McMaster University DOCTOR OF PHILOSOPHY (2019) Hamilton, Ontario (Health Research Methods, Evidence, and Impact) TITLE: Measuring International Health Inequalities and Socioeconomic Status Using Household Survey Data AUTHOR: Mathieu J.P. Poirier, B.Sc., M.P.H. (McMaster University) SUPERVISOR: Dr. Michel Grignon NUMBER OF PAGES: xii, 231 / The methods underlying the quantification of health inequalities have profound consequences for measuring progress in achieving health for all. In Chapter two, associations between household wealth indices, income, and consumption were systematically compiled and different methods of wealth index calculation were evaluated for appropriateness of use in a variety of settings. Researchers are presented with a synthesis of existing evidence about the appropriateness of use of wealth indices in urban and rural areas, their robustness to changes in the asset mix, future applications, and advantages and disadvantages of primary competing methods of quantifying SES using household survey data. In Chapter three, international microdata were analyzed to evaluate how magnitudes of health inequality are affected by different methods of quantifying household socioeconomic status (SES), including income, consumption, and asset wealth. In Chapter four, the need for a transnational approach to measuring health inequalities was justified and the new method was developed using an empirical example. Substantively, these chapters develop the most complete evaluation of the association between the asset wealth, consumption, and income using both critical interpretive synthesis and microdata analysis, as well as the first meta-analysis evaluating changes in health inequality magnitudes according to the SES measure used over time and across country-income levels. The transnational analysis of health inequalities uncovered previously hidden health disparities in the island of Hispaniola, and detailed instructions for all methodological aspects of the new method were presented. The distribution of disease between nations, subnational regions, and urban-rural areas in Hispaniola were analyzed from 1994 to 2013, and the first relative geospatial wealth ranking between Haiti and the Dominican Republic was presented. Global health researchers should strive to measure the equity of health between people, and this sometimes requires analyzing populations that are not neatly contained by national boundaries. / Thesis / Doctor of Philosophy (PhD) / This thesis investigates social inequalities in health and how to measure socioeconomic status (SES) using household surveys in a way that is robust across jurisdictions. It examines how wealth indices compare to income and consumption, and develops a new method to calculate transnational health inequalities. Chapter two conducts a comprehensive evaluation of evidence surrounding the use of wealth indices in urban and rural areas, robustness to changes in assets, future applications, and the advantages and disadvantages of the primary competing methods for quantifying household SES. The third chapter systematically evaluates how health inequality magnitudes evolve over time and across country-incomes according to SES measure. Finally, a transnational measurement of health inequalities was calculated for the island of Hispaniola in chapter four, uncovering the distribution of disease between nations, subnational regions, and urban-rural areas. Detailed instructions for all methodological aspects of the new transnational method are presented.

Many strategies can be used to support the use of research evidence in decision-making. However, such strategies have been understudied in crisis zones, where decision-making may be particularly complex, many factors may influence decision-makers’ use of research evidence, and professional judgements may be particularly relied upon. Using synthesis and qualitative research methods, this dissertation examines the role of research evidence in crisis zones and strategies to support its use in decision-making. First, chapter 2 describes a critical interpretive synthesis, which drew upon a broad body of literature around evidence use in crisis zones to develop a new conceptual framework that outlines strategies that leverage the facilitators and address the barriers to evidence use in crisis zones in four systems, namely the political, health, international humanitarian aid, and health research systems. Second, in chapter 3, the focus narrows, and an embedded qualitative case study design was used to gain a deeper understanding into one of the four identified systems, the political system, and specifically the factors that influenced the use of research evidence in the governmental health policy-development processes for Syrian refugees in Lebanon and Ontario. Finally, in chapter 4, a user testing study design was used to zero-in on decision-makers’ experiences with a particular strategy within the health research system, namely an evidence website focused specifically on topics relevant in crisis zones. This dissertation provides a rich understanding of research evidence use by examining knowledge translation strategies in a setting that has been largely unexplored in the broader KT map: crisis zones. The findings from this thesis point to the need for comprehensive strategies to support evidence use in decision-making that draw upon the existing literature and are adapted for crisis zones, which can occur sequentially or simultaneously within or across the four identified systems. / Thesis / Doctor of Philosophy (PhD) / In humanitarian aid, and specifically in crisis zones, there are many different types of information decision-makers can draw from when making decisions. One specific type of information is research evidence; however, the use of research evidence, and the ways it can inform decision-making in crisis zones, has been understudied. This dissertation addresses this key gap in understanding by: 1) developing a new tool that can help decisions-makers use research evidence to inform their decisions in crisis zones within the political, health, humanitarian aid and health research systems; 2) examining the factors that influence the use of research evidence in the governmental health policy-development processes for Syrian refugees in Lebanon and Ontario; and 3) examining the perspectives of decisions-makers around using one way of supporting the use of research evidence — an evidence website — to support evidence-informed decision-making in crisis zones.

Text in German / Taking the plurality of methods in Biblical studies as starting point this dissertation shows a way to coherent interpretation message. An analysis of the current state and its long history identifies characteristics preventing clear interpretation results as well as ways to work out coherent interpretation messages. It is accompanied by five interpretations of Luke 10:25-37. An interdisciplinary excursus examines the legal interpretation with its claim of clarity. Three levels of interpretation are considered as essential for an adequate process of interpretation: 1. Clarification of the literal meaning on the basis of a historical exegesis. The author calls for the interdisciplinary cooperation of the methods and introduces a synthesis of methods. 2. Consideration of the reception history of texts. Special attention is given to the authority of interpretation in the Roman Catholic Church. The author regards "interpretive communities" as an alternative option. 3. The Holy Spirit's influence on the process of interpretation. Also in post-modern times interpreters need to "inhabit" the biblical texts. / Biblical and Ancient studies / M.Th. (New Testament)

Parents play an integral role in the support of early learning. This study focuses on parent support of learning in an international reception class in Copenhagen, Denmark. This study includes a literature review of parent support of early learning and school facilitation of parent involvement in early learning. A qualitative investigation of parental support of early learning, within the context of global mobility and multi-culturalism, was undertaken in Rygaards School, in particular in its Reception Class. It was established that very little support exists on a global, social and local level, for the globally mobile families whose children attend this particular international school. Furthermore, the school itself does not fully meet the needs of its globally mobile families. Based on the findings of this study, recommendations for introducing comprehensive parent involvement were proposed, amongst others the introduction of an Induction Programme for newcomers to Rygaards, strategies for compensating for the absence of a middle management amongst its teaching staff and the extension of parent participation in curriculum provision. / Educational Studies / M.Ed.

The thesis offers new paradigms for advancing socio-economic rights in Africa. Many States Parties to human rights instruments have failed to promote the common welfare of their citizens partly because of the justiciability debate, which continues to complicate intellectual and practical efforts at advancing socio-economic rights. The debate also prevents the normative development of these rights through adjudication. Furthermore, traditional human rights theory and practice have been state-centric, with non-state actors largely ignored in the identification, formulation, and implementation of human rights norms. Yet, the involvement of non-state entities in international arena has limited states' autonomies considerably, with serious implications for human rights. Transnational Corporations (TNCs) have capacities to foster economic well-being, development, tenchnological improvement, and wealth, but they also often cause deleterious human rights impacts through thei employment practices, environmental policies, relationships with suppliers and consumers, interactions with governments, and other activities. The thesis argues that socio-economic rights are normative and justiciable. It argues that traditional approaches are no longer sufficient to secure human rights and calls for a dismantatling of some structures erected by doctrinal systems; for realignment of relationships among social institutions; and for integrated bundles of fundamental interests that harness benefits of human rights norms and widen the landscape to commit both formal and informal regimes. Fashioning out a new paradigm for advancement of socio-economic rights requires addressing state capacity. It requires an integrative and global interpretive framework. It requires, finally, a new paradigm to commit non-state actors in Africa. The illustrative chapter uses the rights to work and to social security as templates for some prescriptions towards reaslising socio-economic rights in Africa. / Jurisprudence / LL.D.

The purpose of this study is to tell the story of how four peer helpers within the Unisa Peer Help Volunteer Programme managed their portfolio development processes to monitor their growth and development which took place as a result of their involvement in peer helper activities. The epistemological framework of this study is interpretive and involved in-depth interviews with four peer helpers who rendered volunteer services at the University of South Africa and have been developing their career portfolios over a period of time. Hermeneutics was the method used to analyse the data. The stories of the four participants were transcribed and retold by the researcher in the form of themes that emerged. This study contained the stories of how the participants initially struggled to understand the concept and purpose of portfolios; how they took charge of the process; and how their attitudes changed from uncertainty and confusion to viewing the process as worthwhile - thus enabling them to commit themselves, to varying degrees, to the development of their individual portfolios. Recurring themes present in all four stories were described in the researcher's story of the participants' stories. The information generated by this study could serve as guidelines for not only peer helpers interested in developing their own portfolios, but also for project leaders involved in the management of peer helper groups and who plan to implement portfolios in their programmes. / Psychology / M.A. (Psychology)

This study was designed to understand the meaning of the lived experiences of incarcerated male juveniles who had committed drug-related crimes and to suggest guidelines for their rehabilitation with specific reference to their health care needs. In order to achieve these objectives, the researcher used Parse’s (1998) Theory of Human Becoming as a theoretical framework for the study and Parse’s (1998, 2005) phenomenological-hermeneutic research method. This study was restricted to three juvenile correctional centres in the Gauteng province, Republic of South Africa (RSA). A sample of 15 male juveniles (5 at each of the three juvenile correctional centres) was used for the purpose of individual dialogical engagements with the participants. Focus group interview sessions were held with two groups (5 members per group) at two identified juvenile correctional centres. A qualitative content analysis according to methods recommended by Graneheim and Lundman (2004) was performed on the data that was collected from the individual dialogical-engagements and the focus group interviews. The researcher attempted to elucidate the meanings that the participants attached to their experiences of incarceration as narrated by them and analysed the data according to Parse’s (1998; 2005) phenomenological-hermeneutic method comprising of extraction-synthesis and heuristic interpretation. The findings of this research confirm that problems of drug abuse and criminal activity represent a multifaceted, complex and often intractable phenomenon. The research also confirmed that the participants suffer from a variety of emotional and psychological problems such as depression, anxiety, fear, guilt, remorse, regret and a craving for the drugs that they had abused before their incarceration. It appears that the participants find it extremely difficult to deal effectively with these disorders on their own and that they are generally averse to asking for professional help and assistance. Interventions to alleviate these problems are crucial for the success of the current rehabilitation programmes being pursued in the correctional centres where the participants are accommodated. / Health Studies / D. Litt. et Phil. (Health Studies)

A growing body of research recognizes spirituality as a key element in well-being, but the agency of individual spirituality remains unclear. This study explores the role of embodied knowledge in reality construction and its effect on illness by considering how spirituality as embodied existence shapes reality. Spirituality, as a form of embodied knowing, is shown to reach deeply into the fundamental relatedness of existence. The study argues for a mindbody- spirit unity, making no distinction between self and spirit, emotions and subjective experiences situated in the spirit. As the medium between body and self, spirituality gives form to the felt reality of embodied knowledge and meaning, shaping language, cognition, thought and action towards lived reality. New ways of thinking about eating disorders were stimulated by innovative discoveries through investigating the lived reality of the illness within an epistemology that included subjective experiences as part of reality. While acknowledging the influence of social discourse, the study calls for a recognition of vulnerability in the human condition giving rise to the embodiment of a wounded self or disenabling spirituality, manifested in the development of an eating disorder. It uncovers the anti-spiritual properties involved in the lived reality of people struggling with anorexia/bulimia, evident in social withdrawal and/or self-injury. Behavioural patterns of obsession and repetition underscore similarities to addiction and ritual. The study synthesised pastoral therapy and research. A postmodern approach to illness and a qualitative design with interpretive phenomenology were used. Three young women struggling with anorexia/bulimia participated in semi-structured research interviews. Their narrative accounts provided a chronology of developing, living with and healing from anorexia /bulimia. Emphasis shifted from an approach aimed at fixing the body to focusing on individual experiences of the illness; what she brought to the encounter in her own resources and potential to heal. Healing is envisaged as the ongoing development of a renewed sense of self, an inherently spiritual process orchestrated from within. Previous disassociation of body and self is replaced with reconnection between body, self and other, care of the spirit became care of the body, expressed in harmony and wholeness of being. / Practical Theology / D.Div. (Pastoral therapy)

Proceeding from the premise that the meaning of performances flows from contextual, textual, and nonverbal elements, this dissertation explores layers of meaning arising from performances of selected South African struggle songs, poems and plays. In particular, it focuses on performances of the Mayibuye Cultural Group which functioned as an adaptive mechanism in the changing sociopolitical landscape of the 1980s and early 1990s, and on contemporary performances. The analysis of the songs, poems and play underscores the importance of nonverbal elements for the interpretation of performances, and proposes that performances functioned as debate and as a discursive presence in the public sphere. In particular, the performances glorified a masculine conception of the struggle and of South African society which highlighted the fragile gender politics in South Africa, and functioned as a vibrant mechanism for the expression of sanctioned criticism especially for the marginalised and for those at the fringes of power. / Anthropology / M.A. (Anthropology)

This study undertakes to explore the extent to which students at the Elijah Mango College are involved in college decision making structures. The whole process of “carrying” of major subjects was selected to crystallise the extent of this involvement. The varying patterns of meanings attributed by the students to this phenomena were explored. By way of a theoretical contribution, the researcher synthesised features of interpretive and resistance theories in education to further explain this involvement. The empirical component which is attendant on the theoretical elaboration undertakes to explore and capture the patterns of meanings that the students used as a rationale for their reflexive resp^ ,ses to the college decision making structures. The epistemology underlying this investigation also enabled the researcher to gain a sensitivity towards the meanings formulated by the students. / Sociology / M.A. (Sociology)