[pt] A presente dissertação busca colaborar para o estudo da insatisfação de consumo, principalmente para áreas de saúde suplementar e mercados regulados por órgão governamental, contribuindo para estudos acadêmicos e ações empresariais. Para isso, buscou compreender os fatores envolvidos na formação de insatisfação com os serviços de gerenciamento das ações de saúde de uma operadora de saúde suplementar brasileira. O levantamento se baseou em uma pesquisa qualitativa com vinte entrevistas em profundidade com beneficiários da operadora em questão, que formalizaram reclamação em canais da própria organização, do órgão regulador do setor (ANS) ou repercutiram negativamente com conhecidos. A partir dos dados coletados, foi possível encontrar cinco categorias de análise: expectativa do consumidor antes do uso do serviço, o conhecimento prévio do consumidor, os aspectos da prestação de serviço de maior influência na insatisfação de consumo, a forte presença de sentimentos dos consumidores sobre o serviço e as influências nos comportamentos pós-insatisfação. / [en] The present dissertation aims to contribute to the study of consumption dissatisfaction, mainly to supplement the areas of health and markets regulated by government agency, contributing to academic studies and business actions. To do so, it sought to understand the factors involved in the formation of dissatisfaction with the management services of health actions of a Brazilian supplementary health care provider. The survey was based in a qualitative research with 20 in-depth interviews with the beneficiaries from the chosen health care provider, which have formalized complaint in the organization s own communication channels or industry regulator (ANS). From the collected data, it was possible to find five categories of analysis: consumer expectation before usage of the service, prior knowledge of the consumer, the service s aspects that influence the most on consumer dissatisfaction, the strong presence of consumers feelings on the perception of the service and the influence on post-dissatisfaction behaviors.

Studiens syfte är att undersöka hur personer med ätstörning upplever att sjukdomen påverkar sexualiteten samt undersöka vilka erfarenheter de har av samtal om sexuell hälsa och välbefinnande inom ätstörningsvården. Tidigare forskning har visat på sambandet mellan kroppsuppfattning, kroppsmissnöje, kroppsskam och ätstörningar och även sett samband mellan dessa och sexuella dysfunktioner. Forskningen avseende ätstörningar och sexuella svårigheter är något bristfällig, även om det på senare år kommit studier som lyfter ämnet, och i dessa har man sett att individer som har ätstörningar också rapporterar högre vad gäller sexuella svårigheter. Större delen av de studier som gjorts är kvantitativa och i en internationell kontext. Många med ätstörningar kommer i kontakt med hälso- och sjukvården och tidigare forskning har visat att samtal om sexualitet inom en vårdkontext generellt sett är otillräckligt. Studien har en fenomenologisk ansats men även socialkonstruktivistisk och genomförts med en kvalitativ metod bestående av elva halvstrukturerade intervjuer och materialet har analyserats utifrån en reflexiv tematisk analys. Resultaten har analyserats med hjälp av begreppen livsvärld, spegeljag, stigma, skam och skamkompassen för att förstå och visa på samband i kommande analys. Resultatanalysen bygger på de fyra teman: Livsvärlden - en inblick, I-världen-varo med en ätstörning, En hemlös värld samt Vägen mot en tillfredsställande sexualitet - finns den och på vem ligger ansvaret? Resultaten visar att en ätstörning har en biopsykosocial påverkan på sexualiteten och har för många blivit ett hinder vad gäller utlevnad av denna. Resultaten visar även på ett uttryckt behov av sexologiska och relationella samtal inom hälso- och sjukvården för att närma sig en tillfredsställande sexualitet med allt vad det innebär. / The aim of the study is to investigate adults' experiences of how an eating disorder affects their sexuality and to investigate what experiences they have of conversations about sexual health and well-being within eating disorder healthcare services. Previous research has shown the connection between body image, body dissatisfaction, body shame and eating disorders and also seen a correlation between these and sexual dysfunctions. The research regarding eating disorders and sexual difficulties is somewhat lacking, although in recent years there have been studies that highlight the subject, and in these it has been stated that individuals who have an eating disorder also report higher levels of sexual difficulties. Most of existing studies that have been done are quantitative and in an international context. Many people with eating disorders come into contact with healthcare systems and previous research has shown that talking about sexuality within a healthcare context is generally insufficient. This study has a phenomenological but also social constructivist approach. It was conducted with a qualitative method consisting of eleven semi-structured interviews and has been analyzed through a reflexive thematic analysis. The results have been analyzed using the concepts of lifeworld, mirror self, stigma, shame and the compass of shame to understand and show connections in future analysis. The result analysis is based on the four themes: The world of life - an insight, Being-in-the-world with an eating disorder, A homeless world and The road to a satisfying sexuality - does it exist and who is responsible? The results show that an eating disorder has a biopsychosocial impact on sexuality and has for many become an obstacle in terms of experiencing it. The results also show an explicit need for sexological and relational conversations within the healthcare system in order to approach a satisfactory sexuality with all that it entails.

This study seeks to determine if there are patterns of differences according to college major in terms of the percentage of freshmen women who score in the clinically significant range on a measure of attitude toward body shape. Participants (N = 1,982) completed a demographic questionnaire and the Body Shape Questionnaire (BSQ) and were divided into subgroups according to their stated college major. Descriptive statistics regarding BSQ scores were calculated for the total sample and subgroups. Results indicated that a greater percentage of participants in Theater, Communications, Psychology, Dance, Business, and Dietetics majors scored within clinically significant ranges on the BSQ. Students in these majors may benefit from targeted intervention and prevention efforts to address possible body image dissatisfaction.

Die Unzufriedenheit der Patient:innen steht oft in Kohärenz mit überfüllten Notaufnahmen. Dabei sind besonders die Überschreitung der Ressourcen und Verzögerungen bei der Wartezeit zusammenhängend zu betrachten. In den 1990er Jahren wurde nach einem System zur Verbesserung des Zeitmanagements gesucht. Dies führte zur Methode der Triage. Trotz der Einführung der Triage ist die Patientenunzufriedenheit immer noch ein häufiges Gesprächsthema, wenn es um die Notaufnahme geht. Unter Berücksichtigung des architekturpsychologischen Aspekts stellt sich die Frage: „Wie kann die Raumgestaltung des Wartebereiches architektonisch an das individuelle Empfinden von Patient:innen bei einer Triage angepasst werden?“. Um diese Frage zu beantworten, wurde eine Umfrage mit verschiedenen Sichtweisen von Personen durchgeführt. Betrachtet wurden einerseits Patient:innen, sowie Begleitpersonen und andererseits Personen, die noch gar nicht in der Notaufnahme waren. Anhand der Umfrageergebnisse wurden Hauptkriterien ermittelt, die sich auf die Empfindungen der Patient:innen und Begleitpersonen beziehen. Resümierend haben sich zum einen die Privatsphäre, sowie Ausruhmöglichkeiten und zum anderen Gesichtspunkte wie Ablenkung und eine gute Atmosphäre als Hauptkriterien eines Warteraumes ergeben. Aus den aufgestellten Kriterien wurden verschiedene, raumgestaltende Elemente entwickelt, die sich den Bedürfnissen der wartenden Patient:innen und deren Begleitpersonen anpassen. Sie dienen als Gestaltungsempfehlungen.

This dissertation in practice focuses on a review of literature to answer the guiding question, what can teachers and other educational stakeholders do to help address their sources of dissatisfaction in order to build a positive school climate? The author used a modified frame analysis from Bolman and Deal, other published literature, and personal experience to identify seven different, but sometimes related, domains that affect teachers and school climate. These seven domains include operations/management, contract application, professional development, classroom management, interpersonal, financial, and unanticipated events. The modified frame analysis was used to help empower teachers to solve problems that affect their performance and motivation, to prevent burnout, attrition, as well as help build and maintain a positive school climate. This dissertation promotes the notion that school climate is composed of and constructed from these seven domains as constituent parts that combine to create the school climate. The author-created tool, Tools for Teachers to Address Domains of Dissatisfaction, enables teachers to quickly reference potential solutions to problems faced. The tool is a prototype, created based on professional literature sources focusing on research-based strategies to identify problems and methods a teacher can use to solve a problem, thus preventing a negative school environment for the students, staff as well as other stakeholders. The domains of dissatisfaction were tested against real-life issues submitted to a Faculty Advisory Committee in order to provide veracity and justification of the domains.

The aims of the studies were to assess body image perceptions, the role of stress and other possible associated psychopathologies within a non-clinical sample. The prevalence of body image concern is increasing and is widely considered as secondary to evolving socio-cultural trends. Negative self-perceptions about body image can be manifest as measurable indicators of physiological stress, or even psychopathology. This thesis describes two quantitative studies into the role and relevance of various causative factors in the development of negative body image in cohorts of volunteers drawn from the general population of the University of Bradford in West Yorkshire, UK. In Study One, subjects (n=360) completed a self-directed questionnaire that psychometrically measured satisfaction/dissatisfaction with personal appearance, queried which external sources influenced those opinions, and correlated these with demographic information. In particular, we sought to examine how a subject¿s opinion about their personal appearance varied with age, gender, ethnicity, mental health, relationship status, sexual orientation and Body Mass Index (BMI). Subjective views regarding personal appearance were determined by answers given to specific body image questions that revealed a subject¿s day-to-day appearance concerns, all preoccupations, and the extent to which these concerns resulted in distress, all social impairment. Overall, the results demonstrated that BMI values were positively correlated with personal appearance concerns. High BMI values correlated with greater dissatisfaction with personal appearance. Self ratings of appearance values were negatively correlated with BMI scores. Subjects who gave themselves high appearance ratings were relatively unaffected by media influence with regard to their image, compared to subjects rating themselves less attractive. These latter subjects also showed higher peer pressure scores in terms of both the amount of time they compared themselves to peers, and the degree to which peer comparisons affected their self-appearance ratings. Based on responses to the body image questions specifically, the entire cohort of subjects were categorised into principal clusters: those largely unaffected by any body image concerns; and those profoundly distressed by their self assessed body image. Perhaps the most interesting aspect of these findings is that the scores for this latter (n=17) group of subjects on the body image questions revealed a degree of personal distress this is almost identical to the scores expected from those people diagnosed with body dysmorphic disorder (BDD). Collectively, these results suggest that high BMI values in subjects negatively impact on self-appearance ratings, render subjects more prone to media messages that portray body image ideals, and elicit frequent comparisons with peers to validate self-image concerns. Furthermore, severely affected subjects with high BMI scores may show similar psychopathology to that of BDD sufferers. In Study Two, a small cohort of subjects (n=60) were given questionnaires and were interviewed to further investigate self-appearance ratings and mood/depressive traits. The body image questions used in Study One to assess image concerns and the magnitude of distress were repeated in Study Two. Mood and depressive state were measured using the validated Beck¿s Depression Inventory (BDI). In parallel, subjects completed the Derriford Appearance Scale 59 (DAS 59), which is a valid psychometric indication of an individual's perception of their appearance as ¿normal¿ or ¿disfigured¿, and used as a tool by plastic surgeons to inform decisions regarding the necessity for surgery to correct an individual's appearance. Physiological markers were recorded before and after exposure of subjects to a physical and a psychological stressor: these were saliva concentrations of cortisol and sIgA (an immune marker), blood glucose and blood pressure. The results of Study Two revealed no changes in scores for any of the physiological measures following stressors. BDI scores for most subjects fell within normal ranges, although females scored higher than males, but not at a pathological level. Those subjects with a history of mental illness or those who reported feeling a high degree of stress on a daily basis, or those who expressed greater self-appearance concerns, all had significantly elevated BDI values. Perhaps the most intriguing finding from Study Two, as in Study One, was that subjects again tended to fall within specific categories for body image concerns: those unaffected or minimally affected by body image concerns, and those (n=6) greatly and deleteriously affected by body image concerns. This subsection of subjects also scored very high on the DAS 59 for disfigurement. On the basis of these findings it would seem that body image concerns may be severe enough for some individuals for them to perceive themselves as actually being disfigured, or that the DAS 59 (a widely used assessment tool in plastic surgery), may not be entirely appropriate for assessment of an individual's need for surgery because it cannot distinguish between those genuinely disfigured and those merely expressing severe body image concerns.

Despite the developmental and clinical importance of body image during the pre-adolescent and adolescent years, there remains a dearth of information on the body image experiences of immigrant children and adolescents. This thesis represents a purposeful attempt to examine body image experiences among immigrant and ethnic minority children and adolescents in Canada and the United States (US). Specifically, the thesis integrates multiple methods (scoping reviews, qualitative interpretive description, quantitative multi-level modeling) and samples (clinical and population-based samples) to systematically contribute to the academic literature focusing on body image experiences among immigrant and ethnic minority children and adolescents in Canada and the US. Consisting of four conceptually related studies, this thesis makes the following methodological and conceptual contributions to epidemiological and clinical research and practice. First, the results from all four studies point to the need to develop standardized approaches for identifying and classifying immigrant and ethnic-minority children and adolescents. This will substantially increase the field’s ability to systematically characterize the nature and magnitude of body image dissatisfaction, body image distortion, and their associated outcomes among immigrant and ethnic minority children and adolescents. In addition, this systematic classification has the potential to inform the development or adaptation of universal and targeted preventative intervention strategies. Second, Study’s 1 and 2 demonstrate a clear need to further examine the constructs and experiences of acculturation and acculturative stress in relation to the body image experiences of immigrant and ethnic minority children and adolescents. The literature is unclear with respect to whether or not immigrant adolescents’ adoption of the values, behaviours and ideals of the Canadian or US culture increases their risk for body image concerns. On the other hand, we are also unclear as to whether or not immigrant adolescents’ retaining of the values, behaviours and ideals of their culture of origin may offer protection from poor body image experiences. Similarly, we are unclear about whether—and to what extent—stress as a result of adolescents’ acculturative experiences (i.e. acculturative stress) influence the onset or pervasiveness of body image concerns. Greater understanding about these constructs and processes and the extent to which they are implicated in the body image experiences among immigrant children and adolescents has the potential to inform culturally competent and targeted intervention approaches. Results from Study 3 indicate that immigrant adolescents have body image and appearance-related concerns that extend beyond what has typically been found among non-immigrant adolescents. More specifically, immigrant adolescents are concerned about the appearance of their skin (texture, complexion), their hair, their teeth, as well as other bodily features. It would be prudent for future researchers and clinicians to consider this information in relation to measuring, classifying and addressing body image dissatisfaction among immigrant adolescents. Finally, Study 4 demonstrates that females and first generation immigrants with body image dissatisfaction are at significantly elevated risk for body image distortion. This suggests that the assessment and intervention for body image dissatisfaction—particularly among females—soon after the migratory experience may play an important role in reducing body image distortion experiences. Taken together, the findings of this thesis strengthen the body image field by demonstrating that there are several unique aspects about being an immigrant that can influence adolescents’ body image experiences; and therefore, should be considered from a conceptual and methodological standpoint in future research and implementation of body image interventions. / Dissertation / Doctor of Philosophy (PhD) / Body image dissatisfaction and body image distortion have been linked to serious psychological outcomes, including depression and eating disorders. Yet, we know very little about the nature of these experiences among immigrant and ethnic minority children and adolescents. This thesis uses qualitative and quantitative methods, as well as general population and clinical samples to investigate body image dissatisfaction and body image distortion among immigrant and ethnic minority children and adolescents in Canada and the United States. Results provide important information that can inform the development of preventative interventions targeting body image dissatisfaction and body image distortion among immigrant and non-immigrant children and adolescents.

Contexte: L’anxiété alimente l’évitement des traitements dentaires et occasionne une négligence de la santé bucco-dentaire. Cet évitement est amplifié par des inquiétudes liées à la douleur et l’insatisfaction potentielles à la suite d’une rencontre chez le dentiste. L’anxiété, la douleur et l’insatisfaction ne sont donc pas mutuellement exclusives et peuvent être regroupée sous une mesure composite appelée le fardeau de soins. Une intervention d’écoute musicale pourrait s’avérer efficace pour réduire le fardeau de soins des patients tel qu’observé dans la littérature pour divers contextes chirurgicaux. Cependant, les évidences appuyant les bienfaits d’une intervention musicale sur le fardeau de soins au cours de chirurgies dentaires sont limitées et les résultats sont hétérogènes en raison d’un manque de consistance sur le plan méthodologique. Objectif: L’objectif de cette étude était d’explorer les effets d’une intervention d’écoute musicale personnalisée sur le fardeau de soins associé à une greffe gingivale en comparaison à l’écoute de livres audios (contrôle). Méthodologie: Deux groupes de patients ont reçu la greffe gingivale autogène accompagnée de l’intervention musicale personnalisée (n= 25) ou d’un livre audio (n= 22). Les patients ont été attribués aléatoirement aux groupes en double aveugle (le chirurgien ignorait la stimulation auditive et les participants ignoraient la condition contrôle). Des mesures auto-rapportées d’anxiété, de douleur, d’insatisfaction et d’état émotionnel ont été prises avant et après la chirurgie. Les mesures postopératoires d’anxiété, de douleur et d’insatisfaction ont été combinées en une mesure composite du fardeau de soins. Les participants ont également complété les jugements émotionnels de leur stimulation auditive respective après la chirurgie. Résultats: Aucune différence significative n’a été observée entre les stimulations auditives pour le fardeau de soins et ses composantes. Les résultats illustrent une fluctuation des niveaux d’anxiété et de douleur à travers les temps de mesures pour les deux groupes. La musique a été perçue comme plus relaxante que le livre audio (U = 144.00, p =.005, η2=.17). Les participants, ayant rapporté plus d’émotions négatives avant (r =0.44, p =.002, R2 =.19) et après (r =0.42, p =.004, R2 =.17) la chirurgie, ont illustré un fardeau de soins plus important. Il n’y avait pas de différences significatives entre les groupes pour l’état émotionnel des participants. Conclusion: Il est possible que les deux stimulations auditives (musique et livre audio) soient efficaces pour réduire le fardeau de soins (et ses composantes séparément). Des évidences additionnelles sont nécessaires afin de confirmer les bienfaits d’une intervention musicale durant une chirurgie de greffe gingivale. Les recherches futures devraient inclure un troisième groupe recevant le traitement habituel afin d’évaluer l’effet des deux stimulations auditives sur le fardeau de soins. / Background: Anxiety feeds the avoidance of dental treatments which leads to the neglect of general oral health. This avoidance is often amplified by the fear of potential pain and dissatisfaction. Anxiety, pain and dissatisfaction are not mutually exclusive and can be combined into a composite measure called burden of care. A musical intervention could be beneficial to reduce this burden of care as shown in many surgical settings in the literature. However, there is limited evidence of the benefits of music listening during dental surgeries and results are heterogenous due to a lack of consistency in the methodology. Objective: The aim of this study was to explore the effects of a personalized musical intervention on the burden of care during autogenous gingival grafts in adults while comparing it to an active control (audiobook). Method: Two groups of patients received the autogenous gingival graft along with the personalized musical intervention (n=25) or an audiobook of choice (n=22). Participants were distributed randomly between groups in a double-blind design (surgeons were unaware of the assigned auditory stimuli and participants were unaware of the control condition). Self-reported measures of anxiety, pain, dissatisfaction, and emotional state were taken preoperatively and postoperatively. Postoperative measures of anxiety, pain and dissatisfaction were combined into a burden of care composite measure. Emotional ratings of the auditory stimuli were evaluated after the surgery. Results: There were no significant differences between the auditory stimuli on the burden of care and its separated components. Results show a fluctuation of anxiety and pain levels through time for both groups. Music was perceived as more relaxing than the audiobook (U = 144.00, p =.005, η2=.17). Participants, who felt more negative emotions before (r =0.44, p =.002, R2 =.19) and after the surgery (r =0.42, p =.004, R2 =.17), had a larger burden of care. There were no significant differences in the emotional states of the participants between the two groups. Conclusion: It is possible that both auditory stimuli (music or audiobook) are effective in the reduction of the burden of care (and its components separately). Further evidence is needed to verify the benefits of a personalized musical intervention during autogenous gingival grafts. Future research should add a third group of standard care to facilitate the evaluation of both auditory stimuli’s effects on the burden of care.

Word of mouth has been considered a big factor for why brands do not need to make excessive marketing efforts, due to consumers recommending their products or services to other consumers through WoM. Given this thesis explores the relationship between WoM, complaints and repurchase intentions of consumers when it comes to fast-food restaurants, the WoM mostly is that of a negative aspect. This to see how the consumers feel about the area of fast-food and how they themselves spread their Word of Mouth, how and if they complain and what their intentions are on repurchasing. The empirical findings were obtained using a qualitative method. There were 25 interviews conducted with different consumers from three different countries. Later these findings were analyzed with the theoretical framework of this thesis.  The conclusion of the thesis is that the consumers are more likely to spread WoM, both positive and negative depending on their experience with the brands. As the theory mentions, it is the experience that the consumer is after. However, also that if a product is excessively marketed, and that the product does not live up to said marketing, how dissatisfied the consumer becomes with it. / <p>Då kursen bedrevs via zoom, så hade vi presentationen via zoom också. </p>

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