Patients are the recipients of the provision of healthcare and an invaluable source when evaluating the quality of healthcare provided in our hospitals. There is limited research evaluating patient perceptions of overall quality of healthcare. A larger study Convergence and Divergence in Perspectives in Quality represented the first Saskatchewan effort to explore patient perceptions and what aspects patients indicate as important when evaluating the provision of quality of care. In the larger study, patients hospitalized with one of four tracer conditions (cerebral vascular accident, myocardial infarction, prostate disease and hysterectomy) were surveyed about their involvement in and satisfaction with the provision of healthcare. The present study, using a data subset of the larger study, specifically explored patients perceptions on their involvement in decision-making, feelings of being well informed of ones medical condition, and sources of health information. These perceptions were correlated with the overall ratings of quality of care. Findings indicated a moderately high overall rating of quality of care. Increased involvement in decision making regarding medical care and options for treatment, and the feelings of being fairly or well informed were associated with higher ratings of overall quality of care. While few of the correlations reached greater than moderate effect, it is still clear that opportunities for patients participation in decisions related to their medical care and patients feelings of being fairly or well informed contributed to overall perceptions of quality of care. The majority of patients preferred their doctor or nurse to provide information about their medical condition, thus indicating the human touch is still preferred. Nurses can use these results to advocate for time to ensure patients have access to correct information and are included in decisions about their care.

This thesis, comprising two studies, investigated whether negative expectations and self-perceptions relating to the aging process are associated with less physical activity (Study 1), and whether less active adults are likely to report age as a cause for physical activity failure than more active adults (Study 2). Using Sarkisian et al.’s (2002) Expectations Regarding Aging (ERA-38) survey, Study 1 first developed reliable and valid sub-factors for constructs relating to general aging expectations (GAE) and aging self-perceptions (ASP) by conducting exploratory factor analyses on 167 adults (M age = 59.5). Results revealed three acceptable GAE sub-factors relating to satisfaction/contentment, physical function and cognitive function, and three ASP sub-factors pertaining to functional, social, and sexual health. Subsequent MANOVA analyses showed that active adults reported higher GAE for satisfaction/contentment and cognitive function than less active adults. Regression analyses revealed that physical activity levels positively predicted satisfaction/contentment and physical function expectations among 45-54 yr olds. In Study 2, 177 adults (M age = 60.1) completed our Causal Dimension Scale for Aging (CDSA) and a survey asking whether age was a likely cause of failure in various physical activity contexts. Responses on the CDSA were used to validate ‘General Attributions towards Age’ (GATA), a measure which captured how adults view the aging effects. Subsequent analyses of variance determined that GATA interacted with physical activity status (active, less active) to influence the reported likelihood of age as a cause for failure. Less active adults with stable/uncontrollable GATA reported greater likelihood of age as a cause for failure than all other groups in gym, recreational/community program, and unstructured/spontaneous activity settings. Separate age group analyses indicated that these trends were pronounced in an unstructured/spontaneous activity setting for 45-54 yr olds, and in a generally recently inactive scenario for 55-64 yrs.

La tesis aplica el pensamiento sistémico y la Evaluación Integrada (IA) al campo de la gestión costera. En particular, se analiza la contribución que el estudio de las percepciones aporta a los procesos de evaluación ambiental de los sistemas costeros, para mejorar las deficiencias de los métodos más convencionales caracterizados por su unidimensionalidad y dependencia del conocimiento disciplinar. Se han realizado tres estudios de caso relativos a la calidad de las playas en ambientes turísticos y a la erosión costera. El primer caso se ha desarrollado en la zona de la Costa Brava, al Nordeste España. El caso afronta la necesidad de incorporar la perspectiva del usuario a los métodos de evaluación de la calidad de la Playa. Se realizaron 600 cuestionarios a los usuarios de las playas y un conjunto de entrevistas en profundidad a actores locales. Los resultados muestran que los estudios de percepción pueden ser instrumentos muy útiles para los gestores costeros, aportando información sobre el perfil del usuario, sus preferencias y sus valoraciones sobre la calidad de las playas. En estos contextos los sistemas costeros deberían ser gestionados adaptándose a las particularidades ambientales de cada playa y a la diversidad de sus usuarios, evitando prácticas de homogeneización. El segundo caso trata el problema de la erosión costera. El estudio se localiza en Sitges (Cataluña, España) donde se analiza un conflicto social surgido a principios del 2000 como reacción a una propuesta de intervención para frenar la erosión existente. La investigación explora los elementos que dificultan dar respuestas integradas a la erosión costera a partir de un estudio de percepción basado en entrevistas en profundidad. La complejidad e incertidumbre ligadas a los propios procesos erosivos, las características de los marcos de evaluación existentes y el contexto institucional en el campo de la protección costera en España son algunos de las cuestiones analizadas. El estudio muestra como el conocimiento técnico no es suficiente para encontrar soluciones coherentes i sólidas con el contexto local y las necesidades sociales y constata la necesidad de incorporar enfoques más participativos. Finalmente, el tercer caso se desarrolló en el Lido de Séte (Francia) y explora los beneficios de aplicar un Análisis Multicriterio Participativo (AMP) para evaluar estrategias de gestión de la erosión costera. Los resultados muestran que las alternativas más adaptativas como el retroceso controlado de la línea de costa y la recuperación de la dinámica natural son socialmente más aceptados, en el caso de estudio, que alternativas más rígidas basadas en enfoques ingenieriles. El enfoque utilizado contribuye a representar la multidimensionalidad de la costa, integra diferentes perspectivas, facilita el intercambio de conocimiento y permite el tratamiento de la incertidumbre. La disertación concluye ofreciendo una propuesta metodológica para incorporar la dimensión social en la evaluación integrada de sistemas costeros. / The present dissertation applies complex system thinking and Integrated Assessment (IA) to the field of coastal management. It emphasises the social perspective and analyses the added value of integrating public perceptions into the processes of assessing coastal socio-ecological systems. It argues that the Integrated Assessment of coastal systems requires moving away from one-dimensional evaluation methods and to develop innovative assessment approaches capable to understand coasts in as highly complex, multidimensional dynamic systems and explicitly acknowledge their inherent degree of uncertainty. Three case studies have been carried out regarding the assessment of beach quality and coastal erosion. The first one was developed in the area of "Costa Brava", North-East Spain, a tourist hotspot. The case study addressed the lack of bottom-up approaches to assess beach quality. The methods, which were applied on six beaches, involved a survey of 600 beach-users and a set of in-depth interviews to local stakeholders. The results showed that public perception surveys can be useful tools for coastal managers. Coastal systems should be specifically managed in an adaptive fashion considering the particularities of each beach and avoiding homogenising practices. In this way, conservation strategies could be prioritised in natural environments with recognised natural values or with higher potential for ecological recovery. While in the other hand, 'hard' interventionist approaches oriented to enhance recreational beach uses could be pursued in those intensively used beaches, normally located along urban water fronts. The second case deals with coastal erosion. It was carried out in Sitges (Catalonia, Spain) and analyzed a conflict that arose at the beginning of the year 2000 as a reaction to a proposal for intervention to cope with coastal erosion. The research explored the elements that make it difficult to give integrated responses to coastal erosion. In this case, the research of public perception was based on in-depth interviews. Issues related to the very nature of the coastal systems - complexity and uncertainty of coastal erosion- were addressed. Furthermore, the work explored the drawbacks of the existing assessment approaches and the policy framework on coastal protection in Spain. The case study showed that the technical knowledge does not fit enough to find robust solutions that satisfy both social needs and technical requirements. The complexity of coastal erosion risks demands to move beyond the existing assessment frameworks where the role of the experts need to be reformulated. This process should open up the debate to other disciplines and knowledge which may bring more adaptive alternatives more in coherence with natural dynamics of coastal systems. The third case was carried out in the Lido of Séte (France) and explored the suitability of applying participatory MultiCriteria Analysis (MCA) to assess different strategies to cope with coastal erosion risks. The methods used involved the Social Multicriteria Evaluation tool of Naiade combined with in-depths interviews and focus groups. Results showed that more adaptive alternatives such as "retreating the shoreline" were preferred by selected stakeholders to those corresponding to "protecting the shoreline" and the Business as Usual proposals traditionally put forward by experts and policy makers on these matters. Participative MCA contributed to represent coastal multidimensionality, elicit and integrate different views and preferences, facilitated knowledge exchange, and allowed highlighting existing uncertainties. The dissertation concludes by drawing a methodological proposal on how to bring social perspective into the assessment of coastal systems. A 3-step procedure is put forward which includes the following: i) a baseline analysis of the values and perceptions of the society under study; ii) institutional analysis and maping out the stakeholders' relationships in order to identify barriers and opportunities to implementing integrated strategies and, iii) a public participation within the assessment process. We argue that all this in-depth knowledge on the functioning of the social system needs to be combined with an in-depth understanding of the dynamics of the ecological system under consideration.

The study explored risk perceptions and novelty dimensions associated with family vacations. In particular, the study focused on households containing married or common law partners, blended families, single parents and same-sex partners, with at least one child aged twelve years old or younger, located in one of the Region of Waterloo’s three cities, encompassing Kitchener, Waterloo, and Cambridge, Ontario. The research explored whether novelty or familiarity of a vacation destination affected the level of risk perceived as well as the locus of control. Additionally the research focused on particular aspects of the family vacation including the decision making process and the stage of the family life cycle in which respondents are categorized, having either younger or older children, affected the decision making process. Lastly, the study looked at external sources of information including family and/or friends, other sources of information, prior experience at the destination, if applicable, and the distance traveled, borders crossed and transportation utilized. Families in each specified area were initially accessed through five direct contacts and an associated snowball sampling method. A revised data collection method was utilized part way through the study being distribution at a recreation centre within the Region. Respondents were asked to complete a self-administered questionnaire containing questions relating to their last family vacation, preferences for novelty/familiarity, locus of control orientation, degree of risk perception agreement or disagreement and basic sociodemographic characteristics. Data were reduced to minimize complexity through a series of factor analyses through the use of components analysis. It involved taking salient items and factoring them together based on the conceptual fit within each loading having eight components created. T-tests and analyses of variance were utilized to further univariate relationships between variables of interest. Relationships between perceived risk, gender and prior experience were non-significant (p > .05) whereas family life cycle, level of education, crossing an international border, and total distance traveled had a significant effect on risk perceptions (p < .05) and were included in stepwise regression analyses. The present study complemented emerging literature suggesting that parents with older children attributing greater risks as associated with creating memories. There was less support for extant research indicating that families with younger children are more likely to associate as many risks with travel. Similarly, preference for novelty/familiarity was found to not have a significant effect on respondents’ risk perceptions yet certain external sources of information (e.g., friends/family, travel agents) played a large role in the level of risk perceptions.

Sociologists have only recently paid attention to how men experience physical disability. However, current research continues to ignore how different racial groups experience it. The goal of this study was to examine how black and white men experience life with a physical disability. Using qualitative research techniques involving in-depth, face-to-face interviews with 10 black and 10 white men, I focus on how meanings of disability and masculinity shift after a traumatic injury. Using symbolic interactionism and social construction as theoretical frameworks, I examine how these men formed and modified meanings for disability and masculinity through social interactions. I also analyze the strategies they use to manage a stigmatized identity. Finally, I explore how they negotiate a masculine identity within larger social contexts. My findings suggest that black and white men’s constructions of masculinity and disability are more similar than different on all levels. Furthermore, these men used three strategies to negotiate their new social identities: reinforcing idealized masculinity, modified masculinity, and lost masculinity.

The criminal justice and mental health systems increasingly overlap as persons with mental illness (PMI) are disproportionately present throughout components of the criminal justice system, a concern to mental health and criminal justice professionals alike. In response, various initiatives (aimed across components of the criminal justice system) have been developed and implemented as a means of combating this overrepresentation. The following research will focus on one specialized police-based initiative, the Crisis Intervention Team (CIT), which aims to train police how to recognize mental illness, de-escalate persons in crisis, and to seek treatment-based alternatives to arrest, when appropriate (Schwarzfeld, Reuland, & Plotkin, 2008). Alternatives to arrest consist of various community-based mental health services such as public hospitals (some of which are designated as emergency receiving facilities, or ERFs) or private clinics. While the components of CIT training likely influence officers in unique ways, research has yet to empirically examine how CIT influences police perception, behavior or the incidence of referrals to mental health treatment. As an initial step, this research assessed the attitudes police have regarding the hospital and mental health system within their district. Specifically, this research provides a basic understanding of how police regard their local hospitals and mental health facilities that are posited as available alternatives to arrest, and help identify the role CIT plays in shaping these attitudes. This study found almost no significant difference in the attitudes CIT-trained officers had towards district ERF and the local mental health system as compared to non-CIT officers. Only in one of the six departments studied was there a significant difference between the attitudes of CIT-officers and non-CIT officers; with the non-CIT officers actually having more positive attitudes about their local mental health system than CIT-officers. The six departments studied had nearly similar attitudes of their mental health resources, which would barely be considered passing on a standard grading scale. While officers in this study do not have very positive attitudes towards the ERF they use to transport PMI or their districts’ mental health system, these attitudes may in fact be more positive than many police departments without any specialized approach or initiative. The significance and policy implications of these attitudes are discussed at length, as these findings speak to the need for increased attention by both the mental health and criminal justice systems. Recommendations for future research, including expanding this study to rural departments or agencies with no connection to CIT, are also outlined.

Background: Estimations from the Joint Monitoring program for Water Supply and Sanitation (JMP, 2012) reveal that “less than five percent of water and sanitation interventions are revisited once they have been completed and less than one percent are monitored over the long term”. Since 2000, the Centers for Disease Control and Prevention(CDC) has been working with the American Red Cross (ARC) to evaluate the long-term sustainability of post-disaster water, sanitation and hygiene interventions (WASH) provided in Guatemala, Honduras, Nicaragua and El Salvador. Sustainability assessments were conducted in 2006, 2009 and most recently in 2012. In the 2012 evaluation, a qualitative approached was included to extent the results obtained from quantitative surveys through an exploration of individual perceptions and current practices. Methodology: Key-informant interviews were conducted with the heads of household in 15 communities purposively selected. All interviews were recorded, transcribed, coded and analyzed using the computer assisted qualitative data analysis software MAXQDA10 Results: Interviewees discussed issues related to the quality, safety and adequacy of the water and sanitation infrastructure and hygiene education sessions received. Issues of corruption in the water committees and delayed repair of damaged infrastructure resulting in erratic service were frequently reported. In addition, lack of financial support, community engagement, and equity were identified by heads of household as major limitations to sustain and improve WASH interventions. Conclusions: This exploration provides valuable information to further examine the factors driving people’s adoption of hygienic practices and maintenance of water and sanitation facilities in the Central American region.

The study explored risk perceptions and novelty dimensions associated with family vacations. In particular, the study focused on households containing married or common law partners, blended families, single parents and same-sex partners, with at least one child aged twelve years old or younger, located in one of the Region of Waterloo’s three cities, encompassing Kitchener, Waterloo, and Cambridge, Ontario. The research explored whether novelty or familiarity of a vacation destination affected the level of risk perceived as well as the locus of control. Additionally the research focused on particular aspects of the family vacation including the decision making process and the stage of the family life cycle in which respondents are categorized, having either younger or older children, affected the decision making process. Lastly, the study looked at external sources of information including family and/or friends, other sources of information, prior experience at the destination, if applicable, and the distance traveled, borders crossed and transportation utilized. Families in each specified area were initially accessed through five direct contacts and an associated snowball sampling method. A revised data collection method was utilized part way through the study being distribution at a recreation centre within the Region. Respondents were asked to complete a self-administered questionnaire containing questions relating to their last family vacation, preferences for novelty/familiarity, locus of control orientation, degree of risk perception agreement or disagreement and basic sociodemographic characteristics. Data were reduced to minimize complexity through a series of factor analyses through the use of components analysis. It involved taking salient items and factoring them together based on the conceptual fit within each loading having eight components created. T-tests and analyses of variance were utilized to further univariate relationships between variables of interest. Relationships between perceived risk, gender and prior experience were non-significant (p > .05) whereas family life cycle, level of education, crossing an international border, and total distance traveled had a significant effect on risk perceptions (p < .05) and were included in stepwise regression analyses. The present study complemented emerging literature suggesting that parents with older children attributing greater risks as associated with creating memories. There was less support for extant research indicating that families with younger children are more likely to associate as many risks with travel. Similarly, preference for novelty/familiarity was found to not have a significant effect on respondents’ risk perceptions yet certain external sources of information (e.g., friends/family, travel agents) played a large role in the level of risk perceptions.

If the reforms in public education are to be sustained, it is commonly believed that they must be founded in new conceptions of schooling. Recently, to improve school effectiveness and raise students success, educational researchers are devoting increasing attention to research related to transforming our schools into professional learning communities. The purpose of this study was to examine the perceptions of principals concerning the process and dynamics of the implementation of professional learning communities. <p>Qualitative method was used in this study. The perceptions of the principals were explored through six research questions. The research questions addressed the following areas: process and dynamics of the implementation process, challenges to the collaboration and issues of sustainability in professional learning communities. Six principals, four females and two males, from two school divisions were selected and data were collected using semi-structured interviews. The interviews were tape recorded and transcribed. Participants responses were analyzed according to the research questions and recurring themes.<p>The findings of this study revealed that the process and dynamics of implementing professional learning communities, included pre-implementation (self-education), the implementation process itself (training internal stakeholders), teaching the PLC concept to external stakeholders, and facilitating collaboration amongst all stakeholders. Participants emphasized that collaboration was a critical component for the positive development and effectiveness of the professional learning communities. <p> Further analysis of the data indicated that time, funding, diverse interests, preconceived mindsets of stakeholders, constant staff changes, workload, fear of being ridiculed or judged, and evaluation/data collection methods were the major challenges in the implementation process. Regarding sustainability, respondents advocated that it was essential to focus on school vision, create a collaborative culture, provide administrative support to all stakeholders, and retain key people who are self-motivated. <p>In the final analysis, this study determined that the implementation of professional learning communities is a question of will. A group of staff members who are determined to work collaboratively will be able to implement and sustain professional learning communities, regardless of some foreseeable problems.

Patients are the recipients of the provision of healthcare and an invaluable source when evaluating the quality of healthcare provided in our hospitals. There is limited research evaluating patient perceptions of overall quality of healthcare. A larger study Convergence and Divergence in Perspectives in Quality represented the first Saskatchewan effort to explore patient perceptions and what aspects patients indicate as important when evaluating the provision of quality of care. In the larger study, patients hospitalized with one of four tracer conditions (cerebral vascular accident, myocardial infarction, prostate disease and hysterectomy) were surveyed about their involvement in and satisfaction with the provision of healthcare. The present study, using a data subset of the larger study, specifically explored patients perceptions on their involvement in decision-making, feelings of being well informed of ones medical condition, and sources of health information. These perceptions were correlated with the overall ratings of quality of care. Findings indicated a moderately high overall rating of quality of care. Increased involvement in decision making regarding medical care and options for treatment, and the feelings of being fairly or well informed were associated with higher ratings of overall quality of care. While few of the correlations reached greater than moderate effect, it is still clear that opportunities for patients participation in decisions related to their medical care and patients feelings of being fairly or well informed contributed to overall perceptions of quality of care. The majority of patients preferred their doctor or nurse to provide information about their medical condition, thus indicating the human touch is still preferred. Nurses can use these results to advocate for time to ensure patients have access to correct information and are included in decisions about their care.