As a chronic disease, asthma presents a significant public health challenge nationally and in Georgia. In 2007, over 22 million people, including over 9 million children, had asthma in the United States. In Georgia, 230,000, or 10% of children have asthma, which is more prevalent among children less than 18 years of age than among adults. While asthma affects people of all ages and socioeconomic status, low income and minority populations have the highest asthma morbidity. This has proven to be the case with residents of Neighborhood Planning Unit V (NPU-V), a low-income minority community located in southeast Atlanta. Children comprise 35% of NPU-V's population, and over half of them live below the poverty line. Among other concerns, children with asthma have higher rates of hospitalization and absenteeism from school than their peers. The hospitalization rates for children with asthma in South Atlanta aged 0-17 years of age is almost five times the rate of North Fulton County. The Georgia State University Institute of Public Health received grant funding for the planning and implementation of the Accountable Communities: Healthy Together-Asthma (ACHT-A) program to help address the problems associated with asthma in NPU-V and among patients of Southside Medical Center (SMC). The capstone project involved development of an evaluation plan for future determinations about the program’s effectiveness in achieving desired outcomes. The evaluation process included development of a logic model and putting systems in place to track and measure specific indicators. The project culminated in a preliminary assessment of selected program activities to establish baseline information for the program, its participants, and SMC staff.

The objective of this qualitative longitudinal study was to assess stakeholder perceptions after one year of a new school feeding program to contrast and compare to pre-program expectations. Semi-structured interviews were conducted using questions reviewed by an in-country collaborator for cultural sensitivity and appropriateness. Follow up questions were determined from participant response. The interviews were analyzed by performing content analysis using open and axial coding to find key concepts in the data. The results showed the school feeding program met stakeholder expectations regarding reduction in absenteeism and truancy, improving classroom behavior and increasing enrollment as well as relieving short term hunger. The stakeholders also reported unexpected improvements in behavior of the child at home, increased disposable income, and extra meals being served at home.

The Jellyfish Project (JFP) is the environmental initiative that uses music as a means to engage youth, increase awareness about climate realities, and promote behaviour change. Music is an exceptional tool to captivate youths’ attention and increase their receptivity towards environmental messages. The arts also play a role in democratizing engagement and exhibit the potential to mobilize social action and change. Thus, music serves more than a leisure purpose, it can rally youth around a common purpose and create a powerful shared experience between musicians and their audiences. This community-based case study connects arts-centred movements to an ecosystems perspective and social marketing approaches, while establishing social engagement as a social determinant of health. Social engagement is the intentional and active participation in one’s community to create change and requires resources, efficacy, and opportunities for participation. Multiple data collection methods were used, including focus groups with youth, interviews with key informants, and social media analytics. Research themes include 1) The Power of Music, 2) Seeking Connections, 3) Awareness ≠ Change, and 4) Searching for Solutions. Findings showed that The JFP presentation was well-received by its audiences. Awareness, the primary goal of the organization increased, yet it was evident that for behaviour change to occur a broader community-level strategy is necessary. This strategy needs to involve active participation by students, numerous follow-up strategies, and community partnerships to address contextual issues and support sustained change. Implications for practice include developing active participation and partnerships; incorporating additional interaction with youth in the school presentation program; enhancement of online and social media strategies, and the provision of lived, multi-sensory experiences, both online and in the community. This intentionally transdisciplinary research filled gaps in the literature concerning the interconnections between social engagement, the social determinants of health, and the ecosystems perspective. It was also the first body of research to propose that social engagement is an appropriate community-level social determinant of health. Originating in real world experiences, this research advances knowledge translation and exchange immediately, informing the social engagement strategies of not-for-profit organizations as they harness the energy of the arts to effect social change. / Graduate / 0413 / 0515 / 0566 / jlansfie@uvic.ca

This thesis is a subset of a larger “parent” project under the direction of my supervisor, Dr. Cecilia Benoit. The purpose of the larger project is to seize an unique research opportunity that has emerged with the development and implementation of the HerWay Home (HWH) program, a community-based initiative for pregnant and early parenting women who face substance use and other challenges in the Greater Victoria Area. My research has capitalized on the pre-implementation phase of the HWH program between 2010-2011. Thirteen in-person semi-structured interviews were conducted with women who would likely be clients for the HWH program, based on their pregnancy experiences, substance use concerns and other life challenges. The goal of this research has been to explore these women’s pregnancy and postpartum narratives and investigate what, in their view, should be crucial components of the HWH intervention in the short and longterm. My findings indicate that, consistent with the literature on pregnant and early parenting women facing substance use and other life challenges, a range of complex, intertwined disadvantages exist in their lives that translate into multiple barriers to accessing continuous health and social care during their pregnancy and after the birth of their child. An adapted model of the Health Lifestyle Theory is used to frame the analysis of the data collected from this research. The results from this research support the argument that the life choices of the participants are constrained by structural life chances and socially determined inequities that systematically disadvantage and disempower them. The findings also reveal an implicit sense of agency in the women’s narratives, as well as key specifics about what they view as the main gaps in care and their desired program services. The findings will be relayed to HWH organizers, and used to inform the development and implementation of the program’s services. / Graduate

In 2015, the Truth and Reconciliation Commission made their final recommendations for Canadian society to address cultural genocide: by affirming stories of survivors, taking personal and professional inventory of their practices and making concrete steps to meet the Calls to Action. In particular, the TRC recognized damage done by museums and art galleries to perpetuate colonialism and yet, believed that these institutions could be sites of justice, particularly in relation to arts and artists The Art Gallery of Greater Victoria, an institution steeped in colonialism and under pressure to create accountable relationships with Indigenous communities, began to act by revamping their education program for school age children entitled the Gallery in the Schools art program. My study asked Indigenous artists and educators to contribute their ideas for a new art program. I used a blended research of community based and decolonizing research models, contextualized within decolonizing and critical theoretical frameworks. Overall, research findings suggest that process is as important as the end product in the context of reconciliation and decolonization. Significantly, relationships were esteemed over the concept of reconciliation. These finding further imply that a successful art program would ground pedagogical content within a critical historical framework, be informed by a fluid understanding of identity and search out possibilities of hope. The theoretical implications of this study support increased contributions by Indigenous artists as key policy makers, who will challenge the deeply embedded power structures of institutions and offer alternative ways to share power and support Indigenous envisioned futures. / Graduate

State dependency and the lingering impacts of colonialism dancing with Aboriginal peoples are known realities across the Canadian health care landscape. However, delving into the discourses of how to reduce health disparities of a colonized population is a sophisticated issue with many factors to consider. Specifically, nurses can play a central role in the delivery of essential health services to the ‘Other’ within isolated Northern Aboriginal communities. As an extension of the state health care system, nurses have a duty to provide responsive and relevant health care services to Aboriginal peoples. The conducted qualitative research, influenced by a postcolonial epistemology, sought to explore the roles and challenges of nurses working within rural, remote, and Northern Canadian Aboriginal communities, as well as individual, organizational, and system level factors that supported or impeded nurses’ work in helping to meet Aboriginal peoples’ health needs with meaningful care. Theorists include the works of Fanon on colonization and racial construction; Kristeva on semiotics and abjection; and Foucault on power/knowledge, governmentality, and bio-power were used in providing a theoretical framework to help enlighten the research study presented within this dissertation. Critical Discourse Analysis of twenty-five semi-structured interviews with nurses, physicians, and regional health care administrators was deployed to gain a better understanding of the responsibilities and challenges of nurses working in Northern Canada. Specifically, the research study was conducted in one of the three health regions within Northern Saskatchewan. Major findings of this study include: (1) the Aboriginal person did not exist without being in a relation with their colonial agent, the nurse, (2) being ‘Aboriginal’ was constructed as a source of treating illnesses and managing diseases, and (3) as a collective force, nursing was utilized as means of governmentality and as provisions of care situated within colonial laws. Historically, nurses functioned as a weapon to ‘save’ and ‘civilize’ Aboriginal peoples for purposes of the state. Primarily, present day nursing roles focused on health care duties to promote a decency of the state, followed by missionary tasks. In turn, the findings of this research study indicate that nurses must have a better understanding of the impact of colonialism on Aboriginal peoples’ health before they engage with local communities. Knowledge development through postcolonial scholarship in nursing can help nurses and health service providers to strengthen their self-reflective practice, in working towards de-signifying poor discourses around Aboriginal peoples’ health and to help create new discourses.

The notion of placemaking and sustainability are central to planning practice. However, is there a connection between the goals of sustainability and the impacts of placemaking initiatives? The ultimate goal of sustainable planning is the creation of a sustainable community which include the defining features of a healthy climate and environment, social wellbeing, and economic security. Yet, sustainable planning is heavily focused on the environment. Placemaking initiatives focus on underutilized space, permanently or temporarily highlighting location, locale, and sense, the three realms of place. In attempt to answer whether placemaking can contribute to sustainable planning, this research focuses on the case study of the east side neighborhoods of Cleveland, Ohio and three placemaking initiatives which take place in those neighborhoods. Placemaking attendees were surveyed on their perspectives of the impact that the placemaking initiative has on the community. After coding the responses for common themes, these themes were related back to the larger defining features of a sustainable community. It was found that placemaking can be used to support the social and economic realms within sustainable planning and communities. The main characteristics which make these initiatives successful are free and open to the public, expression of uniqueness, and the support of local businesses. Placemaking offers benefits to both community and non-community members. Ultimately, placemaking is a beneficial tool that should be utilized by planners to aid in sustainable planning.

In India poor sanitation accounts for 1,600 daily deaths of children under the age of five (Dasra, 2012). The societal and environmental conditions in India and many other developing countries have continuously stood as barriers to facilitating changes in sanitation behavior. Efforts made to improve hygiene have continuously faced opposing forces including major gaps between the supply and demand of sanitation. This paper will focus on one pilot program conducted in Chennai, India over the summer of 2014. This program was designed to teach school children safe sanitation and hygienic habits by providing a guiding tool to teachers. The study analyzed qualitative observational data collected over the seven-week pilot program period to identify the barriers to implementation experienced in this case study. The results indicate that the school administration was the greatest barrier to implementation in this case study. The results also highlight the contextual sensitivity of each of the barriers and their relationships to one another. The findings suggest that depending on the context of implementation of a health, hygiene, and sanitation program these barriers may be re-ordered in hierarchy to work towards achieving sustainable programs.

Historically, child abuse and neglect (CAN) prevention efforts have focused on individuals and families, with disregard for the contexts and conditions that may underlie family challenges. There is increased recognition that efforts to support families and children must include focus on the societal level (Browne, 2014), yet few studies have examined how institutional processes influence community-based CAN prevention services. I utilized institutional ethnography to identify institutional factors that impact family well-being and CAN prevention work in Alabama. I relied on three primary forms of data: 1) focus group discussions; 2) interview discussions; and 3) analysis of key documents. Preliminary analysis indicates prevention work is diverse and occurs within a system of limited institutional and public support. I will discuss the specific institutional factors that influence child and abuse prevention work in Alabama and close with a discussion of how institutional ethnography can be used to strengthen family research and policy.

Opioid addiction is a physical, mental, and social issue. The insidious habits and behaviors acquired while living an addictive lifestyle are more powerful than human comprehension, and the training required to release these strongholds are extreme to say the least. Capturing the lived experiences of this process is needed to increase understanding of the development that leads to transformation from active addict to addict in recovery. This phenomenological research study on the treatment experience of opioid addicts used a qualitative approach to gain understanding of this phenomenon. For this study, 15 research participants were selected. Their ages ranged from 21 to 30-years-old and they all successfully completed an adult substance abuse treatment program. All participants must have been in active recovery for a minimum of one year. The central question for this study is: what are the intrapersonal and interpersonal conflicts opioid addicts are presented with during their treatment process? By means of conducting and analyzing interview questions and utilizing the conflict resolution theories of human motivation, social identity theory, coordinated management of meaning theory, and relative deprivation theory, this study revealed that the overall essence of the treatment experience is the journey of identity transformation from active addict to addict in recovery through conflict management. The need to manage conflict in five specific areas was uncovered. They include identity formation, stigma, interpersonal relationships, group structure, and conflict styles. The participants’ shared experiences provide insight into identifying conflicts that need to be managed and resolved so recovery is achieved and sustained.