Internet har en allt större roll i vårt samhälle och sökmotorerna är ett av de vanligaste sätten att leta sig fram till relevanta webbplatser. Sökmotorernas algoritmer visar sig dock bli allt mer invecklade och effektiva genom att blanda in användaren och hämta information om dennes intressen. Sökmotorerna hämtar resultat som inte bara är relevanta i förhållande till sökfrasen, utan också i förhållande till användaren. Sökmotorn skapar en profil av varje användare och med den preciseras resultatet. I studien använder vi oss av litteratursökningar och intervjuer för att undersöka vilken inverkan profilerna har på resultatet samt vilka åsikter användare, inom målgruppen studenter, har angående resultatet och profilerna. Vi kommer fram till att de personaliserande sökalgoritmerna skapar ett värdeladdat resultat utifrån vad användaren brukar söka på, vilket har en klar fördel vid informationssökningar på internet. Intervjupersonerna ser emellertid vissa problemområden med det användarspecifika resultatet. De menar att resultatet kan bli ensidigt och därmed ge upphov till personliga verkligheter. Vi argumenterar för att det inte finns belägg för att det är ett verkligt och aktuellt problem, men att problemet kan uppstå genom tekniken. Ytterligare talar intervjupersonerna om att skapandet av profiler kan bli fel, då sökmotorn kan tolka information fel, samt att en säker lagring av profilerna är viktigt på grund av att de beskriver användarna som individer och kan innehålla känslig information. Vi för en diskussion kring hur en lagom insyn på profilerna kan förbättra användarnas sökupplevelser samt förhindra att användarnas integritet kränks. / The Internet has an increasingly bigger role in our society and search engines are some of the most common ways to find relevant websites. The complexity and efficiency of the search engine algorithms increases as the user and his interests are added to the information retrieval process. The search engines retrieve results that are not only relevant in relation to the search phrase, but also in relation to the user. The search engine creates a profile of each user and the profile is used to heighten the precision of the search result. In this study, we use literature search and interviews to examine what impact the profiles may have on the results and what opinions users, within the target group students, might have regarding the results and profiles. We conclude that the personalized search algorithms generate value-laden results, based on what the user tends to search for. This has a clear advantage in information searches on the Internet. The interviewees have some areas of concern with the user-specific results. They argue that the produced result might be biased and might possibly cause personal realities and worldviews. We, however, argue that this is no real world problem, nothing of the sort is visible nor obvious to us, but that the personalisation technique could have the effect of biased personal realities. Moreover the interviewees argue that the making of the profiles is problematic, that the search engine can interpret the information wrong. They also argue that the safe storage of the profiles is important because profiles describe the individual users and may contain sensitive information. We discuss how a proper level of insight in the profiles will improve users’ search experience and prevent the violation of users’ privacy.

Parent engagement in children’s developmental rehabilitation services is thought to be a fundamental component that is needed for children to reach their potential. This is especially true in the approach known as family-centre services – an approach that positions parents as partners in their child’s services. However, service providers and organizations can have difficulty engaging those parents who often miss their child’s appointments. These families are typically referred to as ‘hard-to-reach’, however this label may ascribe ‘blame’ to parents and lead service providers, researchers and policy makers to overlook the social, organizational, and economic barriers that can limit families’ use of services. Chapters 2-4, explore multiple avenues to contextualize parents’ attendance and engagement in children’s therapy services by applying family centred service tenants, Family Stress Theory, and ethical principles. These chapters lay the foundation for the grounded theory study presented in Chapter 5. This study, conducted with parents of children who use developmental rehabilitation services, describes the conditions that affect parent engagement and presents The Phoenix Theory of Parent Engagement to illustrate how parents attend, participate and engage in their child’s therapy service. These results are presented as a metaphorical journey through children’s developmental rehabilitation services in pursuit of child health and happiness. The implications of this theory are presented as they might be relevant to service providers, organizational leadership, and policy makers. These ideas are offered in an effort to inspire a coordinated effort to improve access and excellence in the provision of developmental rehabilitation services for children and families. / Thesis / Doctor of Philosophy (PhD) / Children’s developmental rehabilitation services are thought to be most effective when parents consistently attend, participate and engage in the service. When families do not consistently attend, participate or engage in services they can be labelled as ‘hard-to- reach’. Little is known about why families are hard-to-reach, if there are organizational barriers to service use, and how to promote engagement. This thesis provides a foundation for understanding parent engagement by exploring the clinical application of family-centred service, Family Stress Theory, and ethical principles. A grounded theory study is presented to contextualize parent engagement and explain how parents engage in their child’s developmental rehabilitation services. Service providers, organizational leadership, and policy makers can apply this theory to promote access and engagement in children’s developmental rehabilitation services.

Resource withdrawal from unnecessary medical services is an important issue as the cost of health care continues to rise. In many countries, resource withdrawal is primarily determined by government policies that remove, restrict, reduce, or limit the availability of publically insured medical services. Ideally, resource withdrawal is the result of a careful assessment of clinical and economic evidence regarding a service’s safety and effectiveness in order to ensure that it is the most efficient use of resources. Despite advocacy for a routinized and systematic approach to the withdrawal of resources from medical services, research has indicated that political and social factors often influence government, resulting in decisions that are neither consistent nor transparent. In this dissertation I seek to understand factors that may influence resource withdrawal decisions in an attempt to promote a more routinized and systematic approach. In order to understand the resource withdrawal landscape and provide greater conceptual clarity, the first study in this dissertation identifies and explores its characteristics (antecedents, attributes, and outcomes). Definitions of two prominent terms, disinvestment, and rationing are proposed. In the second study, a qualitative analysis of two examples of resource withdrawal reveals how the characteristics of problem frames affect the shape and timing of government resource withdrawal policies. Findings support the proposition that the complexity of the story told within the problem frame affects the shape of the policy; while visibility affects the timing. In the third study, I analyzed the perspectives of key informants about the Choosing Wisely Canada (CWC) campaign, which has the aim of reducing unnecessary services by encouraging a discussion between physician and patient. Findings reveal that CWC was designed to address pressures from government, patients, and the public. However, CWC was not designed in a way that is expected to address the underlying reasons unnecessary services are provided, including limited time in the clinical encounter, patient demands, uncertainty in the care pathway, and physician fear of litigation. Results from all three studies help establish a common language, identify influences on government led resource withdrawal and reasons why CWC is unlikely to reduce unnecessary services. Together this thesis provides insights into some of the factors affecting resource withdrawal from medical services, and findings may be used to help assess ways to improve the formulation of resource withdrawal policies. / Dissertation / Doctor of Philosophy (PhD) / Currently several governments pay for unnecessary medical services, leading to suboptimal patient health outcomes and a waste of public resources. Several researchers and organizations have proposed methods to identify and assess medical services to determine if they are unnecessary; however, governments have been slow to adopt such methods on a routine basis. It is clear that evidence is rarely sufficient to motivate governments to withdraw resources from unnecessary medical services. Instead, governments are often influenced by social and political factors when they make such decisions. Through a better understanding of these factors, we may be able to find ways to incorporate evidence into governments’ decisions to withdraw resources from medical services. Qualitative methods were used to investigate how resource withdrawal is defined, factors influencing government resource withdrawal decisions in Ontario, and the effectiveness of Choosing Wisely Canada, an initiative led by the medical community to reduce unnecessary services.

The term telemedicine is broadly defined as the use of information and communication technology to deliver health care at a distance. However, the concept of ‘telemedicine’ still lacks consensus both in the literature and in practice. Generation of telemedicine knowledge and evidence for clinical practice is still controversial within the telemedicine scholarship and among decision-makers as telemedicine objectives remain ill-defined and outcomes vary in time. In Ontario, despite the fast pace of information and communication technology change and the increased interest in its health applications, telemedicine is not a mainstream model of care delivery within the medical system. This study empirically investigates the social construction of telemedicine technologies to understand how telemedicine expectations shaped telemedicine in Ontario (Canada) from 1993 to 2017. Drawing from the Social Construction of Technologies framework (SCOT) and historical narrative analytical techniques, it identifies the shared understandings of what telemedicine is (and is not) and what role telemedicine plays in the health care system. I used grounded theory methodology to develop a narrative theory of how the future of telemedicine in Ontario has been constructed over the last 24 years from national newspaper articles, stakeholder documents, service provider websites, and semi-structured interviews with relevant telemedicine stakeholders. Findings show that the development of telemedicine narratives in Ontario is a multi-storied process of conflicting and overlapping visions and expectations among stakeholders and interests. Telemedicine expectations focus mostly on the process of innovation, the provideroriented approach to telemedicine, and the advantages and risks of adopting consumercontrolled telemedicine in a publicly insured health care system. The telemedicine visions result fragmented among different stakeholders and practices, overall inhibiting telemedicine’s future agenda. These findings intend to help researchers, policy makers, private vendors, and health care providers to create a vision of telemedicine that accommodates competing expectations among the clinical, technical, political, and commercial worlds. / Thesis / Doctor of Science (PhD) / Telemedicine delivers health care at a distance by letting doctors talk to patients or other doctors via video, email, or text messages. However, as simple as this idea is, researchers, physicians, policy-makers, and entrepreneurs have speculative, overlapping, and conflicting views about what it should be. These differing views create ambiguity and often confuse the aims of health policy decision-makers and end-users limiting telemedicine’s development. I intend to clarify telemedicine’s shared and diverging understandings of what telemedicine should be by analyzing how stakeholders in Ontario have told and tell stories about telemedicine’s future over the last three decades. I view stories of the technology’s future as persuasive policy arguments that stakeholders adopt to shape and use telemedicine according to their visions and goals. These findings will help researchers, policy-makers, doctors, and businesspeople understand what telemedicine is (and is not) to help them define policies and guidelines for its adoption and implementation.

The research reported here covers the following items: 1. The development of the Reflective Learning Framework (RLF). This framework was developed based on a grounded theoretical approach combined with an exploration of existing student reflections; then-current literature; and years of multiple iterations through real-world trials. This framework has now successfully been used by many educators in courses at McMaster and other institutions of higher education. 2. An investigation of students’ responses to the RLF. Following the development of the RLF, third-year students who had used the RLF to guide, assess, and evaluate their course reflections were surveyed and interviewed about their perceptions of using the RLF. Results of this study demonstrate that students see reflection as a tool to develop and use cognitive and metacognitive skills, and also as a tool to support knowledge retention and transfer. Furthermore, findings suggest how reflection, as studied, contributes to the acquisition of higher-order thinking skills required to address the complex challenges of improving sustainability. 3. Determining the effectiveness of the RLF. Finally, to determine the effectiveness of the RLF to support students in applying and demonstrating their higher-order thinking skills, a comparison of two sets of reflections was performed – one that used the RLF and one that did not. The comparison was based on tests of interrater reliability and a comparison of means was conducted. The results of this study demonstrate the reliability of the Framework to be used by multiple raters and that significantly different reflection outputs were obtained from students who used the RLF compared to those who did not. The results of these studies demonstrate the overall effectiveness of the RLF as a tool to guide, assess, and evaluate reflection through experiential education in university courses. / Thesis / Doctor of Philosophy (PhD) / The research reported here covers the following items: (1) the development of the Reflective Learning Framework (RLF), which was accomplished through a bottom-up approach, and which began with reading and re-reading over 100 student reflections and then reviewing the wealth of literature on the topics of reflection and experiential learning; (2) an investigation of students’ responses to the RLF, which was accomplished through an online survey and in-person interviews; and (3) determining the effectiveness of the RLF by comparing the grades of students who used the RLF to those who did not. The results of these studies demonstrate the overall effectiveness of the RLF as a tool to guide, assess, and evaluate reflection through experiential education in university courses.

This twofold work first presents a state-of-the-art review of the roots and context for freight mobility barriers, and secondly investigates the key barriers to freight mobility in Canada from the perspective of stakeholders. The review provides a holistic approach to understanding the interconnected nature of mobility, spatial structure, congestion, supply chains, and the economy on generating, demanding, and hindering freight movements. The investigation develops a novel theory grounded in the experiences of stakeholders following the Strauss/Corbin extended Grounded Theory approach of symbolic interactionism. From interviews with 28 industry and government stakeholders, a total of 50 themes emerged as barriers. These barriers were grouped into four categories which frame the issue of freight mobility as being impacted by high infrastructure utilization, cost impacts of diminishing distribution reliability, rapidly growing regions and ineffective or absent policy support, and lacking a robust data collection, analysis, and sharing framework. The categories were considered in the frame of addressing goods movement barriers and were argued to be influenced by factors of cost, political risk, implement-ability, and maintainability. A framework was developed by integrating the emergent categories and factors, identifying four high-level interventions: data and knowledge mobilization; public-private collaborative freight evaluations; government funding and political support; and, capacity alterations: improvements and expansions. Overall, the key concepts of the emergent theory are to collect and analyze data to inform public-private stakeholder evaluations of policy interventions, with government funding to support both knowledge generation efforts, policy actions and capacity investments. There is a significant need to expand data collection and information sharing to enable firms and government to address physical and policy barriers which impede the effective goods movements, including infrastructure and land use planning. The theory is generally consistent with barriers identified internationally. / Thesis / Master of Science (MSc) / This twofold work first presents a state-of-the-art review of the roots and context for hinderances to the movement of freight, and secondly, investigates the key barriers to freight mobility in Canada as perceived by Canadian stakeholders. The review provides a holistic approach to understanding the interconnected nature of mobility, spatial structure, congestion, supply chains, and the economy on generating, demanding, and hindering freight movements. The investigation develops a novel theory grounded in the experiences of stakeholders in Canada. Emergent are categories which frame the barriers to freight mobility as high infrastructure utilization, diminishing reliability, rapidly growing regions, ineffective or absent policy support, and insufficient data collection and sharing. These categories are theorized to be influenced by cost, political risk, implement-ability, and maintainability considerations. The concepts are to collect and analyze data to inform stakeholder evaluations of policy interventions, with government funding to support knowledge generation, policy actions, and capacity investments.

The literature indicates that engaging parents in child/youth mental health services is crucial for achieving positive outcomes. Yet, little research exists on how providers and organizations might hinder or facilitate parental engagement. This study aims to address this gap in literature by answering three research questions: (1) how do service providers working in child and youth mental health services define parental engagement? (2) Why does engaging parents in treatment remain a challenge for service providers? (3) What organizational- and provider-level factors contribute to this challenge? To facilitate this aim, semi-structured interviews were conducted with four service providers, including those working in community-based or outpatient child and youth mental health services. Participants were recruited using a snowball sampling recruitment method. Interviews were audio-recorded, transcribed and analyzed following principles of Constructivist Grounded Theory. Study results highlighted system- (e.g., access), organizational- (e.g., expectations and constraints), provider- (e.g., stance) and parental-level (e.g., shame) factors impacting parental engagement in services. These findings coincide with the documented impacts of neoliberalism and New Public Management on shaping mental health services. This study thus challenges traditional conceptualizations of engagement and underscores the interplay of complex factors that occur between service-levels. An expanded definition of parental engagement is therefore warranted if providers and organizations intend on holistically engaging parents in their child/youth’s care. / Thesis / Master of Social Work (MSW)

No description available.

Metatheory, a study of theories, was the focus of this research study. A qualitative, grounded theory research design was used to examine documents on systems theory found outside the field of Clothing and Textiles (CT) and the social psychological theories used within CT. Recognizing the dynamic, complex nature of the human system and its interaction with multiple other systems led to the question of: What multidimensional theoretical framework would address this complexity and provide an expanded view for research and education in the field of CT? Data were collected from documentary materials pertaining to systems theory and CT theories by the researcher in a library search of the literature. Four domains were identified from the data that were collected and analyzed. The domains were Relationship, Process, Organization, and Outcomes. Then, a holistic, systemic theoretical framework and the Human-Environment Systems model were developed from the integration of systems theory and the CT theories. The model was designed to give a general, abstract visual representation of the theoretical concepts of a holistic, systemic view of the human-environment unit. A discussion of the complex societal issue of body image and eating disorders in females served to illustrate the use of the proposed theoretical framework and model. Recommendations were made for future exploration of the use of a holistic perspective for research and educational practices in the field of CT in order to address dynamic, complex human-environment problems. / Ph. D.

The grounded theory presented in this study describes how the supervision of special education instruction occurs in public elementary schools in rural settings. Grounded theory methodology (Strauss & Corbin, 1998) was employed in this study. Nine elementary schools in three rural districts in the state of Virginia participated in the study. Interview data were collected from 34 participants, including special and general education teachers, principals, and directors of special education. Observations were made in the schools and documents pertaining to the supervision process were collected. Data analysis allowed identification of categories and subcategories, processes, influencing conditions, strategies, and outcomes related to supervision, which contributed to the articulation of the theory. The grounded theory suggests that the supervisor's role is assigned to the principal. The principal negotiates among competing priorities and contextual factors while providing supervision. Competing priorities exist in three areas: (1) management and administration versus supervision; (2) monitoring for legal compliance versus supervision of instruction for students with disabilities; and (3) evaluation of teachers versus supervision of instruction. Contextual factors include systemic conditions such as enrollment size of school, time, and number of administrators. Contextual factors also include personal conditions such as knowledge of special education, definitions of special education instruction, and perceived competence of teachers. The outcome of negotiating competing priorities and contextual factors is a dispersal of responsibility for supervision to three groups of educators. Principals, as the primary supervisors, utilize three strategies to address supervision: (1) the observation/evaluation process; (2) supervision by wandering; and (3) open communication. Directors of special education have a supportive role in supervision through communication and collaboration with teachers and principals. Teachers provide some supervision when they mentor new teachers and serve as special education coordinators. / Ph. D.