Although U.S. breastfeeding rates have steadily increased since 2000, there continues to be a disparity in breastfeeding rates for African American (AA) women compared to their non-Hispanic White counterparts. A male partner's perception, specifically his positive attitude toward breastfeeding, may influence breastfeeding initiation and duration rates. This study was an exploration of AA male perceptions and attitudes toward breastfeeding and what effect masculinity ideology (gender norms) has on such attitudes. The socio-ecological model (SEM) was used as the theoretical framework to examine the various environmental levels that intersect with one another to influence these attitudes. A mixed methods study design, using (a) an online survey combining the Iowa Infant Feeding Attitudes Scale (IIFAS) and the Male Role Norms Scales (MRNS) (N =206) and (b) 3 focus group sessions (N = 17), was used to collect data. African American men ages 18 and older were eligible to participate in the study. Results of the regression analysis showed a negative correlation between positive breastfeeding attitudes and traditional masculinity ideology. Nvivo analysis of focus group transcripts revealed themes of gender norms, knowledge of breastfeeding, and public opinions. The themes from the focus groups were categorized using the 4 levels of the SEM: Individual, Relationships, Community, and Societal; themes corresponded with Levels 1 (Individual) and 4 (Societal) of the SEM. These results indicate that a gender-transformative approach may be used to strengthen breastfeeding-promotion interventions targeting AA males. The positive social change implications of this research include a paradigm shift in views on gender norms and increased engagement of men in decisions that affect infant and child health and development.

Breastfeeding offers numerous health benefits to both the mother and infant, yet it is not routinely practiced due to a number of internal and external factors that influence the mother's decision. Guided by the social ecological model, the purpose of this study was to examine the effect of required reporting to The Joint Commission on perinatal measures, a proxy measure for maternity care practices, and those professional effects on breastfeeding initiation and exclusivity for first-time mothers. The hypotheses were that the mandatory reporting, and thus an increase in maternity care practices, would increase the initiation of breastfeeding and exclusive breastfeeding on discharge in first-time mothers. This study was a quantitative retrospective study design that included data collected from the medical records of 1,000 mothers from Southeast Alabama Medical Center who gave birth between 2013 and 2014. The multiple logistic regression analysis indicated that the odds ratio for initiation of breastfeeding was greater among first-time mothers after implementation of mandatory reporting measures (OR = 2.07; p = 0.0007); however, the odds for exclusive breastfeeding on discharge did not show a statistically significant change (OR = 0.94; p = 0.7507). These findings may inform the work of healthcare providers at hospitals, community centers, and public health workers, guiding their maternity care practices to increase the number of first-time mothers who will breastfeed for longer periods of time and improving children's health outcomes.

"May 2015" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Max A. Ito Participation in social roles and daily activities is considered a primary outcome for children with cerebral palsy (CP) and thus is an important focus of pediatric therapy. The purpose of this study was to describe the participation patterns of children ages 2 to 6 years with CP, investigate how gross motor impairment affects participation, and identify those family and environmental factors that may influence participation in daily activities and social roles. A convenience sample of 51 children with CP between the ages of 2 and 6 years and their parents completed this study. Parents completed four standardized instruments: the Assessment of Life Habits (LIFE-H), the Impact on Family Scale, The Child and Adolescent Scale of Environment, and the Child Health Conditions Questionnaire, which measured participation, family burden, the environment, and associated conditions respectively. Hierarchical multiple regression analysis was used to determine the extent to which family and environmental factors explained participation in daily activities and social roles while controlling for gross motor impairment (GMFCS), associated conditions and age. The findings of this study suggest that very young children with CP experience substantial restrictions across 10 of 11 domains of participation. Parents report greater environmental barriers, associated health conditions and impact on family as GMFCS levels increase. Gross motor impairment, associated health conditions, and age accounted for 65% of the variance in participation. The environment and family factors did not contribute significantly to the model. For the children in this study, intrinsic factors accounted for most of the variance in participation.

In today’s health care environment of quick discharges and shortened hospital stays discharge planning has become increasingly important in acute care occupational therapy practice. Discharge planning is a complex process and an important aspect of patient care as poor discharge planning has been associated with poor patient outcomes and increased risk of adverse events and readmission. This study addressed the following research questions: (a) How do acute care occupational therapists describe their role in the discharge planning process? (b) What guides acute care occupational therapists discharge decisions and recommendations? (c) How do acute care occupational therapists define optimal discharge planning? and (d) What actions can acute care occupational therapists take to optimize the effectiveness of their discharge planning skills within the current health care system? Using an action research methodology, two groups of five occupational therapists met online to discuss acute care occupational therapy discharge planning practices, and actions that could be taken to strengthen their practice. Action plans generated, implemented, and evaluated focused on improving communication with discharge planners, language used in documentation, and incorporating the use of standardized assessments to assist with discharge planning. Schell’s ecological model of professional reasoning as the theoretical model underlying this study was used to examine factors that influence occupational therapy discharge decision making. Data were collected from audio chat transcripts, survey responses, and researcher notes, and analyzed using Stringer’s action research sequential data analysis and interpretation methodology. Five themes emerged including (a) the role of occupational therapy, (b) the complexity of discharge planning, (c) pragmatics of practice, (d) why don’t they pay attention, and (e) the importance of stakeholder communication. Participants felt that discharge planners were not reading occupational therapy documentation, occupational therapy consults were late so that occupational therapy discharge recommendations were just a formality, and physical therapy discharge recommendations had more weight than occupational therapy recommendations. Participants felt that if patients were discharged without benefit of occupational therapy recommendations they could be at increased risk for an adverse event and compromised safety. Good communication among stakeholders was seen as essential for optimal discharge planning.

The aim of this study was to contribute to the limited literature on Mixed-Race identity development in the post-apartheid context while providing a personal, evocative, and critical exploration of Mixed-Race identity. The objectives were to use self-reflection as a tool to think critically about how close relationships and other systemic factors (such as friendships, school environment and broader societal factors) that contributed to my Mixed-Race identity development, played a significant role. The autoethnographic methodology was used to harness the quality of evocative and personal writing in the process of knowledge creation and establishing a voice for the Mixed-Race experience through the narration of my personal experiences. Autoethnography is a methodology that situates the researcher as the ‘data’ by using first-person accounts of their experiences to analyse and discuss particular social and cultural phenomena. Root’s ecological model for multiracial identity development was used as a framework to explore and analyse how systemic factors influenced and shaped my Mixed-Race identity development. Additionally, Worthman’s bio-ecocultural model was used to explore the influence of my bond with my parents on my racial identity formation in childhood. Data collection involved me engaging in a reflexive journaling process. Thematic analysis was used to develop themes from my reflexive journal. Three main themes were found, namely my bond with my parents and their socialisation practices, my experience of being ‘the other’ and an outsider in social settings, and my close friendships. While I discuss the themes separately, there was considerable overlap between the themes and the factors involved in the discussion which suggests a complex relationship between multiple systemic factors (i.e. gender, skin tone, familial relationships, and social settings) that influenced my racial identity development. In conclusion, my racial identity development was (and still is) a lifelong process of self-discovery as I continue to be confronted with my dual-racial heritage in a predominantly monoracial South Africa. Based on the findings and conclusions of this study, the limitations and potential recommendations for future research has also been discussed. / Mini Dissertation (MA (Clinical Psychology))-- University of Pretoria, 2021. / Psychology / MA (Clinical Psychology) / Unrestricted

Background: To date, little is known about the perspectives of healthcare and social service providers on the acceptability of long-term home visiting programs serving low-income, first-time mothers within a community. The present study reports on the experiences and perspectives of community professionals who participate in program referrals or deliver auxiliary services to these mothers who are enrolled in the Nurse-Family Partnership (NFP), a targeted nurse home visitation program. Methods: The present study comprised two phases. In phase one, a secondary qualitative data analysis was conducted to analyze a purposeful sample of 24 individual interviews with healthcare and social service providers, which was part of a larger qualitative case study examining adaptations required to increase the acceptability of NFP for families and service providers in Hamilton, Ontario, Canada. In phase two, identified themes from phase one were further explored and confirmed through individual, semi-structured interviews with service providers using a qualitative descriptive approach. Findings: Healthcare and social service providers recognized the added value of NFP to existing community services for low-income, first-time mothers. The public health nurses (PHNs) who delivered the NFP intervention were perceived as playing a crucial role in connecting the first-time mothers to community services, preparing them for motherhood, and for preventing or ending the involvement of child protection services. NFP services were not perceived as interfering with the logistics of existing services being delivered; they were viewed as addressing an important service gap. Discussion: This is the first qualitative study to examine the acceptability of a home visiting intervention from the perspectives of healthcare and social service providers in a community context. The study findings have relevance for policymakers by informing the general understanding of how a new early childhood prevention program is integrated among existing community-based supports servicing low-income, first-time mothers. / Thesis / Master of Health Sciences (MSc)

Det huvudsakliga syftet i denna studie var att ta reda på skolpersonals uppfattning om varför ätstörningar uppstår bland unga flickor samt vilka metoder de använder sig av i förebyggande syfte för att motverka ett ätstörningsutvecklande. Empirin bygger på kvalitativa semistrukturerade intervjuer bestående av två skolkuratorer, två skolsköterskor samt en skolpsykolog i en mellanstor svensk stad. Fyra huvudteman identifierades i intervjuerna vilka var: Olika typer av yttre påverkan, Tonåringar har störst tendens att utveckla ätstörningar, Preventiva metoder samt Skolpersonal saknar hållbara metoder. Analysen av de teman som framkom i studien kan ge en förståelse för hur skolpersonal preventivt arbetar med unga flickor och ätstörningsproblematik samt vilka faktorer som uppfattas vara bidragande till ett ätstörningsutvecklande. Sammanfattningsvis visar studien att skolpersonal i stort uppfattar att faktorer såsom självkänsla, krav och stress, koncentrationssvårigheter samt media och skönhetsideal kan bidra till ett ätstörningsutvecklande. Vidare visar studien att skolpersonal gör försök att arbeta preventivt med ätstörningsproblematik genom att reagera på förändrat beteende och samtala med vårdnadshavare och elev men även genom att arbeta med självkänslan hos flickorna. Det framkommer dock inga gemensamma hållbara metoder i skolpersonalens arbetssätt med unga flickor som tenderar att utveckla en ätstörning där flertalet informanter tycks vara i behov av detta. / The main purpose of this study was to find out the view of the school staff on why eating disorders arise among young girls and which methods the school staff use for prevention. The empirical data is based on qualitative semi-structured interviews with two school counselors, two school nurses and a school psychologist in a medium-sized Swedish town. Four main themes were identified in the interviews which were: Different kinds of external influences, Adolescents have the greatest tendency to develop eating disorders, Prevention methods and School staff lack sustainable methods. The analysis of the themes that emerged from the study can provide an understanding of how school staff preventively work with young girls and eating disorder problems and the factors that are perceived to be contributing to a developing eating disorder. In summary, the study showed that school staff, at large, perceive that factors such as self-esteem, demands and stress, concentration difficulties, as well as the media and beauty ideals can contribute to a developing eating disorder. Furthermore, the study showed that school staff do try to work preventively with the eating disorder problems by reacting to changes in behavior and talking with both parents and students, but also by working with the self-esteem amongst girls. No common sustainable methods were found in the school staff’s work with young girls that tend to develop an eating disorder in which the majority of respondents appear to be in need of this.

The high teen birth rate in Holyoke, Massachusetts is a complex problem. The teen birth rate is over five times the state‘s rate and nearly three times the national rate. Since a majority of these births are to Latinas of Puerto Rican descent it is important to include the perceptions of Puerto Rican teens in approaches to prevent teen pregnancy and reduce the birth rate. Although there is a plethora of research on the topic of teen pregnancy and births, there is scarcity in the area of perceptions held by teens of Puerto Rican descent about teen pregnancy and births, future consequences faced by teen parents, contributing and protective factors of teen pregnancy, and potential preventive interventions. This qualitative study used a series of eight focus groups to gather data and examine perceptions held by Puerto Rican teens living in Holyoke about teen pregnancy and birth. The Ecological Model of Health Behavior provided the theoretical framework. Findings indicate that Puerto Rican teens in Holyoke perceive that: teen pregnancy is largely unintentional and a problem with negative outcomes, a lack of information on sexual health and reproduction contributes to this problem, sexual and reproductive health education should be provided to all teens, social factors may either contribute to or prevent teen pregnancy teens, and they want their ideas heard. These findings suggest that teen pregnancy and birth is a complex public health problem in need of a comprehensive approach recognizing that interventions focused on individuals are not likely to have powerful or sustained effects. Rather a combination of interventions addressing individual, interpersonal, community and societal levels are needed for risk reduction and effective behavior change

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