Aims: This thesis had three aims: to review evidence evaluating the effectiveness of decision aids at increasing cancer patients’ treatment-related knowledge and reducing decisional conflict; to explore the decision-making processes of ovarian cancer patients who had opted for or against CA-125 testing during post-treatment surveillance; and to elicit patients’ and health professionals’ views on the proposed development of a decision aid aimed at helping women decide for or against CA-125 testing during post-treatment surveillance for ovarian cancer. Methods: A systematic review was conducted of evidence relating to the effectiveness of cancer treatment-related decision aids at increasing treatment-related knowledge and reducing decisional conflict. In the qualitative study, semi-structured interviews were conducted with ovarian cancer patients (n = 18) and health professionals (n = 6) in an outpatient gynecological oncology clinic. Framework analysis was used to identify themes in the qualitative data. Results: Overall, results from the systematic review supported previous research where decision aids were found to improve patient knowledge and reduce decisional conflict across a range of cancer treatment-related decisions. However, the lack of psychometric support for the treatment-related knowledge measures used in the majority of the studies compromised their ability to address the review question. In the qualitative study, accurate knowledge about CA-125 testing in post-treatment surveillance was found to greatly influence participants’ decision-making processes. Most women with less knowledge about the test chose to have testing based on the false belief that earlier detection of recurrence would lead to earlier treatment and prolonged survival. There was strong enthusiasm from patients and health professionals for the development of the proposed decision aid to assist women facing this treatment decision. Conclusions: The systematic review findings add to previous research supporting the use of decision aids in cancer-related treatment decisions and advocate for their continued development, evaluation and implementation into the healthcare system. The need for a decision aid to ensure accurate knowledge about CA-125 and to aid decision-making for women with ovarian cancer was supported. As well as assisting women with this decision, the proposed decision aid may ultimately support health professionals in practicing shared decision-making regarding CA-125 testing with ovarian cancer patients.

abstract: Using models identified by communications scholars Herbert W. Simons and Charles J. Stewart, a rhetorical analysis was conducted on contemporary Tea Party Movement (TPM) artifacts in an attempt to gauge the movement's authenticity as it relates to grassroots advocacy versus astroturfing. The models provided a theoretical framework in which the functions of social movement leaders were analyzed, as well as the rhetorical phases of a movement. Additionally, the notions of advocacy and astroturfing were defined and the concepts compared and contrasted. Used in conjunction with one another the models provided a framework in which TPM artifacts could be analyzed. Analysis was conducted on the websites for the Tea Party Patriots and Tea Party Express, a one-month sample of Sarah Palin FaceBook posts, two speeches delivered by Michelle Bachmann, and finally one speech given by Palin. Examples for each of the necessary rhetorical components identified were found within TPM sources, thus leading to the conclusion that the TPM operates primarily as a grassroots advocacy movement. / Dissertation/Thesis / M.A. Communication Studies 2011

The three primary purposes of this study were to (1) acquire knowledge of parents’ psychological experiences obtaining a diagnosis and accessing services for their child with ASD by examining the actual situation, as lived through and experienced by the parents, (2) gain knowledge of the meaning of advocacy and empowerment from parents who are living these experiences, and (3) derive possible implications for enhancing services provided by mental health professionals, service providers, and policy-makers to parents of children with autism. I utilized a sequential transformative integrated design, drawing data in Wave II of a larger, on-going investigation examining child, family, and community variables associated with early identification and treatment of autism spectrum disorders in the Pacific Northwest. I conducted a descriptive exploratory analysis to describe all participants from Wave II with respect to measures of sociodemographic variables, parental satisfaction with services, family empowerment, and reported relationships among these variables. Next, I conducted in-depth semi-structured interviews with six participants identifying as low-income and/or ethnic minorities to explore their experiences throughout the process of obtaining a diagnosis and accessing services for their child with ASD. Interviews were recorded and transcribed. Data were analyzed using a phenomenological reduction and integrated with quantitative results. Constituent elements of the parent experiences included, but were not limited to: a desire and/or appreciation for sources of support and information regarding services; engaging in ongoing research and networking to learn about services; a need to be the expert on their child; and fear regarding availability of future services and child’s future after parents die. Constituent elements of empowerment and advocacy showed that these were conceptually and experientially related to one another, such that advocacy functioned as a behavioral manifestation of empowerment for parents in this study. Findings contribute to the literature on family experiences with the diagnostic and service utilization processes for ASD. Findings are discussed in regards to recommendations and implications for mental health professionals, service providers, and policy-makers working towards fostering more supportive and equitable diagnostic and service utilization pathways for these families.

Over the past several decades the number of youth living with a chronic health condition has drastically increased. A chronic health condition can be defined as an illness that lasts three months or more that can be controlled but not cured (Centers for Disease Control and Prevention [CDC], 2010). Although there is existing literature on youth with chronic health conditions, there are very few studies that examine the levels of health literacy, resiliency and support/advocacy within this population. The current study is a secondary analysis that utilized data collected from the 37-item Youth Health Literacy and Resiliency Scale (HLRS-Y version) in order to determine if there was a relationship between different categories of chronic health conditions and reported levels of health literacy, resiliency and support/advocacy. Ages of participants were also examined to determine if there was an interaction effect. The study consisted of a 143 youth between the ages of 13- 21 years old. All participants completed the Youth Health Literacy and Resiliency Scale (Bradley-Klug, Shaffer-Hudkins, Lynn, DeLoatche, & Montgomery, 2017) and were placed into one of three categories of chronic health condition: 1) Endocrine, nutritional, and metabolic diseases, 2) Diseases of the musculoskeletal system and connective tissue, and 3) Diseases of congenital malformation, deformations, and chromosomal abnormalities. The data were analyzed to determine if there was a difference in the reported constructs of health literacy, resiliency and support/self-advocacy among the three different categories of chronic health illnesses. The results indicated that there was a significant relation between support/self-advocacy and age. As participants increased in age, they reported having lower levels of support/self-advocacy. This finding was significant regardless of the category of chronic health condition that the participants were placed in. There were no other significant findings for the other constructs. This study contributes to the literature because it is one of few to examine health literacy, resiliency and support/self-advocacy levels among youth with chronic health conditions. In addition, it is the first study aside from the pilot, to utilize the HLRS. The findings from this study can be utilized to drive support/self-advocacy interventions for youth with chronic health conditions.

The world is becoming increasingly urban. This puts pressure on a number of functions within cities, not the least the transportation system. Motorized traffic is responsible for a number of negative environmental effects, such as carbon dioxide emissions and particle pollution. To halt this development an increased share of bicyclists is needed. Stockholm County is an area with rapid urbanization. Therefore, a comparative study was undertaken to analyse how Stockholm City and Nacka Municipality are including communication, advocacy and participation measures in documents important for increased bicycling. This as those measures are important to increase the number of bicyclists. The analysis was undertaken by using two typologies, a modified version of the Transtheoretical Model of Change (TTM) to understand how the two cases include communication and advocacy measures whereas Arnstein’s Ladder of Citizens Participation was chosen to understand how participation is included in the documents. The findings suggest many similarities between the two cases but Nacka Municipality perform better with their use of social media, and the activities ”bicycle-friendly workplace” and ”winter bicycling”. From the findings three recommendations where provided: create bicycle councils to improve inclusion of bicyclists in the processes. Second, it is important to have different type of role models across the municipality, both in socio-economic strong and weak areas. And third, create dedicated outlets for bicycle issues, tentatively on a social media outlet. This will increase the status of bicycles, it will promote bicycling as a good transportation choice and it open ups channels for citizens interaction. / I dagens allt mer urbaniserade värld börjar fler funktioner i staden sättas under hårt tryck, inte minst transportsektorn. Motordriven trafik är orsaken till en rad negativa miljöeffekter, så som koldioxidutsläpp och partikelföroreningar. För att stävja denna utveckling och öka framkomligheten i de allt mer fullbelagda städerna behöver andelen cyklister öka. Tre områden som är av stort intresse för att öka andelen cyklister är kommunikation, påverkan och delaktighet. Därav undersöktes dessa områden i en jämförande studie. Stockholms län är en region med kraftigt ökande befolkningsandel och där transportsektorn är särskilt ansatt. Därför valdes regionen för att genomföra en jämförande studie där Stockholms stad och Nacka kommun selekterades som studieobjekt. Detta eftersom Stockholms stad är den störta kommunen i regionen, de är många som arbetar i de centrala delarna och de finns ökande framkomlighetsproblem i kommunen. Därefter valdes Nacka kommun som jämförande kommun, baserat på differensmetoden. Stockholms stad och Nacka kommun har liknande socio-ekonomisk sammansättning och de har liknande förutsättningar vad gäller cykelmöjligheter. Utöver det har båda kommunerna egna cykelstrategier. De som skiljer kommunerna åt är att Nacka kommun under senare år har blivit prisat för sitt arbete inom cykelområdet. De tilldelades 2016 Årets Cykelprestation av Stockholms regionala cykelkansli under 2017 placerade sig Nacka kommun som nummer ett för medelstora kommuner, och fyra totalt, i Kommunvelometern presenterat av Cykelfrämjandet. I Kommunvelometern hamnar Stockholm Stad som 8 av 11 stora kommuner och på plats 16 totalt. Undersökningen gjordes genom analys av dokument som ansågs ha betydelse för cykelsatsningar inom respektive kommun. Det innefattade bland annat översiktsplaner, framkomlighetsstrategier och interna kommunikationsdokument. Analysen gjordes med hjälp av två typologier. För att se hur kommunikation och påverkan används i dokumenten användes en utveckling av typologin Transtheoretical Model of Change (TTM) och för att se hur delaktighets beskrevs i dokumenten användes Arnsteins delaktighetsstege. Analysen visade många likheter mellan fallen. Dock framgick det att Nacka kommun presterade bättre med sin användning av sociala medier och genom främst två aktiviteter, Cykelvänlig arbetsplats och Cykla på vintern. Från slutsatsen kunde sedan tre rekommendationer lämnas. För det första bör cyklister inkluderas tidigt i processerna genom någon from av cykelråd. Det är också viktigt att försöka skapa cykelförebilder runtom i hela kommunerna, både i socio-ekonomiska starka och svaga områden. Till sist bör cykeldedikerade kommunikationskanaler skapas, förslagsvis på sociala medier. Detta ger en plattform som ger cykling ökad status, där cykling kan främjas och det skapar inte minst en möjlighet för medborgarkommunikation.

Doing business "the French way" in a Francophone market niche may be somehow different from doing it "the English way" in an Anglophone market niche. Since both the employees’ and the customers’ knowledge of an organisation underpins the organisation’s performance in complex business world environments, Multinational Organisations (MNOs) need to find a manner in which they can achieve coherence between their strategic vision, organisational culture and corporate image across the different linguistic and socio-economic markets they interact with through the various marketing tools they use to stimulate recognition. As a result this can support the integrity and sustainability of their corporate brand across markets and across different linguistics landscapes while interacting with their existing and new foreign markets. This study concentrates particularly on the rhetoric figures and visual cues employed in the selected French and English advertising/promotional messages from different types of advertisements and different product packages of multinational organisation subsidiaries. The study looks at how both the rhetoric figures and visual cues in the selected advertising/promotional messages support the integrity and maintain the sustainability of the corporate brand of the selected companies. The latter is examined across different linguistic and socio-economic markets. The study explores and examines how the possible linguistic properties are used in the selected French and English advertising/promotional messages from different types of advertisements, including those on different product packages. It also looks at how the linguistic properties in selected advertising/promotional messages belonging to different types of advertisements are used in creating and maintaining a positive corporate image of the MNOs and that of their parent companies. In addition, this study analyzes the potential impacts and challenges on moral, cultural and life-style values that multinational subsidiaries inflict on customers through the advertising/promotional messages from different types of advertisements in the promotion and branding of their products and how this affects their corporate image and that of their parent organisations. This is a content analytical study of language features evident in the selected advertising/promotional messages from different types of advertisements and different product packages at the lexical, syntactic and discourse levels and their role and impact on selected multinational parent organisations and their subsidiaries’ corporate images together with those of their selected products. In order to conduct a data-driven study, the author built a data corpus based on 29 advertising messages from different types of advertisements and advertising messages printed on different product packages. The types of advertisements include the photographs and scanned images of billboards, mural billboards, outdoor advertising billboards and leaflets advertising/promoting specific services or products. The product packages include photographs and scanned images of product covers/wraps, primary packages of products, product containers’ stickers with messages printed on them, and primary boxes. The sample comes from six selected multinational subsidiary organisations from two different countries, the Democratic Republic of Congo, a Francophone and multilingual country, and the Republic of South Africa, an Anglophone and multilingual country. Through a detailed content analysis of the advertising/promotional messages from a diversity of sources used as a means of communication, with a focus on rhetoric figures ,visual cues and language features, their roles and potential impact on MNO’s, corporate images in foreign markets will be summarized. In the end, possible conclusions are drawn in the light of the role and impact that they have on the selected companies’ corporate image across different linguistic and socio-economic markets.

Policy coherence for development (PCD) has risen on the donor community’s agenda over the years as globalization makes it impossible to ignore non-aid policies’ impact on development. Although straightforward in theory, PCD has proven much more difficult to achieve in practice. Policy incoherence remains commonplace, even as the number of guidelines and best practices for avoiding it increase. This thesis used the Advocacy Coalition Framework to analyze two cases of policy change in Sweden and Germany, namely the adoption of the democracy criterion for arms exports and the coal phase-out respectively. The findings suggest that the current discourse about PCD among donors and donor institutions – that PCD can be achieved through better evidence and greater policy coordination – requires careful scrutiny. The Swedish and German case studies strongly suggest that bureaucratic mechanisms for PCD are insufficient to make the significant political trade-offs PCD typically demands. This analysis argues that achieving policy coherence, especially where there are significant conflicts between development and self-interest, requires political direction catalyzed by an external event. This event, or series of events, must be disruptive and focus significant public attention on the policy issue, to trigger a redistribution of power in the policy subsystem. A combination of other necessary and sufficient factors is also needed for successful policy change in favour of PCD. Institutional mechanisms cannot substitute for political will, and the current move towards a de-politicized treatment of PCD – as something that can be achieved through technocratic means – should be re-examined.

Stand-up comedy represents a particularly potent form of rhetorical and performative criticism because of its potential duality. On the surface, a comedy set can look breezy and entertaining while containing a sharper, more critical message underneath. Like a fluffy, besprinkled cupcake hiding a potent antibiotic, stand-up comedy offers potentially healing insight under the cover of whimsy. Comedians have always utilized their performances to skewer those in power, but an increasing number have taken to the stage recently to address a particularly insidious social and cultural malady. The stigma associated with mental illness continues to limit the opportunities of those living with mental disorders, meaning comedians utilizing their performances to push back against this stigma represent a significant form of anti-mental-illness-stigma advocacy. In this dissertation, I argue that stand-up comedy is a uniquely subversive and resistant communicative act that enables performers to combat the stigma associated with mental illness. Grounding my discussion in literature about mental illness and two of the most common disorders, anxiety and depression, I construct an original performance criticism evaluative framework derived from three anti-stigma-advocacy techniques: protest, educate, and contact. While these techniques offer guidance for any kind of anti-stigma advocacy, I draw them into the realm of anti-mental-illness-stigma advocacy by utilizing my framework in a performance criticism of stand-up performances by Aparna Nancherla, Maria Bamford, Bo Burnham, and Chris Gethard—four comics known for discussing their mental health onstage. Moreover, I weave autoethnographic responses to each performance throughout my analysis to showcase the power of these cases of comedic anti-mental-illness-stigma advocacy to alter my perspective on my own anxiety.Ultimately, this dissertation demonstrates the potential of stand-up comedy as anti-mental-illness-stigma advocacy by chronicling my own growth in response to the work of these comedians. It also identifies aspects of stand-up that may be potentially useful to other kinds of anti-stigma advocacy. Additionally, the framework created and used in this dissertation provides both a rubric for future anti-stigma performance criticism and a blueprint for creating anti-stigma performance. Stand-up comedy is a significant performance genre and stand-up comedians can launch biting critiques that cultivate greater cultural citizenship for the marginalized and disenfranchised. A significant number of people will undoubtedly continue to spot the silly facade of stand-up comedy and look past the deeper insight, even though it can educate an audience, protest misinformation, and provide opportunities for contact between otherwise unfamiliar demographics. My effort here is to value stand-up comedy as a powerful communicative act because it has changed my life and will continue to incite change for many others. And that’s no joke.

Thesis advisor: Lisa A. Goodman / Recent research suggests that half or more of today’s domestic violence (DV) advocates are survivors of intimate partner violence (IPV) or other forms of abuse, consistent with the survivor-led early stages of the DV movement. Advocates who are themselves survivors (survivor-advocates) are at risk of experiencing vicarious trauma and other negative outcomes in response to their challenging work. Emerging research has also identified the possibility of deriving personal growth and healing from the work of advocacy, which bolster survivor-advocates against the stressors in their work. However, the processes by which survivor-advocates navigate their work and cope with its challenges are poorly understood. To date, only one qualitative study has asked survivor-advocates about their experiences. This study began illustrating some of the ways that survivor-advocates approach and experience their work; however, it is vital that we develop a richer understanding of how survivor-advocates experience their work as both healing and harmful, in order to maintain the sustainability and effectiveness of the services they provide. This study used grounded theory methodology to explore how survivor-advocates apply their survivorship to their work, and how their work influenced their well-being and recovery. The theoretical model that emerged was anchored by a central process called bringing my whole self to work, which participants described as consisting of four interrelated components: 1) constructing a personal narrative about how their identity connects to their work, 2) applying those connections to shape their work in numerous ways, 3) experiencing healing as an outcome of the previous two components and 4) the organizational contexts that shaped the process through validating or invalidating the survivor identity. Successfully engaging in this process helped survivor-advocates feel a greater sense of connection and integrity to their survivor identity and work, as well as possibly enhanced well-being. This process suggests numerous ways for DV organizations to encourage and support survivor-advocates to engage more openly, meaningfully, and effectively in their work and points toward new directions in understanding vicarious trauma. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Chronic health conditions in youth have increased over the last several decades. It is estimated that within the United States there are between 15% to 18% of youth who are living with a chronic health condition (Centers for Disease Control and Prevention [CDC], 2010). The CDC defines a chronic health condition as an illness that lasts for three months or longer that can be managed, but not cured (CDC, 2010). Although there is some research on youth living with chronic illnesses, there are minimal studies that assess the constructs of health literacy, resiliency, and support/advocacy within this population. The current investigation was a validity study of the Health Literacy and Resiliency Scale (HLRS). This is a newly developed 37-item measure that assesses the level of health literacy, resiliency, and support/self-advocacy among chronically ill youth (Bradley-Klug, Shaffer-Hudkins, Lynn, DeLoatche, & Montgomery, 2017). Specifically, the study correlated the construct of resiliency in the HLRS with the resiliency construct from the Child Youth and Resiliency Measure (CYRM; Ungar & Liebenberg, 2011). This measure is a 28-item measure that assesses levels of resiliency among youth and young adults. The goals for this study included: 1) determining the extent to which the results of the factor analysis from the current study are consistent with the three-factor model from the original study, 2) assessing the relationship between the HLRS and the CYRM, and 3) determining the reliability (internal consistency) of the scores of the HLRS. More importantly, since there have only been preliminary analyses conducted on the psychometric properties for the HLRS, this study was the first step towards providing validation for this measure. Participants were recruited through several methods including community-based organizations and online outlets. There were a total of 226 participants, with 54% identifying as White, 31% African American, and the remaining identifying as other. Sixty-one percent were female. The participants were English-speaking with a diagnosis of a chronic health condition given at least six months prior. Some of the conditions that were frequently identified among the sample included: diabetes, HIV, lupus, cystic fibrosis, ADHD, and asthma. Individuals were asked to complete the HLRS, CYRM, and a demographic survey online. The results indicated that the reliability of the values of the three factors in the HLRS ranged from acceptable to excellent. The results also included a correlation between the scores from the HLRS and CYRM. For the HLRS there were strong correlations between the resiliency and support/self-advocacy factors and health literacy and support/self-advocacy factors. For the CYRM, there was a strong correlation (r =.954) with the resiliency factor indicating that the resiliency factor within the HLRS aligns with the resiliency construct that is measured in the CYRM. Some items on the HLRS loaded on more than one factor indicating the need for further consideration of particular items on that scale. Overall, these data provide additional support for the HLRS scale and suggest that the scale may be a step closer to being utilized in applied settings.