Mental health in the United States is a rising concern. More concerning still is the growing number of children and adolescents with serious depression and other mental health disorders (SAMHSA, 2009; Merikangas et al., 2010). Despite a growing list of proven and best-practice prevention and intervention initiatives that have been made available to children and adolescents, 80 percent of children and adolescents with a diagnosable mental health disorder will not receive services for their associated mental health concerns (U.S. Department of Health and Human Services, 1999; Cummings 2014). Children and adolescents with mental health disorders are faced with an ever-increasing list of barriers that prevent them from accessing much needed mental health services. At a particular disadvantage are Black adolescents, who are even less likely than their non-minority peers to have access to or receive services for mental health concerns (Lindsey, Chambers, Pohle, Beall, & Lucksted, 2013). As result, this Q Methodology study was designed to understand the perspectives Black adolescents hold toward access to mental health care. The researcher first developed a naturalistic, 36-item Q Sample from participant responses to open-ended prompts designed to elicit distinct thoughts around perceptions of access to mental health care, including supports and barriers. Thirty Black adolescents sorted this 36-item Q sample in a forced distribution resembling a semi-normal curve ranging from “least like my perspective” (-4) to “most like my perspective” (+4) and also wrote explanations for why they sorted they ways they did. Subsequently, these 30 Q sorts were correlated and these correlations were factor analyzed, rotated, and extracted producing five factors. Based on an analysis of these five factors, or shared perspectives, they were named: Building My Own Barriers (Factor 1), I Don’t Talk About My Feelings! (Factor 2), I’m Looking For A Shift In My Perspective (Factor 3), Counseling When I Want It; Not Always From A Counselor (Factor 4), and Money Is The Least Of My Problems (Factor 5). These five factors represented distinct and diverse viewpoints toward the access to mental health counseling. A primary implication from this study was that school leaders and community leaders, educators, parents and caregivers, and policy-makers must find ways to decrease the barriers youth experience as they seek and attempt to participate in mental health counseling services, while working also to leverage the power of those things that support access.

Certaines personnes peuvent être stigmatisées quand elles présentent un attribut relié à une identité sociale qui est dénigrée dans un contexte particulier. Il existe plusieurs stéréotypes au sujet des personnes qui ont une perte d'audition. Le grand public associe souvent la perte d'audition à des comportements indésirables, au vieillissement et à une capacité intellectuelle réduite. Ces stéréotypes affectent négativement la participation des personnes ayant une perte auditive à diverses activités. Malgré les impacts évidents et importants que la stigmatisation a sur la participation sociale des personnes ayant une perte auditive et leur propension à recourir aux services de réadaptation, on constate une pénurie relative de recherche sur le stigmate lié à la perte d'audition. Ces dernières années, les chercheurs en sciences sociales ont fait de grands pas pour conceptualiser le stigmate selon la perspective des personnes qui sont la cible des attitudes nuisibles. La plupart de ces concepts peuvent s'appliquer au stigmate social lié à la perte d'audition. Le premier article de cette thèse tente de placer le stigmate lié à la perte d'audition dans un modèle de menace à l’identité induite par le stigmate (stigma-induced identity threat model). Ce chapitre explore comment les services pourraient être modifiés pour mieux soutenir les individus qui montrent des signes que leur identité personnelle est compromise à cause de leur perte d'audition. De façon générale, les buts de ce manuscrit sont a) de dresser un bref résumé de la question du stigmate lié à la perte d'audition ; b) de présenter un modèle spécifique de menace d'identité induite par le stigmate et d’incorporer des notions propres au stigmate lié à la perte d'audition à cette conceptualisation générale du stigmate et c) de réfléchir sur la pertinence de ce modèle pour la réadaptation audiologique. L'intention de la deuxième étude est de mieux comprendre comment le stigmate affecte les comportements de recherche d’aide des adultes ayant une perte d'audition acquise. Dix personnes ayant une perte d'audition, et appartenant à des groupes de soutien par les pairs ont participé à des entrevues semi-structurées audio-enregistrées. Les transcriptions de ces entrevues ont été analysées au moyen d’analyses thématiques. Les analyses ont indiqué que les répondants montre une plus grande propension à chercher de l'aide à la suite d’étapes charnières, où l’équilibre entre le stress négatif et l'énergie positive était rompu : a) un moment où le stress était de loin supérieur à l'énergie positive (première étape charnière) et b) un moment où l'énergie positive était de loin supérieure au stress négatif (deuxième étape charnière). On propose une série de représentations graphiques qui dépeignent comment les influences positives et négatives présentes dans l'environnement social et physique du répondant influencent la recherche d'aide. Le but de la troisième étude est d'identifier les facteurs qui amènent des individus à cacher ou révéler leur perte d'audition dans leur lieu de travail. Des entrevues semi-structurées ont été menées en utilisant une technique d’élicitation par photographies pour susciter des informations liées à la révélation de la perte d'audition. Les thèmes dégagés des entrevues incluent : l'importance perçue de la situation, la perception du sentiment de contrôle, l'affiliation à la communauté, le fardeau de communication et la présence de problèmes connexes à la perte d'audition. Les résultats de cette étude offrent un aperçu du monde caché des travailleurs ayant une perte d'audition. Cette étude sert à documenter certaines stratégies que les travailleurs avec une perte d'audition utilisent pour contrôler leur identité professionnelle et, plus spécifiquement, comment certains gèrent le dévoilement de leur perte d'audition dans leur lieu de travail. Les résultats fournissent des informations utiles pour le développement de programmes d'intervention appropriés pour des travailleurs ayant une perte d'audition. / Individuals are stigmatized when they possess, or are thought to possess, an attribute or characteristic that conveys a social identity that is devalued in a particular social context. There are several stereotypes, or commonly held (often erroneous) beliefs about people who have hearing loss. The general public often associate people with hearing loss to undesirable behaviours, ageing, and reduced intellect. Stereotypes such as these negatively impact upon activities of daily living engaged in by people with hearing loss. In spite of the obvious and important impacts that stigma has on social participation and inclination to use rehabilitative strategies, there has been a relative dearth of research on the stigma associated with hearing loss. In recent years, researchers in the social sciences have made great strides to conceptualize “stigma” from the perspective of people who are the target of prejudicial attitudes. Most of these concepts are applicable to the social stigma associated with hearing loss. The first study presented in this dissertation attempts to position hearing loss stigma within a model of stigma-induced identity threat. Overall, the goals of this paper are to a) offer a brief summary of hearing loss stigma; b) present a specific stigma identity threat model and incorporate ideas about hearing loss stigma into this general conceptualization of stigma; and c) reflect on the appropriateness of this model for the domain of rehabilitative audiology. The intent of the second study was to better understand how stigma impacted upon the help-seeking activities of adults with an acquired hearing loss. Ten people who had hearing loss, and were members of peer-support groups participated in audio-recorded semi-structured interviews. Thematic analyses of verbatim transcripts revealed that respondents experienced a heightened propensity to seek help following Critical Junctures, when negative stress and positive energy were out of balance: 1) a time when negative stress far outweighed positive energy (i.e., Critical Juncture One); and 2) a time when positive energy far outweighed negative stress (i.e., Critical juncture Two). A series of graphic representations are proposed that depict how positive and negative influences found in the respondent’s social and physical environment influenced help seeking. The purpose of the third study was to identify the factors that lead individuals to conceal or disclose their hearing loss in the workplace. We conducted semi-structured interviews using a photo-elicitation technique to aid in probing issues related to disclosure of hearing loss. Emergent themes included: Perceived importance of the situation, Perceived sense of control, Community affiliation, Burden of Communication and Coexisting issues related to hearing loss. This study serves to document some of the ways that workers with hearing loss manage their workplace identity, and more specifically, how some people manage revealing their hearing loss in workplace settings. The findings also inform the development of pertinent intervention programs for workers with hearing loss.

Objectius: determinar si la demora diagnòstica o terapèutica influeix en la supervivència o en l'estadi del càncer colorectal (CCR), identificar els factors que fan que es consulti al metge davant la presència de símptomes de CCR. Doble abordatge metodològic: revisió sistemàtica amb metaanàlisi i investigació qualitativa. Resultats: S'han identificat 40 publicacions sobre supervivència i 50 sobre estadi. S'exclogueren 14 i 13 estudis respectivament perquè utilitzaven mostres molt restrictives. Dels 26 de supervivència restants, a 20 no hi havia associació. El metaanàlisi de supervivència es va fer amb 8, RR: 0,92 (IC 95%: 0,87-0,97). Dels 38 estudis d'estadi, a 26 no hi havia associació. El metaanàlisi d'estadi es va fer amb 16, OR: 0,98 (IC 95%: 0,76-1,25). Quan s'examinaren colon i recte per separat, s'observaren associacions no significatives en sentit contrari. Els factors que fan que una persona amb símptomes de CCR consulti al metge estan relacionats amb el gènere. / Objetivos: Determinar si la demora diagnóstica o terapéutica influye en la supervivencia o en el estadio del cáncer colorectal (CCR) (objetivos 1 y 2), conocer la interpretación que las personas hacen ante los primeros síntomas de CCR, identificar los factores que desencadenan la consulta al médico y describir el proceso diagnóstico del CCR desde el punto de vista de las personas que lo padecen (objetivos 3, 4 y 5). Doble abordaje metodológico: revisió sistemàtica con metaanálisis (objetivos 1 y 2) y investigación cualitativa (objetivos 3, 4 y 5). Resultados: Se han identificado 40 publicaciones sobre demora y supervivencia y 50 sobre demora y estadio. Se han excluido 14 y 13 estudios por utilizar muestras excesivamente restringidas. De los 26 estudios de supervivencia restantes, en 20 no se observó asociación, en 4 la demora fue un factor protector de la supervivencia y en 2 un factor de riesgo. El metaanálisis de supervivència se pudo realizar con 8 estudios y se obtuvo un RR de 0,92 (IC 95%: 0,87-0,97). De los 38 estudios de estadio restantens, en 26 no se observó asociación, en 4 la demora fue un factor protector y en 7 un factor de riesgo. El metaanálisis de estadio se pudo hacer con 16 estudios y se obtuvo una OR de 0,98 (IC 95%: 0,76-1,25). Cuando se examinaron colon y recto por separado, se observaron asociaciones no significativas en sentido contrario. En definitiva, no parece existir asociación entre demora y supervivencia o demora y estadio en el CCR, pero es necesario estudiar más el tema considerando colon y recto por separado. Los primeros síntomas del CCR se atribuyen a procesos banales. El hecho de que la persona se encuentre bien hace que de poca importancia a los síntomas. Los factores que hacen que una persona con síntomas de CCR consulte al médico están relacionados con el género. Mientras que las mujeres cercanas son un desencadenante directo de consulta en los hombres, las mujeres no suelen mencionar su problema de salud a la familia hasta que no han consultado al médico. El tiempo de espera para la realización de una colonoscopia es vivido como largo.

Certaines personnes peuvent être stigmatisées quand elles présentent un attribut relié à une identité sociale qui est dénigrée dans un contexte particulier. Il existe plusieurs stéréotypes au sujet des personnes qui ont une perte d'audition. Le grand public associe souvent la perte d'audition à des comportements indésirables, au vieillissement et à une capacité intellectuelle réduite. Ces stéréotypes affectent négativement la participation des personnes ayant une perte auditive à diverses activités. Malgré les impacts évidents et importants que la stigmatisation a sur la participation sociale des personnes ayant une perte auditive et leur propension à recourir aux services de réadaptation, on constate une pénurie relative de recherche sur le stigmate lié à la perte d'audition. Ces dernières années, les chercheurs en sciences sociales ont fait de grands pas pour conceptualiser le stigmate selon la perspective des personnes qui sont la cible des attitudes nuisibles. La plupart de ces concepts peuvent s'appliquer au stigmate social lié à la perte d'audition. Le premier article de cette thèse tente de placer le stigmate lié à la perte d'audition dans un modèle de menace à l’identité induite par le stigmate (stigma-induced identity threat model). Ce chapitre explore comment les services pourraient être modifiés pour mieux soutenir les individus qui montrent des signes que leur identité personnelle est compromise à cause de leur perte d'audition. De façon générale, les buts de ce manuscrit sont a) de dresser un bref résumé de la question du stigmate lié à la perte d'audition ; b) de présenter un modèle spécifique de menace d'identité induite par le stigmate et d’incorporer des notions propres au stigmate lié à la perte d'audition à cette conceptualisation générale du stigmate et c) de réfléchir sur la pertinence de ce modèle pour la réadaptation audiologique. L'intention de la deuxième étude est de mieux comprendre comment le stigmate affecte les comportements de recherche d’aide des adultes ayant une perte d'audition acquise. Dix personnes ayant une perte d'audition, et appartenant à des groupes de soutien par les pairs ont participé à des entrevues semi-structurées audio-enregistrées. Les transcriptions de ces entrevues ont été analysées au moyen d’analyses thématiques. Les analyses ont indiqué que les répondants montre une plus grande propension à chercher de l'aide à la suite d’étapes charnières, où l’équilibre entre le stress négatif et l'énergie positive était rompu : a) un moment où le stress était de loin supérieur à l'énergie positive (première étape charnière) et b) un moment où l'énergie positive était de loin supérieure au stress négatif (deuxième étape charnière). On propose une série de représentations graphiques qui dépeignent comment les influences positives et négatives présentes dans l'environnement social et physique du répondant influencent la recherche d'aide. Le but de la troisième étude est d'identifier les facteurs qui amènent des individus à cacher ou révéler leur perte d'audition dans leur lieu de travail. Des entrevues semi-structurées ont été menées en utilisant une technique d’élicitation par photographies pour susciter des informations liées à la révélation de la perte d'audition. Les thèmes dégagés des entrevues incluent : l'importance perçue de la situation, la perception du sentiment de contrôle, l'affiliation à la communauté, le fardeau de communication et la présence de problèmes connexes à la perte d'audition. Les résultats de cette étude offrent un aperçu du monde caché des travailleurs ayant une perte d'audition. Cette étude sert à documenter certaines stratégies que les travailleurs avec une perte d'audition utilisent pour contrôler leur identité professionnelle et, plus spécifiquement, comment certains gèrent le dévoilement de leur perte d'audition dans leur lieu de travail. Les résultats fournissent des informations utiles pour le développement de programmes d'intervention appropriés pour des travailleurs ayant une perte d'audition. / Individuals are stigmatized when they possess, or are thought to possess, an attribute or characteristic that conveys a social identity that is devalued in a particular social context. There are several stereotypes, or commonly held (often erroneous) beliefs about people who have hearing loss. The general public often associate people with hearing loss to undesirable behaviours, ageing, and reduced intellect. Stereotypes such as these negatively impact upon activities of daily living engaged in by people with hearing loss. In spite of the obvious and important impacts that stigma has on social participation and inclination to use rehabilitative strategies, there has been a relative dearth of research on the stigma associated with hearing loss. In recent years, researchers in the social sciences have made great strides to conceptualize “stigma” from the perspective of people who are the target of prejudicial attitudes. Most of these concepts are applicable to the social stigma associated with hearing loss. The first study presented in this dissertation attempts to position hearing loss stigma within a model of stigma-induced identity threat. Overall, the goals of this paper are to a) offer a brief summary of hearing loss stigma; b) present a specific stigma identity threat model and incorporate ideas about hearing loss stigma into this general conceptualization of stigma; and c) reflect on the appropriateness of this model for the domain of rehabilitative audiology. The intent of the second study was to better understand how stigma impacted upon the help-seeking activities of adults with an acquired hearing loss. Ten people who had hearing loss, and were members of peer-support groups participated in audio-recorded semi-structured interviews. Thematic analyses of verbatim transcripts revealed that respondents experienced a heightened propensity to seek help following Critical Junctures, when negative stress and positive energy were out of balance: 1) a time when negative stress far outweighed positive energy (i.e., Critical Juncture One); and 2) a time when positive energy far outweighed negative stress (i.e., Critical juncture Two). A series of graphic representations are proposed that depict how positive and negative influences found in the respondent’s social and physical environment influenced help seeking. The purpose of the third study was to identify the factors that lead individuals to conceal or disclose their hearing loss in the workplace. We conducted semi-structured interviews using a photo-elicitation technique to aid in probing issues related to disclosure of hearing loss. Emergent themes included: Perceived importance of the situation, Perceived sense of control, Community affiliation, Burden of Communication and Coexisting issues related to hearing loss. This study serves to document some of the ways that workers with hearing loss manage their workplace identity, and more specifically, how some people manage revealing their hearing loss in workplace settings. The findings also inform the development of pertinent intervention programs for workers with hearing loss.

Adolescent peer counselling as a social support strategy to assist adolescents to cope with stress in their peer group provides the focus for the present thesis. The prosocial behaviour of providing emotional and psychological support through the use of helping conversations by young people is examined. Current programs for training adolescent peer counsellors have failed to discover what skills adolescents bring to the helping conversation. They ignore, actively discourage, and censor, some typical adolescent conversational helping behaviours and idiosyncratic communication processes. Current programs for training adolescent peer counsellors rely on teaching microcounselling skills from adult counselling models. When using this approach, the adolescent peer helper training literature reports skill implementation, role attribution and status differences as being problematic for trained adolescent peer counsellors (Carr, 1984; de Rosenroll, 1988; Morey & Miller, 1993). For example Carr (1984) recognised that once core counselling skills have been reasonably mastered that young people " may feel awkward, mechanical or phoney" (p. 11) when trying to implement the new skills. Problematic issues with regard to role attribution and status differences appear to relate to the term 'peer counsellor' and its professional expectations, including training and duties (Anderson, 1976; Jacobs, Masson & Vass, 1976; Myrick, 1976). A particular concern of Peavy (1977) was that for too many people counselling was an acceptable label for advice giving and that the role of counsellor could imply professional status. De Rosenroll (1988) cautioned against creating miniature mirror images of counselling and therapeutic professionals in young people. However, he described a process whereby status difference is implied when a group of adolescent peer counsellors is trained and invited to participate in activities that require appropriate ethical guidelines including competencies, training, confidentiality and supervision. While Carr and Saunders (1981) suggest, "student resentment of the peer counsellor is not a problem" they go on to say, "this is not to say that the problem does not exist" (p. 21). The authors suggest that as a concern the problem can be minimised by making sure the peer counsellors are not 'forced' on the student body and by providing opportunities for peer counsellors to develop ways of managing resentment. De Rosenroll (1988) acknowledges that the adolescent peer counsellor relationship may fall within a paraprofessional framework in that a difference in status may be inferred from the differing life experiences of the peer counsellor when compared with their student peers. The current project aimed to discover whether the issues of skill implementation, role attribution and status differences could be addressed so that adolescent peer counselling, a valuable social support resource, could be made more attractive to, and useful for adolescents. The researcher's goal was to discover what young people typically do when they help each other conversationally, what they want to learn that would enhance their conversational helping behaviour, and how they experience and respond to their role as peer counsellor, and then to use the information obtained in the development of an adolescent-friendly peer counsellor training program. By doing this, the expectation was that the problematic issues cited in the literature could be addressed. Guided by an ethnographic framework the project also examined the influence of an adolescent-friendly peer counsellor training program on the non-peer counsellor students in the wider adolescent community of the high school. Three sequential studies were undertaken. In Study 1, the typical adolescent conversational and communications skills that young people use when helping each other were identified. In addition, those microcounselling skills that young people found useful and compatible with their typical communication processes were identified. In Study 2, an intervention research process was used to develop, deliver, and evaluate an adolescent-friendly peer counsellor training program which combined typical adolescent helping behaviours with preferred counselling microskills selected by participants in Study 1. The intervention research paradigm was selected as the most appropriate methodology for this study because it is designed to provide an integrated perspective for understanding, developing, and examining the feasibility and effectiveness of innovative human services interventions (Bailey-Dempsey & Reid, 1996; Rothman & Thomas, 1994). Intervention research is typically conducted in a field setting in which researchers and practitioners work together to design and assess interventions. When applying intervention research methodology researchers and practitioners begin by selecting the problem they want to remedy, reviewing the literature, identifying criteria for appropriate and effective intervention, integrating the information into plans for the intervention and then testing the intervention to reveal the intervention's strengths and flaws. Researchers then suggest modifications to make the intervention more effective, and satisfying for participants. In the final stage of intervention research, researchers disseminate information about the intervention and make available manuals and other training materials developed along the way (Comer, Meier, & Galinsky, 2004). In Study 2 an adolescent-friendly peer counsellor training manual was developed. Study 3 evaluated the impact of the peer counsellor training longitudinally on the wider school community. In particular, the project was interested in whether exposure to trained peer counsellors influenced students who were not peer counsellors with regard to their perceptions of self-concept, the degree of use of specific coping strategies and on their perceptions of the school climate. Study three included the development of A School Climate Survey which focused on the psychosocial aspects of school climate from the student's perspective. Two factors which were significantly correlated (p<.01) were identified. Factor 1 measured students' perceptions of student relationships, and Factor 2 measured students' perceptions of teachers' relationships with students. The present project provides confirmation of a number of findings that other studies have identified regarding the idiosyncratic nature of adolescent communication, and the conversational and relational behaviours of young people (Chan, 2001; Noller, Feeney, & Peterson, 2001; Papini & Farmer, 1990; Rafaelli & Duckett, 1989; Readdick & Mullis, 1997; Rotenberg, 1995; Turkstra, 2001; Worcel et al., 1999; Young et al., 1999). It extends this research by identifying the specific conversational characteristics that young people use in helping conversations. The project confirmed the researcher's expectation that some counselling microskills currently used in training adolescent peer counsellors are not easy to use by adolescents and are considered by adolescents to be unhelpful. It also confirmed that some typical adolescent conversational helping behaviours which have been proscribed for use in other adolescent peer counsellor training programs are useful in adolescent peer counselling. The project conclusively demonstrated that the adolescent-friendly peer counsellor training program developed in the project overcame the difficulties of skill implementation identified in the adolescent peer counselling literature (Carr, 1984). The project identified for the first time the process used by adolescent peer counsellors to deal with issues related to role attribution and status difference. The current project contributes new information to the peer counselling literature through the discovery of important differences between early adolescent and late adolescent peer counsellors with regard to acquiring and mastering counselling skills, and their response to role attribution and status difference issues among their peers following counsellor training. As a result of the substantive findings the current project makes a significant contribution to social support theory and prosocial theory and to the adolescent peer counselling literature. It extends the range of prosocial behaviours addressed in published research by specifically examining the conversational helping behaviour of adolescents from a relational perspective. The current project provides new information that contributes to knowledge of social support in the form of conversational behaviour among adolescents identifying the interactive, collaborative, reciprocal and idiosyncratic nature of helping conversations in adolescents. Tindall (1989) suggests that peer counsellor trainers explore a variety of ways to approach a single training model that can augment and supplement the training process to meet specific group needs. The current project responded to this suggestion by investigating which counselling skills and behaviours adolescent peer counsellor trainees preferred, were easy to use by them, and were familiar to them, and then by using an intervention research process, devised a training program which incorporated these skills and behaviours into a typical adolescent helping conversation. A mixed method longitudinal design was used in an ecologically valid setting. The longitudinal nature of the design enabled statements about the process of the peer counsellors' experience to be made. The project combined qualitative and quantitative methods of data gathering. Qualitative data reflects the phenomenological experience of the adolescent peer counsellor and the researcher and quantitative data provides an additional platform from which to view the findings. The intervention research paradigm provided a developmental research method that is appropriate for practice research. The intervention research model is more flexible than conventional experimental designs, capitalises on the availability of small samples, accommodates the dynamism and variation in practice conditions and diverse populations, and explicitly values the insights of the researcher as a practitioner. The project combines intervention research with involvement of the researcher in the project thus enabling the researcher to view and report the findings through her own professional and practice lens.

The present study aimed to explore the culture specificity of student self-regulation and its supporting motivational attitudes. Specifically, it enquired about similarities and differences between Chilean and English 8 to 9 year-old students in terms of their expression of self-regulatory behaviours, the psychological factors underlying these behaviours, and the functionality of these behaviours for task performance. It also compared student adoption of achievement motivational attitudes as well as the functionality of these attitudes for investment of effort and self-regulatory activity between cultures. Finally, the role of classroom cultures for self-regulation was studied. In particular, it examined the effects of classrooms and the quality of teacher talk (teacher-to-student communicative interactions/demands), such as teacher ‘regulatory talk’ and ‘socio-motivational talk’, on student self-regulation. A quantitative approach to the analysis of qualitative data (i.e. videos of student behaviour engaged in 11 to 13 experimental tasks, semi-structured interviews, videoed literacy lessons) was adopted. Eight classrooms situated in different schools from Chile and England were part of the study. In total, 8 teachers and 49 students – one teacher and six to seven students per classroom – took active part in the study. Qualitative data was primarily analysed using observational scales (for student behaviour), thematic analysis (for interview data), as well as socio-cultural discourse analysis (for videoed lessons). Statistical techniques, such as Mann Whitney U test, Factor Analysis, Multinomial logistic regressions, and Multilevel regressions were then applied on numerical transformations of the data. Overall, results suggest that self-regulation and achievement motivational attitudes vary to important extents according to culture. Most interestingly, these varied between cultures not so much in terms of the degree to which children used or adopted them, but rather in terms of their functionality. Some key findings supporting this conclusion were: i) Strong similarities between English and Chilean children’s levels of self-regulatory behaviours; ii) substantial differences across country samples in relation to the psychological factors underlying the expression of specific self-regulatory behaviours; iii) the finding of evaluative actions being self-regulatory in England but not in Chile; iv) a higher variety of self-regulatory behaviours being predictive of task performance in England than in Chile; v) the fact that learned self-regulatory behaviours accounted for effects of effective metacognitive control on task performance in England but not Chile; vi) some important differences in the achievement motivational attitudes expressed by Chilean and English students; and vii) culture-specific functionalities of various achievement motivational attitudes with respect to student effort and self-regulatory behaviours. Moreover, results suggest that some aspects of children’s self-regulation and motivational attitudes develop as tools to adapt to classroom cultures, specifically to the learning interactions/demands socially afforded by teacher talk. Among key findings supporting this conclusion were: i) effects of classrooms on children’s cognitive, social, and motivational self-regulation behavioural strategies, and ii) clear effects of teacher ‘regulatory talk’ (e.g., teacher ‘self-regulatory talk’ predicting more planning and asking for clarifications in students) and ‘socio-motivational talk’ (e.g., teacher ‘talk against self-efficacy’ predicting higher dependency-oriented help-seeking in students) on those behaviours with respect to which classrooms were found to matter. Thus a theory about the culturally adaptive functionality (CAF) of self-regulation and motivational attitudes supporting self-regulation is developed throughout the thesis.

This research was stimulated by an indication that members of the Africa Gospel Church do not utilise professional health care services optimally, probably due to religious reasons. This may also be the result of registered nurses&#8217; inability to render culture congruent care. To render culture congruent care, nurses require knowledge of the belief system and the health seeking behaviours of the church members. The qualitative research investigated the religious beliefs and health seeking behaviours of members of the Africa Gospel Church in Francistown, Botswana. An exploratory ethnonursing research method was applied. Semi-structured interviews were held with two purposively selected samples. Qualitative data analysis was done using computer software to reduce data and interpret the research results. The study indicated that members utilise the Church structure for health care purposes and seek health care mainly from priests and prophets. / Advanced Nursing Sciences / M.A. (Nursing Science)

Background. Previous research suggests that individuals experiencing DSM-IV panic attacks (PA) are at increased risk for various forms of psychopathology, including anxiety, depressive and substance use disorders. However, little is known regarding whether the sole occurrence of fearful spells (FS-only; distressing spells of anxiety with less than four panic symptoms and/or lacking crescendo in symptom onset) similarly elevates the risk for subsequent psychopathology and could therefore be promising to identify high-risk groups for targeted preventive interventions. Thus, the current dissertation thesis aims to examine (a) whether FS-only predict incident mental disorders in addition to full-blown PA and whether their associations with subsequent psychopathology differ from those obtained for PA, (b) whether FS-only, PA, and panic disorder (PD) share similar etiologies, (c) which characteristics of initial FS/PA and other risk factors predict a progression to more severe panic pathology and other mental disorders, and (d) whether help-seeking/potential treatment in individuals with panic alters the risk for subsequent psychopathology. Methods. A representative community sample of adolescents and young adults (N=3021, aged 14-24 at baseline) was prospectively followed up in up to three assessment waves over a time period of up to 10 years. FS-only, PA, PD, and other mental disorders were assessed at each assessment wave using the DSM-IV-M-CIDI. Additional modules/questionnaires were used to assess characteristics of initial FS/PA (T1/T2), potential risk factors, and help-seeking/potential treatment. Logistic regressions were applied to test associations (Odds Ratios, OR) of FS-only and PA at baseline with incident mental disorders at follow-up as well as respective interactive effects with help-seeking at baseline. Associations (Hazard Ratios, HR) of putative risk factors with the onset of panic pathology (FS-only, PA, and PD) or the onset of subsequent anxiety/depressive vs. substance use disorders in those with panic pathology (aggregated data across assessment waves) were estimated with Cox regressions. Multinomial logistic regressions were used to test associations of initial FS/PA characteristics (aggregated from T1 and T2) with PA and PD (lifetime incidences aggregated across assessment waves). Results. FS-only at baseline predicted incident anxiety and depressive disorders at follow-up (OR 1.59-4.36), while PA at baseline predicted incident anxiety, depressive, and substance use disorders at follow-up (OR 2.08-8.75; reference group: No FS/PA). Merely any anxiety disorder (OR=3.26) and alcohol abuse/dependence (OR=2.26) were significantly more strongly associated with PA than with FS-only. Female sex, parental anxiety disorders, parental depressive disorders, behavioral inhibition, harm avoidance, lower coping efficacy, and parental rejection predicted FS-only, PA, and PD (HR 1.2-3.0), whereas the associations with other risk factors partially differed for FS-only, PA, and PD and tended to be more pronounced for PA and PD than for FS-only. Alcohol consumption, use of drugs/medication, and physical illness as perceived reasons for the initial FS/PA were associated with the occurrence of full-blown PA (without PD, OR 2.46-5.44), while feelings of anxiety/depression and having always been anxious/nervous as perceived reasons for the initial FS/PA, appraising the initial FS/PA as terrible and long-term irritating/burdensome, subsequent feelings of depression, avoidance of situations/places, and consumption of medication, alcohol, or drugs were associated with the development of PD (OR 2.64-4.15). A longer duration until “feeling okay again” was associated with both PA and PD (OR 1.29-1.63 per category). Moreover, partially different risk constellations in subjects with panic pathology (FS/PA/PD) predicted the onset of subsequent anxiety/depressive vs. substance use disorders. Panic pathology (FS/PA) and help-seeking/potential treatment at baseline interacted on predicting incident PD (OR=0.09) and depression (OR=0.22) at follow-up in a way that panic pathology only predicted these disorders in individuals not seeking help at baseline. Conclusions. Findings suggest that individuals with FS-only are at similar risk of developing subsequent psychopathology compared to individuals with full-blown PA. Specific initial FS/PA characteristics and additional risk factors may be used to identify sub-groups of individuals with panic pathology, which are at particular risk of progressing to more severe panic pathology or other mental disorders and might therefore profit from supplemental outcome-related preventive interventions in addition to panic-specific treatment. Future research may replicate the current findings and test the efficacy of targeted preventive interventions in panickers at elevated risk for PD and other forms of psychopathology.:CONTENT 0 Synopsis 10 1 Introduction 13 1.1 Current challenges in clinical psychology 13 1.2 Psychological models of mental disorders 13 1.3 Diagnostic approaches to psychopathology 15 1.4 Methodological issues 16 1.5 Preventive and early treatment interventions 17 2 Panic pathology 18 2.1 Definitions 18 2.2 Epidemiology 19 2.3 Etiology 20 2.4 Physiological, neurobiological, and genetic findings 21 2.5 Unresolved issues 22 3 Aims 24 4 Methods 26 5 Study I: Associations of fearful spells and panic attacks with incident anxiety, depressive, and substance use disorders: A 10-year prospective-longitudinal community study of adolescents and young adults 27 5.1 Abstract 27 5.2 Introduction 27 5.3 Materials and methods 28 5.4 Results 30 5.5 Discussion 35 6 Study II: Characteristics of initial fearful spells and their associations with DSM-IV panic attacks and panic disorder in adolescents and young adults from the community 37 6.1 Abstract 37 6.2 Introduction 37 6.3 Materials and methods 38 6.4 Results 41 6.5 Discussion 43 7 Study III: Risk factors for fearful spells and panic: A 10-year prospective-longitudinal study among adolescents and young adults 47 7.1 Abstract 47 7.2 Introduction 47 7.3 Materials and methods 49 7.4 Results 52 7.5 Discussion 60 8 Study IV: Does help-seeking alter the risk for incident psychopathology in adolescents and young adults with and without fearful spells or panic attacks? Findings from a 10-year prospective-longitudinal community study 63 8.1 Abstract 63 8.2 Introduction 63 8.3 Materials and methods 64 8.4 Results 66 8.5 Discussion 70 9 General discussion 73 9.1 Summary and discussion of main findings 73 9.2 Preventive interventions among individuals with panic pathology 75 9.3 Research implications 77 10 Conclusions 78 11 References 79 12 Appendix 94 12.1 Acknowledgements 94 12.2 Erklärung zu den Eigenanteilen an einzelnen Publikationen 95 12.3 Eigenständigkeitserklärung 96 / Theoretischer Hintergrund. Auf Grundlage früherer Forschungsbefunde ist anzunehmen, dass Personen mit DSM-IV-Panikattacken (PA) ein erhöhtes Risiko für zahlreiche psychische Störungen, einschließlich Angst-, depressiver und Substanzstörungen, aufweisen. Unklar ist jedoch, ob das alleinige Auftreten von Fearful Spells (FS-only, Angstanfälle mit weniger als vier Paniksymptomen und/oder fehlendem Crescendo in der Symptomentwicklung) das Risiko für Psychopathologie in ähnlicher Weise erhöht und hilfreich sein könnte, um Hochrisikogruppen für Präventivinterventionen zu identifizieren. Innerhalb der vorliegenden Dissertation wird daher untersucht, (a) ob FS-only zusätzlich zu PA inzidente psychische Störungen vorhersagen und ob sich Unterschiede in den Assoziationen von FS-only vs. PA mit nachfolgender Psychopathologie ergeben, (b) ob FS-only, PA und Panikstörung (PS) ähnliche Ätiologien teilen, (c) welche Merkmale initialer FS/PA und welche anderen Risikofaktoren die Entwicklung schwerer Panikpathologie und weiterer psychischer Störungen vorhersagen und (d) ob Hilfesuchverhalten/potenzielle Behandlung bei Personen mit Panik das Risiko für nachfolgende Psychopathologie verändert. Methodik. Eine repräsentative Bevölkerungsstichprobe Jugendlicher und junger Erwachsener (N=3021, 14-24 Jahre zur Baseline-Erhebung) wurde in bis zu drei Erhebungswellen über einen Zeitraum von bis zu 10 Jahren untersucht. FS-only, PA, PS und andere psychische Störungen wurden zu jeder Erhebungswelle mithilfe des DSM-IV-M-CIDI erfasst. Merkmale initialer FS/PA (T1/T2), mögliche Risikofaktoren sowie Hilfesuchverhalten/potenzielle Behandlung wurden mit weiteren Modulen und Fragebögen erhoben. Mithilfe logistischer Regressionen wurden Assoziationen (Odds Ratios, OR) von FS-only und PA zu Baseline mit inzidenten psychischen Störungen zum Follow-Up sowie diesbezügliche Interaktionen mit Hilfesuchverhalten zu Baseline getestet. Zusammenhänge zwischen möglichen Risikofaktoren und dem Auftreten von Panikpathologie (FS-only, PA und PS) bzw. nachfolgender Angst-/depressiver und Substanzstörungen bei Personen mit Panikpathologie (Verwendung von über die Erhebungswellen hinweg aggregierter Daten) wurden mithilfe von Cox-Regressionen geschätzt. Multinomiale logistische Regressionen wurden genutzt, um Assoziationen von Merkmalen initialer FS/PA (aggregiert über T1 und T2) mit PA und PS (über die Erhebungswellen hinweg aggregierte Lebenszeitinzidenzen) zu erfassen. Ergebnisse. FS-only zu Baseline sagten inzidente Angst- und depressive Störungen zum Follow-Up vorher (OR 1.59-4.36), wohingegen PA zu Baseline inzidente Angst-, depressive und Substanzstörungen zum Follow-Up vorhersagten (OR 2.08-8.75; Referenzkategorie: Keine FS/PA). Lediglich irgendeine Angststörung (OR=3.26) und Alkoholmissbrauch/-abhängigkeit (OR=2.26) waren signifikant stärker mit PA als mit FS-only assoziiert. Weibliches Geschlecht, elterliche Angst- und depressive Störungen, Verhaltenshemmung, Schadensvermeidung, geringere Coping-Erwartung und elterliche Zurückweisung sagten FS-only, PA und PS vorher (HR 1.2-3.0), während sich teils unterschiedliche Assoziationen anderer Risikofaktoren mit FS-only, PA und PS ergaben, die tendenziell stärker für PA und PS als für FS-only waren. Alkoholkonsum, Drogen-/Medikamentengebrauch und körperliche Erkrankungen als wahrgenommene Gründe für die initiale FS/PA waren mit dem Auftreten vollständiger PA assoziiert (ohne PS; OR 2.46-5.44), während Gefühle von Angst/Depression und die Einschätzung schon immer ängstlich/nervös gewesen zu sein als wahrgenommene Gründe für die initiale FS/PA, die Bewertung der initialen FS/PA als schrecklich und langfristig verunsichernd/belastend, nachfolgende Gefühle von Niedergeschlagenheit, Vermeidung von Situationen/Orten und Konsum von Medikamenten, Alkohol oder Drogen mit der Entwicklung von PS assoziiert waren (OR 2.64-4.15). Eine längere Dauer bis sich die betroffene Person wieder vollständig in Ordnung fühlte war sowohl mit PA als auch mit PS assoziiert (OR 1.29-1.63 pro Kategorie). Weiterhin sagten teils unterschiedliche Risikokonstellationen bei Personen mit Panikpathologie (FS/PA/PS) die nachfolgende Entstehung von Angst-/depressiven und Substanzstörungen vorher. Panikpathologie (FS/PA) und Hilfesuchverhalten/potenzielle Behandlung zu Baseline interagierten bei der Vorhersage von inzidenter PS (OR=0.09) und Depression (OR=0.22) zum Follow-Up; d.h. das Vorhandensein von Panikpathologie sagte diese Störungen nur bei Personen ohne, nicht aber bei Personen mit Hilfesuchverhalten zu Baseline vorher. Schlussfolgerungen. Die vorliegenden Ergebnisse implizieren, dass Personen mit FS-only im Vergleich zu Personen mit vollständigen PA ein ähnliches Risiko für die Entwicklung nachfolgender Psychopathologie aufweisen. Spezifische Merkmale initialer FS/PA und zusätzliche Risikofaktoren könnten zur Identifikation von Sub-Gruppen von Personen mit Panik genutzt werden, die sich durch ein besonderes Risiko für schwergradige Panikpathologie und andere psychische Störungen auszeichnen und demzufolge von Outcome-bezogenen Präventionen (ergänzend zu Panik-spezifischer Intervention) profitieren könnten. Zukünftige Studien sollten die vorliegenden Befunde replizieren und die Effektivität gezielter Präventivinterventionen bei Personen mit erhöhtem Risiko für PS und andere psychische Störungen testen.:CONTENT 0 Synopsis 10 1 Introduction 13 1.1 Current challenges in clinical psychology 13 1.2 Psychological models of mental disorders 13 1.3 Diagnostic approaches to psychopathology 15 1.4 Methodological issues 16 1.5 Preventive and early treatment interventions 17 2 Panic pathology 18 2.1 Definitions 18 2.2 Epidemiology 19 2.3 Etiology 20 2.4 Physiological, neurobiological, and genetic findings 21 2.5 Unresolved issues 22 3 Aims 24 4 Methods 26 5 Study I: Associations of fearful spells and panic attacks with incident anxiety, depressive, and substance use disorders: A 10-year prospective-longitudinal community study of adolescents and young adults 27 5.1 Abstract 27 5.2 Introduction 27 5.3 Materials and methods 28 5.4 Results 30 5.5 Discussion 35 6 Study II: Characteristics of initial fearful spells and their associations with DSM-IV panic attacks and panic disorder in adolescents and young adults from the community 37 6.1 Abstract 37 6.2 Introduction 37 6.3 Materials and methods 38 6.4 Results 41 6.5 Discussion 43 7 Study III: Risk factors for fearful spells and panic: A 10-year prospective-longitudinal study among adolescents and young adults 47 7.1 Abstract 47 7.2 Introduction 47 7.3 Materials and methods 49 7.4 Results 52 7.5 Discussion 60 8 Study IV: Does help-seeking alter the risk for incident psychopathology in adolescents and young adults with and without fearful spells or panic attacks? Findings from a 10-year prospective-longitudinal community study 63 8.1 Abstract 63 8.2 Introduction 63 8.3 Materials and methods 64 8.4 Results 66 8.5 Discussion 70 9 General discussion 73 9.1 Summary and discussion of main findings 73 9.2 Preventive interventions among individuals with panic pathology 75 9.3 Research implications 77 10 Conclusions 78 11 References 79 12 Appendix 94 12.1 Acknowledgements 94 12.2 Erklärung zu den Eigenanteilen an einzelnen Publikationen 95 12.3 Eigenständigkeitserklärung 96

<p dir="ltr">This dissertation is a two-study dissertation divided into two chapters focused broadly on the help-seeking experiences of racial-ethnic minority caregivers of children with autism spectrum disorder (ASD). In chapter one, a systematic literature review was conducted to identify articles that have studied barriers in help-seeking for racial-ethnic minority caregivers of children with autism. A broad literature search across four databases was conducted (i.e., PubMed, PsycINFO, Education Resources Information Center, and Child Development and Adolescent Studies). The coding team identified 17 articles on help-seeking barriers for racial-ethnic minority caregivers of children with autism. A thematic analysis was then used to synthesize the help-seeking barriers identified across these 17 studies. Four themes emerged from our findings: logistical barriers, provider competence, ASD literacy, and cultural stigma. We also provided clinical recommendations for healthcare providers working with families with racial-ethnic minority caregivers of children with autism.</p><p dir="ltr">The second chapter was informed by the results found in chapter one. In chapter one, we found little research on Asian American caregiver perspectives on help-seeking barriers to autism services. Using caregiver perspectives, this research study sought to understand the help-seeking experiences of Asian American families. In this study, we conducted semi-structured qualitative interviews with 10 Asian American caregivers with a child aged 3-17 diagnosed with ASD. Interviews were conducted virtually, audio recorded, transcribed, and coded by three researchers. Data was analyzed using thematic analysis (Braun & Clarke, 2006). Our results indicated four themes in perceived barriers by Asian American caregivers of children with autism interviewees. Themes included: (1) logistical barriers, (2) provider level barriers competence, (3) ASD literacy, and (4) cultural stigma. We deliver clinical recommendations for providers to address the four barriers found in our study when working with Asian American families of children with ASD.</p>