There is a call for occupational therapists to extend their practice from correctional institutions to community settings with people who have been incarcerated; an emerging area of occupational therapy (OT) practice. However, with no published studies from the perspective of therapists in emerging settings, understanding the nature of emerging OT practice with people who have been incarcerated becomes problematic. Limited information about community integration makes it difficult to fill practice gaps and adhere to principles of evidence-based practice (EBP). Simultaneously, men with a criminal record experience stigma and exclusion from participation in everyday life extending well-beyond the completion of their sentence. Often denied a voice by people who control the media, correctional policies or political discussion about crime in the community, overcoming stereotypes of deviant, violent or aggressive criminals is difficult. The results of a participatory action research (PAR) project completed by men with a criminal record and a critical, first-person account about emerging OT practice from the perspective of a registered occupational therapist are presented. Through Photovoice, co-researchers collected and analyzed photographs during group sessions that were audio recorded, transcribed, analyzed and summarized by the primary author. Summaries contributed to critical dialogue with the co-researchers throughout the collection, analysis and, writing stages. ‘The cards you are dealt’ emerged as a metaphor depicting everyday life as a strategic game played with cards specific to a person’s social location. Co-researchers shared their individual and collective narratives through various knowledge dissemination methods. Documenting narratives from the perspective of men with a criminal record counteracts status quo understandings of community re-entry, creating space for marginalized populations to share stories that might otherwise be lost. Autoethnography, a post-modern, interpretive approach to research explores the meaning of emerging OT practice with criminalized men. Data were collected through reflective journaling and clinical process notes that upon review, guided systematic reflections required to write and re-write an analytical narrative of key experiences. Role-emerging placements were found to influence the chosen emerging setting. Preliminary insights about the role of evidence-based practice and advocacy work in supporting emerging OT practice is presented. Where occupation-focused research and regulatory body support remains limited, autoethnography contributes to professional development and the identification of knowledge gaps. Together, this thesis contributes to knowledge about: (1) emerging OT practice with men transitioning to the community post-incarceration; (2) daily life/community integration from the perspective of criminalized men in the community; (3) tensions in emerging OT practice; and (4) insights about the nature of anti-oppressive OT practice. / Thesis / Master of Science Rehabilitation Science (MSc) / This master’s thesis focuses on role-emerging occupational therapy (OT) practice with men with a criminal record. As a registered occupational therapist working with co-researchers with lived experience of incarceration, we completed a research project using photography to create and share narratives about community reintegration. The men generated a research question, collected data (photographs), completed data analysis as a group, disseminated knowledge and contributed to the publishing process as co-authors. A shared metaphor increased understanding about socio-political factors that impact community integration for men with a criminal record. Because emerging settings have been primarily explored as an educational tool for OT students, the role of evidence-based practice, advocacy and the potential of emerging OT practice with criminalized men adds a critical narrative from the perspective of a registered occupational therapist. Autoethnography is used as a method of research and professional development. Therefore, this thesis adds to the limited information about emerging OT practice with men transitioning to the community post-incarceration, tensions in emerging practice, community integration from the perspective of men with lived experience of incarceration and provides preliminary insights into the concepts of anti-oppressive OT practice.

During and following the Deepwater Horizon (DWH) accident in 2010, concerns about air and seafood quality were paramount. Though individual perceptions varied, many people in coastal communities in southeast Louisiana felt they had been exposed to oil- and dispersant-related compounds. We hypothesized that implementation of a Community-based Participatory Research (CBPR) project would promote a more transparent and mutually beneficial relationship between researchers and the community. We conducted both in-home and community-based assessments (n=198) in culturally diverse populations most impacted by the DWH event, including the Vietnamese in New Orleans East and the residents of the Bayou communities. Levels of volatile organic compounds (VOCs) in paired indoor/outdoor air samples and polycyclic aromatic hydrocarbons (PAHs) in seafood samples were determined with chemical analysis. Data were collected from multiple self-administered surveys regarding environmental awareness and impact of the DWH event, access to, and trusted sources of, information, perceptions about safety, and selected behavioral and socio-demographic variables. In an effort to enhance public understanding of the interconnectedness of their health with the Gulf ecosystem, we disseminated the information directly to the participants as well as the larger communities at risk. Through post-dissemination follow-up surveys, we explored the effectiveness of our environmental CBPR research strategy with our primary goals being to improve risk communication and promote informed decision-making among our coastal populations. / Jessi Howard

Reducing health disparities requires intervention on the social determinants of health, as well as a means to monitor and evaluate these actions. Indicators are powerful evaluation tools that can support these efforts, but they are often developed without the input of those being measured and invariably reflect the value judgments of those who create them. This is particularly evident in the measurement of subjective social constructs such as gender equity, and the participation and collaboration of the intended beneficiaries are critical to the creation of relevant and useful indicators. These issues are examined in the context of a study to develop indicators to measure gender equity in the Nicaraguan Fair Trade coffee cooperative PROCOCER. Recent studies report that Fair Trade cooperatives are not adequately addressing the needs of its women members. Indicators can provide cooperatives with a consistent means to plan, implement, and sustain actions to improve gender equity. This study used participatory and feminist research methods to develop indicators based on focus groups and interviews with women members of PROCOCER, the cooperative staff, and external experts. The findings suggest that the cooperative has a role in promoting gender equity not only at the organizational level, but in the member families as well. Moreover, gender equity requires the empowerment of women in four broad dimensions of measurement: economic, political, sociocultural, and wellbeing. The indicator set proposes 22 objective and subjective indicators for immediate use by the cooperative and 7 indicators for future integration, mirroring its evolving gender strategy. The results also highlight salient lessons from the participatory process of indicator development, where the selected indicators were inherently shaped by the organizational context, the emerging research partnership, and the unique study constraints. These findings speak to the need for continued efforts to develop a critical awareness and organizational response to gender inequities, as well as the importance of providing spaces for women to define their own tools of evaluation.

Reducing health disparities requires intervention on the social determinants of health, as well as a means to monitor and evaluate these actions. Indicators are powerful evaluation tools that can support these efforts, but they are often developed without the input of those being measured and invariably reflect the value judgments of those who create them. This is particularly evident in the measurement of subjective social constructs such as gender equity, and the participation and collaboration of the intended beneficiaries are critical to the creation of relevant and useful indicators. These issues are examined in the context of a study to develop indicators to measure gender equity in the Nicaraguan Fair Trade coffee cooperative PROCOCER. Recent studies report that Fair Trade cooperatives are not adequately addressing the needs of its women members. Indicators can provide cooperatives with a consistent means to plan, implement, and sustain actions to improve gender equity. This study used participatory and feminist research methods to develop indicators based on focus groups and interviews with women members of PROCOCER, the cooperative staff, and external experts. The findings suggest that the cooperative has a role in promoting gender equity not only at the organizational level, but in the member families as well. Moreover, gender equity requires the empowerment of women in four broad dimensions of measurement: economic, political, sociocultural, and wellbeing. The indicator set proposes 22 objective and subjective indicators for immediate use by the cooperative and 7 indicators for future integration, mirroring its evolving gender strategy. The results also highlight salient lessons from the participatory process of indicator development, where the selected indicators were inherently shaped by the organizational context, the emerging research partnership, and the unique study constraints. These findings speak to the need for continued efforts to develop a critical awareness and organizational response to gender inequities, as well as the importance of providing spaces for women to define their own tools of evaluation.

Background: Promoting mental health for Indigenous youth in Canada is a well-documented priority. Indigenous approaches to health promotion share similarities with the holistic process in outdoor adventure and experiential education contexts. The purpose of this study was to develop, implement, and evaluate an Outdoor Adventure Leadership Experience (OALE) for Indigenous adolescents from one First Nations community in Northeastern Ontario, Canada. Methods: Principles of community-based participatory research were used to guide this mixed method study that included three phases. Phase 1 involved the development of a culturally relevant OALE intervention. The intervention was available to adolescents, aged 12-18 years, living in Wikwemikong Unceded Indian Reserve. Phase 2 consisted of a quantitative evaluation of the effectiveness of the OALE, based on participant self-report. It focused primarily on assessing resilience using the 14-Item Resilience Scale (RS-14). Using an ethnographic approach, Phase 3 comprised a qualitative evaluation of the ways in which the OALE promoted resilience and well-being. Results: Phase 1 occurred over a period of 10 months (September 2008 to June 2009), and it resulted in the development of an intentionally designed 10-day OALE program. The program was implemented in the summer of 2009 and 2010 with 73 adolescent participants, aged 12-18 years. Results from Phase 2 revealed that there was a 3.40 point increase in mean resilience for the adolescent participants at one month post-OALE compared to one day pre-OALE (n=46, p=.011), but the improvement was not sustained one year later. Phase 3 results revealed that the OALE facilitated the development of resilience and well-being by helping the adolescents connect to Anishinaabe Bimaadziwin, an Ojibway concept that can be translated as the Good iv Life. Connecting involved an external experiential process of connecting with various aspects of creation and an internal reflective process of connecting within to different aspects of self. Conclusion: The OALE appears to be a program that helped the adolescents: (1) become more resilient in the short-term, and (2) become more aware of Anishinaabe Bimaadziwin (the Good Life) by providing opportunities for connecting with creation and self through a variety of experiences and reflections that were unique for each youth.

Weight-gain and physical inactivity in pregnancy have important implications for First Nations and Métis women, populations that experience a disproportionate burden of poor health outcomes in pregnancy. Utilizing a postcolonial feminist theoretical lens in conjunction with a social determinants of health framework and tenets of cultural safety, the purpose of my doctoral research, which was written in the publishable paper format, was to address four questions: a) Are First Nations women marginalized through current physical activity pregnancy guidelines?; b) How do pregnant First Nations and Métis women understand weight-gain and physical activity during pregnancy?; c) What are the factors that influence excessive weight-gain during pregnancy in urban First Nations and Métis women?; and d) How can obesity prevention programs with pregnant First Nations and Métis women who live in urban centres be reflective of and sensitive to their cultural practices? To answer these questions, I conducted community-based qualitative research, which included 15 semi-structured interviews with key informants who are health/service providers for Aboriginal women in Ottawa and focus groups and semi-structured interviews with 25 pregnant/postpartum First Nations and Métis women. I also conducted two focus groups with both health/service providers and pregnant/postpartum women to determine what type of resource would benefit pregnant, urban First Nations and Métis women. Ultimately, I used this information to develop this resource. My research results revealed a complex interaction between the social determinants of health underlined by current manifestations of colonialism, which impact urban First Nations and Métis women’s physical activity and weight-gain during pregnancy. These findings emphasize the need for culturally safe physical activity and weight-gain resources for First Nations and Métis women during pregnancy. Ultimately, this study identified the importance of community consultation to develop culturally safe, community-driven, and useful health interventions for urban, pregnant First Nations and Métis women.

Many public health and social issues faced by society today are multifaceted and require joint and collaborative efforts through health promotion partnerships. Community-based participatory research (CBPR) is one strategy that consists of engaging community stakeholders from various sectors to pool their expertise and resources in addressing health and social issues holistically. The literature indicates that the effectiveness of partnerships, such as those established within CBPR initiatives, is influenced by collaborative mechanisms that promote the creation of synergy among partners. There is, however, a lack of knowledge with regards to synergy and its key determinants in the context of health promotion partnerships. This qualitative thesis study is conducted as part of The EnRiCH Project, a CBPR initiative conducted in four communities across Canada, which aims at enhancing resilience and preparedness for disasters among high-risk populations. It explores the creation of synergy through the study of dynamics of collaboration shaping the EnRiCH-Québec City partnership and influencing its ability to leverage community resources for emergency preparedness. Emergent themes highlight that optimal collaboration in the EnRiCH-Québec City partnership is about having the “right people, in the right place, at the right time”. These findings provide evidence to inform community stakeholders, researchers and decision-makers on the dynamics of synergy creation and its implications for partnership growth and effectiveness.

Obesity is an increasing problem in the United States with 17% of youth currently classified as obese and an even higher prevalence of obesity among disadvantaged populations. The food environment may be contributing to these high rates as there has been a well documented association among increased away from home food consumption and excess adiposity, as well as evidence to support that children\'s diets are composed of a large portion of restaurant foods. The main purpose of this study is to describe the quality of restaurant food offered to children in a rural health disparate region. Two trained research assistants conducted systematic audits of all food outlets offering a children\'s menu in the Dan River region using the Children\'s Menu Assessment (CMA) tool. A composite score for each outlet for was calculated from the 29 scored items on the CMA. The total sample consisted of 137 outlets with CMA scores ranging from -4 to 9 with a mean score of 1.6+2.7. Scores were lowest in the predominantly Black block groups (0.2+0.4) when compared to the predominately White block groups (1.4+1.6) and Mixed block groups (2.6+2.4) with significantly lower scores in the predominantly Black block group than the Mixed block groups (F=4.3; p<0.05). The results of this study reveal a lack of few healthy food options available for children in this region. These findings have the potential to contribute to public health efforts in developing public policy changes or environmental interventions for the children\'s food environment in the Dan River Region. / Master of Science

Background: Community gardens have existed in America since the late 1800s and have served multiple purposes from food subsidies to neighborhood beautification. The use of community gardens has grown in popularity and has been recommended as a way to encourage healthy eating habits in youth. Though the health benefits of having a diet high in fruits and vegetables is well known, youth in the United States do not meet recommendations for fruit and vegetable intake. Under-consumption of fruits and vegetables is problematic in youth, as eating habits are established in childhood. Community gardens have been successfully used to improve access, self-efficacy, preference, and consumption of fruits and vegetables. However, few published community garden studies have focused on low socioeconomic youth. The Dan River Partnership for a Healthy Community (DRPHC) was developed according to community-based participatory research (CBPR) principles. With a mission to reduce obesity using healthy lifestyle initiatives, community gardens are an evolving DRPHC initiative. Objective: To evaluate the feasibility (i.e., demand, acceptability, implementation, and limited-effectiveness testing) of a 10-week experiential theory-based gardening and nutrition education program targeting youth living in two public housing sites in the Dan River Region. Methods: Using pre- and post-program questionnaires/interviews, demand and acceptability were measured among youth, parents and site leaders. Implementation was measures via field notes and attendance. Limited-effectiveness was measured among youth using a pre-post design. Three researchers independently coded the qualitative transcripts, met to resolve disagreements, and built consensus through discussion of the codes. Similarly, field notes were reviewed and evaluated for reoccurring themes regarding barriers, facilitators, and other observations. For the quantitative measures, descriptive statistics were used to summarize the variables and Cronbach's alphas used to assess the reliability of each scale at baseline. Overall effects were tested with repeated measures ANOVA. An intent-to-treat analysis using the last observation carried forward method was used. A critical value of .05 was used for significance testing. A standard equation for reporting effect sizes on a single-group, pre-post study design is also reported. Results: Program enrollment included 43 youth, primarily African American. The positive demand and acceptability findings indicate the potential of the program to be used and suitable for the youth, parents, and site leaders. Field notes revealed numerous implementation facilitators and barriers. Youth weekly attendance averaged 4.6 of 10 sessions. Significant improvements (p<0.05) were found for some (e.g., FV asking self-efficacy, overall gardening knowledge, knowledge of MyPlate recommendations), but not all limited-effectiveness measures (e.g., willingness to try FV, FV eating self-efficacy). Study Implications: This study addresses recommendations for utilizing CBPR in community garden efforts and builds on community identified research priorities of the DRPHC. Results demonstrate the feasibility of a gardening and nutrition program targeting youth in public housing. Lessons learned are being used to adapt and strengthen the program for future efforts targeting FV behaviors. Findings will be shared with local community stakeholders and used to adapt and strengthen the program for future efforts in the Dan River Region targeting of fruit and vegetable behaviors. / Master of Science

As defined by the US Department of Health and Human Services, health disparities are "a particular type of health differences that are closely linked with social or economic disadvantages." These disadvantages include, but are not limited to, unequal access to quality health care and health information. Health disparities adversely affect groups of people based on racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion. To address the root cause of health disparities there has been a call for more comprehensive frameworks for detecting, understanding, and designing interventions that will reduce or eliminate health disparities. One such framework is a Community-Based Participatory Research (CBPR) approach. CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of co-learning, mutual benefits, and long term commitment. CBPR also focuses on aspects of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities. The overall goal of this dissertation is to build capacity and address health disparities among youth and adults in the Dan River Region. This region is federally designated as a medically under-served area/population and is located in the health disparate region of south central Virginia and north central North Carolina. This research draws on two CBPR projects, including an 8-week community garden program lead by the Dan River Partnership for a Healthy Community (DRPHC) and a 3-month childhood obesity treatment program, iChoose, led by the Partnering for Obesity Planning and Sustainability (POPS) Community Advisory Board (CAB). Since one of the primary aims for CBPR is to increase community capacity, this approach is the ideal process for engaging communities that suffer from health disparities. Thus, engaging community members as collaborators, our studies reported on the relevance and application of CBPR while simultaneously addressing health and capacity outcomes in the health disparate Dan River Region. / Ph. D.