Magister Educationis (Adult Learning and Global Change) - MEd(AL) / The choice of topic for the research paper was influenced by my experiences of attending university as an adult student and contemporary policy developments. In its White Paper for Post School Education (2013) the Department of Higher Education and Training (DHET) expresses intentions to expand access to post-school education for all people of all ages, including adults. The research paper focuses on the relationships between access, barriers to participation and success related to adult students who attended a university.

Introduction: Although colorectal cancer (CRC) is the second leading cause of cancer-related deaths among men and women combined in the United States, only 61% of eligible adults are up-to-date with current screening recommendations. Effective screening is hindered by numerous barriers and underutilization of evidence-based interventions. The purpose of this clinical dissertation project was to increase CRC screening in the rural community of Elgin, North Dakota, determine the efficacy of providing targeted educational handouts and endorsement letters, and to identify screening barriers and facilitators. Methods: Educational handouts and screening endorsement letters were developed and distributed to 75 average risk patients (without personal or family history of CRC or certain types of polyps, personal history of inflammatory bowel disease, personal history of receiving radiation to the abdomen or pelvic region, and confirmed or suspected hereditary CRC syndrome). Additional handouts were placed around the community of Elgin. Patients who presented for CRC screening were sent a questionnaire to determine the impact of the interventions. These 75 patients were also contacted via telephone and completed a questionnaire to identify barriers and facilitators and to highlight the effectiveness of the educational handout and the endorsement letter. Results: Five patients contacted the clinic to receive CRC screening. Ninety-seven percent of patients who recalled receiving the endorsement letter and educational handout (n=32) found the material to be informative, 91% of patients appreciated being contacted on behalf of the clinic, and 59% found the handwritten signature on the endorsement letter to be influential. Fifty-one patients identified screening barriers including (in descending order) lack of awareness/knowledge, cost, unpleasant previous experience, embarrassment, lack of motivation, and fear of abnormal findings. Forty-one patients identified screening facilitators including (in descending order) recommending during office visits, providing education on different screening options, sending letter reminders, calling patients, utilizing social media, and sending email reminders. Conclusion: The clinical dissertation project increased CRC screening compliance in Elgin, ND, identified barriers, and highlighted screening facilitators that can be utilized. Future projects should focus efforts on alleviating these barriers via targeted patient education and provider recommendation in order to decrease CRC morbidity and mortality.

Permeable reactive biobarrier (PRBB) is a flow-through zone where microorganisms degrade contaminants in groundwater. Discontinuous presence of contaminants in groundwater causes performance loss of a PRBB in removing the target contaminant. A novel enricher reactor (ER) - PRBB system was developed to treat groundwater with contaminants that reappear after an absence period. ER is an offline reactor for enriching contaminant degraders, which were used for augmenting PRBB to maintain its performance after a period of contaminant absence. The ER-PRBB concept was initially applied to remove benzene that reappeared after absence periods of 10 and 25 days. PRBBs without ER augmentation experienced performance losses of up to 15% higher than ER-PRBBs. The role of inducer compounds in the ER to enrich bacteria that can degrade a mixture of benzene, toluene, ethylbenzene, and xylene (BTEX) was investigated with an objective to minimize the use of toxic chemicals as inducers. Three inducer types were studied: individual BTEX compounds, BTEX mixture, and benzoate (a non toxic and a common intermediate for BTEX biodegradation). Complete BTEX removal was observed for degraders enriched on all three inducer types; however, the removal rates were dependent on the inducer type. Degraders enriched on toluene and BTEX had the highest degradation rates for BTEX of 0.006 to 0.014 day-1 and 0.006 to 0.012 day-1, respectively, while degraders enriched on benzoate showed the lowest degradation rates of 0.004 to 0.009 day-1. The ER-PRBB technique was finally applied to address the performance loss of a PRBB due to inhibition interactions among BTEX, when the mixture reappeared after a 10 day absence period. The ER-PRBBs experienced minimal to no performance loss, while PRBBs without ER augmentation experienced performance losses between 11% and 35%. Presence of ethanol during the BTEX absence period increased the performance loss of PRBB for benzene removal. PRBBs augmented with degraders enriched on toluene alone overcame the inhibition interaction between benzene and toluene indicating that toluene can be used as a single effective inducer in an ER. The ER-PRBB was demonstrated to be a promising remediation technique and has potential for applications to a wide range of organic contaminants.

End of life planning is an essential component of complete care for patients established in a primary care clinic. Family medicine clinics, where treatment begins with birth and ends with death, it is imperative for clinicians both seasoned and new have the knowledge and resources available to ensure effective discussion of this complex subject. Surveys across the country of both patients and providers show that anywhere between 5-25% of patients have an advanced directive filled out and on file. Furthermore, most patients report a preference for holding this discussion with their established primary care physician. Numerous barriers have been identified in previous surveys and studies that tend to limit this discussion in the primary care setting in the academic and private sector. By identifying these barriers and providing possible solutions, primary care providers should be able to more effectively facilitate and navigate a discussion about end of life care. We designed a quality improvement project for family medicine residents in an effort to identify location specific barriers and to provide an educational didactic session which is aimed at overcoming these barriers. A survey was designed to be filled out by participates prior to the presentation to measure baseline comfort and understanding of advanced directives. The same survey was administered after the presentation to measure the effectiveness of the presented didactic. Statistical analysis of these two surveys will be completed and reviewed. The expected outcome is that participants in the session leave with an improved comfort with the subject of advanced directives and end of life planning. Participants are expected to have increased knowledge of available resources that can be utilized during these discussions. By providing this session to both residents and supervising physicians, the hope is that an increase in documented advanced care directives will be seen at the family medicine clinic. If this session is found to be an effective tool to address the identified barriers to end of life planning, it may be suitable to extend throughout the family medicine department at East Tennessee State University. Following this didactic session, multiple residents reported utilizing resources that were presented during discussions, with patients in regards to end of life planning and advanced care directives.

Background: Since 2012, nurse practitioners (NPs) in Ontario have the professional capacity to assume the role of the most responsible provider (MRP) in hospitals; however, few have implemented this model. Aim: To explore the barriers and facilitators to the integration of the NP as MRP model of care in a hospital setting. Methods: A qualitative descriptive design with secondary data collected from a larger study, was used with principles from integrated knowledge translation. Findings: Thirteen barriers and eleven facilitators were found, such as: (i) challenges with off hour coverage; (ii) funding and remuneration; (iii) discrepancies in the employment standards regulations; and (iv) lack of a critical mass. Facilitators included the plan for role implementation, establishment of trust and leadership from the team. Conclusion: Many barriers, predominantly at the healthcare system-level, make it difficult to integrate the NP as MRP model of care in hospitals.

No description available.

No description available.

Stereotypical definitions associating disability with incapacity or abnormality, marginalise persons with disabilities and subject them to discrimination, neglect and abuse. Although societal inclusion of persons with disabilities is progressively recognised as a human right, many obstacles still prevent them from participating in all aspects of community life, including church activities. The paucity of literature on disability within religious environments include few studies applicable to the diverse Southern African socio-cultural context. The purpose of this study was to determine and describe the perceptions of persons with disabilities, primary caregivers of persons with disabilities, and church leaders within a specific Christian congregation, to determine what they deem barriers and facilitators to participation within their unique context. The study was framed within a qualitative, descriptive case study design. Using focus groups with three different participant groups as the data collection method, a comprehensive and in-depth account of the participants’ (n=17) perceptions was documented. Data analysis occurred inductively and deductively. Emergent themes were linked to the relevant theoretical framework, the ICF. Themes included perceptions concerning the social status of persons with disabilities, and how this relates to addressing and accommodating their needs, based on the levels of awareness and understanding of disability. Additionally, perceptions surfaced around access to the physical environment and necessary resources. Numerous connections between the themes and the ICF environmental codes verified the participants’ perceptions that factors in their congregation’s environment hinder, rather than enable, the participation of persons with disabilities in church-related activities. The findings were presented by a social deconstruction of disability, describing disability from a systems thinking perspective. The results implied the need for practical measures to ensure the participation of persons with disabilities in church ministries, and for open communication among all the stakeholders. It is essential to recognise and change the mental conceptualisations that sustain exclusion. The findings also provide recommendations where future research can make additional contributions to the relatively small body of knowledge addressing participation in local churches. / Dissertation (MA)--University of Pretoria, 2019. / Centre for Augmentative and Alternative Communication (CAAC) / MA / Unrestricted

Background: Cluster randomized control trials (cRCTs) are useful for asking about system-level interventions compared to other types of clinical research design, however they present unique challenges with conduct and delivery. Numerous cRCTs in hospitals have encountered challenges and time delays in enrolling hospitals and launching the trials which contributes to research waste. While each cRCT has unique barriers and enablers to their conduct, it is important to understand and explore these factors at the general level of the cRCT itself. Previous literature has documented factors associated with successful cRCTs, however, these studies focused primarily on the statistical aspect, while neglecting to evaluate the delivery of the trial. Objectives: The goal of this dissertation was to explore barriers and enablers to conducting cRCTs in hospitals, and to identify potential strategies that facilitate their delivery. This research was conducted to identify evidence and generate guidance for researchers aiming to conduct these trials. Specifically, the objectives were: 1) To explore the current knowledge and evidence surrounding the implementation of cRCTs in hospitals; 2) To explore from the perspective of the coordinating site, what influenced the delivery and hospital engagement of an ongoing cRCT, and what challenges were encountered; 3) To identify strategies to facilitate delivery of cRCTs in hospitals; 4) To systematically review reported recruitment strategies of healthcare facilities in cRCTs. Methods: The dissertation employed multiple research methods. To address the first objective, a scoping review was performed of current literature related to hospitals in cRCTs. The second objective was addressed with a qualitative case study. Semi-structured interviews were carried out with six key members of the team to understand their perceptions of the delivery of the trial. For the third objective, a tool matching two implementation concepts (the Consolidated Framework for Implementation Research (CFIR)- Expert Recommendations for Implementing Change (ERIC) matching tool) was used to identify strategies targeted to address barriers and enablers to cRCT conduct identified in the first two studies. Lastly, a systematic review was performed to address the fourth objective, to identify reported strategies used for hospital engagement in cRCTs. The thesis was guided and analyzed using an over-arching implementation framework, CFIR, and an implementation strategies list, the ERIC compilation. This was done to allow comparability and synthesis of results between methodologies from the dissertation, and between the results from the studies and previous literature. Results: Several key CFIR domains were identified in the literature in the scoping review that were determined to being influential for conducting the cRCTs in hospitals: the adaptability to tailor the trial to each site; the engagement of opinion leaders, champions and formally appointed implementation leaders in the cRCT process as facilitators to conducting the trial; the lack of a site perceiving a relative priority for the trial or tension for change for the clinical field presenting barriers to conducting the cRCT; and limited available resources can present barriers to conducting the cRCT. The qualitative case study identified similar CFIR domains and constructs as potentially influential for cRCT conduct, including the emphasis on adaptability of trial, the importance of tension for change in the sites for accepting inclusion in the trial, the availability of resources, and the engagement of leaders. The CFIR-ERIC matching study identified strategies that may be used to overcome barriers and target enablers for cRCT delivery from CFIR domains and constructs identified in the first two studies. A list of strategies was generated, ranked by the number of many determinants for which the strategy was listed as a Level 1 strategy, then by how many determinants for which the strategy was listed as a Level 2 strategy. The top ERIC strategies that were endorsed as a Level 1 strategy for any or multiple CFIR domains were: 1) Identify and prepare champions, 2) Conduct local needs assessment, 3) Conduct educational meetings, 4) Inform local opinion leaders, 5) Build a coalition, 6) Promote adaptability, 7) Develop a formal implementation blueprint, 8) Involve patients/consumers and family members, 9) Obtain and use patients/consumers and family feedback, 10) Develop educational materials, 11) Promote network weaving, 12) Distribute educational materials, 13) Access new funding, and 14) Develop academic partnerships. The systematic review identified literature reporting on the recruitment of healthcare facility sites into cRCTs. Numerous strategies for cRCT site recruitment were identified, and these were coded to the ERIC compilation. Strategies that were commonly cited were: involve executive boards, promote network weaving, conduct educational meetings, inform local opinion leaders, and centralize technical assistance. Conclusions: The results from the dissertation can contribute to the knowledge for facilitating cRCT delivery in hospitals while recognizing the critical limitations in the studies. Key concepts and strategies to facilitate the conduct and delivery of cRCTs in hospitals were identified. Future research should aim to empirically evaluate the identified strategies. Researchers should aim to address the reporting gap for cRCT delivery identified by this dissertation.

A disparity in access to higher education exists between rural and urban regions of the world. Equal access to higher education for students from rural areas is a priority for government leaders in Kyrgyzstan and Tajikistan. This study addressed the problem of lower-than-expected enrollment of students from rural areas at branches of the International Mountainous University (IMU, pseudonym) located in rural regions of Kyrgyzstan and Tajikistan. The purpose of this qualitative case study was to investigate the experiences and perceptions of 10 IMU students about gaining access to higher education. Informed by the theory of habitus, the research questions focused on perceptions of (a) the experience of gaining access and (b) sacrifices related to gaining access to higher education. Transcripts of individual, open-ended interviews were analyzed using elemental coding and verified through member checking. Four themes emerged: (a) academic barriers, (b) information and communication barriers, (c) support, and (d) material and nonmaterial sacrifices. Findings led to the development of a white paper recommending that IMU establish partnerships with high schools, develop parent outreach programs, and introduce inclusive admissions practices. Positive social change may result from providing IMU with program and policy recommendations that support the institution's vision of increased access to education for rural residents of Kyrgyzstan and Tajikistan.