Internet-based cognitive behavior therapy (ICBT) has the potential of providing many patients with an effective form of psychological treatment. However, despite helping to improve mental health and well-being, far from everyone seem to benefit. In some cases, negative effects may also emerge. The overall aim of the present thesis was to establish the occurrence and characteristics of such incidents in ICBT using a combination of quantitative and qualitative methods. Study I determined deterioration, non-response, and adverse and unwanted events in a sample of 133 patients undergoing ICBT for social anxiety disorder. The results indicated that up to 6.8% fared worse during the treatment period, depending on the self-report measure and time point, as determined using the Reliable Change Index (RCI), while the non-response rate was between 29.3 to 86.5% at post treatment assessment, and 12.9% experienced other negative effects. Study II investigated the responses to open-ended questions on adverse and unwanted events among 556 patients in four separate clinical trials of ICBT; social anxiety disorder, panic disorder, major depressive disorder, and procrastination. In total, 9.3% reported negative effects, with a qualitative content analysis revealing two categories and four subcategories; patient-related, i.e., gaining insight and experiencing new symptoms, and treatment-related, i.e., difficulties applying the treatment interventions and problems related to the treatment format. Study III explored the number of patients achieving reliable deterioration, as determined using the RCI on the individual raw scores of 2866 patients from 29 clinical trials of ICBT. The results showed that the deterioration rate was higher among patients in a control condition, 17.4%, in comparison to treatment, 5.8%. Predictors were related to decreased odds of deterioration for patients receiving treatment; clinical severity at pre treatment assessment, being in a relationship, having a university degree, and being older. As for the control condition, only clinical severity at pre treatment assessment was associated with decreased odds of deterioration. Study IV examined a newly developed self-report measure for monitoring and reporting adverse and unwanted events, the Negative Effects Questionnaire. The results suggested a six-factor solution with 32 items; symptoms, quality, dependency, stigma, hopelessness, and failure. One-third of the patients reported experiencing unpleasant memories, stress, and anxiety, with novel symptoms and a lack of quality in the treatment and therapeutic relationship having the greatest negative impact. The general finding of the present thesis is that negative effects do occur in ICBT and that they are characterized by deterioration, non-response, and adverse and unwanted events, similar to psychological treatments delivered face-to-face. Researchers and clinicians in ICBT are recommended to monitor and report negative effects to prevent a negative treatment trend and further the understanding of what might contribute to their incidents. Future research should investigate the relationship between negative effects and treatment outcome, especially at follow-up, to examine if they are transient or enduring. Also, interviews could be conducted with those achieving reliable deterioration to explore if and how it is experienced by the patients and to see if it is attributed to the treatment interventions or other circumstances. / Internetbaserad kognitiv beteendeterapi (IKBT) har goda förutsättningar att kunna bli en form av psykologisk behandling som på ett effektivt sätt hjälper patienter med att hantera sin psykiska ohälsa och förbättra sitt välmående. Trots detta är det dock långtifrån alla som tycks bli bättre. För en del kan det till och med resultera i negativa effekter. Det övergripande syftet med denna avhandling har således varit att undersöka förekomsten av sådana fall och hur dessa uttrycks, såväl med kvantitativa som kvalitativa metoder. Studie I fastställde andelen försämrade, oförändrade samt andra ogynnsamma eller oönskade händelser bland 133 personer som behandlades med IKBT för social ångest. Resultatet visade att uppemot 6,8 % försämrades under sin behandlingsperiod beroende på vilket självskattningsformulär respektive tidpunkt som studerades, beräknat enligt metoden Reliable Change Index (RCI). Likaså var 29,3 % till 86,5 % oförändrade vid eftermätningen samt att 12,9 % rapporterade andra former av negativa effekter. Studie II undersökte svaren på öppna frågor som gällde ogynnsamma eller oönskade händelser bland 556 patienter i fyra olika kliniska studier med IKBT; social ångest, paniksyndrom, egentlig depressionsepisod och prokrastinering. Totalt sett rapporterade 9,3 % att de hade erfarit negativa effekter, vilka analyserades med hjälp av kvalitativ innehållsanalys. Två övergripande kategorier och fyra subkategorier framkom; patientrelaterade, som ökad insikt respektive nya symptom, samt behandlingsrelaterade, som svårigheter att implementera behandlingsinterventionerna respektive problem med behandlingsformatet. Studie III utrönte andelen patienter som försämrades i enlighet med RCI, baserat på insamlad rådata från 2866 personer i 29 olika kliniska studier med IKBT. Resultatet visade att försämring var mer förekommande hos de som var i en kontrollgrupp, 17,4 %, jämfört med de som fick behandling, 5,8 %. Bland de som genomgick behandling existerade det även ett par prediktorer som innebar lägre odds för försämring; större svårigheter vid förmätningen, att befinna sig i en relation, att ha en universitetsutbildning respektive att vara äldre. För de som var i en kontrollgrupp var enbart större svårigheter vid förmätningen relaterat till lägre odds för försämring. Studie IV testade ett nykonstruerat självskattningsformulär; Negative Effects Questionnaire. Resultatet visade på en faktorlösning med sex faktorer och 32 påståenden; symptom, kvalitet, beroende, stigma, hopplöshet respektive misslyckande. En tredjedel av personerna svarade att de hade upplevt obehagliga minnen, stress och ångest, samtidigt som nya symptom och bristande kvalitet i både behandlingen respektive den terapeutiska relationen hade haft störst negativ inverkan på dem. Den generella slutsatsen av denna avhandling är således att negativa effekter förekommer i IKBT och att de kännetecknas av försämring, ett oförändrat tillstånd samt andra ogynnsamma eller oönskade händelser, något som liknar tidigare forskning av psykologisk behandling som bedrivs ansikte-mot-ansikte. Forskare och behandlare i IKBT rekommenderas att övervaka och rapportera negativa effekter i syfte att förhindra en negativ utveckling i behandlingen samt för att öka kunskapen om vad som kan bidra till deras förekomst. Framtida forskning bör undersöka relationen mellan negativa effekter och behandlingsutfall utifrån längre tidsperspektiv för att se om dess påverkan är övergående eller ihållande. Vidare kan till exempel intervjuer utföras med de patienter som har försämrats för att ta reda på om och hur det uppfattas samt huruvida det har förorsakats av behandlingen eller andra omständigheter. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: In press.</p>

Text in English / Developments in Internet technology and pervasive computing over the past two and half decades have resulted in a variety of Web-based applications (WBAs) that provide products and services to online users or customers. The Internet is used not only to transfer information via the web but is increasingly used to provide electronic services including business transactions, information-delivery and social networking, as well as e-government, e-health and e-learning. For such organisations, e-service quality, usability and user experience are considered to be critical determinants of their products’ or services’ success. Many studies to model these three concepts separately have been undertaken as part of broader studies of software quality or service quality modelling. However, to the current researcher’s knowledge, none of the studies have focussed on proposing an evaluation model that integrates and combines the three of them. This research is an effort to fill that gap. The primary purpose of this mixed-methods research was to develop a conceptual integrated model for evaluating e-service quality, usability and user experience (e-SQUUX) of WBAs and then contextualise it to evaluation of a University web portal (UWP). This was undertaken using an exploratory sequential research design. During a qualitative phase, an extensive extensive systematic literature review of 264 relevant sources relating to dimensions of e-service quality, usability and user experience, was undertaken to derive an integrated conceptual e-service quality, usability and user experience (e-SQUUX) Model for evaluating WBAs. The model was then empirically refined through a sequential series of validations, thus developing various versions of the e-SQUUX Model. First, it was content validated by a set of four expert reviewers. Second, during the quantitative phase, in the context of a University web portal, a questionnaire survey was conducted that included a comprehensive pilot study with 29 partipants, prior to the main survey. The main survey data from 174 particiapants was used to determine a validated model, using Exploratory factor analysis (EFA), followed by producing a structural model, using partial least square – structural equation modelling (PLS-SEM). This version consisted of the components of the final e-SQUUX Model. Consequently, the research enriches the body of knowledge on IS and HCI by providing the e-SQUUX Model as an evaluation tool. For designers, developers and managers of UWPs, the model serves as a customisable set of evaluation criteria and also provides specific recommendations for design. In line with the Exploratory sequential design of mixed methods research, the findings of the qualitative work in this research influenced the subsequent quantitative study, since the potential Likert-scale questionnaire items were derived from the definitions and meanings of the components that emanated from the qualitative phase of the study. Consequently, this research is an exemplar for developing an integrated evaluation model for specific facets or domains, and of its application in a particular context, in this case, a University web portal. Keywords: e-service quality, usability, user experience, evaluation model, integrated model, exploratory factor analysis, partial least square – structural equation modelling (PLS-SEM), mixed methods research, Exploratory sequential design, quantitative study, qualitative study, validation, Web-based applications, University web portal / Information System / Ph D. (Information Systems)

Text in English / This study investigates the nature of spiritual intelligence and its link to ethnic identity, and gauges the difference across the main ethnic groups in Mauritius. A new scale, the Multicultural Spiritual Intelligence Scale (MSIS) was proposed, using the following six dimensions: self-awareness, transcendental awareness, levels of consciousness, the quest for meaning, sensitivity, and resilience. The MSIS was developed and tested using a cross-sectional survey research design with the option of completing a paper or online version, administered to a sample of 1,177 adult participants in Mauritius. This research looked at the three major ethnic groups in Mauritius: Hindu-Mauritians, Creole-Mauritians, and Muslim-Mauritians, and examined their conceptions of spiritual intelligence and ethnic identification. A factor analysis was conducted on the scale and five specific factors: self-mastery, transcendental awareness, spiritual sensitivity, resilience, and the existential quest. These factors emerged with factor loadings greater than 0.35. The MSIS’s construct validity was tested with other similar scales, particularly Meaning in Life (MLQ) (Steger et al., 2006), the Connor-Davison Resilience Scale (CD-RISC) (Connor & Davidson, 2011), Private Self-Consciousness (PSC) (Scheir & Carver, 1985), and New Indices of Religious Orientation (NIRO) (Francis, 2007). The Balanced Inventory of Desirable Responding (BIDR) (Paulhus, 1991) was also included to check for social desirable responses and MSIS’s divergent validity. A Welch ANOVA revealed a statistical difference in spiritual intelligence among the ethnic groups: Welch’s F (2, 639.98) = 3.923. Spearman’s rank order correlation revealed that ethnic identification was connected to spiritual intelligence: rs (98) = 0.52, p < 0.0005. A Games-Howell post-hoc analysis indicated a statistically significant mean difference between Muslim-Mauritians and Hindu Mauritians (0.27, 95% CI [0.083, 0.45]) and between Muslim-Mauritians and Creole Mauritians (0.44, 95% CI [0.25, 0.62]). The Muslim-Mauritians obtained the highest score in both ethnic exploration and ethnic commitment. Ethnic identification implied a prior quest for identity, which was connected with spiritual development. A second study was conducted on a sample of 303 participants using a shorter version of MSIS to confirm the five-factor model. Implications for further research include analysing the MSIS in terms of other constructs and using the MSIS with other minority groups in Mauritius. / Psychology / D.Litt et Phil. (Psychology)

The purpose of the study was to identify and transform, as necessary, constructs of communication satisfaction and to develop a hybrid quantitative audit of organisational communication satisfaction for collectivist contexts that is both reliable and valid, using Amos Graphics for structural equation modelling. The objective was also to develop a full latent variable model and to test its fitness to the data collected from a random sample of civil servants across Addis Ababa’s civil service bureaus. The study comprised three sequential parts, namely pilot, exploratory factor analysis (EFA) (Main Study One) and confirmatory factor analysis (CFA) (Main Study Two). These were used as per the existing framework in instrument development and validation. The pilot study indicated the need for more robust data. After a series of tests, principal factor axis factoring with oblique rotation was used as the most appropriate for perceptual data, out of several options on the EFA menu. The initially hypothesised six-factor solution with the dimensions of horizontal communication, personal feedback, supervisory communication, communication climate, relational trust and job satisfaction was found to be unfit for the data on conceptual and statistical grounds and psychometric analyses which involved the use of eigenvalues and the scree plot. A more appropriate two-factor solution based on the more precise parallel analysis strategy was consistent with current research that communication satisfaction is best conceptualised in terms of informational and relational domains as operationalised using the EFA procedure. The two-factor solution led to the formation of a 17-item scale out of the original 30-item measure, with two latent dimensions namely relational satisfaction and informational satisfaction. The items of the new EFA-generated organisational communication satisfaction scale were renumbered consecutively and the scale was cross-validated on a xiv new sample of 288 civil servants from the Addis Ababa City Administration. The cross-validation necessitated model respecification and re-estimation. The respecified model underwent validation at different levels. All seven aspects of validity, namely content validity, construct validity, factorial validity, reliability, convergent validity, discriminant validity and nomological validity, were addressed and found to be adequate. However limitations are also indicated as avenues for further enquiry. / Communication Science / D. Litt. et Phil. (Communication)

Researchers perform multivariate techniques MANOVA, discriminant analysis and factor analysis. The most common applications in social science are to identify and test the effects from the analysis. The use of this multivariate technique is uncommon in investigating the effects of power usage and Province in South Africa on the amounts of the five power modes. This dissertation discusses this issue, the methodology and practical problems of the three multivariate techniques. The author examines the applications of each technique in social public research and comparisons are made between the three multivariate techniques. This dissertation concludes with a discussion of both the concepts of the present multivariate techniques and the results found on the use of the three multivariate techniques in the energy household consumption. The author recommends focusing on the hypotheses of the study or typical questions surrounding of each technique to guide the researcher in choosing the appropriate analysis in the social research, as each technique has some strengths and limitations. / Statistics / M. Sc. (Statistics)

Orientador: Andréa Aparecida Zacharias / Resumo: Na atualidade, uma série de desastres inter-relacionados ganharam notoriedade no Brasil e no mundo, reunindo episódios que marcaram crescentes perdas, humanas e econômicas, associadas aos riscos e suas consequências. O processo de urbanização, juntamente com a impermeabilização do solo, retificação e assentamento em cursos d’água e encostas, contribuíram para o aumento do impacto de inundações, enchentes e vários outros processos advindos da ação antrópica que levam ao risco socioambiental. Somam-se nas últimas cinco décadas mais de dez mil mortes em desastres naturais no Brasil, a maioria destes relacionadas a inundações e queda de encostas. A magnitude de um desastre está vinculada com os fenômenos sociais, econômicos e demográficos, entre outros, e contribuem para aumentar a vulnerabilidade e exposição da população. O recorte espacial aqui analisado compreende a Região Administrativa do Lavapés, macrozona que envolve a área urbana do município de Bragança Paulista/SP. Bragança Paulista sofre, historicamente, uma série de problemas socioeconômicos e ambientais. Destaca-se o aumento na magnitude e frequência das enchentes devido à extensa cobertura impermeabilizada, pois grande parte da água que antes era infiltrada no solo, passa então a compor o volume que escoa superficialmente. O objetivo principal desta pesquisa funda-se sobre o estudo da espacialidade da vulnerabilidade socioambiental aos riscos hidrológicos, em específico as inundações, considerando a atuação dos fato... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: A series of interrelated disasters have currently gained prominence over the Brazil and worldwide, gathering episodes that have resulted in increasing losses, both human and economic, related to risks and their consequences. The urbanization process, along with degree of saturation, soil imperviousness, rectification and improper settlement on hillslopes and near to the rivers, have contributed to an increasing impact of floods and several human-induced processes that lead to socio-environmental risk. In the last five decades, there have been more than ten thousand deaths caused by natural disasters, most of them related to floods and landslide. The magnitude of a disaster is related to social, economic and demographic phenomena, among others, and contributes to increasing the population's vulnerability and exposure. We analyzed the Lavapés Administrative Region, a macrozone encompassing the urban area of Bragança Paulista/SP municipality. The city of Bragança Paulista have suffered, historically, a plenty of socioeconomic and environmental issues. The increasing intensity and frequency of the floods are noteworthy due to extensive impervious cover, since large water volumes that were previously infiltrating, now become part of the surface runoff. The main objective here relies on the spatial distribution of socio-environmental vulnerability related to hydrological risks, particularly floods, considering the triggering factors in urban areas. The methodological procedures are... (Complete abstract click electronic access below) / Mestre

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Appendix B (leaves 217-218), Appendix M (leaves 239-247) and Appendix O (leaves 253-259) in English and Amharic / The purpose of this research was to develop HIV testing Health Belief Scale (HTBS) that contains the constructs of Health Belief Model (HBM), and also to analyse HIV testing intention and behaviour among university students. The mixed method approach was used in phases. First, Literature review and in-depth interviews were conducted to develop item pool for HTBS, which was followed by content validity assessment by experts. In the second phase, a pilot survey was conducted on randomly selected 318 university students to refine the HTBS using item analysis and Exploratory Factor Analysis (EFA). Lastly, cross-sectional survey was conducted on representative sample of 612 students in order to further refine the HTBS using Confirmatory Factor Analysis (CFA) and also analyse predictors of HIV testing intention and behaviour. A total of 61 items was written for the HTBS and 23 of these were generated from the in-depth interviews. Content validity assessment by three experts indicated that the average content validity index (CVI) for the 61 items was 91.2% which was more than the recommended cut off point of 90%. The HTBS, after experts review, contained 64 items. EFA indicated that a five factor model which was roughly consistent with HBM was identified and 44 items were retained based on factor loading and reliability analysis. The Cronbach’s alpha for all the six constructs of HBM and HIV testing intention in the HTBS were >0,70. (susceptibility, benefit, self-efficacy and HIV testing intention) fitted the sample data based on chi-square test. However, all the seven constructs demonstrated RMSEA value of less than 0.08 and GFI value of >0.90 indicating acceptable fit. The final HTBS was reduced to 39 items based on factor loading and reliability assessment. All the constructs demonstrated a Cronbach’s alpha value >0.70 except for perceived susceptibility and cues to action. Analysis of multiple linear regression indicated that class year, perceived benefit, perceived self-efficacy and cues to action were significant predictors of HIV testing intention. However, only marital status and cues to action were significant predictors of recent history of HIV testing through analysis of binary logistic regression. / Health Studies / D.Litt. et Phil. (Health Studies)

D. Tech. (Business, Faculty of Management Sciences), Vaal University of Technology / Organisational performance in the public sector has emerged as a critical topic in the post-1994 era in South Africa. This could ostensibly be attributed to the inability of the majority of most public organisations in the country to deliver a satisfactory standard of service to the public. An intense controversy has also emerged the world over on the selection of performance measures that are appropriate for use in public organisations. This debate is actuated by the existence of a multiplicity of performance measurement indices as well as frameworks that can be applied to manage performance in organisations. The existence of these multiple measurement mechanisms tends to confound the entire process of managing organisational performance. Another unresolved controversy focuses on the extent to which various organisational resources impact on organisational performance. The purpose of this study was to examine the relationship between organisational performance and three organisational resources; specifically, the human factor, organisational systems and organisational processes. A quantitative design was adopted in which a survey questionnaire was administered to 272 managers and employees of a South African National Government Department. Respondents were selected using a blend of purposive sampling and convenience sampling approaches. Data were analysed using the Statistical Packages for the Social Sciences (SPSS version 20.0). Reliabilities were measured using Cronbach’s alpha coefficient. Exploratory factor analysis was used to identify the human factors, organisational systems and organisational processes. Spearman’s correlation and multiple linear regression analyses were used to investigate the relationship between organisational performance and the sub-elements under each of the three organisational resources. The impacts of each of the three factors on organisational performance were compared using the mean-score ranking technique. Performance of the National Government Department was measured using the four performance yardsticks of the Balanced Scorecard; namely, customer satisfaction, financial performance, innovation and learning, and internal processes The findings of the study revealed that performance of the National Government Department was highest in four strategic areas; which are the promotion of good corporate ethics and values, client satisfaction, service quality and relations with external organisations. However, performance shortfalls were observed in four key areas; namely, organisational speed, attrition of manpower, overloading of employees and the overburdening of divisions with high workloads. Correlation analysis showed that there were positive relationships between organisational performance and the five human factor components; life satisfaction, quality of work life, ability utilisation, creativity and autonomy. Regression analysis indicated that there were significant and predictive relationships between organisational performance and three human factor elements; namely, quality of work life, ability utilisation and life satisfaction. Among the five human factor elements, life satisfaction exerted the greatest impact on organisational performance. Significant, positive and predictive associations were also found between organisational performance and three organisational system factors; quality, innovation and inter-organisational systems, with quality exerting the greatest impact on organisational performance. Significant, positive and predictive relationships were further observed between organisational performance and the four organisational process factors identified in the study; namely, organisational structure, organisational change, team processes and organisational change. Among these, team processes exerted the greatest influence on organisational performance. Overall, the human factor applied the greatest impact on organisational performance, followed by organisational processes with organisational systems having the least impact. Based on these findings, recommendations were made and implications for further studies were suggested. The findings of the study provide empirical confirmation of the effectiveness of the Balanced Scorecard as a tool for the measurement and management of performance in public sector organisations. Additionally, managers in different public organisations may enhance the performance of their organisations by optimising the sub-elements of the three organisational resources examined in this study.

Appendix B (leaves 217-218), Appendix M (leaves 239-247) and Appendix O (leaves 253-259) in English and Amharic / The purpose of this research was to develop HIV testing Health Belief Scale (HTBS) that contains the constructs of Health Belief Model (HBM), and also to analyse HIV testing intention and behaviour among university students. The mixed method approach was used in phases. First, Literature review and in-depth interviews were conducted to develop item pool for HTBS, which was followed by content validity assessment by experts. In the second phase, a pilot survey was conducted on randomly selected 318 university students to refine the HTBS using item analysis and Exploratory Factor Analysis (EFA). Lastly, cross-sectional survey was conducted on representative sample of 612 students in order to further refine the HTBS using Confirmatory Factor Analysis (CFA) and also analyse predictors of HIV testing intention and behaviour. A total of 61 items was written for the HTBS and 23 of these were generated from the in-depth interviews. Content validity assessment by three experts indicated that the average content validity index (CVI) for the 61 items was 91.2% which was more than the recommended cut off point of 90%. The HTBS, after experts review, contained 64 items. EFA indicated that a five factor model which was roughly consistent with HBM was identified and 44 items were retained based on factor loading and reliability analysis. The Cronbach’s alpha for all the six constructs of HBM and HIV testing intention in the HTBS were >0,70. (susceptibility, benefit, self-efficacy and HIV testing intention) fitted the sample data based on chi-square test. However, all the seven constructs demonstrated RMSEA value of less than 0.08 and GFI value of >0.90 indicating acceptable fit. The final HTBS was reduced to 39 items based on factor loading and reliability assessment. All the constructs demonstrated a Cronbach’s alpha value >0.70 except for perceived susceptibility and cues to action. Analysis of multiple linear regression indicated that class year, perceived benefit, perceived self-efficacy and cues to action were significant predictors of HIV testing intention. However, only marital status and cues to action were significant predictors of recent history of HIV testing through analysis of binary logistic regression. / Health Studies / D.Litt. et Phil. (Health Studies)