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<p>Consistent with the paradigm of evidence informed decision making we assume that research findings are integrated into health services practice and policy. However, there is a gap betweeen research findings and usual practice. Collaborative research, where researchers are encouraged to partner with decision makers to conduct mutually agreed and relevant research, may facilitate prompt utilization of new findings. My study explored decision makers’ experiences of collaborative teams executing federally funded health research. The principles of interpretive description were used to guide sampling, data collection, and analysis. A purposeful sample of 27 decision makers, collaborating on Partnerships for Health System Improvement (PHSI) projects funded by the Canadian Institutes of Health Research, participated in two in-depth interviews. Conventional content analysis was used to identify concepts. The conceptual framework was developed inductively from the descriptive data and provided a structure for interpreting decision maker perspectives. The framework posits an explanation leading to contextual understanding of their experiences. This study describes factors affecting PHSI engagement that include: availability of new funding; positive history with the researcher; prospect of tangible benefits to constituents of decision makers; desire to contribute to research that informs health services programs and policies; capacity building; and knowledge creation. The partnership process is facilitated by fostering connections; identifying required skills and competencies; maintaining a sustainable focus of inquiry; clarifying roles and responsibilities; cultivating a nurturing learning environment. My findings will inform decision makers, researchers, and funding agencies about the experience and legacy of collaborative research partnerships.</p> / Doctor of Philosophy (PhD)

According to the literature, youth experiencing with either homelessness or disabilities face severe barriers throughout their life-time which would negatively impact their physical development, psychological development, and mental health, but also contribute to a vicious circle of homeless and poverty. However, the intersection between homeless youth with learning, developmental and/or intellectual disabilities (LD/DD/ID) in the school system has rarely been explored. This population is invisible to the school system which indicates an urgency in identifying and understanding their experience at school. This research, as a part of the Partnering for Change initiative, aimed to provide some insight into the socially constructed problems which cause barriers for this invisible population. In this study, an interpretive lens and a critical approach were adopted as a guide to data analysis and as a means to identify constructed barriers based on the interviews with homeless youth with LD/DD/ID in Hamilton, Ontario, Canada. The data on homeless youth with LD/DD/ID was analysed for impacts on relationships, academic performance, and the effects of invisibility on multiple levels of their school life. The data also revealed the way schools respond to disabilities and homelessness. In the discussion I investigate the way policy, funding structure and implementation of support are significantly affected by the neoliberal context with its emphasis on market-driven pedagogy and individuals conceptualized as agents of self- capitalization. This thesis argues for a better alternative, as referenced from Finland. The Finnish approach emphasizes human rights, equality, and inclusion, and aims to demonstrate how changes in fundamental beliefs and values can construct a barrier-free and supportive education system for everyone. / Thesis / Master of Social Work (MSW)

Introduction: Dexterity impairments are common and disabling. Measuring the extent of these impairments is important for care and service provision. Despite this, dexterity is poorly operationalized in the management of persons with hand and wrist conditions (HWC). Thesis purpose: To understand: 1) how dexterity is defined in the management of persons with HWC and 2) how therapists working with persons with HWC perceive/understand the concept and measurement of dexterity and use of performance-based outcome measures of dexterity (PBOMD). Methods: In study one, Interpretive Description was used to understand the perceptions and measurement practices of occupational therapists working with persons with HWC in Singapore. Study two involved a content analysis of the literature outlining the constructs measured by PBOMD that were validated for use in persons with HWC. Results: Both studies highlighted the lack of conceptual clarity around ‘dexterity’ that is reflected in therapists’ and tool developers’ discourse. Many of the therapists we interviewed, perceive PBOMD to lack clinical value. Studies from this thesis suggest that identified PBOMD do not adequately cover dexterity. Conclusion: Findings highlight the challenges surrounding the construct of dexterity and provide clinical practice recommendations. / Thesis / Master of Science Rehabilitation Science (MSc) / Dexterity is the ability to do tasks, successfully, quickly and accurately. Loss of dexterity is common and affects our ability to do our tasks of daily life and work. Unfortunately, there is a lack of agreement on the best way to measure dexterity. Our study aims to explore what dexterity means to health professionals. We focused on occupational therapists seeing persons with hand and arm injuries. In the first study, we interviewed therapists to understand how they measured dexterity. In the second study, we searched for dexterity tests used with persons with hand injuries. Then, we compared the tests we found to dexterity theories. We found that dexterity is measured in different ways. Therapists faced many barriers to using dexterity tests. Current dexterity tests are an incomplete reflection of a person’s dexterity. The information gained from these studies could be used to inform future research on the measurement of dexterity.

Urinary incontinence (UI) is a common complication of type 2 diabetes mellitus (T2DM) for older adults (≥65 years) that is associated with reduced quality of life and risk of institutionalization. This convergent, mixed methods research study, informed by a model of clinical complexity, explored the complexities for older adults living with UI and T2DM, and home-care nurses providing care to this population in Ontario. In the quantitative strand, the most recently completed Resident Assessment Instruments for Home Care from 2011-2016 for older home-care clients with diabetes were analyzed to determine the prevalence and correlates of UI. The qualitative strand used interpretive description methodology to explore the experiences of 18 older adults living with T2DM and UI receiving home-care services and the experiences of 15 home-care nurses caring for this population. These data sources were converged to describe the factors that contributed to complexity for older adults with UI and T2DM: (a) challenges of living with multiple chronic conditions (MCC), medical instability, and high care needs; (b) financial barriers; (c) lack of understanding of older adults’ values and preferences by health-care providers; (d) caregiver burden; and (e) functional impairments. The health-care system contributed to this complexity through: (a) inadequate and minimal provision of nursing and interprofessional home-care services; (b) task-focused structure of home care; (c) minimal interprofessional collaboration; (d) lack of an integrated communication system; and (e) lack of navigation to community resources. Providing health-promoting care for older adults with UI and T2DM requires a system-wide enactment of integrated care that takes both a person- and family-centred care and social determinants of health approach. Interventions for older adults with MCC should involve standardized and comprehensive assessment, care coordination, enhanced nursing service provision, and interprofessional team collaboration to attend to the dimensions of complexity and ensure the needs of older adults and their caregivers are met. / Thesis / Doctor of Philosophy (PhD) / Many older adults with diabetes have urinary incontinence that is emotionally and physically bothersome. These older adults also receive home-care services. In this study, older adults were asked about how they care for their diabetes and incontinence and how their home-care workers help them with this care. Nurse participants were asked how they help older adults with diabetes and incontinence and the challenges they face. The results of home-care assessments done in Ontario were also analyzed to learn how common incontinence is in older adults with diabetes and factors associated with having incontinence. The study found many factors, such as living with many chronic conditions and lack of finances, as well limited home-care service provision and the task-focus of home care created challenges for these older adults. The findings can help in making changes to home-care service delivery to improve care for older adults and their caregivers.

The effectiveness of a guide training program was evaluated as a means of providing interpretive services to commercial boaters at the New River Gorge National River. Commercial river guides attended a National Park Service sponsored training program which provided accurate information and education concerning natural and cultural history of the New River, the national significance of the New River Gorge National River, the history and purpose of the National Park Service, and information and services available at the visitor centers. The emphasis of the training session was to increase the river guides’ knowledge base and to encourage their interpretive presentation of this information to their customers. Customers of a commercial outfitter were administered a questionnaire before and after the guide training program. Significant differences in the amount of interpretation guides presented on the river, the amount of knowledge customers acquired during the trip, and the customers' overall trip rating were noted by empirical testing. Increases in the means of all three outcome variables occurred following guide training. Customers’ intentions to visit a New River Gorge Visitor Center did not significantly change following guide training. The validity and reliability of the instrument is discussed as well as potential biases and constraints of the study. Implications for management and further research are also discussed. / M.S.

Background and Objectives: Recent immigrants experience unique challenges when accessing health services. Registered Nurses (RNs) working in primary health care (PHC) have the competencies and are well-positioned to facilitate healthcare access for immigrants. Aim: This study explored how PHC-RNs in Ontario support healthcare access and address barriers among recent immigrants. Methods: This study used a qualitative, interpretive descriptive approach and was informed by Levesque et al.’s (2013) access to care framework. Semi-structured interviews were conducted with 10 PHC RNs practising in Toronto, Ottawa-Gatineau, Hamilton, Kitchener-Cambridge-Waterloo, and London. Data were collected and analyzed concurrently using an inductive and deductive approach. Results: Findings show that PHC-RNs play instrumental roles in supporting recent immigrants through facilitating healthcare access across 9 dimensions of Levesque et al.’s (2013) access framework: (1) appropriateness, (2) availability and accommodation, (3) ability to perceive, (4) ability to engage, (5) ability to seek, (6) ability to reach, (7) affordability, (8) ability to pay, and (9) acceptability. RNs addressed significant challenges to health service access for recent immigrants, including language, geographical, and financial barriers. Several opportunities were identified to enhance the PHC RN clinical practice role to improve the delivery of PHC for recent immigrants, such as increasing organizational resources, utilizing their expertise and role beyond the PHC clinic, and promoting culturally appropriate care. Conclusions: PHC-RNs are key facilitators of healthcare access for recent immigrants by coordinating their care, educating, and connecting this population to services across the health system. However, there are opportunities to optimize nursing roles and more effectively utilize their scope of practice within interdisciplinary teams to promote the health of immigrants. / Thesis / Master of Science in Nursing (MSN)

The software development continues to become more competitive and demanding, placing pressure on developers. Changes in the international political climate have resulted in shrinking military budgets, putting developers of defence software under further pressure. At present, systematic reuse is probably the most realistic way of addressing this pressure by improving software development productivity and quality. Software product line (SPL) engineering provides a comprehensive approach to systematic software reuse and is becoming widely accepted. The focus of this interpretive case study was ground station software development in a small multidisciplinary project-centric company which produces avionics systems for military aircraft. The purpose of the study was to investigate the potential implementation of systematic software reuse in the company. The study consisted of three phases, a literature study, a contextualisation and a set of field interviews, and used elements of the Carnegie-Mellon Software Engineering Institute (SEI) Product Line Practice Framework to examine the suitability of SPL engineering for the company. The findings of the study highlight the potential challenges that SPL engineering poses for the company, and emphasise how the company's project-centric structure could impede its implementation of systematic software reuse. / Computing / M.Sc. (Information Systems)

The aim of this study was to explore women's perceptions of ageing in order to shed light on how individual women feel about getting older. The qualitative interpretive research paradigm was chosen for the purposes of this study. In-depth interviews were held with three women who gave their accounts of their perceptions of ageing. The data was analysed using hermeneutic thematic analysis. The accounts of the participants were reconstructed in terms of themes which emerged. Recurring themes in the accounts of all three participants were linked with the literature. This study provided rich descriptions of women's perceptions of ageing and helped to create new insights and meanings both for the participants and the readers. The information gained could serve as guidelines for clinical practice and future research. / Psychology / M.A. (Clinical Psychology)