Yes / Tranquillity trails (TTs) are designed to provide a quiet and peaceful walk through mainly leafy lanes and roads and connect green open spaces where visitors can stop for thought and relaxation. There are numerous health benefits from being in close proximity to nature and TTs can facilitate this contact in mainly urban areas. This study involved the design of a trail in Tramore, a coastal town in south east Ireland. The trail links an old coastguard station, now converted to a cultural centre and coffee shop, with a Japanese garden. The trail includes a coastal path with fine views across a bay, wooded areas as well as leafy residential streets. The design of the trail was facilitated by the use of a previous developed tranquillity rating prediction tool (TRAPT) that involved the estimation of the level of man-made noise and the percentage of natural features in view. Participants who had completed the whole of the trail were encouraged to complete a questionnaire to gauge any benefits. As expected, it was reported that there were increased levels of relaxation and reduced stress. It was concluded that the approach can be used elsewhere to improve the well-being of residents and visitors.

The theoretical part is focused on upbringing and education as health determinants in an individual. It observes upbringing and education as they create conditions for sustaining and support of health and healthy lifestyle. Historical connections and particular educational schools from antiquity up to present day are compared. Current state of affairs at schools in the Czech Republic and abroad is surveyed. Different contemporary perspectives are brought into focus, as well as attitudes in society and ensuing educational goals and competence. The empirical part is based on research designed as questionnaire survey and related analysis. The respondents are divided according to the evaluating criterion: What is your evaluation of the client-worker relationship? Particular responses: a) The worker is advantaged. b) The worker and the client are equally matched. c) The client is advantaged. The responses represent the workers' subjective sense of well-being in the workplace. The groups are then analysed with regard to their education. The survey explores whether respondents self-study, attend one-day or regular training courses, or are not educated at all. Subsequently, the relation between the extent of education and workplace evaluation is assessed. The results indicate connection between the extent...

Land use decisions can facilitate or hinder the creation of healthy communities and as such, the health and well-being of their residents. This research project has the goal of exploring the connections between land use planning and community health in remote, Arctic communities; it asks a central question: if we were given the means to improve community health through planning, how would we best proceed? Arctic communities are experiencing rapid change as a result of demographic, economic and technological factors. The pressure for resource development in the Arctic is significant and communities are facing challenging decisions in terms of land use in their regions. In addition, measures of health and well-being indicate health deficits in Arctic communities in comparison with non-Arctic communities in Canada. As such, Arctic communities represent an important study region due to both this compelling health deficit, as well as increased pressure on the land base. For this research project, the Inuvialuit region, NWT was used as a case study. A qualitative inquiry was undertaken given the research objective of generating localized and specific information in the context of remote, Arctic communities. In addition, limited information was available on the subject area which made this ‘theory generating’ methodology most relevant. Fifteen semi-structured interviews were conducted with expert/ knowledge holders, the majority of whom were from the study area. Information gathered was analyzed using the constant comparison method. Available statistical and quantitative data from secondary sources was compiled into community profiles and used for comparison with interview data and to add richness to the analysis. The study indicated that there was strong connection between community health and land use in the region. The reasons given for this connection were as follows: cultural connection – describing the basis for culture that arises from the historic and current connection with the land, self-determination – as it relates to ownership and control over ancestral lands, functional relationship with land – in terms of services provided including air, water, wildlife, and food, economic basis in the land – in terms of monetary value (or replacement value) of goods obtained directly from the land and the holistic connection between the land and community well-being – describing the innate value of the land as it positively impacts people’s health beyond the functional or cultural value. Variations in infrastructure and services between communities were examined but not found to be strongly linked to community health; however there is some evidence to indicate that the level of participation in cultural activities is linked to community health. Promoting and increasing levels of community health in the study region was shown to be linked to increased opportunities for education, local governance and control over community and regional affairs, economic development that strengthens the traditional economy, healing and treatment for individuals, and recreation opportunities that promote personal development. Implications for planning in the study region were examined. Collaborative planning theory was used as a basis. The recommendations for planning in the study region were: recognizing the historical and cultural connections with the land, integrating the hinterland and the town lands in community design, designing to support social networks, local control over the planning process, and planning to enhance opportunities in northern communities. Explicitly considering community health in planning policy holds some promise for dealing with the complex issues surrounding land use in the north in particular in providing a measure emphasizes the needs of the local communities.

Land use decisions can facilitate or hinder the creation of healthy communities and as such, the health and well-being of their residents. This research project has the goal of exploring the connections between land use planning and community health in remote, Arctic communities; it asks a central question: if we were given the means to improve community health through planning, how would we best proceed? Arctic communities are experiencing rapid change as a result of demographic, economic and technological factors. The pressure for resource development in the Arctic is significant and communities are facing challenging decisions in terms of land use in their regions. In addition, measures of health and well-being indicate health deficits in Arctic communities in comparison with non-Arctic communities in Canada. As such, Arctic communities represent an important study region due to both this compelling health deficit, as well as increased pressure on the land base. For this research project, the Inuvialuit region, NWT was used as a case study. A qualitative inquiry was undertaken given the research objective of generating localized and specific information in the context of remote, Arctic communities. In addition, limited information was available on the subject area which made this ‘theory generating’ methodology most relevant. Fifteen semi-structured interviews were conducted with expert/ knowledge holders, the majority of whom were from the study area. Information gathered was analyzed using the constant comparison method. Available statistical and quantitative data from secondary sources was compiled into community profiles and used for comparison with interview data and to add richness to the analysis. The study indicated that there was strong connection between community health and land use in the region. The reasons given for this connection were as follows: cultural connection – describing the basis for culture that arises from the historic and current connection with the land, self-determination – as it relates to ownership and control over ancestral lands, functional relationship with land – in terms of services provided including air, water, wildlife, and food, economic basis in the land – in terms of monetary value (or replacement value) of goods obtained directly from the land and the holistic connection between the land and community well-being – describing the innate value of the land as it positively impacts people’s health beyond the functional or cultural value. Variations in infrastructure and services between communities were examined but not found to be strongly linked to community health; however there is some evidence to indicate that the level of participation in cultural activities is linked to community health. Promoting and increasing levels of community health in the study region was shown to be linked to increased opportunities for education, local governance and control over community and regional affairs, economic development that strengthens the traditional economy, healing and treatment for individuals, and recreation opportunities that promote personal development. Implications for planning in the study region were examined. Collaborative planning theory was used as a basis. The recommendations for planning in the study region were: recognizing the historical and cultural connections with the land, integrating the hinterland and the town lands in community design, designing to support social networks, local control over the planning process, and planning to enhance opportunities in northern communities. Explicitly considering community health in planning policy holds some promise for dealing with the complex issues surrounding land use in the north in particular in providing a measure emphasizes the needs of the local communities.

In Scotland, Health and Well-Being (HWB) has become a core area in school curricula following the introduction of Scotland’s Curriculum for Excellence in 2004. Physical Education (PE) is one of the subjects within HWB, which places it within a prominent position to positively influence children’s decisions to live a healthy and active lifestyle. Scottish Government guidelines indicate that each child aged 3 – 11 years should receive 2 hours of PE each week and children aged 12 – 18 years should receive 2 periods of PE each week. The percentage of schools achieving 2 hours/2 periods each week is encouraging with 99% of primary schools and 93% of secondary schools in 2015. Some head teachers might have had concerns that increasing the time spent in PE would detrimentally affect academic attainment and achievement in other curricula areas such as numeracy and literacy. Evidence does not support these concerns; some studies showed no detrimental effect whilst other studies identified a beneficial effect as a result of increased time spent in PE. However, the understanding of how these positive effects were mediated remains unclear. The literature considers physical activity (PA) as a potential mediator with more recent studies evaluating the impact of physical activity (PA) on academic achievement and attainment. A clearer understanding about which approaches to PE and PA are most effective in positively influencing children’s learning would be of value aligned with the knowledge of student’s experiences and perceptions of PE. The aim of this thesis was to evaluate if a novel approach to PE known as ‘Better Movers and Thinkers (BMT)’ could positively influence children’s coordination and cognition and to evaluate student’s experiences of this approach. Three studies were planned to explore this aim. Study one involved a feasibility study being undertaken with students who were in their sixth year of education (n = 46) within two primary schools from one local authority to evaluate the feasibility of running BMT as an intervention within school. The study involved pre- and post-testing of two quantitative outcome measures; the Movement Assessment Battery for Children – 2nd Edition and the Lucid Assessment for Schools System as well as collecting qualitative data from the students and class teachers using focus groups and semi-structured interviews to obtain an understanding of their experiences following a 16-week intervention phase. Academic skills were assessed using the Lucid Assessment System for Schools 8 – 11 and physical testing was undertaken using balance and coordination subtests from the Movement Assessment Battery for Children (2nd Edition). Quantitative results revealed significant increased score changes between pre- and post-test conditions in the areas of phonological skills (p = .042), segmentation skills (p = .014) and working memory (p = .040) in favour of the intervention condition. Analysis of qualitative data from a sample of students from the intervention condition (n = 8) and their class teacher indicated good acceptability of BMT as an alternative approach to PE. The results and reflections from study one informed the design of study two. In response to study one, more specific measures of cognition were used as the nature of the academic skills testing was limited in this area. Similarly, the physical testing did not specifically measure coordination and new physical subtests were added to the outcome variable. Further PA habits were included as an additional outcome measure to control for the effects of student activity levels. Finally, the addition of a follow-up testing phase helped to evaluate if changes did occur between pre- and post-testing similar to study one, would these changes be maintained over time. The aim of study two was to identify what impact BMT had on children’s coordination and cognition. The study involved 6 schools from within the same local authority, 3 acting as the control condition schools (C-schools) and 3 as the intervention condition schools (I-Schools). The schools were selected at random by the Quality Improvement Officer (QIO) within the local authority. There were a number of potential schools and the QIO chose schools based on two criteria: their proximity with one another ensuring that catchment areas would be similar in regard to local history, geography and socioeconomic variables and schools where it would be feasible to run the research. Once the schools were identified, their names were placed within opaque-sealed envelopes and a person external to the study chose 3 schools and allocated them to the intervention condition leaving the other 3 as the control condition. Students (n = 150) were all in their sixth year of primary education attending mainstream public school. Study two involved four phases; pre-test, a 16-week intervention phase, post-testing, and, 6-month follow-up testing. Physical activity habits were assessed using the ‘Physical Activity Habits Questionnaire for Children (PAQ-C),’ coordination was assessed using four patterns of locomotion (crawling on the stomach, creeping on hands and knees, marching and skipping) and cognition was assessed using the ‘Cognitive Assessment System (CAS).’ Overall findings from study two suggested significant intervention effects in coordination (p = .001) and cognition (p = .001) with no significant effects for physical activity habits (p = .200). Semi-structured focus group interviews were conducted in each of the 6 schools. Grounded theory was used to identify emergent themes and categories to evaluate student perceptions of their PE experiences following completion of the intervention phase. Analysis identified that BMT provided different experiences compared with traditional approaches to PE suggesting that key aspects of BMT should be incorporated into the delivery of PE lessons to build on current good practice. These aspects include the direct focus on developing the children’s ability to move and think simultaneously and, directly targeting the development of Executive Function (EF) skills. The findings from this thesis have implications for Continued Lifelong Professional Learning (CLPL) for primary school teachers and for specialist PE teachers. The findings may also influence course programmes within Initial Teacher Education (ITE) and specialist PE training and for future PE programme design.

The role of natural environments, especially ‘green space’, in promoting human health and well-being is well-researched. However, less is known about the benefits of ‘blue space’ (e.g. the coast) or ‘managed’ nature (e.g. zoos). In this thesis, six studies investigated the restorative potential of sub-aquatic settings, specifically public aquariums and the biological diversity within them. Studies 1 and 2 investigated preferences for, affective responses to, and the restorative potential of, five built and natural settings (i.e. built, green space, blue space, natural underwater and public aquariums). Using the same measures, Study 3 focused solely on people’s responses to aquarium exhibits, sub-categorised by geographic region, level of species richness and abundance, and taxonomic group. Study 4 examined behavioural, physiological and psychological responses to one aquarium exhibit during three stages of restocking. Finally, to establish how perceptions of species richness and abundance influenced well-being outcomes, people viewed and evaluated either one (Study 5) or two (Study 6) large aquarium exhibits. These studies found that natural sub-aquatic and aquarium settings were as preferred, and perceived as potentially restorative, as green space environments, and different exhibits elicited different responses: ratings were higher for tropical exhibits (vs. temperate), high abundance (vs. low) and vertebrates (vs. invertebrates), although findings for species richness were mixed. Within one exhibit, higher stocking levels resulted in increased attention and interest, greater improvements in mood, and some physiological evidence of relaxation (e.g. decreased heart rate). Broad levels of marine life could be distinguished but estimates of actual numbers were poor. Viewing one or two exhibits tended to improve mood, decrease arousal and be perceived as restorative; any differences between the two exhibits were more evident when both had been viewed. Overall, findings suggest that engaging with different types of managed nature may provide valuable perceived human health and well-being benefits.

Magister Scientiae (Occupational Therapy) - MSc(OT) / TB is a multi- faceted public health problem spurred on by the biological progression of the disease as well as the social issues associated with it. The treatment of TB is however primarily driven by the medical model where the focus is on the disease and not on a holistic view of the patient. Occupational therapy is a profession concerned with the use of occupation in the promotion of health and well being through the facilitation of the process of occupational adaptation. There is however a paucity of literature pertaining to the role that occupational therapy could play within the TB context. The aim of this study was to explore how adults with MDR- TB who undergo long-term hospitalisation at a hospital in the Western Cape experience occupational adaptation. The objectives of the study were to explore how the participants perceive their occupational identity, to explore the meaning and purpose the participants assign to their occupational engagement and to explore the how the participants perceive their occupational competence. The interpretive research paradigm employing a phenomenological qualitative research approach was utilized in this study. Purposive sampling was used to select four participants based on specific selection criteria. The data gathering methods utilized included diaries, semistructured interviews, participant observation and a focus group. Photographs taken by the researcher for the purpose of participant observation were used to elicit a rich, in depth response from the participants during the focus group discussion. All data was analysed through thematic content analysis. The study findings highlighted that the participants viewed themselves as occupational beings and that they valued the role that occupational engagement played in facilitating their occupational competence and ultimately their ability to adapt to long- term hospitalisation. The environmental demands and constraints that they experienced however infringed their engagement in meaningful occupation and hampered their ability to achieve occupational competence. It was recommended that the hospital adopt an integrative intervention approach to the management of MDR- TB patients that include principles of psychosocial rehabilitation and occupational enrichment to address occupational risk factors and institutionalisation.

This thesis investigates the implications of area-based regeneration for residents' health and well-being. The last three decades have seen significant investment in area-based initiatives in the UK to regenerate declining areas. However, there is a dearth of robust evidence on the impact that area regeneration practices have on health and health inequalities. This is particularly so in the case of the Scottish Area Regeneration Partnership (SARP) Programmes initiated in the mid-1990s, the evaluation of which was beset by a lack of baseline data and poor data collection generally. This study therefore seeks to address the lack of evidence by employing a rigorous mixed methods approach to evaluate the SARP programmes. Firstly, a quasi-experimental analysis of data from the Scottish Longitudinal Study (SLS) is undertaken. Comparator areas were identified using propensity score matching and a series of models was fitted to examine whether health outcomes of residents and migrants differed between regeneration areas and comparator areas. This is followed by a qualitative study exploring experiences of regeneration, carried out to provide insight into the results of the quasi-experiment. The findings provide no evidence that the programme had a positive impact on the health and well-being of SARP area residents relative to comparator area residents, and moreover, suggest that the programme may even have had a negative impact. Nor do they support the often stated hypothesis that those who move out of regeneration areas have done so because they have benefited from the programme and been replaced with residents who are likely to be more deprived. In addition, interviews with regeneration professionals and residents found that smaller initiatives overlapped with the SARPs, making it difficult to isolate the impacts of the programme under study. The conclusion reflects on the implications of these findings for the evaluation of public policy programmes.

People are living longer and this increases the risk of encountering financial difficulties when trying to make fixed retirement incomes stretch over additional years. Increased life expectancies also increase the likelihood of encountering a health issue including cognitive or functional declines that can affect money management capabilities. There are government entitlement programs available to assist retired Canadians but these programs are under review and new policies are being considered in order to reduce fiscal pressures. At the same time, family roles and structures are changing and informal supports available to previous generations may be reduced. As well, if an older person’s money is poorly managed there will be fewer options for maintaining quality of life in the retirement years. This increases the risk of poverty for older Canadians. The goals of this research are to: understand individual risk factors including demographic, clinical and social support characteristics among Canadians age 55 and over who are experiencing poverty; to understand the predictive characteristics for moving into or exiting from poverty; and, to develop a comprehensive description of those who have great difficulty managing their finances. In order to achieve this, data from the interRAI Home Care (RAI-HC) assessment instrument were used. Three regions, Winnipeg Regional Health Authority (WRHA), Nova Scotia and Ontario, were analyzed in order to understand the characteristics of those making economic trade-offs (N=345,678). Data from the province of Ontario was used to understand predictors of poverty transitions (N=47,653) and to develop a profile of those having great difficulty managing their finances (N=321,816). In order to answer each question of interest multivariable logistic regression modeling was used. Results from the analyses found that those most at risk for making economic trade-offs were in the age 55 to 64 group, had three or more depressive symptoms and were separated or divorced. Gender was not a risk factor. Regional differences for poverty risks were also identified showing greater risks for those experiencing mental health issues in WHRA, for those with more clinical indicators in Ontario, and for younger residents (age 55 to 64) in Nova Scotia. The longitudinal analyses on poverty transitions revealed that females who had completed at least a grade eight education were more likely to exit poverty. The younger group (age 55 to 64 years) with three or more depressive symptoms and experiencing unstable health were more likely to enter poverty. Marriage and older age were protective from the risks of entering poverty. Results from the analyses of those likely to have great difficulty with financial management indicated that deficits in cognition, procedural memory and function increased the risk of being unable to manage personal finances. Gender and marital status were not associated with financial management difficulty. The development of a profile of those who are making economic trade-offs and those at risk of having difficulty with financial management provides the opportunity for early intervention. Those who have not reached the traditional retirement age of 65 have an increased risk of poverty. Understanding characteristics of those who exit poverty will help establish policies and programs that will assist older Canadians. These are important issues due to the increased number of post-employment years that Canadians are living and the national focus on fiscal restraints. The management of finances has received minimal scientific research and evidence is needed to understand when changes in capability occur and how these changes may be supported by appropriate levels of assistance and supportive devices.

Suicide in later life is a growing public health concern that is expected to increase as the baby boom generation reach late adulthood. In the general population, older adults have rates of suicide that are higher than any other age group. The rate of suicide is particularly higher for older men. In Canada, older men between 80 and 84 years have rates of suicide approximately six times greater than older women the same age. Older adults living in the community are a sub-set of the population that are at high risk for suicide yet are not typically a focus of suicide research. As a result they remain hidden from the view of mental health promotion and suicide prevention programs until a decline in mental status brings them to the attention of formal mental health care services. Improving our understanding of suicide in later life particularly among community-residing older men can inform suicide prevention strategies. To improve this understanding, the goals of this research were three-fold: to comprehensively describe the sociodemographic and clinical characteristics of community residing older adults who have experienced suicide-related behaviour; to describe the rates, risk and protective factors, and predictors of suicide-related behaviour among this population; and to compare these findings to a subpopulation of community-residing older adults with neurological conditions. To achieve these aims, this research utilized a secondary data analysis approach using health information from multiple linked datasets. The Canadian Institute of Health Information (CIHI) performed record linkages between Ontario hospital administrative data (Discharge Abstract Database, National Ambulatory Care Reporting System, and Ontario Mental Health Reporting System) and Ontario home care data (Home Care Reporting System). Home care data are sourced from the Resident Assessment Instrument–Home Care (RAI-HC) Assessment Instrument, the provincially mandated assessment tool used to identify the strengths, preferences and needs of all long-stay home care clients. The RAI-HC contains over 350 items across a wide range of domains including health, functional status and resource use. Linkages of these data records between home care and hospital sectors enabled the prospective examination of community-residing older adults with recent suicide-related behaviour. This is one of the first national and international studies to use the RAI-HC to examine older home care clients with experiences of suicide-related behaviour. The study samples consisted of Ontario home care clients aged 60 years or older assessed with the RAI-HC between April 2007 and September 2010. Clients’ initial RAI-HC assessment was examined followed by corresponding hospital records for suicide-related behaviour (N = 222,149). The prevalence of suicide-related behaviour for the sample was 1.01% (n=2,077) with higher rates for older men than women. Rates were examined across geographic regions of Ontario. Descriptive analyses demonstrated that older adults with suicide-related behaviour had more indicators of psychiatric distress (including cognitive impairment) and psychosocial dysfunction than the general home care population. Multivariate analyses showed significant effects for age and gender in the prediction of suicide-related behaviour after adjusting for risk and protective covariates. Tangible areas for intervention were revealed that may reduce future suicide risk such as managing alcohol use and dependence, managing pain, increasing positive social relationships, and reducing social isolation. Time-to-event analysis supported the multivariate regression findings. Analyses of two subpopulations of older adults with neurological conditions (dementia and Parkinson’s disease) demonstrated marked differences in suicide risk and protective factors compared to the general home care population. Findings suggest that a one-size-fits-all approach to suicide prevention and intervention is not appropriate for persons with these conditions, as their specific risk and protective factors need to be taken into consideration. This study based on provincial data covering the home care sector in Ontario defined high risk groups of older adults and provided evidence for risk and protective factors associated with suicide-related behaviour. Findings point to several areas that should be assessed by home care professionals to reduce risk in the older home care client population. This multi-dimensional profile of high risk older adults will assist in initiating a policy dialogue regarding the need for targeted suicide prevention strategies in Ontario’s home care sector.