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<p>The purpose of this qualitative, interpretive study was to gain an understanding of the client experience at a health promotion and illness/injury prevention health centre within a First Nations community in Southern Ontario. A Heideggerian, hermeneutic approach and participatory processes were used within the research framework. Data were collected through the use of face-to-face, semi-structured interviews with 7 female and 5 male members of a First Nations community. Thematic analysis based upon the work of Max van Manen was employed and resulted in three overriding themes: (a) health and being healthy, (b) I use the health centre, and (c) I don’t use the health centre. Essential components of being healthy included having choices and being able to make them, being able to care for self and others and eating right. Some participants viewed their health centre as a valued source of information and services for both health and illness and as a trusted location for accessing traditional healers. Other participants reported little or no use of their health centre due to a lack of awareness of services offered, a lack of comfort and familiarity with the health centre's staff, services and building structure, a reliance on self-healing methods, and/or a reliance on other sources of health information such as family, community Elders and the Internet. The study provided insights on a First Nations community vision of an ideal health centre. Implications for nursing education, research and policy are provided.</p> / Doctor of Philosophy (PhD)

This dissertation examines the effect of accountability and client risk on auditor efficiency and effectiveness during an audit review task. I considered two types of accountability. The first type is outcome accountability, which represents the type of accountability in the current audit review process. The second type of accountability is process accountability, which is not currently utilized in the audit review process. I also examined two levels of client risk (high and low) because client risk has been shown to impact efficiency and effectiveness of the audit review process. An internet-based experimental instrument was utilized for this study. Participants were practicing auditors. Findings indicate that process accountability improved performance by exhibiting both an increase in identification of errors and a decrease in likelihood of agreement with the preparer. Findings also show that process accountability decreases efficiency by increasing overall time to complete the study and the amount of information reviewed. These results suggest that process accountability, the act of documenting the process used to perform a task, may reduce the chances of audit failure, making the reduction in efficiency acceptable. I also find that participants in the process accountability and high risk groups may have experienced information overload. Both high client risk and process accountability have been shown to increase attention to information and time spent on a task. A decrease in errors identified by individuals in this group when compared to individuals in the process accountability and low risk group may indicate information overload. Also, attrition rates and followup responses from participants who did not complete the study indicate that information overload may have been an issue for participants in the process accountability/high risk group. / Ph. D.

This dissertation presents the results of three research studies investigating the role trust plays in an auditor's decisions. The first study examines whether auditors develop trust in a client's management after working with the client during prior audit engagements. The results indicate that auditors have higher trust in the client's management after a positive, overall satisfying experience working with the client compared to a negative, overall unsatisfying experience. The first study also investigates whether auditors" trust in a client affects their audit decisions. The results show a negative relationship between auditors" trust and their fraud risk assessment. Specifically, lower levels of trust are associated with higher levels of risk, and vice versa. Together, the results suggest that auditors may indeed develop trust in a client's management and this trust may affect their audit decisions. The second study examines whether Certified Public Accountants’ (CPAs) level of moral reasoning affects their decision to trust a client's management and the extent to which to trust them. The results show that CPAs with relatively higher levels of moral reasoning have less trust in the client's management than CPAs with relatively lower levels of moral reasoning. The findings indicate that an auditor's decision to trust a client's management is, at least in part, an ethical judgment. Also, because the decision is an ethical one, the findings suggest that trust beyond some threshold would be considered unethical. The third study extends the results of the first study by simultaneously examining how an auditor's trust and the financial importance of the client affect the auditor's decision to accept the client's preferred method of recognizing revenue. The results indicate that auditors" trust in the client's management is positively related to their commitment to the goal of supporting the client's preferred reporting methods (goal commitment), which in turn is positively related to the auditors" assessments of the acceptability of the client's methods for reporting purposes. The importance of the client did not affect auditors" goal commitment or their acceptability assessments. The findings suggest that auditors with higher levels of trust may be more likely to accept the client's preferred method of financial reporting. Overall, these results add to our knowledge of audit judgment and decision-making by providing evidence that auditors do indeed develop trust in a client's management; that the decision and extent to trust the client is in part an ethical judgment; and that auditors" trust may affect their audit decisions. This dissertation highlights the important role that an auditor's trust plays in his or her audit decisions. / Ph. D.

The amount of data that is shared on the Internet is growing at an alarming rate. Current estimates state that approximately 2.5 exabytes of data were generated every day in 2012. This rate is only growing as people continue to increase their on-line presence. As the amount of data grows, so too do the number of people who are attempting to gain access to the data. Attackers try many methods to gain access to information, including a number of attacks that occur at the network layer. A network-based moving target defense is a technique that obfuscates the location of a machine on the Internet by arbitrarily changing its IP address periodically. MT6D is one of these techniques that leverages the size of the IPv6 address space to make it statistically impossible for an attacker to find a specific target machine. MT6D was designed with a number of limitations that include manually generated static configurations and support for only peer to peer networks. This work presents extensions to MT6D that provide dynamically generated configurations, a secure and dynamic means of exchanging configurations, and with these new features, an ability to function as a server supporting a large number of clients. This work makes three primary contributions to the field of network-based moving target defense systems. First, it provides a means to exchange arbitrary information in a way that provides network anonymity, authentication, and security. Second, it demonstrates a technique that gives MT6D the capability to exchange configuration information by only sharing public keys. Finally, it introduces a session establishment protocol that clients can use to establish concurrent connections with an MT6D server. / Ph. D.

Contentious interactions may arise between a tax professional and client upon a disagreement over a tax position. In an increasingly competitive tax return preparation market, these contentious interactions represent a significant threat to tax practitioners' client satisfaction and retention objectives. I conduct an experiment in which I examine the effect of three factors on tax clients' (1) likelihood to accept the advice of the tax accountant and (2) likelihood to switch tax accountants upon receiving professional advice counter to their preferred tax position. The three factors are: (1) clients' antagonistic narcissism; (2) clients' relationship with the accountant; and (3) how the advice is framed by the tax accountant. The results are based on a sample of 93 taxpayers. First, this study examines how clients' measured levels of narcissistic antagonism (hereafter, antagonism) impacts their reaction to "being told no" by their tax professional. Results indicate that upon the receipt of advice contrary to their preferences, highly antagonistic clients are more likely to (1) engage in a contentious interaction with their professional and (2) switch to a new tax professional. Supplemental path analyses document that individuals with high levels of antagonism cognitively react to instances of "being told no" by simultaneously devaluing their professionals' credibility and role as a client advocate, leading to these aggressive behaviors. This study also examines how the social closeness of the professional-client relationship influences the argue and switch decisions. Multivariate analysis indicates that social closeness is significantly related to the argue and switch decision. However, univariate results do not show significant relationship between social closeness and each of the decisions individually. That is, I find partial support for the professional publications and AICPA recommendations that tax practitioners should develop personal relationships with their clients to improve client satisfaction and likelihood of retention. Clients are marginally more likely to retain their current tax professional for future years when they feel they have a personal relationship with their tax practitioner, as opposed to those in a purely professional relationship. Finally, this dissertation considers the manner in which a tax professional frames his/her advice that is counter to a client's preferences. Results indicate that contrary advice that focuses on the potential downsides of an aggressive tax position (e.g., IRS audits and penalties) significantly dissuades client argument with the professional and significantly deters switching to a new tax accountant as compared to advice that is framed as being in the clients' "best interest."

For some considerable time, client satisfaction has been a problematic issue in the UK construction industry with many projects failing to satisfy the client needs and meet or exceed the client expectations. Client satisfaction is, however, a key performance measure and a major determinant of project success. There is a common belief that strategic decisions made by clients have a significant impact on the levels of client satisfaction. Strategic decisions in the context of construction projects are often associated with project stages including pre-design, design, tender, construction, occupancy & maintenance and disposal and vary in nature. Consequently the impact of strategic decisions on client satisfaction depends as much on timing as on the subjects of the decisions. While such findings are useful to facilitate the industry’s focus on addressing the failure in achieving client satisfaction, and point to the route for improvement, they are arbitrary and do not provide a systematic basis for investigating the real impact on client satisfaction. The nature of strategic decisions and the significance of its impact on client satisfaction have not been clearly identified and client satisfaction has remained an elusive issue for a majority of construction professionals. This research was hence undertaken to seek empirical evidence of an interrelationship between strategic decisions and client satisfaction. Defining strategic decisions, often associated with project stages, as ones that are complex and made under uncertainty and have a long-term impact on project success, a quantitative research methodology combined with qualitative approaches, was adopted in investigating the interrelationship between strategic decisions and client satisfaction. Findings of a detailed literature review revealed that client satisfaction at any stage depends as much on the service quality attributes of service providers including overall service delivery, people of service providers and communications with clients as on the influence of strategic decisions and the client itself. These performance attributes and the groups of strategic decisions, referred as strategic decision cluster (SDC), were further assessed and the relationships between these measures and strategic decisions were examined using factor analysis and multiple regression modelling techniques. Analyses revealed SDCs including Design Approach, Procurement and Implementation predict better the outcomes of service quality and hence higher levels of client satisfaction. Service delivery and communications with clients have a positively significant correlation with the levels of client satisfaction. Of these two attributes, communications with clients makes the largest unique contribution to the variance and is considered the better predictor for client satisfaction. The developed models is validated via external and internal validation and the findings support the thesis that strategic decisions have a impact on client satisfaction by strongly influencing the performance of service quality although causality cannot be assumed. It is recommended that service providers including contractors and consultants devote more efforts to improve their performance on the attributes of service quality identified as having significant association with client satisfaction, particularly service delivery and communications with clients. Further research efforts focusing on providing a practical tool or expert system so as to address the practical issues for a wider range of clients and service providers are also recommended.