BUT : Cette étude longitudinale a pour objectif d’évaluer l’impact à court terme des programmes d’enseignement sur l’autogestion du diabète dispensés par l’équipe multidisciplinaire de l’Unité de jour de diabète (UJD) de l’Hôtel-Dieu du CHUM. L'UJD offre une formation de 4 jours (F4), avec une intervention mixte de type individuelle et de groupe, et une autre de 2 jours (F2), avec une intervention de groupe uniquement. MÉTHODE : En plus des mesures liées au contrôle métabolique (hémoglobine glyquée, indice de masse corporelle), des outils validés ont été retenus afin d’évaluer le niveau de littératie des patients, de même que les connaissances, les comportements d’autogestion et les attitudes par rapport au diabète à 0, 1 et 6 mois d’intervalle. Un total de 43 patients a été recruté, dont 13 en F2 et 30 en F4. RÉSULTATS : Âgés en moyenne de 59 ans, 77% des participants aux formations ont une scolarité de niveau collégial et plus. Cela les situe à un niveau satisfaisant de littératie, c'est-à-dire au regard de l’aptitude à comprendre et à utiliser l’information écrite dans la vie courante. En revanche, 64% des patients qui ne se sont pas présentés au cours (N=11) avaient un niveau de scolarité équivalent ou inférieur à un secondaire cinq. Les données analysées à l’aide de tests non-paramétriques montrent que les formations permettent à court terme une amélioration significative du contrôle métabolique des patients (p=0,042; N=33) et une perte pondérale moyenne de 2,4 kg (p=0,004; N=27). Les deux types de formations favorisent l’augmentation des connaissances sur la maladie (p=0,000 2jrs/4jrs) et contribuent à faire progresser favorablement les attitudes, soit de façon significative dans le cas des participants à la formation de 4 jours (p=0,000). La formation de 2 jours s’avère particulièrement efficace pour améliorer les comportements d’autosoins comme la prise de glycémie et les soins des pieds, alors qu’elle n’a eu que très peu d’effet sur les comportements liés au mode de vie. CONCLUSION : Les résultats de cette étude sont en faveur d’une intervention de type mixte et d’un plus grand nombre d’heures de contact entre les éducateurs et éducatrices et la ou le patient. Les données suggèrent finalement que bien que les interventions soient efficaces, ce sont les patients déjà fortement scolarisés qui tendent à participer à ce type de formation structurée. / OBJECTIVES : The objective of this longitudinal study is to evaluate the short term impact of diabetes self-management programs given by the multidisciplinary team of the CHUM Hôtel-Dieu Diabetes Day-Care Unit over 2-days (T2) or 4-days (T4) training sessions. METHODS : A total of 43 patients were recruited; 13 in the 2-day program, providing only group intervention and 30 in the 4-day program, providing both group and individual interventions. Besides measures of metabolic control (glycated haemoglobin, body-mass index), validated tools were used to evaluate literacy, as well as knowledge, self-care behaviours, and attitudes towards diabetes (at 0, 1 and 6 months). RESULTS : The average age of patients participating in the training sessions is 59 years old, and 77% have reached collegial or higher educational levels. This gives them sufficient literacy skills in terms of capacity to understand and use written information in everyday life. However, 64 % of the patients that did not show up or complete the training (N=11) had educational levels equal or lower to secondary 5. Outcome data, analyzed with nonparametric tests, show that diabetes self-management education programs of the Hôtel-Dieu CHUM lead to significant short-term improvement of metabolic control in patients (p=0,042, N=33) and result in a average weight loss of 2.4 kg (p=0,004, N=27). Both types of training increase patients knowledge of the disease (p=0,000 F2/F4), and the 4-days training session significantly contribute to positive attitudes towards the disease (p=0,000). The 2-days training program is particularly effective in improving self-care behaviours such as blood glucose monitoring and foot care, but it had very little effect on behaviours related to lifestyle. CONCLUSION : These results show that the 4-day program has proven more effective in improving self-management competency suggesting that the duration of interaction time between educators and patient seems to be a good predictor of the impact of the training. Although interventions are found to be effective, outcomes ultimately suggest that it is mostly patients with higher education that tend to participate in this formal training. / Réalisé en collaboration avec l'équipe de l'Unité de jour de diabète de l'Hôtel-Dieu du CHUM: Hortensia Mircescu M.D., Françoise Desrochers, Michelle Messier et Stéphanie Chanel Lefort.

Les tendances de la participation à la formation des adultes au Canada n’ont pas évolué depuis des décennies, malgré les nouvelles influences économiques qui ont stimulé l’augmentation et la diversification permanente de la formation des employés et malgré les initiatives plus nombreuses en faveur de l’apprentissage des employés en milieu de travail. Il est donc nécessaire de ne plus se contenter d’étudier les prédicteurs de la formation déjà connus dans les profils des employés et des employeurs. Il est, en revanche, indispensable d’étudier les antécédents de la participation des employés à la formation, y compris les aspects et les étapes du processus qui la précède. Cette étude porte sur les antécédents de la participation des employés aux formations dans un important collège communautaire urbain en Ontario. Afin de préparer le recueil des données, un cadre théorique a été élaboré à partir du concept d’expression de la demande. Ce cadre implique l’existence d’un processus qui comporte plusieurs étapes, au cours desquelles plusieurs intervenants interagissent et dont la formation est susceptible d’être le résultat. Les résultats de l’enquête sur le profil d’apprentissage ont permis de conclure que le comportement des employés et de l’employeur est conforme aux modèles de prédicteurs existants et que les taux et les types de participation étaient similaires aux tendances nationales et internationales. L’analyse des entrevues d’un groupe d’employés atypiques, de leurs superviseurs, ainsi que de représentants du collège et du syndicat, a révélé d’importants thèmes clés : l’expression de la demande n’est pas structurée et elle est communiquée par plusieurs canaux, en excluant parfois les superviseurs. De plus, la place de l’auto évaluation est importante, ainsi que la phase de prise de décision. Ces thèmes ont souligné l’interaction de plusieurs intervenants dans le processus d’expression de la demande d’apprentissage et pendant la prise de décision. L’examen des attentes de chacun de ces intervenants au cours de ce processus nous a permis de découvrir un désir tacite chez les superviseurs et les employés, à savoir que la conversation soit à l’initiative de « l’autre ». Ces thèmes clés ont été ensuite abordés dans une discussion qui a révélé une discordance entre le profil de l’employeur et les profils des employés. Celle-ci se prête à la correction par l’employeur de son profil institutionnel pour l’harmoniser avec le profil dispositionnel des employés et optimiser ainsi vraisemblablement son offre de formation. Ils doivent, pour cela, appliquer un processus plus systématique et plus structuré, doté de meilleurs outils. La discussion a porté finalement sur les effets des motivations économiques sur la participation des employés et a permis de conclure que, bien que les employés ne semblent pas se méfier de l’offre de formation de l’employeur et que celle ci ne semble pas non plus les décourager, des questions de pouvoir sont bel et bien en jeu. Elles se sont principalement manifestées pendant le processus de prise de décision et, à cet égard, les superviseurs comme les employés reconnaissent qu’un processus plus structuré serait bénéfique, puisqu’il atténuerait les problèmes d’asymétrie et d’ambiguïté. Les constatations de cette étude sont pertinentes pour le secteur de la formation des adultes et de la formation en milieu de travail et, plus particulièrement, pour la méthodologie de recherche. Nous avons constaté l’avantage d’une méthodologie à deux volets, à l’écoute de l’employeur et des employés, afin de mieux comprendre la relation entre l’offre de formation et la participation à la formation. La définition des antécédents de la participation sous la forme d’un processus dans lequel plusieurs intervenants remplissent plusieurs rôles a permis de créer un modèle plus détaillé qui servira à la recherche future. Ce dernier a démontré qu’il est indispensable de reconnaître que la prise de décision constitue une étape à part entière, située entre l’expression de la demande et la participation à la formation. Ces constatations ont également révélé qu’il est véritablement indispensable que le secteur de la formation des adultes continue à traiter les questions reliées à la reconnaissance de la formation informelle. Ces conclusions et la discussion sur les constatations clés nous ont inspiré des recommandations à appliquer pour modifier les retombées du processus précédant la participation des employés à la formation. La majorité de ces recommandations ont trait à l’infrastructure de ce processus et ciblent donc principalement l’employeur. Certaines recommandations sont cependant destinées aux syndicats, aux superviseurs et aux employés qui peuvent aider l’employeur à remplir son rôle et favoriser la participation efficace de tous à ce processus. Les recommandations qui précédent impliquent que ce sont les antécédents de la formation qui gagneraient à être plus structurés et non la formation elle même. La structuration de l’infrastructure de l’apprentissage présente cependant des risques à elle seule. En liaison avec ce phénomène, une étude spécifique des effets de la nature, de la qualité et de l’asymétrie de la relation superviseur employé sur la participation des employés à la formation serait bénéfique. Mots clés : formation en entreprise, formation professionnelle continue, antécédents à la participation, employés de soutien / Trends in adult learning participation in Canada have remained unchanged for decades. This is despite emerging economic pressures to increase and widen continuous employee participation in learning and despite increased efforts towards employee learning in the workplace. This means that there is a need to go beyond examining the already well-established learning predictor profiles of employees and employers. There is in fact a need to examine the antecedents to participation, including aspects and steps of the process that precedes participation. This study set out to research the antecedents to participation in employer-sponsored learning among the support staff population in a large, urban community college in Ontario. In preparation for the data collection, a theoretical framework was developed based on the concept of expression of demand. This framework implies that there is a multi-step process involving interactions between several parties and wherein participation may be the outcome. Based on the results of the Learning Profile Survey, the employees and the employer were found to be behaving according to existing predictor models and the rates and types of participation were similar to national and international trends. The analysis of the interviews conducted among a group of atypical employees, their supervisors, as well as with representatives from the college and from the union, revealed important key themes: informality of the expression of demand through multiple channels, sometimes excluding the supervisors, the reliance on self-assessment, and the importance of the decision-making phase. These themes reinforced the fact that there are several parties interacting during the process of expressing demand for learning and during decision-making. By examining the expectations of each party during the process, we uncovered a tacit desire by the supervisors and by the employees to have “the other” initiate the conversation. The key themes were then discussed in relation to the research and knowledge gaps identified as the basis and context for this study. In this light, the misalignment between the employer and the employees’ profiles revealed some opportunities for the employer to address its institutional profile in order to better match the employees’ dispositional profile and thus be more likely to maximize the employer’s learning offer. The deconstruction of the antecedents to participation in learning activities provided insights along the same lines. Here there are opportunities for the employer, the supervisors and the union to better support the employees in the identification of their learning needs and the articulation of their learning demand by providing a more systematic, more formalized process with better tools. This would once again be a better match for the employees’ situational and dispositional profile. Finally, the discussion examined the impact of the economic drivers on the employees’ participation and concluded that even though the employees did not appear suspicious or deterred by the employer’s offer of learning, there are indeed issues of power in play. Those manifested themselves mainly during the decision-making process, and in this regard, both the supervisors and the employees agree that a more formalized process would be beneficial as a way to mitigate the issue of asymmetry and the issue of ambiguity. The findings of this study have implications for the field of adult education and workplace learning, particularly in regards to research methodology. We found that the use of mix methodology capturing the employer and the employees’ voice was beneficial in providing new insights about the alignment between the offer and the uptake. The recognition of the antecedents to participation as a process involving several, multi-faceted actors allowed for the creation of a more detailed model useful for further research. It identified the need to separate decision-making as a stand-alone step between the expression of demand and participation in learning. The findings also reinforced the need for the field of adult education to continue to address issues related to the recognition of informal learning. Based on the results and the discussion of key findings there are several recommendations that can be considered if we are to affect the outcome of the process preceding employee participation in learning. Most of the recommendations pertain to the infrastructure that supports the process and therefore are largely targeted at the employer. However, as the employers consider the implementation of a more solid infrastructure and the use of more intervention methods, there are recommendations for unions, supervisors and for employees that can assist the employer living up to its role and facilitate everyone’s effective participation in the process. The above recommendations imply that it is the antecedents to learning that could benefit from greater formality, not the learning itself. On the other hand, there are risks associated with formalizing even the infrastructure for learning. Future research should further explore the new type of workplace learning participants for whom participation is an expression of control and power over their work. In relation to this phenomenon, a specific study on the impact of the nature, quality and asymmetry of the supervisor-employee relationship on employee participation in learning would be beneficial. Keywords: workplace learning, antecedents to participation, support staff

In the late 1990s, many Western governments introduced policy programs to make information and communication technology (ICT) accessible to all. More than a decade later, however, such universal access is far from a reality. Between 2002 and 2005, in response to a request from a group of contingent workers who felt excluded from effective access to ICT training, a university research group on contingency conducted an applied research project in the form of a series of basic ICT courses. This qualitative dissertation both critically examines the training process and treats it as a case study for exploring broader issues of exclusion and resistance in the context of access to ICT. Specifically, it explores: (1) the symptoms of exclusion as they relate to ICT, social capital, and the community; (2) possibilities for resistance that can alleviate the conditions of exclusion; (3) the assumptions, theories, knowledge construction, policy methods, and processes that underlie the symptoms of exclusion; and (4) alternative assumptions, strategies, and activities that offer possibilities for resistive action. The case study provided an environment in which exclusionary and resistive experiences with access to ICT and training were examined from the perspective of excluded contingent workers, as supported by a university research group. A key finding is that generational behaviour in the domestic sphere erects barriers that contribute to the silencing and exclusion of immigrant contingent women; these barriers then reinforce similar patterns of exclusion in institutionalized ICT training. Another major finding is the need for alleviating the barrier that limited English skills create for ICT learning; addressing this issue must be part of any recommendations for curricular change. Guided throughout by a critical approach that focuses on the concept of ruling relations, this dissertation marshals critical knowledge gained from below in support of change by policymakers, educators, and community practitioners.

This study examines the experiences of highly educated South Asian immigrant women working as home-based entrepreneurs within ethnic enclaves in Toronto, Canada. The importance of their work and experiences need to be understood in the context of two processes. On the one hand, there is the neoliberal hegemonic discourse of “enterprising self” that encourages individuals to become “productive”, self-responsible, citizen-subjects, without depending on state help or welfare to succeed in the labour market. On the other hand, there is the racialized and gendered labour market that systematically devalues the previous education and skills of non-white immigrants and pushes them towards jobs that are low-paid, temporary and precarious in nature. In the light of the above situations, I argue that in the process of setting up their home-based businesses, South Asian immigrant women in my study negotiate the barriers they experience in two ways. First, despite being inducted into different (re)training and (re)learning that aim to improve their deficiencies, they continue to believe in their abilities and resourcefulness, thereby challenging the “remedial” processes that try to locate lack in their abilities. Second, by negotiating gender ideologies within their families and drawing on community ties within enclaves they keep at check the individuating and achievement oriented ideology of neoliberalism. They, therefore, demonstrate how the values of an “enterprising self” can be based on collaboration and relationship rather than competition, profit or material success. The concept of “negotiation”, as employed in this thesis, denotes a form of agency different from the commonly perceived notions of agency as formal, large-scale, macro organization or resistance. Rather, the concept is based on how women resort to multiple, various and situational practices of conformity and contestation that often can blend into each other.

This thesis focuses on the structural and behavioural factors that placed South Asian immigrant women living with HIV/AIDS in the Greater Toronto Area at risk. Informed by Connell's social theory of gender (1987), this study examined the role of hegemonic masculinity in legitimizing male power and contributing to the HIV risk of these women. By conducting one-on-one interviews with 12 HIV-positive immigrant women, meaningful constructions of the women's narratives and accounts of their experiences relative to HIV were created. This study examined the intersection of power ideologies such as gender, race and class in specific contexts as they generated particular experiences that affected women's risk for HIV. Following a community-based research approach, a collaborative relationship was established with the Alliance for South Asian AIDS Prevention where qualitative methods of analysis and an inductive approach with an iterative process were followed. Factors such as isolation, economic dependence on their husbands, discrimination, racism, investment in psychologically and emotionally abusive relationships, combined with the absence of support from their family of origin exacerbated the women's risk of HIV infection. The strong ties exhibited by most of the women to their religious/ethnic communities helped sustain a gender-based social hierarchy. To facilitate dialogue and social change for South Asian women, gender and culture need to be situated in social and historical contexts. As such, programs should be understood within a larger critical understanding of the social power relations and history of Canadian immigration patterns. Using anti-racist frameworks, initiatives should address violence against women, while tackling interrelated issues (i.e., housing, poverty, etc.). This work draws attention to oppressions through the experiences of a community of women who are rarely given a voice within the context of research on HIV/AIDS. It will be also helpful for Ontario’s HIV prevention strategy and the field of women's sexual health.

This thesis describes a study that was done with tutors and students in Frontier College’s Beat the Street: Literacy and Basic Skills program. Using a qualitative methodology, it focuses on stories of literacy, life and learning from tutors and students. The author’s own experiences, stories and reflections as a tutor are an important piece of the work. The thesis operates on and argues for the notion that people are made up of their stories, and that they interact with other people and the world through those stories. This research process revealed many ways in which tutor and student perceptions of literacy, learning, and each other were affected by their stories. It also revealed that in the overlaps between stories lies the potential for a moment of profound connection and learning the author describes as resonance. The thesis explores some of the ways resonance was perceived to enhance the literacy environment.

This thesis focuses on the structural and behavioural factors that placed South Asian immigrant women living with HIV/AIDS in the Greater Toronto Area at risk. Informed by Connell's social theory of gender (1987), this study examined the role of hegemonic masculinity in legitimizing male power and contributing to the HIV risk of these women. By conducting one-on-one interviews with 12 HIV-positive immigrant women, meaningful constructions of the women's narratives and accounts of their experiences relative to HIV were created. This study examined the intersection of power ideologies such as gender, race and class in specific contexts as they generated particular experiences that affected women's risk for HIV. Following a community-based research approach, a collaborative relationship was established with the Alliance for South Asian AIDS Prevention where qualitative methods of analysis and an inductive approach with an iterative process were followed. Factors such as isolation, economic dependence on their husbands, discrimination, racism, investment in psychologically and emotionally abusive relationships, combined with the absence of support from their family of origin exacerbated the women's risk of HIV infection. The strong ties exhibited by most of the women to their religious/ethnic communities helped sustain a gender-based social hierarchy. To facilitate dialogue and social change for South Asian women, gender and culture need to be situated in social and historical contexts. As such, programs should be understood within a larger critical understanding of the social power relations and history of Canadian immigration patterns. Using anti-racist frameworks, initiatives should address violence against women, while tackling interrelated issues (i.e., housing, poverty, etc.). This work draws attention to oppressions through the experiences of a community of women who are rarely given a voice within the context of research on HIV/AIDS. It will be also helpful for Ontario’s HIV prevention strategy and the field of women's sexual health.

This thesis describes a study that was done with tutors and students in Frontier College’s Beat the Street: Literacy and Basic Skills program. Using a qualitative methodology, it focuses on stories of literacy, life and learning from tutors and students. The author’s own experiences, stories and reflections as a tutor are an important piece of the work. The thesis operates on and argues for the notion that people are made up of their stories, and that they interact with other people and the world through those stories. This research process revealed many ways in which tutor and student perceptions of literacy, learning, and each other were affected by their stories. It also revealed that in the overlaps between stories lies the potential for a moment of profound connection and learning the author describes as resonance. The thesis explores some of the ways resonance was perceived to enhance the literacy environment.

This is an arts-informed qualitative research study looking at violence against women and how it affects their educational outcomes. It uses an art installation in which the narratives of the women involved are combined with photographs and real world objects in which viewers take on a ‘walking meditation’ as well as the use of participation stations for viewer feedback and further sharing of stories anonymously. This project is based on the belief that through a feminist research lens, participatory practice with the use of storytelling can be a form of transformation in community development.

Current understandings of aging and the life course are largely based on taken-for-granted hetero-normative assumptions. Gay men lack aging road maps that are unique to their life course experiences and which consider the changing contextual and social conditions that shape their participation choices in family and community roles. This is particularly so for gay men aging in rural environments as most studies of aging gay men focus on the urban experience. This study adds to understandings of aging and the life course by examining the lives of three gay men aging in rural environments. I use a life history approach to shed light on how sexual identity development and marginalization within rural environments intersect with shifting social contexts to shape the aging process in terms of engagement in social role opportunities, namely, community and family participation. As a life course researcher, I pay particular attention to the tensions between individual agency and structural constraints and how they are revealed through the life histories. Epistemological and methodological assumptions based on social constructivism, critical and queer theory inform the study while my own lived experiences as a gay man and an occupational therapist practitioner and educator ground the study. Cross-cutting themes identified in the life narratives reveal connections between sexual identity development and the coming out processes with patterns of social relationships and the gay aging process. These themes are then discussed in terms of their relevance to broader aging and life course constructs including generativity, social capital and gay aging; agency and structure in identity development; and expanded notions of family and social support for gay men. Findings from this study have implications for current explanations of ageing and life course processes; challenge limiting stereotypes of older gay men; inform health and social service professionals who work with older gay people; and provide examples of alternative queer life pathways for gay people of all ages.