The purpose of this study was to evaluate the utility of the Adaptive Tasks Framework for assessing parental needs when providing primary care for their child with a chronic health condition. A qualitative descriptive methodology framed the study and two methods were employed to collect data: a secondary analysis of existing interview data from seven parents of children with chronic health conditions and interviews with four parents who were currently providing primary care for their child with a chronic health condition. The data was analyzed using content analysis, whereby interview data was explored to determine if it fit into one or more of the eight adaptive tasks categories. Parents reported needs in all of the eight adaptive tasks categories, with the need for information regarding their child's chronic health condition being the foremost concern among parents. The need for caring, empathetic, and patient health care professionals who are sympathetic to the informational needs of parents, while at the same time acknowledging their expertise, was the second need expressed by the parents in this study. Implications of these findings for nurses is that the Adaptive Tasks Framework provides a useful tool for assessing parental needs when managing their child's chronic health condition and for determining areas in which the parents may require support.

Made available in DSpace on 2014-09-09T12:22:47Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 69593.pdf: 4082516 bytes, checksum: da8a949f72d95d68103995d0a1e225e7 (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil. / O presente trabalho teve como objeto de estudo o cuidado às condições crônicas de saúde de crianças e adolescentes, caracterizado pela interação e relação entre diferentes sujeitos, pelo elevado tempo médio de internação, pela transformação das vidas de crianças e familiares, pelos processos de alta e reinternações , pela demarcação de locais específicos para sua produção e reprodução e pela utilização de recursos e insumos tecnológicos, tendo o conhecimento científico e a academia perpassando como fontes produtoras de saber e de práticas. Buscou compreender como se constrói o cuidado às condições crônicas de saúde da criança e do adolescente em hospitais de média e alta complexidade. Para tanto, foi necessário analisar a produção do cuidado às condições crônicas de saúde de crianças e adolescentes em hospitais de méd ia e alta complexidade; compreender as relações entre profissionais e usuários (pacientes e familiares) na dinâmica dos serviços e entender como se estabelecem as redes de apoio sócio - assistenciais envolvidas com o cuidado às condições crônicas de saúde de crianças e adolescentes. O estudo utilizou a abordagem qualitativa, assentada no arcabouço teórico da microssociologia, que buscou compreender as interações e os códigos sociais dos sujeitos em estudo. Os locais de estudo foram enfermarias de Neonatologia , Pediatria e Cirurgia Pediátrica de hospitais de referência no cuidado às condições crônicas de saúde da criança, ambos situados no Município do Rio de Janeiro. O sujeitos de pesquisa foram profissionais e mães de crianças internadas. Como recursos metodo lógicos, foram realizadas observações de campo e entrevistas. Através dos resultados, pôde - se compreender que o paciente crônico estabelece, desde o diagnóstico, uma forte interação com os profissionais e com os serviços de saúde. São condições que altera m a rotina de vida dos familiares e pacientes , que passam a conviver com o universo hospitalar, dependência de tecnologias e necessidade de aprendizagem de novos conhecimentos. Para os profissionais atuar nesse cuidado exige enfrentar lacunas entre o model o de formação, centrado na busca pela cura e salvação, e as realidades dos pacientes, que demandam cuidado e atenção. Por isso, é um cuidado também assumido como difícil e desgastante, demandando dedicação, empenho, especialização e doação. Nesse sentido, a produção do cuidado mostrou - se fortemente marcada pelo modelo de formação biomédico, pelos avanços tecnológicos e científicos. É um cuidado que acontece por meio e através de muitas interações sociais, relacionando profissionais, usuários e familiares. C om isso, o fator comunicacional é fundamental para ser possível diminuir as lacunas entre os sujeitos. Trata - se de um cuidado que demanda e conforma redes entre os sujeitos e as instituições, as quais se apresentam ora mais consolidadas, ora mais incomplet as, colocando como questão a necessidade de estruturação de rede de saúde e seus serviços. Conclui - se que a vivência de uma condição crônica não é somente um traço da transição epidemiológica, nem apenas um processo de trabalho que envolve tecnologias do c uidado, mas também refere - se a produção de novas relações, dimensões socioculturais que precisam ser perspectivadas através de suas potencialidades de transformar os saberes, os conhecimentos e as práticas. / The present work have as subject of the sutdy the care given for chronic health conditions of children and adolescentes, characterized by the interaction and relationship between different individual s, for the high aver age length of stay, the transformation of the lives of childrens and relatives, by the pro cesses of high readmissions, the demarcation of specific locations for their production and reproduction and the use of res ources and technological inputs, having tne scientific knowledge and the academy permeating as source producers of guideline and practices. Sought to understand how to build care for chronic health conditions of children and adolescents in hospitals of medium and high complexity. Therefore, it was necessary to analyze the production of care for chronic health conditions of children and adolescents in hospital s of medium and high complexity ; understand the relationships be tween professionals and patients and families in the dynamics of services and u nderstand how to establish networks of social assistance support involved with the care of chronic health conditions in children and adolescent s . The study used a qualitative approach setting in the theor etical framework of microsociology , which sought to understand the interactions and social co des of the subjects under study The study sites were wards of Neonatology , Pediatrics and Pediatric Surgery of referral hospital care for chroni c health conditions of children , both locate d in the city of Rio de Jan eiro. The research subjects were professionals and mothers of hospitalized children. As methodological resources, field observations and interviews were conducted. Through the results , we could unde rstand that since the diagnosis , the chronic patient estab lishes a strong interaction with pr ofessionals and health services. These conditions alter the routine of family members and the patient, which now liv e with the hospital environment , dependence on technology and need for learning new knowledge. For profes sional s act is this care requires addressing gaps between the training model , centered on the quest for healing and salvation , and the realities of patients that require care and attention . So it is also assumed as a difficult and exhausting care , demandin g dedication, commi tment, expertise and donation. In this sense, the production of care showed being strongly m arked by the model of biomedical formation , and by techno logical and scientific advances. It is a care that happens by and t hrough many social in teractions , linking profession als, users and families. Thus, the communicative factor is crucial to be able to decrease the gaps betw een subjects. It is a caution that demand and linked networks among individu als and institutions, which sometimes present m ore consolidate, sometimes m ore incomplete, putting as question the need for structuring the health network and its services . Concludes that the experience of a chronic condition is not only a trace of the epidemiological transition, and not just a work pr ocess that involves care technologies , but also refers to the production of new relationships socio - cultural dimensions that ne ed to be envisaged through there poten tials to transform the knowledge , expertise and practices .

The purpose of this study was to evaluate the utility of the Adaptive Tasks Framework for assessing parental needs when providing primary care for their child with a chronic health condition. A qualitative descriptive methodology framed the study and two methods were employed to collect data: a secondary analysis of existing interview data from seven parents of children with chronic health conditions and interviews with four parents who were currently providing primary care for their child with a chronic health condition. The data was analyzed using content analysis, whereby interview data was explored to determine if it fit into one or more of the eight adaptive tasks categories. Parents reported needs in all of the eight adaptive tasks categories, with the need for information regarding their child's chronic health condition being the foremost concern among parents. The need for caring, empathetic, and patient health care professionals who are sympathetic to the informational needs of parents, while at the same time acknowledging their expertise, was the second need expressed by the parents in this study. Implications of these findings for nurses is that the Adaptive Tasks Framework provides a useful tool for assessing parental needs when managing their child's chronic health condition and for determining areas in which the parents may require support. / Applied Science, Faculty of / Nursing, School of / Graduate

This thesis consists of three essays on the economics of sleep time and work stress. The first essay, “the impact of economic factors on sleep: the role of insomnia”, discusses the role played by insomnia on the link between economic variables and sleep time. Insomnia is a common phenomenon experienced by many Canadians. This paper uses the Canadian General Social Survey (GSS) 2005 to investigate the effect of economic factors on the sleep time of the labour force. It replicates previous work by Biddle and Hamermesh (1990) and then extends this work to look at the role played by insomnia on the link between economic variables and sleep time. The paper concludes that the presence of sleep problems can significantly change the impact of economic determinants such as wage and education on sleep time. This paper finds that a 10 percent increase in the wage rate decreases sleep time by almost 20 minutes per week for non-insomniacs while an increase in the wage rate does not have any impact on sleep time for insomniacs. In fact, the link between wage and sleep time appears to be broken for insomniacs as they do not want to, or cannot, sacrifice their sleep time in order to have more money in their pockets. The second essay, “sleep time and wages: the role of chronic diseases and work environment”, examines the role played by chronic diseases and work environment on the link between economic variables and sleep time. This paper, which expands on the work of the first essay, uses the Canadian Community Health Survey (CCHS) 2001 to investigate the roles of insomnia, chronic diseases and stressful work environments on the link between the wage rate and sleep time. Whereas Biddle and Hamermesh (1990) report that individuals sleep 14 minutes less per week as a result of a 10% increase in the wage rate, I find that this number increases to 30 minutes for individuals without sleep problems while it is zero for insomniacs. Moreover, the impact of wages on sleep time is even more pronounced – more than 60 minutes per week - once account is taken of health conditions and of the work environment. Interestingly, these health and environmental effects are in addition to their impact on insomnia: in other words, individuals with chronic health problems who are not insomniacs do not respond to an increase in the wage rate by reducing their sleep time. This means that the actual impact of wages on sleep time for those who do not suffer from these conditions is much more important than originally reported by Biddle and Hamermesh (1990). The third essay, “are Québecers more stressed out at work than others? An investigation into the differences between Québec and the Rest of Canada in the level of work stress” discusses the level of stress experienced by workers in Canada. Work stress has a large socio-economic impact: it affects worker absenteeism, productivity, and family life. Psychological health problems including stress at workplace are an important issue in Canada. Using nine cycles spanning twelve years of the Canadian Community Health Survey (CCHS), I find that the level of work stress in Québec is much higher than in any other province. In Québec, 40% of the population report having quite a bit or extremely stressful jobs. In the other provinces, this number is much smaller, in the order of 30% in Ontario, Alberta, Manitoba and British Columbia, and even lower in the Atlantic Provinces. I find that Québec still has a higher level of reported work stress even after controlling for the main determinants of work stress: income, education, health, age, gender, marital status, children and work environment. Unionization rate and unemployment rate in the province do not seem to matter. However, I find that immigrants in Québec have less work stress than native-born Francophones. Also, Francophones in Québec and elsewhere have higher levels of work stress than Anglophones and Allophones. A body of literature has examined the subject of work stress, and while it has been noted by a few authors (Bordeleau and Traoré, 2007 and Lesage et al., 2010) that Québec is different; a thorough analysis of the causes of this phenomenon needs to be done. This paper estimates regression models that include a large number of factors such as age, gender, marital status, census metropolitan area (CMA), urban, immigrants, having young children, household type, living arrangement, mother tongue, language of conversation, race, education, income, working hours, part time job, health, physical activity, type of smoker, type of drinker, sense of belonging to community, provincial unionization rate and provincial unemployment rate to examine why there may be a consistent and persistent different between those who reside in Québec relative to the rest of Canada. I find that, even after controlling for those factors, work stress is still higher in Québec. This study suggests that differences in the legal systems and in cultures may be some of the reasons of the differences between Québec and the rest of Canada.

Philosophiae Doctor - PhD / This thesis researched the relationship between alcohol consumption, socioeconomic characteristics and alcohol-related harms such as subjective health status, chronic health conditions and mental health status in South Africa. The study sought to determine if the alcohol harm paradox (AHP) exists in the country. The AHP is the empirical finding that socioeconomically disadvantaged individuals tend to suffer more alcohol-related harms compared to individuals who are socioeconomically advantaged, despite reporting similar or lower levels of alcohol consumption on average. The research presented the contextual background to alcohol consumption in the country that helped form the current drinking culture, which includes the harmful drinking culture fomented by the apartheid system in the townships and farms of South Africa. The study also reviewed the effectiveness of current alcohol policies and legislation in addressing alcohol-related harms in the South African society. / 2023

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Background: Although research in healthcare transition is not novel, youth with chronic health conditions (YCHC) and parents still struggle with this complex process. Currently, there is limited theoretically-driven studies to inform transition research. The key foundation of this thesis is on the integration and application of theories and conceptual frameworks to studying the complexities of the transition process to inform research on a conceptual level. Purpose: Three study objectives were: 1) to gain a better understanding of the experiences of YCHC, parents, and healthcare providers with self-management during the transition process; 2) explore theoretical frameworks to guide research in transition and inform the planning and delivery of holistic transition services that is developmentally appropriate and culturally sensitive; and 3) to identify strategies to facilitate knowledge mobilization in transition. Methods: This “sandwich thesis” includes four individual scholarly works (Chapters 2-5) positioned between the introduction (Chapter 1) and the conclusions (Chapter 6). The Knowledge to Action (KTA) framework was used to framed all of my four scholarly works together. Chapter 2 was a qualitative study to examine the collective experiences YCHC, parents, and healthcare providers with self-management during transition. Chapter 3 was a critical appraisal of the literature to explored the potential application of acculturation theory in transition through the use of a clinical vignette. Chapter 4 was a scoping review about the current use of the ICF and transition research and practice. Chapter 5 was a demonstration project with the primary aim of working with youth (i.e. university students with and without a disability) and researchers to identify engagement strategies in research to develop partnerships to facilitate knowledge mobilization. Results: Key findings of Chapter 2: i) the process of self-management is interconnected and interdependent between YCHC, parents, and healthcare providers, and ii) results began to uncover cultural nuances between pediatric and adult healthcare. Key findings of Chapter 3: i) acculturation theory provides a concrete conceptual framework to guide thinking about the process of change within an individual with a change in culture to another; and ii) acculturation can become a natural framework for health systems practitioners when integrated into clinical practice frameworks. Key findings of Chapter 4: i) the ICF broadens our view on health to include personal and environment factors, and ii) the ICF enhances multidisciplinary communication and collaboration. However, the ICF is not without limitation. Specifically, there are limited descriptions around personal and environmental factors and the underlying processes, defining differences between the domains of activity and participation, and the ICF’s static nature which does not address change over time. Key findings of Chapter 5: five engagement strategies: 1) creating a physical or virtual hub with updated information or updating current websites to ensure usability and accessibility (e.g. for course selection), 2) hosting “speed dating” events between students and faculty/researchers to enhance communication and knowledge exchange, 3) hosting monthly lectures/workshops/webinars, 4) capacity building via emailing lists for new opportunities, and 5) peer mentoring to connect stakeholders within the University and Hamilton communities. Conclusions: Synthesis of the knowledge from this thesis contributes to the thinking and doing of transition research. Specifically, acculturation theory (a social science and psychology theory) and the International Classification of Functioning, Disability, and Health (ICF) (a bio-psycho-social theory) are offered as complementary conceptual frameworks to inform transition research. Stakeholder involvement in transition research is critical in facilitating knowledge mobilization, however, researchers need to consider the challenges of research partnership with YCHC. It is recommended to explore and assess opportunities for YCHC to have experiences starting in childhood and through adolescence; these experiences can assist in building YCHC’s capacity to assume adult roles and responsibilities for self-management. / Thesis / Doctor of Philosophy (PhD) / Today, one in five Canadian children, adolescents, and young adults live with a chronic physical, developmental, behavioural or emotional condition that impact their developmental trajectories. Youth with chronic health conditions (YCHC) and their families find it difficult to go from pediatric to adult healthcare. Although the topic of transition is not new, YCHC and parents continue to experience barriers in the adult system for meeting their needs (e.g. fragmented services, accessibility to available services, and biomedical focus of healthcare to name a few). Moreover, research evidence is not reaching the people who need it most, YCHC and their parents, and they are not benefitting optimally from advances in research. Thus, research is needed to carefully examine the process of transition to better understand the underlying processes, to identify current knowledge gaps, and to facilitate knowledge mobilization. The overall aim of this thesis is on the application of theories (acculturation theory) and frameworks (International Classification of Functioning, Disability, and Health-ICF) to provide a new outlook and lens to unraveling the complexities and underlying processes of transition, which has not been examined before. The Knowledge to Action (KTA) framework is used to inform the research process and stakeholder consultation to facilitate knowledge mobilization. The goal is to ultimately produce meaningful and relevant outcomes for YCHC and those involved in the transition process. YCHC and other stakeholders (parents, healthcare providers, community partners, and policymakers) were consulted throughout all of the components of the thesis ensure their voices and needs were heard. Results from this thesis will bring new insights and knowledge to those involved in transition research and practice.

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U.S. healthcare consumers have access to various provider ratings from several organizations that are meant to assist in selecting their healthcare providers. Leapfrog Hospital Safety Grades is one such rating system that professes to allow consumers the ability to select the best hospital for their care. However, since consumers ranking mortality risk as their most important concern, it is essential to determine if Leapfrog grades align with consumer expectations. Andersen's Phase-4 behavioral model of healthcare utilization was used as the foundation for understanding healthcare consumer preferences. This study was designed to determine if Leapfrog grades are predictive of CMS 30-day mortality rates for pneumonia, chronic heart failure, and acute myocardial infarction data, while also adjusting for selected organizational descriptors: state of residency, Medicare expansion, safety-net status, ownership type, teaching classification, and number of licensed beds. Linear regression demonstrated that Leapfrog grades are not reliable predictors of the 3 inpatient mortality rates analyzed. The study demonstrated that ownership type was a significant predictor for 2 of the 3 dependent variables. Furthermore, most of the covariates also provided some predictive value for at least 1 of the included outcomes; however, in most cases, the effect (β) was small. This study can help provide positive social change by elucidating that Leapfrog grades are not reliable predictors of patient outcomes for consumers, while also demonstrating that efforts to reduce 30-day mortality rates, especially for pneumonia, can be targeted by selected states, ownership type, and teaching status.