Childhood anxiety disorders are highly prevalent, cause significant distress and functional impairment, are risk factors for depression, suicidal ideation and attempts, substance abuse and smoking, yet often go unrecognized and untreated. As a result, effective prevention and early intervention have become policy and research priorities. This study evaluated the effectiveness of a universal school-based cognitive behavioural intervention in decreasing anxiety symptoms experienced by early adolescents during the transition from elementary to middle or secondary school. The role of gender, coping style, geographic location, and timing of the intervention were also assessed. Participants were 722 grade 7 and 8 students (11 – 14 years) from 41 classrooms in 20 randomly selected public schools in British Columbia. Schools were randomly assigned to either the FRIENDS for Youth program provided within regular classrooms, one hour weekly for 10 weeks or to a waitlist control group. Self-reported anxiety, depression and coping, and parent and teacher assessed difficulties were assessed at pre-, post, and six month follow-up. Results were examined universally and for children who scored above the clinical cut-off for anxiety at pre-test. Results indicate students, including those “at risk”, who participated in the FRIENDS for Youth program had lower anxiety than those in the control group at 6-month follow-up. Gender differences in self-reported anxiety as well as in response to the intervention were found, with girls, including those “at risk” reporting higher anxiety scores than boys, and intervention group girls reporting significantly lower anxiety scores at post-intervention and at 6-month follow-up compared to the control group. Teachers assessed girls as having lower difficulties scores than boys, and intervention group girls reporting significantly lower difficulties scores at post-intervention than the control group. Grade 7 elementary students had significantly lower anxiety scores than middle school students and grade 7 students in the intervention group had significantly lower anxiety scores at post-intervention than the control group. Overall, intervention effects on anxiety were small. For “at risk” participants and for girls, however, the intervention was effective. Results demonstrated a prevention effect with significantly fewer “at risk” students at 6-month follow-up in the intervention group than the control group.

Childhood anxiety disorders are highly prevalent, cause significant distress and functional impairment, are risk factors for depression, suicidal ideation and attempts, substance abuse and smoking, yet often go unrecognized and untreated. As a result, effective prevention and early intervention have become policy and research priorities. This study evaluated the effectiveness of a universal school-based cognitive behavioural intervention in decreasing anxiety symptoms experienced by early adolescents during the transition from elementary to middle or secondary school. The role of gender, coping style, geographic location, and timing of the intervention were also assessed. Participants were 722 grade 7 and 8 students (11 – 14 years) from 41 classrooms in 20 randomly selected public schools in British Columbia. Schools were randomly assigned to either the FRIENDS for Youth program provided within regular classrooms, one hour weekly for 10 weeks or to a waitlist control group. Self-reported anxiety, depression and coping, and parent and teacher assessed difficulties were assessed at pre-, post, and six month follow-up. Results were examined universally and for children who scored above the clinical cut-off for anxiety at pre-test. Results indicate students, including those “at risk”, who participated in the FRIENDS for Youth program had lower anxiety than those in the control group at 6-month follow-up. Gender differences in self-reported anxiety as well as in response to the intervention were found, with girls, including those “at risk” reporting higher anxiety scores than boys, and intervention group girls reporting significantly lower anxiety scores at post-intervention and at 6-month follow-up compared to the control group. Teachers assessed girls as having lower difficulties scores than boys, and intervention group girls reporting significantly lower difficulties scores at post-intervention than the control group. Grade 7 elementary students had significantly lower anxiety scores than middle school students and grade 7 students in the intervention group had significantly lower anxiety scores at post-intervention than the control group. Overall, intervention effects on anxiety were small. For “at risk” participants and for girls, however, the intervention was effective. Results demonstrated a prevention effect with significantly fewer “at risk” students at 6-month follow-up in the intervention group than the control group.

Childhood anxiety disorders are highly prevalent, cause significant distress and functional impairment, are risk factors for depression, suicidal ideation and attempts, substance abuse and smoking, yet often go unrecognized and untreated. As a result, effective prevention and early intervention have become policy and research priorities. This study evaluated the effectiveness of a universal school-based cognitive behavioural intervention in decreasing anxiety symptoms experienced by early adolescents during the transition from elementary to middle or secondary school. The role of gender, coping style, geographic location, and timing of the intervention were also assessed. Participants were 722 grade 7 and 8 students (11 – 14 years) from 41 classrooms in 20 randomly selected public schools in British Columbia. Schools were randomly assigned to either the FRIENDS for Youth program provided within regular classrooms, one hour weekly for 10 weeks or to a waitlist control group. Self-reported anxiety, depression and coping, and parent and teacher assessed difficulties were assessed at pre-, post, and six month follow-up. Results were examined universally and for children who scored above the clinical cut-off for anxiety at pre-test. Results indicate students, including those “at risk”, who participated in the FRIENDS for Youth program had lower anxiety than those in the control group at 6-month follow-up. Gender differences in self-reported anxiety as well as in response to the intervention were found, with girls, including those “at risk” reporting higher anxiety scores than boys, and intervention group girls reporting significantly lower anxiety scores at post-intervention and at 6-month follow-up compared to the control group. Teachers assessed girls as having lower difficulties scores than boys, and intervention group girls reporting significantly lower difficulties scores at post-intervention than the control group. Grade 7 elementary students had significantly lower anxiety scores than middle school students and grade 7 students in the intervention group had significantly lower anxiety scores at post-intervention than the control group. Overall, intervention effects on anxiety were small. For “at risk” participants and for girls, however, the intervention was effective. Results demonstrated a prevention effect with significantly fewer “at risk” students at 6-month follow-up in the intervention group than the control group. / Graduate and Postdoctoral Studies / Graduate

Parents of children with a chronic disease are usually highly involved in their child’s treatment and may be affected by the heavy demands and constant stress. This can increase the risk of developing burnout, which is an individual reaction to long-term stress consisting of symptoms associated with emotional exhaustion, as well as physical and cognitive fatigue. The overall aim was to estimate the prevalence of burnout in parents of children with Type 1 Diabetes Mellitus (T1DM) and inflammatory bowel disease (IBD) (paper I), identify the risk factors associated with parenting a child with T1DM (paper II), explore how mothers suffering from burnout describe their mothering of a child with diabetes, with special focus on their need for control and Performance-based self-esteem (PBSE) (paper IV), and to evaluate the effect of a group intervention aimed at reducing stress-related symptoms (paper III). A total of 251 parents of children with T1DM, 38 parents of children with IBD and 124 parents of healthy children participated in a population-based study (I, II). The validated Shirom-Melamed Burnout Questionnaire (SMBQ) was used to assess burnout. 16 parents (SMBQ ≥3.75) participated in a group intervention and were evaluated for changes in SMBQ and PBSE (III). A total of 21 mothers of children with T1DM who scored for clinical burnout (SMBQ) participated in a qualitative study. Semi-structured interviews were conducted and Inductive content analysis was used (IV). In the study group 36.0% parents of children with a chronic disease scored for clinical burnout (SMBQ ≥3.75) compared to 20.2% of the reference parents (p=0.001) with a preponderance of mothers compared to fathers, 42% vs. 20.5% (p=0.001), respectively (I). Less support from the social network, sleep disturbances and lack of personal leisure time and recovery seem to be important risk factors for clinical burnout in parents of children with T1DM, especially mothers (II). Mothers’ experiences of mothering a child with T1DM were interpreted as one theme; Mission impossible, illustrating the extremely difficult circumstances under which they bring up the child with diabetes to adulthood (IV). Parents’ subjective evaluation of the intervention group was mainly positive and SMBQ (p=0.01) and PBSE scale (p= 0.04) measurements were significantly reduced 6 months after completion of the intervention (III). It is important to pay attention to how parents and especially mothers experience their daily life in order to support those who are at risk of developing burnout.

<p>Promotion of exclusive breastfeeding (EBF), (giving breast milk only without any solids or liquids), has proved to be very challenging in the South African context, although this infant feeding practice has been found to protect babies against diarrhoea and respiratory tract infections and to carry a lower risk of HIV infection than mixed feeding (breastfeeding combined with formula or solids). Study design: The PROMISE-EBF study is a multi-country cluster randomised trial to examine peer support to promote exclusive breastfeeding in Africa. For the South African site in the PROMISE-EBF study, three sites, Paarl, Rietvlei and Umlazi, were selected because of their different geographic settings and each site operated as a separate stratum for cluster selection and randomisation purposes. The clusters were then randomised into intervention and control arms making a total of 17 clusters in each arm. HIV positive and negative women in the intervention arm received support on their choice of infant feeding from the peer supporters who visited them at their homes while the women in the control group only received the standard infant feeding counselling and support provided by health care&nbsp / workers at health facilities. Data collection: Mothers were interviewed at recruitment during the antepartum period to establish eligibility, obtain informed consent and data on socio-economic status. Home visits were scheduled for data collection by trained data collectors at 3, 6, 12 and 24 weeks after birth. Analysis of results: This mini-thesis was a secondary analysis of the PROMISE-EBF data focusing on the South African data only. The data was adjusted for clustering and analysed using SAS. Comparison of variables between the intervention and control groups within sites was done. Results: A significant difference, regarding counselling and infant feeding practices, was observed among all women who received peer support compared to those who received the standard antenatal counselling, with more women in the intervention group (20.5%) practising EBF than those in the control group (12.8%) by Week 3. When the women‟s HIV status was considered, more than 65% of HIV positive and 40% of HIV negative women practised MF and EFF (giving formula milk only with no breast milk) throughout the study, respectively, regardless of the group they were in. For women who hadintended to practise EBF at recruitment, 33% in the control group and 20% in the intervention group actually practised EBF by Week 3. Regarding disclosure and feeding choice, 77.4% of women who had disclosed their HIV status actually practised MF versus 8.6% who practised EBF by Week 3.Conclusion: Community peer counselling should be strengthened as the results from this study showed that a high percentage of women who practised EBF were those who had received counselling, irrespective of their HIV status. The high percentage of HIV positive women who practised high risk feeding, despite receiving infant counselling, is of concern. Disclosure of the women‟s HIV status did not translate to them practising low risk infant feeding methods, which may suggest that there are other issues that determine the women‟s choice of infant feeding.</p>

<p>Promotion of exclusive breastfeeding (EBF), (giving breast milk only without any solids or liquids), has proved to be very challenging in the South African context, although this infant feeding practice has been found to protect babies against diarrhoea and respiratory tract infections and to carry a lower risk of HIV infection than mixed feeding (breastfeeding combined with formula or solids). Study design: The PROMISE-EBF study is a multi-country cluster randomised trial to examine peer support to promote exclusive breastfeeding in Africa. For the South African site in the PROMISE-EBF study, three sites, Paarl, Rietvlei and Umlazi, were selected because of their different geographic settings and each site operated as a separate stratum for cluster selection and randomisation purposes. The clusters were then randomised into intervention and control arms making a total of 17 clusters in each arm. HIV positive and negative women in the intervention arm received support on their choice of infant feeding from the peer supporters who visited them at their homes while the women in the control group only received the standard infant feeding counselling and support provided by health care&nbsp / workers at health facilities. Data collection: Mothers were interviewed at recruitment during the antepartum period to establish eligibility, obtain informed consent and data on socio-economic status. Home visits were scheduled for data collection by trained data collectors at 3, 6, 12 and 24 weeks after birth. Analysis of results: This mini-thesis was a secondary analysis of the PROMISE-EBF data focusing on the South African data only. The data was adjusted for clustering and analysed using SAS. Comparison of variables between the intervention and control groups within sites was done. Results: A significant difference, regarding counselling and infant feeding practices, was observed among all women who received peer support compared to those who received the standard antenatal counselling, with more women in the intervention group (20.5%) practising EBF than those in the control group (12.8%) by Week 3. When the women‟s HIV status was considered, more than 65% of HIV positive and 40% of HIV negative women practised MF and EFF (giving formula milk only with no breast milk) throughout the study, respectively, regardless of the group they were in. For women who hadintended to practise EBF at recruitment, 33% in the control group and 20% in the intervention group actually practised EBF by Week 3. Regarding disclosure and feeding choice, 77.4% of women who had disclosed their HIV status actually practised MF versus 8.6% who practised EBF by Week 3.Conclusion: Community peer counselling should be strengthened as the results from this study showed that a high percentage of women who practised EBF were those who had received counselling, irrespective of their HIV status. The high percentage of HIV positive women who practised high risk feeding, despite receiving infant counselling, is of concern. Disclosure of the women‟s HIV status did not translate to them practising low risk infant feeding methods, which may suggest that there are other issues that determine the women‟s choice of infant feeding.</p>

Magister Public Health - MPH / Promotion of exclusive breastfeeding (EBF), (giving breast milk only without any solids or liquids), has proved to be very challenging in the South African context, although this infant feeding practice has been found to protect babies against diarrhoea and respiratory tract infections and to carry a lower risk of HIV infection than mixed feeding (breastfeeding combined with formula or solids). Study design: The PROMISE-EBF study is a multi-country cluster randomised trial to examine peer support to promote exclusive breastfeeding in Africa. For the South African site in the PROMISE-EBF study, three sites, Paarl, Rietvlei and Umlazi, were selected because of their different geographic settings and each site operated as a separate stratum for cluster selection and randomisation purposes. The clusters were then randomised into intervention and control arms making a total of 17 clusters in each arm. HIV positive and negative women in the intervention arm received support on their choice of infant feeding from the peer supporters who visited them at their homes while the women in the control group only received the standard infant feeding counselling and support provided by health care workers at health facilities. Data collection: Mothers were interviewed at recruitment during the antepartum period to establish eligibility, obtain informed consent and data on socio-economic status. Home visits were scheduled for data collection by trained data collectors at 3, 6, 12 and 24 weeks after birth. Analysis of results: This mini-thesis was a secondary analysis of the PROMISE-EBF data focusing on the South African data only. The data was adjusted for clustering and analysed using SAS. Comparison of variables between the intervention and control groups within sites was done. Results: A significant difference, regarding counselling and infant feeding practices, was observed among all women who received peer support compared to those who received the standard antenatal counselling, with more women in the intervention group (20.5%) practising EBF than those in the control group (12.8%) by Week 3. When the women's HIV status was considered, more than 65% of HIV positive and 40% of HIV negative women practised MF and EFF (giving formula milk only with no breast milk) throughout the study, respectively, regardless of the group they were in. For women who hadintended to practise EBF at recruitment, 33% in the control group and 20% in the intervention group actually practised EBF by Week 3. Regarding disclosure and feeding choice, 77.4% of women who had disclosed their HIV status actually practised MF versus 8.6% who practised EBF by Week 3.Conclusion: Community peer counselling should be strengthened as the results from this study showed that a high percentage of women who practised EBF were those who had received counselling, irrespective of their HIV status. The high percentage of HIV positive women who practised high risk feeding, despite receiving infant counselling, is of concern. Disclosure of the women's HIV status did not translate to them practising low risk infant feeding methods, which may suggest that there are other issues that determine the women's choice of infant feeding. / South Africa

Contexte Depuis la création du système humanitaire, ce dernier a subi de fortes transformations et a fait l’expérience de plusieurs désillusions. La réponse principale à ces événements a été de chercher à professionnaliser le système humanitaire via une plus grande structuration des organismes. Cette volonté vise, entre autres, l’harmonisation des pratiques, la salarisation et la formation des travailleurs ou encore la mise en place de mode de gestion qui permettent de suivre les interventions au plus prêt. Cette transformation est aujourd’hui en partie remise en question de par son inadéquation avec des réalités d’intervention d’urgence dans des pays aux cultures et aux contextes socio-économiques différents. De plus, cette volonté de la professionnalisation interroge quant à la façon dont est gérée la transmission et la montée en compétences des travailleurs qui doivent souvent apprendre sur le tas, au contact des autres travailleurs déjà en place. Objectif Cette thèse propose de mieux comprendre les effets de la professionnalisation par rationalisation sur les collectifs d’intervention humanitaire au prisme des dynamiques de transmission. Méthodologie Afin de répondre à cet objectif, un cadre méthodologique a été développé en cinq grandes phases. Une première d’exploration et d’instruction de la demande, une seconde d’analyse de la littérature scientifique pour affiner la problématique et positionner la recherche, une troisième de ciblage de projets d’intervention et de préparation à la collecte de données. La quatrième phase s’est déroulée directement sur un terrain d’intervention de l’ONG partenaire, au siège de cette ONG et à distance. Enfin, la cinquième phase a consisté au traitement et à l’analyse des données ainsi qu’à la diffusion des résultats. Les outils de collecte des données utilisés sont les entretiens individuels, les observations flottantes, la tenue d’un journal de bord ainsi que d’une méthode innovante de photographie participative. Résultats Les résultats ont permis d’examiner les mécanismes qui soutiennent la professionnalisation par rationalisation au sein d’une ONG en mettant l'accent sur les dynamiques de transmission. Il a été observé que les interactions au sein d'un site d'intervention sont constamment influencées par des transmissions formelles et informelles qui émergent à différents lieux d’un même site géographique et abordant diverses thématiques et pôles de l’activité en fonction des domaines d’expertise des travailleurs. Ces transmissions jouent un rôle crucial dans le façonnement de l'identité individuelle des intervenants, de l'identité collective du projet et en répercussion, de l'identité organisationnelle de l'ONG. Concernant la professionnalisation, les déterminants identifiés englobent la gouvernance, axée sur la détermination de l'identité organisationnelle, les politiques opérationnelles et les relations avec les bailleurs de fonds. La coordination sert de relais entre la gouvernance et les initiatives sur le terrain, tout en mettant en œuvre diverses règles internes. Au niveau du projet, l'accent est mis sur la relation entre les directives organisationnelles et la gestion au quotidien. Le collectif d'intervention est segmenté par activités et statuts, créant un référentiel commun. Sur le plan individuel, la montée en compétences et l'établissement d'une identité conforme aux valeurs de l'ONG sont prééminents. Ces déterminants, lorsqu'ils sont synergiquement actionnés, peuvent contribuer à une professionnalisation efficace. Discussion/Conclusion La professionnalisation par rationalisation du secteur humanitaire soulève des préoccupations quant à l'équilibre entre standardisation des pratiques, adaptabilité et prise en considération des réalités du terrain. Alors que cette professionnalisation vise une amélioration du système de gestion, elle peut engendrer des inégalités entre les travailleurs et s’avérer peu adaptée aux divers contextes d’intervention. Par ailleurs, la valorisation de l’approche descendante dans la gestion de la transmission entrave une compréhension profonde des besoins sur le terrain et impacte directement la construction de la santé des travailleurs. Les encadrants de proximité, acteurs pivots dans ce système, sont souvent placés devant divers paradoxes, pris entre les injonctions de l’ONG et les réalités du terrain. / Background Since its creation, the humanitarian system has undergone major changes and experienced a number of disappointments. The main response to these events has been to professionalise by rationalization the humanitarian system by structuring organisations. Among other things, this has involved harmonising practices, employing and training workers and introducing management systems that monitor operations as closely as possible. This transformation is now being called into question in part because it does not reflect the realities of emergency response in countries with different cultures and socio-economic contexts. What's more, this drive towards professionalisation raises questions about the way in which the transfer of skills and the development of the skills of workers is managed, as they often have to learn on the job, in contact with other workers already in place. Objective The aim of this thesis is to gain a better understanding of the effects of professionalisation on humanitarian aid groups through the lens of transmission dynamics. Methodology In order to meet this objective, the methodological framework was developed in five main phases. The first involved exploring and appraising the request, the second analysed the scientific literature to refine the problem and position the research, and the third targeted intervention projects and prepared for data collection. The fourth phase took place in the partner NGO's field, at its head office and remotely. Finally, the fifth phase consisted of processing and analysing the data and disseminating the results. The data collection tools used were individual interviews, floating observations, a logbook and an innovative participatory photography method. Results The results made it possible to examine the mechanisms underpinning professionalisation within NGOs, focusing on the dynamics of transmission. It was observed that interactions within an intervention site are constantly influenced by formal and informal transmissions emerging at different locations within the same geographical site and addressing different themes and poles of activity depending on the workers' areas of expertise. These transmissions play a crucial role in shaping the individual identity of the workers, the collective identity of the project and, in turn, the organisational identity of the NGO. As far as professionalisation is concerned, the determinants identified include governance, which focuses on determining organisational identity, operational policies and relations with funders. Coordination acts as a relay between governance and initiatives in the field, while implementing various internal rules. At project level, the emphasis is on the relationship between organisational guidelines and day-to-day management. The project team is segmented by activity and status, creating a common frame of reference. At an individual level, the emphasis is on developing skills and establishing an identity in line with the NGO's values. When synergistically applied, these determinants lead to effective professionalisation of NGOs. Discussion/Conclusion The professionalization by rationalization of the humanitarian sector raises concerns about the balance between standardisation of practices, adaptability and taking into account the realities on the ground. Whilst this professionalisation aims to improve the management system, it can lead to inequalities between workers and prove ill-suited to the various contexts in which it takes place. In addition, the emphasis on a top-down approach to transmission management can hamper a thorough understanding of needs on the ground and have a direct impact on the development of workers' health. Local supervisors, the pivotal players in this organisational system, are often faced with various paradoxes, caught between the NGO's injunctions and the realities on the ground.

The purpose of this study was to examine the ways by which student learning improvement and the self-regulation of learning are possible through the use of quality formative assessment in the teaching of a university course. In recent years, researchers in educational assessment are showing an increased interest to the improvement of learning resulting from the use of formative assessment. Formative assessment is generally recognised as an improvement oriented assessment. It is believed to result in instructional effectiveness. Quality formative assessment includes formative feedback, self-assessment and peer assessment. Previous studies show the contribution of each of these quality formative assessments to learning improvement. However, less attention has been given to studying the combined effect of quality formative assessments on learning improvement. On the other hand, the predominant use of summative assessment remains a challenge to the improvement in instruction. Thus, the question was to determine the extent to which the use of quality formative assessment improves learning. The literature review in this study show an over reliance upon summative assessment in the context of higher education classrooms. There is also recognition in that formative assessment improves learning and enhances self-regulation. This study followed a mixed-methods research design of the type partially mixed sequential and applied a quasi-experimental intervention, where the educators used quality formative assessment on lessons with the students in the intervention group. The quasiexperimentation was implemented with 378 (214 male and 164 female) first year students of three universities enrolled for “General Psychology” course and six educators who were teaching the course. The students in this study were taken from intact classes, because this is possible in quasi experimental research. Data for the quantitative part of the study were generated using a structured questionnaire and achievement tests. Interviews with the educators, focus group discussions with the students, and classroom observations were used to generate data for the qualitative phase of study. The pretestposttest scores as well as the students’ perceptions on self-regulating learning were compared between the intervention (N =191) and the comparison (N = 187) groups. The quantitative analysis used different inferential statistics, which proved the presence of statistically significant variations between the intervention and comparison groups for the outcome measures (posttest achievement and perception about self-regulating learning). Although the qualitative study showed the presence of positive perceptions towards quality formative assessment, the practice was found to be inconsistent. Perhaps, this may be because of the predominantly summative assessment tradition and the reluctance to use quality formative assessment. Finally, recommendations were made to promote the use of quality formative assessment aiming at the improvement and the self-regulation on learning. / Curriculum and Instructional Studies / D. Ed. (Didactics)