Theses (Psy. D.)--Marshall University, 2006. / Title from document title page. Includes abstract. Document formatted into pages: contains iv, 81 pages. Bibliography: p. 53-66.

Aims: This study aims to explore the experience of osteoarthritis (OA) in older adults, drawing on concepts from the literature on chronic illness including social-cognition models (e.g. Self-Regulatory Model) and cognitive concepts (e.g. self-schema). Design and Participants: A qualitative research design and Phenomenological Interpretative Analysis Methodology were used. Sixteen participants were interviewed. Ten were recruited from an orthopaedic surgical waiting list source and six from a GP source: age ranged from 67 to 79 years, and history of osteoarthritis ranged from one to 35 years. Measures: A semi-structured interview schedule was designed and piloted, based on the research literature. Results: Analysis identified the following themes: Demands of OA (pain, impact on activity, and impact on mood); Perceptions ofOA (onset/deterioration, cause, label, seriousness, prognosis); Strategies to manage OA (use of health services, changes in behaviour, psychological strategies, appraisal of strategies); Perception of Self (compared to past/future/others) and Contextual factors (age, co-morbidity, waiting list). Links between themes were reciprocal, and a tentative model ofOA is presented. Implications: A comprehensive model of the experience of chronic illness could provide a framework to guide interventions for direct clinical interventions (e.g. adjustment to chronic illness, pain management, identification of psychological comorbidity) and indirect interventions (e.g. consultancy with other health professionals).

Thesis (Ph. D.)--Drexel University, 2006. / Includes abstract and vita. Includes bibliographical references (leaves 110-129).

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 38-41).

Background: Whilst the experience of chronic physical conditions is well documented and has been recognised as relevant for health policy and practice little is known about notions of recovery and prognosis from the point of view of those with long-term physical health conditions. The extent to which people consider the future outcomes of their conditions is relevant to health policy which seeks to engage people in shared decision making, care plans, and self-management. This gap in knowledge about lay perceptions of recovery and prognosis becomes more pronounced when compared with literature from the mental health field in which recovery is one of the dominant foci, is comparatively well researched and in recent years has fed into policy and management approaches.Aims: The aim of the thesis is to explore perceptions of recovery and prognosis with people with long-term physical health conditions and to compare these with perspectives on recovery and prognosis apparent in the mental health field.Methodology: Using qualitative methods, a two phased approach to data collection and analysis was undertaken. Phase 1 used secondary data analysis with two existing datasets to examine whether notions of recovery and prognosis were implicit in narratives about the experience of illness. Phase 2 built on the findings from phase 1 and utilised longitudinal, primary data collection in the form of narrative interviews undertaken at two time points (baseline and 12 month follow-up). The analysis in both phases involved a cross case thematic analysis to look for commonalities and differences across individuals. Data from phase 2 were also subject to a narrative emplotment of individual stories which were used to capture the longitudinal changes in patient perspectives over time.Results: There were similarities with findings from the mental health field (recovery as a complex, nonlinear journey, the input from friends and family, notions of burden and the impact of condition on sense of self). However, there were nuanced differences in relation to physical health conditions which related to expectations about mortality, the experience of time, the extent to which narratives were future oriented and the experience of stigma. The dual focus on mental and physical health recovery proved useful for understanding those experiences of multiple morbidities. The results were used to develop a model of recovery narratives based on two dimensions (expectations and responsibility) which gave rise to four typologies of narratives. The aim of this model was to further highlight and summarise the themes arising from the data analysis.Discussion: The results of this study highlight the importance of understanding notions of recovery and prognosis in order to better understand the experience of illness and self-management. The thesis challenges the blanket use of health promotion strategies for those with and without chronic health conditions and supports a shift in policy focus from improved choice and autonomy to what Mol (2009) refers to as ‘enhanced care’.

An interpretive description qualitative approach was utilized in this study. The main aim to was to understand the South Asian (SA) Punjabi community’s experience of having accessed mental health services for depression within Ontario, Canada. A sub-aim was to capture the participants’ conceptualizations and experiences of having depression, which provided context about this ethnic community and deepened insights into their accessibility experience. Six Punjabi persons living with depression (PLDs) and six family members were interviewed in Punjabi and/or English. Data analysis was guided by Thorne’s strategy for interpretive description. Twelve major themes detailed the challenges of PLDs and their family members regarding i) identification and understanding of depression and ii) accessing mental health support. Major themes revealing the community’s conceptualizations of depression are: i) most of us didn’t know what depression is, ii) we realized it was depression after getting help, iii) we keep depression a secret, iv) my family didn’t understand my depression, v) my family helped, vi) my family didn’t help- some made me sick, and vii) my family also became “sick”. These themes supported a better understanding of the major themes discussing the community’s access to mental health service for depression, which are: viii) we didn’t know where to get help, ix) my health providers’ lack of familiarity with my culture caused stress, x) I waited to get help, xi) treating my depression cost me, and xii) knowing my culture will help you treat me better. Findings of this qualitative study provide details of how these participants had their own unique cultural conceptualizations of depression and continue to experience difficulty with accessibility of mental health services while receiving care. Results suggest culturally tailored improvements of mental health service accessibility are required to support this population as they navigate the mental health system for their depression. / Thesis / Master of Science (MSc)

Thesis (M.S.W.)--University of Hong Kong, 1990.

Perceptions can be influenced by the media concerning different groups of people. As a result of the importance of the media in how individuals obtain information and formulate opinions, how different groups are presented whether negatively or positively is important. This research examines the portrayal of mental illness in films and the impact that such portrayals have on the perceptions of mental illness of the viewers. Mental illness representations can be found quite prevalently among film and the way in which it is represented can be important as to how populations perceive those with mental disorders. This thesis looks to explore perceptions of mental illness and beliefs from those who have viewed films that portray characters with mental disorders. Through the use of an online survey, one hundred and ninety five participants provided data for this study. Based on previous research, it was hypothesized that individuals who had seen more films portraying mental illness would have more knowledge and sympathy regarding mental illness compared those who had seen less films portraying mental illness. It was also hypothesized that social stereotypes surrounding mental disorders would be present in the knowledge that individuals had more so than factual data about mental disorders. Women were predicted to express more sympathy than men. A statistical analysis program was used to analyze the resulting data including the use of correlations and t-tests. Evidence indicated that the amount of films viewed portraying mental illness did not have an impact on knowledge or sympathy regarding mental illness. Perceptions of mental illness are still a relevant topic and the awareness of facts surrounding mental disorders should continue to be spread.

Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disease causing inflammation of the synovium resulting in severe pain, joint disfigurement and disability as well as malaise, fatigue and a depressed immune system. Treatment consists of three broad phases; firstly, following diagnosis treatment is focussed on rapid reduction of pain and inflammation. Secondly, maintenance of quiescence is sought through medication. Finally, if disease activity remains high despite medication, escalation to anti-TNF α therapy is required to prevent permanent joint damage and disability. The primary course of treatment is prescription of disease modifying anti-rheumatic drugs (DMARDs) within 3 months of onset of symptoms. However, DMARDs can take 8-12 weeks to exhibit a noticeable benefit whereas unpleasant side effects can occur shortly after initiation. Also, DMARDs do not alleviate pain; therefore it is difficult for patients to attribute recovery to this medication. For these reasons, although it is imperative for future health and functioning to take DMARDs as prescribed, non-adherence is common at 30-50%. Non-adherence to treatment can be intentional, where a decision is made not to conform to the prescription, or unintentional which is often due to forgetting. To measure intentional non-adherence, a validated measure of adherence for rheumatoid arthritis was reduced through exploratory factor analysis from 19 items to 5 items by removing items that did not add to the explained variance of adherence. The CQR5 explained 53% of the variance in adherence and was shown to have a good fit to the data through confirmatory factor analysis. A discriminant function equation was generated that correctly identifies 88.5% of patients as high or low adherers and has high clinical utility due to the brevity for patients and unidimensionality for easy interpretation. The CQR5 was used throughout the programme of research to measure intentional non-adherence along with a separate measure of unintentional non-adherence. Four commonly used social cognition models of illness were measured in 227 RA patients to determine which had the best utility for predicting non-adherence to DMARDs. Patients were recruited to represent the three stages of illness including newly diagnosed, established on DMARD therapy and established with concurrent anti-TNF α therapy. Logistic regression analysis showed that the Self Regulatory Model best predicted intentional non-adherence as patients with perceptions of worse consequences of RA and longer disease duration were more likely to be highly adherent to DMARDs in cross-sectional analysis. In contrast, the Theory of Planned Behaviour better predicted patients who self-reported forgetting their DMARDs with patients with more confidence in being able to take their medications (Perceived Behavioural Control) being less likely to forget. 171 patients were successfully followed-up six months after baseline recruitment. The longitudinal results showed that the social cognition models differed for patients at different stages of the illness suggesting that their experience of living with rheumatoid arthritis influenced perceptions of their illness and medications. Newly diagnosed patients scored lower on factors measuring perceptions of disease chronicity and seriousness whereas patients that had escalated to anti-TNF α therapy scored higher on these factors. The newly diagnosed patients also showed more variability in the social cognition scores whereas the more established patients demonstrated stable models of illness. This supports Leventhal’s (1992) theory that illness representations will be regulated through integration of knowledge and experience of an illness. Structural equation modelling was used to establish the best predictors of intentional non-adherence at six month follow-up. In support of research in other chronic illnesses (Horne & Weinman, 2002; Niklas, Dunbar & Wild, 2010), the effect of perceptions of the consequences and chronicity of the illness on adherence are mediated by perceptions of the necessity of the medication. In addition, the impact of the emotional reaction to the illness on adherence to DMARDs is mediated by concerns about the medication. In addition, this study incorporated factors from the Theory of Planned Behaviour to explain medication adherence and found that the influence of friends and family impacts on the patient’s confidence to follow the prescription accurately which in turn as an effect on adherence to DMARDs. This large longitudinal study found that by combining factors from a number of social cognition models, it is possible to explain and predict intentional non-adherence and provides some evidence for best ways to intervene to improve adherence and prognosis. To provide a more comprehensive and clinically useful picture of non-adherence, a Cost of Illness study was carried which found that patients self-reporting low adherence to DMARDs also had significantly higher costs for this medication. This was caused by an increased incidence of Leflunamide prescribing for patients who often forget their medication and was maintained longitudinally. This association has not been previously reported in the literature and provides some evidence that non-adherence to DMARDs is having a concrete effect on the clinical management of patients. Finally, an SMS text message based reminder service designed to remind patients who self-report forgetting their medications was tested through a simulation study for the cost and likely benefit in health related quality of life using the health economic analysis of the longitudinal study and the results of a survey establishing the feasibility of implementing such a service in the rheumatology clinic. A sensitivity analysis testing the number of messages sent and the cost per message found that a reminder service for the sample of patients in this programme of research would cost between £1387.00 and £142.27 per year. This would equate to a cost per Quality Adjusted Life Year (QALY) gain of between £2889.58 and £296.40 by enabling patients to adhere more rigorously to their DMARD regimen. This programme of research is the first to test four commonly used social cognition models to predict adherence to DMARDs in a large, multi-centre longitudinal study of rheumatoid arthritis patients. Perceptions of the likely duration and consequences of the illness, as measured by the Illness Perceptions Questionnaire and the necessity of medications (measured by the Beliefs about Medications Questionnaire) along with self-efficacy (measured by the Theory of Planned Behaviour) explained 24% of the variance in intentional adherence over six months. The results show the importance of considering intentional and unintentional non-adherence separately as they appear to have different underlying mechanisms as well as patients in different phases of the illness as their experience influences their social cognition models of illness. A simple SMS based reminder service could act as a cue to action to reduce unintentional non-adherence whereas addressing issues surrounding maladaptive perceptions about the illness and the treatment could improve intentional non-adherence which has the potential to improve the prognosis and quality of life for patients as well as safe costs for the NHS.

O mundo do trabalho vive um extraordinário avanço tecnológico caracterizado pela introdução de modernas tecnologias, automação acelerada, que resultam em novas formas de racionalização e organização do trabalho e no aumento da exploração intensiva da força de trabalho. Esse processo foi marcado pela reestruturação produtiva, que resultou em maior intensificação e precarização do trabalho, fatos que refletiram nas relações e nas condições laborais. O setor calçadista, conhecido pela grande capacidade de geração de empregos, também foi atingido por essas mudanças, com consequentes agravos à saúde de seus trabalhadores. Tendo como pano de fundo este quadro de transformações, foi objetivo da pesquisa investigar como se acidentam e adoecem no trabalho os trabalhadores envolvidos na produção de calçados em Franca (SP) e como isto repercute em suas vidas, dentro e fora do espaço produtivo. A pesquisa, de cunho qualitativo, teve como principal técnica de coleta de dados a entrevista. Foram entrevistados 20 trabalhadores, 15 mulheres e cinco homens; um profissional da área da saúde e dois representantes do Sindicato dos Trabalhadores nas Indústrias de Calçados de Franca. Os trabalhadores entrevistados foram contatados através do sindicato da categoria, que também forneceu as Comunicações de Acidentes de Trabalho (CATs) utilizadas como fonte de informações. Os resultados demonstraram que o trabalho na produção de calçados tem sido fonte de agravos à saúde dos trabalhadores. Os dados obtidos pela pesquisa permitiram relacionar os acidentes e doenças apresentados pelos trabalhadores à organização e às condições do trabalho às quais estão submetidos. As principais queixas foram: LER lesões por esforços repetitivos, ferimentos corto-contusos, amputações de membros superiores (mãos, dedos, antebraços e braços), dores lombares, estresse, depressão, ansiedade, tristeza, angústia, além de terem se referido a sentimentos de insatisfação e desvalorização no trabalho. Os dados revelaram também como os episódios de acidentes e doenças ocupacionais repercutiram na vida dos trabalhadores. A violência sofrida pelos trabalhadores não se resumiu apenas ao acidente em si e às circunstâncias em que ocorreu, mas se estendeu pelo longo processo de tratamento e pela trajetória institucional percorrida para estabelecer o nexo entre o acidente e/ou doença e o seu trabalho. / The labor world is currently experiencing a remarkable technological advance characterized by the introduction of modern technologies, accelerated automation, which results in new ways of work rationalization and organization and the increase of workforce exploration. This process was marked by a productive restructuring which resulted in the work being more intensive and precarious, thus affecting work relations and conditions. The footwear sector, known for its huge capacity of generating new work positions, was also affected by these changes, resulting in a consequential damage of the workers health. Having these aforementioned transformations as backdrop, this research has as its purpose investigate how the footwear workers of Franca (SP) get injured and ill and analyze the consequences these injuries and illnesses bring into their lives both in the workplace and their private lives. The research has a qualitative approach and gathers data through personal interviews. A total of 20 workers, including 15 women and five men, were interviewed. A health professional and two Footwear Industry Union representatives were also interviewed. The workers were contacted through their Union. The Union has also provided the Work Accident Reports (CATs) which were used as source of information. The results showed that working in the footwear production has been a source of hazards to the workers health. The data allowed the research to relate accidents and illnesses suffered by workers to the working conditions and organizations to which they are submitted. The main complaints were: RSI repetitive strain injuries, wounds, amputation of members (hands, fingers, forearms and arms), backaches, stress, depression, anxiety, sadness and grief. They have also demonstrated being dissatisfied with their jobs and feeling undervalued. The data also revealed how occupational accidents and illnesses episodes affected the workers lives. The violence experienced by workers is not enclosed in the accident itself and the circumstances in which it happened, it is extended through a long treatment/healing process and also by the institutional path which must be followed in order to establish a connection between the accident and/or illness to the work.