences to analyse and discuss particular social and cultural phenomena. Root’s ecological model for multiracial identity development was used as a framework to explore and analyse how systemic factors influenced and shaped my Mixed-Race identity development. Additionally, Worthman’s bio-ecocultural model was used to explore the influence of my bond with my parents on my racial identity formation in childhood. Data collection involved me engaging in a reflexive journaling process. Thematic analysis was used to develop themes from my reflexive journal. Three main themes were found, namely my bond with my parents and their socialisation practices, my experience of being ‘the other’ and an outsider in social settings, and my close friendships. While I discuss the themes separately, there was considerable overlap between the themes and the factors involved in the discussion which suggests a complex relationship between multiple systemic factors (i.e. gender, skin tone, familial relationships, and social settings) that influenced my racial identity development. In conclusion, my racial identity development was (and still is) a lifelong process of self-discovery as I continue to be confronted with my dual-racial heritage in a predominantly monoracial South Africa. Based on the findings and conclusions of this study, the limitations and potential recommendations for future research has also been discussed. / Mini Dissertation (MA (Clinical Psychology))-- University of Pretoria, 2021. / Psychology / MA (Clinical Psychology) / Unrestricted

Background: To date, little is known about the perspectives of healthcare and social service providers on the acceptability of long-term home visiting programs serving low-income, first-time mothers within a community. The present study reports on the experiences and perspectives of community professionals who participate in program referrals or deliver auxiliary services to these mothers who are enrolled in the Nurse-Family Partnership (NFP), a targeted nurse home visitation program. Methods: The present study comprised two phases. In phase one, a secondary qualitative data analysis was conducted to analyze a purposeful sample of 24 individual interviews with healthcare and social service providers, which was part of a larger qualitative case study examining adaptations required to increase the acceptability of NFP for families and service providers in Hamilton, Ontario, Canada. In phase two, identified themes from phase one were further explored and confirmed through individual, semi-structured interviews with service providers using a qualitative descriptive approach. Findings: Healthcare and social service providers recognized the added value of NFP to existing community services for low-income, first-time mothers. The public health nurses (PHNs) who delivered the NFP intervention were perceived as playing a crucial role in connecting the first-time mothers to community services, preparing them for motherhood, and for preventing or ending the involvement of child protection services. NFP services were not perceived as interfering with the logistics of existing services being delivered; they were viewed as addressing an important service gap. Discussion: This is the first qualitative study to examine the acceptability of a home visiting intervention from the perspectives of healthcare and social service providers in a community context. The study findings have relevance for policymakers by informing the general understanding of how a new early childhood prevention program is integrated among existing community-based supports servicing low-income, first-time mothers. / Thesis / Master of Health Sciences (MSc)

Det huvudsakliga syftet i denna studie var att ta reda på skolpersonals uppfattning om varför ätstörningar uppstår bland unga flickor samt vilka metoder de använder sig av i förebyggande syfte för att motverka ett ätstörningsutvecklande. Empirin bygger på kvalitativa semistrukturerade intervjuer bestående av två skolkuratorer, två skolsköterskor samt en skolpsykolog i en mellanstor svensk stad. Fyra huvudteman identifierades i intervjuerna vilka var: Olika typer av yttre påverkan, Tonåringar har störst tendens att utveckla ätstörningar, Preventiva metoder samt Skolpersonal saknar hållbara metoder. Analysen av de teman som framkom i studien kan ge en förståelse för hur skolpersonal preventivt arbetar med unga flickor och ätstörningsproblematik samt vilka faktorer som uppfattas vara bidragande till ett ätstörningsutvecklande. Sammanfattningsvis visar studien att skolpersonal i stort uppfattar att faktorer såsom självkänsla, krav och stress, koncentrationssvårigheter samt media och skönhetsideal kan bidra till ett ätstörningsutvecklande. Vidare visar studien att skolpersonal gör försök att arbeta preventivt med ätstörningsproblematik genom att reagera på förändrat beteende och samtala med vårdnadshavare och elev men även genom att arbeta med självkänslan hos flickorna. Det framkommer dock inga gemensamma hållbara metoder i skolpersonalens arbetssätt med unga flickor som tenderar att utveckla en ätstörning där flertalet informanter tycks vara i behov av detta. / The main purpose of this study was to find out the view of the school staff on why eating disorders arise among young girls and which methods the school staff use for prevention. The empirical data is based on qualitative semi-structured interviews with two school counselors, two school nurses and a school psychologist in a medium-sized Swedish town. Four main themes were identified in the interviews which were: Different kinds of external influences, Adolescents have the greatest tendency to develop eating disorders, Prevention methods and School staff lack sustainable methods. The analysis of the themes that emerged from the study can provide an understanding of how school staff preventively work with young girls and eating disorder problems and the factors that are perceived to be contributing to a developing eating disorder. In summary, the study showed that school staff, at large, perceive that factors such as self-esteem, demands and stress, concentration difficulties, as well as the media and beauty ideals can contribute to a developing eating disorder. Furthermore, the study showed that school staff do try to work preventively with the eating disorder problems by reacting to changes in behavior and talking with both parents and students, but also by working with the self-esteem amongst girls. No common sustainable methods were found in the school staff’s work with young girls that tend to develop an eating disorder in which the majority of respondents appear to be in need of this.

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Community violence can have lasting impacts on populations that experience it, including but not limited to, financial damages, property damage, and psychological trauma. Therefore, exploring mechanisms of violence prevention is increasingly important, especially within the context of multicultural societies. This research does just that by approaching community violence prevention from an interdisciplinary perspective, including aspects of public health, political science, criminology, and sociology. This dissertation explores the interfaith organization InterFaith Leadership Council of Metro Detroit and those in the organization's network. It considers how interfaith leaders, through activism and dialogue, can contribute to community violence prevention. By applying the social ecological model and social disorganization theory, this research considers how to prevent community violence through building social capital, collective efficacy, and community capacity. This inquiry also utilized the social determinants of health to describe how violence and violence prevention is linked to community health. This dissertation uses qualitative data, including interviews, document analysis, and field notes to explore the mechanisms by which interfaith leadership can prevent community violence, specifically gang violence and violent extremism. / Doctor of Philosophy / Community violence can have lasting impacts on populations that experience it, including but not limited to, financial damages, property damage, and psychological trauma. Therefore, exploring methods of violence prevention is increasingly important. This dissertation uses qualitative data to explore community violence prevention in Metro Detroit as carried out by the InterFaith Leadership Council and its broader network. Included in this dissertation are insights from interviews, document analysis, and field notes. All this data informs the research and attempts to address how the question of how the interfaith community in Metro Detroit is working to prevent community violence. This research utilizes the social ecological model and social disorganization theory as its overarching framework for analysis. The analysis examines interfaith relationships, collective efficacy, and community capacity. This research also frames violence and violence prevention within the context of the social determinants of health in an attempt to identify the factors that affect violence and violence prevention.

Yes / Greenspace is important for physical and mental health. Low-income, multi-ethnic populations in deprived urban areas experience several barriers to using greenspace. This may exacerbate health inequalities. The current study explored structural and individual determinants of greenspace use amongst parents of young children in an urban, deprived, multi-cultural area situated in the North of England, UK. Semi-structured in-depth interviews and focus group discussions were conducted with 30 parents of children aged 0–3 between December 2016 and May 2017 from a range of ethnic groups. Thematic analyses were informed by the Human Health Habitat Map and the Theoretical Domains Framework. The results show that whilst all families recognised the benefits of greenspaces, use was bounded by a variety of structural, community, and individual determinants. Individual determinants preventing use included lack of knowledge about where to go, or how to get there and confidence in managing young children whilst outdoors. Fear of crime, antisocial behaviour and accidents were the overriding barriers to use, even in high quality spaces. Social and community influences both positively encouraged use (for example, positive social interactions, and practical support by others) and prevented use (antisocial or inappropriate behaviours experienced in greenspace). The built environment was a key barrier to use. Problems related to unsuitable or unsafe playgrounds, no gardens or safe areas for children's play, poor accessibility, and lack of toilets were identified. However, the value that parents and children placed on natural blue and green features was an enabler to use. Contextual influences included external time pressures, difficulties of transporting and caring for young children and poor weather. Multi-sectoral efforts are needed to tackle the uneven playing field experienced by multi-ethnic, urban, deprived communities. Initiatives to increase use should tackle structural quality issues, addressing fears about safety, whilst simultaneously encouraging communities to reclaim their local greenspaces. / received funding through a peer review process from the Big Lottery Fund as part of the A Better Start programme. RM is partly funded by the NIHR CLAHRC Yorkshire and Humber.

The study of health disparities and the social determinants of health has resulted in the call for public health researchers to investigate the mid- and upstream factors that influence the incidence of chronic diseases (Adler & Rehkopf, 2008; Berkman, 2009; Braveman P. , 2006; Braveman & Gottlieb, 2014; Krieger, 2011; Rose, 1985). Social ecological models (SEMs) provide important conceptual tools to inform this research and practice (Krieger, 2011; Golden & Earp, 2012; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008; Glanz, Rimer, & Lewis, 2002). These models can help us look at the social and physical environments in rural Arizona communities and consider how health policies and environmental interventions address mediating factors, such as disparities in access to fresh food, that contribute to ill health in marginalized, rural, populations. Rural residents are at greater risk for obesity than their urban counterparts (Jackson, Doescher, Jerant, & Hart, 2006; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008). And while human life expectancy has steadily increased over the past thousand years, current projections indicate that the rise in obesity-related illnesses will soon result in its decline (Olshansky, et al., 2005). One reason for this decline, may be the reduced availability of healthy food – an important predictor of positive health outcomes including reduced obesity and chronic disease - in many parts of the United States (Brownson, Haire-Joshu, & Luke, 2006; Ahen, Brown, & Dukas, 2011; Braveman & Gottlieb, 2014; Braveman, Egerter, & Williams, 2011). The United States Department of Agriculture (USDA) defines food deserts as geographic areas in which there is limited access to grocery stores and whose populations have a high rate of poverty. In Arizona, 24% of the rural census tracts are considered food deserts; compared to an average of eight percent of rural census tracts across the nation (United States Department of Agriculture, 2013). Food deserts are one example of the upstream factors influencing the health of rural populations. Local health departments have been encouraged through the National Association for City and County Health Officials (NACCHO) and through the Public Health Accreditation Board (PHAB) to conduct community health assessments (CHAs) in order to identify unique contexts and community resources, health disparities, and the social determinants of health as well as potential areas for advocacy, policy change, environmental interventions, and health promotion interventions. Public health challenges like chronic diseases, which have multiple causes, can be explored in-depth through CHAs. CHAs often contain recommendations for action and/or are followed by community health improvement plans (CHIPs) which help local health departments prioritize resources and set measurable goals. In Florence, AZ recommendations made in a CHA are being acted upon by a non-profit agency, the Future Forward Foundation (3F). This investigation explores two interrelated issues regarding the use of CHAs and CHIPs as practical tools to set public health priorities. First, what makes a CHA useful to rural public health practitioners? What methods of conducting a CHA and subsequently analyzing the data results in actionable policy recommendations and/or environmental level interventions? Second, to what extent can public health agencies engage nontraditional partners to work in partnership to address the social determinants of health? As an example, I will look at the impact of a volunteer-based non-profit agency, located in a rural food desert on improving the social and physical nutrition environment as recommended by a local CHA. This inquiry will provide insights to public health practitioners seeking to identify and implement policy and environmental change addressing complex, multi-causal, public health issues, and provide insights regarding engaging nontraditional partners who may not self-identify as public health agencies.