Thesis advisor: Rosanna Demarco / For 21 years (1983-2004), the civil war in Sudan concentrated in the South resulting in massive population displacements and human suffering. Following the comprehensive peace agreement in 2005, the government of South Sudan is rebuilding the country's infrastructure. However, the post war South Sudan has some of the worst health indicators, lack of basic services, poor health infrastructure and severe shortage of skilled labor. The maternal mortality ratio for example is 2,054/100,000 live births, currently the highest in the world. Abortion complication leads among causes of admission at the gynecology units. This research contributes nursing knowledge on reproductive health among populations affected by war. The purpose was to explore the experiences of women with abortion complications in the post war South Sudan. Using qualitative descriptive methodology, in-depth interviews were conducted with 26 women following treatment for abortion complications at the gynecology unit of a county hospital. Data was collected from March 2nd to April 26th, 2008. Spontaneous abortion was the most common among study participants. Post abortion care was nonexistent at the community level health facilities, but present at the hospital. The women interviewed were reluctant to reflect in-depth about their experiences with abortion complications. They described the process, signs, symptoms and the events that led to the pregnancy loss, and were more concerned about regaining their reproductive function, a societal expectation of a married woman in South Sudan. A female child in South Sudan is assigned a "special" role in the family and community - that of getting married, attracting a high bride wealth paid as dowry to her parents and delivering children for the husband. Arranged and/or forced early marriage is common. A woman's world view about reproductive health and experiences with abortion complications is therefore influenced by this cultural context. Implications of these findings include the need to develop the nurse midwifery profession in South Sudan. Nurse midwives can lead in providing gender and culturally sensitive reproductive health services including post abortion care. Plans for care must include opportunities to listen to women's perspectives. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Background: The Philippines gained independency year 1946. Health services in the country were decentralized year 1991 and was moved from a national level to local government. The public health care system still appears obscure among the growing population and concerns over the public health care settings’ accessibility and quality remain. Religion is significant for the 95 percent Christians who lives in the country and the population obtain a deep faith in God. As the leading exporter of health workforce, nurses that remain in the public health care setting face challenges of workload in a challenging work environment. This study has been made to obtain deeper understanding of Filipino nurses’ experiences of practicing nursing in the public health care settings in the Philippines. Aim: The aim was to describe Filipino nurses’ experiences of practice nursing in the public health care settings in the Philippines. Method: The design is a descriptive qualitative interview study consisting of semi-structured interviews with nine nurses in Palawan, Philippines. The material was analyzed using qualitative content analysis with an inductive approach. Result: Nurses in this study experience challenges caused by lack of resources and restricted budget. This results in an increased workload and an inadequate nurse to patient ratio which in order create experiences of threatened patient’s safety. Nurses experience feelings of insufficiency in the profession and therefore, have an increased risk of burnout and errors. Discussion: The discussion addresses nurses’ challenges of practice nursing in public health care settings. The nurses are not able to deliver the care they want due to an oppressive workload and time constraint which in order affect the interaction with patients. Several nurses’ experience patient safety being threatened and mention their way of practicing nursing as unsafe which cause feelings of being helpless and insufficient among the nurses in this study. Christianity plays a significant role for the participants in practicing nursing. Nurses coming on and off shifts have daily prayers together which is experienced as energizing for the nurses, as they find strength and wisdom through the beliefs in God.

Research on public perceptions of the police has identified various individual characteristics that have been found to influence police legitimacy. These individual characteristics often reflect demographic factors such as race/ethnicity, age and socioeconomic status. In addition to demographic factors, process-based factors such as procedural justice and fairness have also been found to influence individual perceptions of legitimacy. What has not been fully established within the literature on public perceptions of police is the extent to which neighborhood characteristics and context shape neighborhood assessments of police legitimacy. This thesis seeks to fill in the gap on public perceptions of police by examining whether expressive concerns and accumulated experiences with police at the neighborhood-level influence legitimacy judgments across high-crime areas. Using baseline survey data collected for the St. Louis County Hot Spots in Residential Areas (SCHIRA) project between March and May of 2012, residents in St. Louis County, Missouri are aggregated to 71 crime hot spots. Findings suggest that neighborhood-level expressive concerns and accumulated experiences do not influence legitimacy judgments across the high-crime areas. However, low neighborhood cohesion predicts the percentage of residents in the area having a recent negative experience with police. Implications for future research and police practice are discussed.

People with intellectual disabilities are increasingly being diagnosed with cancer due, in part, to increases in life expectancy for this population. Despite the growing number of people with cancer and intellectual disabilities, the cancer-related experiences of people with intellectual disabilities are under-researched. Person-centred approaches to research are needed to better understand the needs and psychosocial outcomes of people with cancer and intellectual disabilities. This thesis aims to better understand the cancer-related experiences of people with intellectual disabilities, and the impact on the people who support them. The thesis comprises four related studies: (1) a systematic review of psychosocial experiences of cancer in people with intellectual disabilities; (2) a qualitative study of cancer experiences in people with intellectual disabilities using thematic analysis informed by grounded theory; (3) a survey of UK oncology nurses' attitudes and care perceptions towards people with intellectual disabilities; and (4) a feasibility study of an intervention to improve healthcare professionals' perceptions of communicating with people with cancer and intellectual disabilities. Five themes emerged from the ten papers included in the systematic review: delayed diagnosis; information, communication, and understanding; negative psychological consequences; negative physical consequences; and social support. Six of the ten papers included data from the same ethnographic study of 13 people, highlighting a paucity of empirical research regarding the psychosocial cancer experiences of people with intellectual disabilities. The qualitative study indicated that people with intellectual disabilities were often excluded from conversations about their diagnosis, treatment, and ongoing care, and expressed confusion and anxiety about their cancer. Attempts to protect them from distress inhibited communication, but where additional support was offered, participants engaged more meaningfully in their experience and this should, therefore, be encouraged. In the qualitative study, oncology nurses were reported to be important figures in the care of patients with intellectual disabilities. The survey of oncology nurses highlighted that caring for cancer patients with intellectual disabilities may intensify their already difficult role; however, previous experience may ameliorate negative consequences. This sample identified their need for training about communicating with people with intellectual disabilities. The first three studies informed the development of a novel, brief, online, video-based intervention for healthcare professionals working with people with intellectual disabilities and cancer. The feasibility trial of this intervention indicated that there were problems with recruitment, high attrition, and intervention adherence. These problems were, most likely due to participants finding the content and delivery method to be unacceptable. It is clear that the intervention is not feasible in its current format, and that further theoretical and modelling work is needed before the intervention is feasibility tested again ahead of a definitive trial. This body of work has demonstrated that people with intellectual disabilities and cancer face multiple barriers to accessing cancer care, including informative and understandable communication with healthcare professionals. With appropriate support, psychological and physical outcomes can be improved for people with intellectual disabilities and cancer, but caring for people with cancer and intellectual disabilities can be challenging for paid and informal carers, and oncology staff. Difficulties with communication are bi-directional, and improving communication might be an appropriate first step to improving cancer experiences for this population, but developing effective interventions presents numerous feasibility challenges.

The impact of test anxiety on children’s wellbeing is of increasing concern to educationalists (National Union of Teachers/Exam Factories, 2015). In addition, the impact of SATs on children’s well-being is currently at the heart of much media interest (refer to articles in The Guardian 30.4.17 and The Independent 1.5.17). Despite a growing research base, the focus has been largely on the experiences of secondary or college students, and has primarily been investigated using quantitative approaches. The aim of the current study was to develop an understanding of the emotional impact of national assessment on primary aged children, and to explore how the construction of children’s identities might relate to these experiences. Initially twelve children from two schools were identified with Special Educational Needs Coordinators (SENCOs) on the basis of them representing a range of social backgrounds, and emotional and cognitive abilities. A total of eleven children were interviewed twice. The data from five children from year six and a child from year two were then further analysed using Interpretative Phenomenological Analysis. Four superordinate themes emerged from analysis, each with a number of subordinate themes. The theme ‘Support from others’ illustrates the way in which the children’s learning was situated within a social context, from which testing created a rupture, as described in the theme ‘Tests create anxiety’. Children described a tendency to keep negative feelings about testing to themselves, creating a split between the private and the public self. Performance in tests informed children’s sense of value, beyond the confines of the target ability (‘Self-evaluation from feedback’). The theme ‘Who I want to become’ captures a process of negotiation as children became immersed in reflection on their identities, negotiating a compromise between self-evaluation on the basis of the tests and possible future selves. Due to the research method and size of this study, implications from the results have to be treated cautiously. However, it would seem advantageous for schools to address the potential negative effects of testing on emotional well-being, identity and aspiration. Suggested ways of achieving this are increased opportunities for children to express their private anxieties with regard to testing, including discussion with adults in non- teaching roles, and specific interventions that promote well-being and self-esteem in relation to test anxiety and the implications of results. In addition, policy and practice should consider ways to minimise the rupture to learning created by testing.

Magister Public Health - MPH / Being healthy (‘feeling fine’) and health deterioration (‘getting sick’) were key health concerns among PLHIV prior to ART initiation. PLHIV often referred living with HIV as ‘being sick’ and experiencing poor health when already infected with HIV as ‘very sick’ and this perception about sickness and wellness partly determined the need and value placed on accessing HIV services. Motivations for starting treatment included needing to maintain or regain health, encouragement from HCWs, relatives and friends and believing in the effectiveness of ART to improve health. Prevention of HIV transmission to others was not cited to influence uptake. The majority of PLHIV reported stringent adherence to ART; even a half-hour delay in taking treatment was sometimes defined by participants as ‘non-adherence’. Initial reminders for taking ART (setting alarm, placing pills where visible) fell away as daily medication became routine. However, daily uptake of treatment had its own psychosocial and economic consequences which PLHIV had to navigate. With few exceptions, when taking the first line regimen, most PLHIV experienced both temporal (hallucinations, vomiting) and long-term (dizziness and irregular heartbeat) side-effects attributed to ART, which although not considered life threatening, could undermine ART adherence. HIV status disclosure was both limited and selective (mainly to spouses, close relatives, friends and co-workers) and deemed as promoting adherence to treatment and access to HIV services. HIV/AIDS stigma persisted even among relatively healthy PLHIV due to links with ‘promiscuity’, hampering disclosure and access to HIV services. Competing demands on participants’ time, especially livelihood activities, also disrupted accessing services. Good relationships between HCWs and PLHIV promoted access to services.

The purpose of study was to examine similarities and differences in experiences between male and female high school principals and district administrators in addition to similarities and differences in leadership style and skills. This was an in-depth study with participants working in the same district and matched with descriptors such as age, similar position, and time served. Therefore the statement of the problem for the present study is what similarities and differences in experiences exist between male and female high school principals and district administrators in addition to similarities and differences in leadership style and skills. Two male high school principals, one female high school principal, and one female district supervisor participated. Only top-level administrative positions were considered. The participants were interviewed and asked to take a survey on their leadership skills and their leadership style. All of the participants had experience as high school teachers with varying levels of teaching experience. There was a fairly small range of assistant principal experience. The participants reported having people who had been an influence in their decision to become administrators and someone who had mentored them. Barriers did not seem present in obtaining positions for either the male or female participants. Barriers that were listed involved issues that arose in their job such as implementing multiple new programs.

Adverse childhood experiences (ACEs) are related to a variety of detrimental outcomes, including psychopathology and criminal activity. Adolescents and other youth who have engaged in sexually abusive behaviors are a high-risk population in which ACEs are exceptionally common and interrelated. However, the experiences of adversity faced by these youth are not homogenous, and exploring further aspects and details of ACEs may assist in better understanding the etiology of problematic outcomes such as psychopathology and criminal activity in these populations. The deleterious impact of polyvictimization may be one facet of adversity worth considering, as the persistence of maltreatment, presence of multiple perpetrators, and relationship to perpetrator(s) have been linked to poorer outcomes. Regression analyses were used to examine the relationship between ACEs and psychopathology and criminal activity in a sample of adolescents who have engaged in problematic sexual behavior. Incorporating facets of polyvictimization better explained several of such outcomes.

This study included 114 Native adults and 6 Native/non-Native pairs of friends (age 18-25). Experiences and attitudes for close interethnic friendships were investigated. Friendship patterns and predictors were quantitatively assessed for the 114 Natives, with qualitative examination of the development and qualities of the six friend pairs. Results of quantitative analysis revealed that 80% of this sample reported friendship investment with Whites, and 55% reported friendship investment with same-tribe members. Over 90% of participants were open to engaging in friendships with member of any ethnicity or race. Approximately 98% of participants reported being targeted for racial discrimination, with most reporting some distress, often at a low level. Significant positive correlates of past and future friendships with Whites included: household income in childhood, identification with White culture, racial/ethnic composition of students in college, multicultural experiences, and past support from parents. Multiple regressions included as significant predictors of past friendships: past parental support (t = 6.488, p < .001), past multicultural experiences (t = 3.852, p < .001), racial composition in college (t = 3.083, p = .003), and diversity climate in high school (t = 2.468, p = .015). Multiple regressions for future friendships with Whites revealed as significant predictors: past friendships (t = 5.187, p < .001), and past parental support (t = 2.507, p = .014). Qualitative findings revealed authenticity/acceptance, communication, similarity, and trust as aspects of close friendships with non-Natives. Opportunities to share cultural teachings, and shared cultural interests helped friendships develop. Participants’ descriptions of their friendships largely coincided with contact/opportunity theories, with propinquity allowing homophily, reciprocation, and disclosure to develop within the friendship. All friendship pairs weathered periods of time during which contact between friends became infrequent, but all participants asserted that they were still close friends during those periods. Findings illuminate the prominence of interethnic friendships in the lives of Native youth, and positive intergroup attitudes expressed within those relationships.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Persons with lower limb amputations (LLA) experience different challenges in the community. These challenges include the physical, psychological and social function of an individual. Little is known in Malawi on what persons with lower limb amputations go through in the communities where they live. Therefore, the study aimed at exploring and determining community experiences of persons with LLA in Malawi. The study sought to address the following objectives: 1) To determine the functional and psychological status of persons with LLA in the community; 2) To explore and describe experiences on social participation of persons with LLA in the community; 3). To explore experiences on community re-integration following LLA.