The purpose of this thesis is to improve our knowledge of substance users in the normal population. The main concern is with how the meaning of drug use is constructed. To answer this, the thesis draws on different theoretical principles and mixed methods design. The thesis is made up of four sub-studies, with interconnected foci. The first three papers are based on a qualitative research project in which 44 socially integrated drug users in Stockholm were interviewed. The fourth paper is a cross-national quantitative analysis of nationally representative student samples. The first of the three qualitative papers explores the construction of the informant’s self-identity. The second paper analyses the informant’s perceptions of drug-related risk, whilst the third paper analyses the drug users’ perception of differences between men’s and women’s drug use. The fourth paper sets the detailed analyses of the first three papers in a broader comparative frame, exploring differences in the correlates of drug use, in light of the different levels of drug use in Sweden and Switzerland. The thesis reveals that the drug users are striving to be understood as normal integrated citizens of Swedish society. They present themselves as inherently different from drug abusers and the informants’ risk perceptions are based on a modified form of core Swedish cultural ideals of conscientiousness. The informants also waver back and forth when called upon to discuss gender and drug-taking. On the one hand they were explicit about existing differences between men’s and women’s drug use; on the other hand they were quite uncomfortable having to explicitly explain them, as this meant that they needed to draw on conservative gender roles, something which in Swedish society is a strong sign of being politically incorrect. Furthermore, the thesis shows that young drug abstainers and cannabis users are quite similar in regards to conventional social bonds.

The impact of Internet technology on critical thinking is of growing interest among researchers. However, there still remains much to explore in terms of how critical thinking can be fostered through online environments for higher education. Ten years ago, Garrison, Anderson, and Archer (2000) published an article describing the Community of Inquiry (CoI) framework which provided an outline of three core elements that were able to describe and measure a collaborative and positive educational experience in an online learning environment, namely teaching presence (design, facilitation, and direct instruction), social presence (the ability of learners to project themselves socially and emotionally), and cognitive presence (the extent to which learners are able to construct and confirm meaning through sustained reflection and discourse). This dissertation extends the body of research surrounding the CoI framework and also the literature on developing critical thinking in online environments by examining and exploring the extent to which teaching and social presence contribute to cognitive presence. The researcher was able to do this by offering 189 learners enrolled in 10 research methods courses and educational research courses an opportunity to use an innovative online resource (Research Design Learning Resource – RDLR) to assist them in learning about educational research and developing research proposals. By exploring how participants used this resource the researcher was able to gain insight into what factors contributed to a successful online learning experience and fostered cognitive presence. Quantitative and qualitative research approaches (mixed methods) were used in this study. The quantitative results indicated that both social and teaching presence had a strong positive relationship with cognitive presence and that learners generally perceived to have a positive learning experience using the RDLR. The qualitative findings helped elaborate the significant quantitative results and were organised into the following themes: making connections, multiple perspectives, resource design, being a self-directed learner, learning strategies, learning preferences, and barriers to cognitive presence. Future directions for critical thinking in online environments are discussed.

Leadership is important to quality improvement initiatives in healthcare. However, few studies have evaluated leadership interventions to enhance nurses’ use of guideline recommendations in the field of knowledge translation. Purpose: To develop and evaluate an intervention designed to operationalize a leadership strategy composed of relations, change, and task-orientated leadership behaviours, and to examine its influence on nurses’ use of guideline recommendations in home-care nursing. Design: Sequential mixed methods pilot study with post-only cluster randomized controlled trial. Methods Phase I: Intervention Development 1. A participatory approach was used at a community healthcare organization with 23 units across the province of Ontario, Canada. The guideline selected was developed by the Registered Nurses’ Association of Ontario for the assessment and management of foot ulcers for people with diabetes. 2. Integrative literature review, qualitative interviews, and baseline chart audits were conducted. 3. Four units were randomized to control or experimental groups. 4. Clinical and management leadership teams participated in a 12-week intervention consisting of printed materials, interactive workshop, and teleconferences. Participants received summarized chart audit data, identified priority indicators for change, and created a team leadership action plan to address barriers and influence guideline use. Phase II: Evaluation 5. Chart audits compared differences in nursing process and patient outcomes. Primary outcome: eight-item nursing assessment score. 6. Qualitative interviews evaluated the intervention and leadership behaviours. Results: No significant difference was found in the primary outcome. A significant difference was observed in nurses’ documentation of five priority indicators chosen by the experimental groups (p=.02). Gaps in care included: 53%, 76%, and 94% of patients not assessed for ulcer depth, foot circulation, or neuropathy (respectively); 75% and 93% did not receive wound debridement or hydrogel dressings. Receiving data to identify priority indicators for change and developing a leadership action plan were reported as useful to guideline implementation. The experimental group described using more relations-oriented leadership behaviours conducting audit and feedback, and sending reminders. Conclusion: Findings from this pilot study suggest that leadership is a team process involving relations, change, and task-oriented behaviours enacted by managers and clinical leaders. A leadership model is proposed as a beginning taxonomy to inform future leadership intervention studies.

Self-regulation capacity allows individuals to manage their thoughts, feelings, and actions to attain personal goals (e.g., well-being and performance), as well as adjust to their changing social and physical environment (Zimmerman, 2000). Self-regulation as a positive adaptive skill and process has not been examined in relation to well-being in the context of medicine. The purpose of the current study was to examine self-regulation with 37 medical students and 25 supervising physicians to determine whether or not it may enhance well-being and performance, and reduce stress and burnout. A mixed-methods design was used to collect and analyze the data, and findings from the quantitative and qualitative phases were presented in two separate articles. Self-regulation capacity appears to be an important skill that may help both physicians and medical students to meet the demands of the medical profession and maintain an adequate level of well-being and performance in their work and daily life.

Introduction: Cancer poses a substantial burden on the health of Canadians. Although advancements in screening and treatment have reduced, cancer-related morbidity and quality of life remain important concerns throughout cancer treatment and survivorship. <p>Purpose: This study examined the impact of Iyengar yoga on quality of life and other cancer-related symptoms among people with cancer. <p>Methods: All individuals registered for the Fall 2006 and Winter 2007, 10-week Iyengar yoga programs, offered by CancerCare Manitoba through private donations, were invited to participate in the study. Participants were asked to complete standard self-report questionnaires and participant diaries at baseline, week-5, week-10, and 6 weeks following the last class. The interventions impact on study outcomes were determined using repeated measures ANOVAs and paired samples t-tests. Six participant interviews and a review of participant diaries were conducted and analyzed using categorical aggregation and direct interpretation to identify other relevant issues as raised by participants and to document any negative effects of the program.<p>Results: Nineteen female participants completed the yoga intervention. The mean age of the sample was 50 years and the majority self-identified as Caucasian. Approximately one third had breast cancer and 63% were undergoing treatment for cancer at baseline. Results from the questionnaires showed statistically significant improvements in quality of life, mood disturbance, spiritual well-being, anxiety, nausea, pain, participants most bothersome symptom at baseline, and trait anxiety. Results from the interviews and participant diaries showed that participants experienced increases in social support, relaxation, mental concentration, and in flexibility, strength, and mobility in problem areas. Participants also expressed that their Iyengar yoga practice was empowering and supported their need to take an active role in their health and take a holistic approach to care. It was suggested that Iyengar yoga might contribute to the benefits reported through an ability to facilitate the development of coping skills or mindfulness.<p>Conclusions: The Iyengar yoga program for people living with cancer offered by CancerCare Manitoba can be considered a complex, multi-level, multi-modal intervention. Although, due to design limitations, neither causality nor a dose-response relationship between the Iyengar yoga intervention and the improvements in cancer-related outcomes could be inferred, the present study lends support to the assertion that Iyengar yoga is beneficial to the well-being of those living with cancer.

An engaging education attends to the subjective quality of students’ perceptions and experiences within learning and school life: It converges on whether, how, and why students meaning-make and belong within the school; and focuses on the conditions for their attachment, participation, and commitment within school programmes, practices, policies, and people. Three main questions guided this two-phase, mixed-methods study: 1) What makes international schools engaging places for students? 2) What meanings do students attach to key areas of their day-to-day experiences within the international school in Hong Kong? 3) How might re-imagining student engagement through a cosmopolitan lens lead to clearer understandings of students’ experiences within the international school? In Phase 1, an achieved sample of 729 senior secondary students at 9 purposively selected schools were surveyed using a mainly Likert scale questionnaire: to describe their socio-demographics; to examine the relationships between their socio-demographics, attitudinal features, and schooling experiences, as measured by the researcher-designed Experience of International School – Revised (EIS-R) scale; and to cluster using their socio-demographics and attitudinal profiles. Building on the tripartite cluster solution, Phase 2 used observations and interviews with 30 purposively sampled teacher-leaders and 34 students, from across the three clusters, to investigate how the “institutional habitus” (Thomas, 2002) the students encountered at two international schools shaped their experiences of and engagement within the contexts of school culture, community, curriculum, and co-curriculum. A two-stage process of thematic content analysis revealed two super ordinate themes: 1) race/ethnic, linguistic, and nationality identities intersected to shape and challenge patterns of relationships amongst students (and between students/families) and the school to both include and exclude; and 2) the institutional contexts supported and constrained students’ sense of belonging therein. Overall, seen through a cosmopolitan lens the study implications are discussed as three lessons to achieve a better fit between students and the international school: 1) Attend to the school’s living and learning environment; 2) Take a cosmopolitan turn to school for cosmopolitan subjectivity; and 3) Adopt a student engagement-driven approach to improve and reform school policy, administration, and practice.

This thesis is involved with exploration of key changes drivers and market phenomena in the Southeast Asia and the development of new conceptual frameworks for business environmental analysis of airlines. The research is constructed under the phenomenology paradigm which adopts a coherentism approach and mainly takes airline industry’s publications, statistics, and executives as units of analysis. Hermeneutic phenomenology, a single-embedded case study, concurrent triangulation mixed method, and grounded theory are all used as methodologies. Methods using document reviews, interviews, and questionnaires are applied to surface the key changes drivers, market phenomena and the perceptions of the importance of changes factors. The collected data are analysed by content analysis, thematic analysis, cognitive mapping analysis, constant comparative analysis and descriptive analysis to classify, generalise and develop into proper forms. The research reveals that ‘market’, ‘competition/strategy’, ‘regulation/policy’, ‘infrastructure/resource’, ‘cooperation’, ‘distribution’, ‘technology, and ‘broad’ factors are discovered as key change drivers. Their different importance levels are measured by occurrences, density, centrality, and tail occurrences as root causes of changes. The characteristics of their interrelationships are based on directional and influential dimensions. There are 16 emerged changes/market phenomena and 11 generalised conceptual frameworks and 3 newly developed frameworks for analysing the airline business environment. The quantitative findings from content analysis are evaluated by inter-coder analysis which achieves kappa coefficient = 0.87 indicating high reliability of the analysis. The qualitative findings are qualified through ten criteria assessment of research quality. The deliverables provide both theoretical and methodological contributions. The research limitations are found in some sources of collected data and findings which are caused by scarce data availability and three types of biases. The recommendations for future research into financial performance, changes’ leading indicators and comparative in-depth study in other ASEAN countries and regions are made.

An engaging education attends to the subjective quality of students’ perceptions and experiences within learning and school life: It converges on whether, how, and why students meaning-make and belong within the school; and focuses on the conditions for their attachment, participation, and commitment within school programmes, practices, policies, and people. Three main questions guided this two-phase, mixed-methods study: 1) What makes international schools engaging places for students? 2) What meanings do students attach to key areas of their day-to-day experiences within the international school in Hong Kong? 3) How might re-imagining student engagement through a cosmopolitan lens lead to clearer understandings of students’ experiences within the international school? In Phase 1, an achieved sample of 729 senior secondary students at 9 purposively selected schools were surveyed using a mainly Likert scale questionnaire: to describe their socio-demographics; to examine the relationships between their socio-demographics, attitudinal features, and schooling experiences, as measured by the researcher-designed Experience of International School – Revised (EIS-R) scale; and to cluster using their socio-demographics and attitudinal profiles. Building on the tripartite cluster solution, Phase 2 used observations and interviews with 30 purposively sampled teacher-leaders and 34 students, from across the three clusters, to investigate how the “institutional habitus” (Thomas, 2002) the students encountered at two international schools shaped their experiences of and engagement within the contexts of school culture, community, curriculum, and co-curriculum. A two-stage process of thematic content analysis revealed two super ordinate themes: 1) race/ethnic, linguistic, and nationality identities intersected to shape and challenge patterns of relationships amongst students (and between students/families) and the school to both include and exclude; and 2) the institutional contexts supported and constrained students’ sense of belonging therein. Overall, seen through a cosmopolitan lens the study implications are discussed as three lessons to achieve a better fit between students and the international school: 1) Attend to the school’s living and learning environment; 2) Take a cosmopolitan turn to school for cosmopolitan subjectivity; and 3) Adopt a student engagement-driven approach to improve and reform school policy, administration, and practice.

The impact of Internet technology on critical thinking is of growing interest among researchers. However, there still remains much to explore in terms of how critical thinking can be fostered through online environments for higher education. Ten years ago, Garrison, Anderson, and Archer (2000) published an article describing the Community of Inquiry (CoI) framework which provided an outline of three core elements that were able to describe and measure a collaborative and positive educational experience in an online learning environment, namely teaching presence (design, facilitation, and direct instruction), social presence (the ability of learners to project themselves socially and emotionally), and cognitive presence (the extent to which learners are able to construct and confirm meaning through sustained reflection and discourse). This dissertation extends the body of research surrounding the CoI framework and also the literature on developing critical thinking in online environments by examining and exploring the extent to which teaching and social presence contribute to cognitive presence. The researcher was able to do this by offering 189 learners enrolled in 10 research methods courses and educational research courses an opportunity to use an innovative online resource (Research Design Learning Resource – RDLR) to assist them in learning about educational research and developing research proposals. By exploring how participants used this resource the researcher was able to gain insight into what factors contributed to a successful online learning experience and fostered cognitive presence. Quantitative and qualitative research approaches (mixed methods) were used in this study. The quantitative results indicated that both social and teaching presence had a strong positive relationship with cognitive presence and that learners generally perceived to have a positive learning experience using the RDLR. The qualitative findings helped elaborate the significant quantitative results and were organised into the following themes: making connections, multiple perspectives, resource design, being a self-directed learner, learning strategies, learning preferences, and barriers to cognitive presence. Future directions for critical thinking in online environments are discussed.

Leadership is important to quality improvement initiatives in healthcare. However, few studies have evaluated leadership interventions to enhance nurses’ use of guideline recommendations in the field of knowledge translation. Purpose: To develop and evaluate an intervention designed to operationalize a leadership strategy composed of relations, change, and task-orientated leadership behaviours, and to examine its influence on nurses’ use of guideline recommendations in home-care nursing. Design: Sequential mixed methods pilot study with post-only cluster randomized controlled trial. Methods Phase I: Intervention Development 1. A participatory approach was used at a community healthcare organization with 23 units across the province of Ontario, Canada. The guideline selected was developed by the Registered Nurses’ Association of Ontario for the assessment and management of foot ulcers for people with diabetes. 2. Integrative literature review, qualitative interviews, and baseline chart audits were conducted. 3. Four units were randomized to control or experimental groups. 4. Clinical and management leadership teams participated in a 12-week intervention consisting of printed materials, interactive workshop, and teleconferences. Participants received summarized chart audit data, identified priority indicators for change, and created a team leadership action plan to address barriers and influence guideline use. Phase II: Evaluation 5. Chart audits compared differences in nursing process and patient outcomes. Primary outcome: eight-item nursing assessment score. 6. Qualitative interviews evaluated the intervention and leadership behaviours. Results: No significant difference was found in the primary outcome. A significant difference was observed in nurses’ documentation of five priority indicators chosen by the experimental groups (p=.02). Gaps in care included: 53%, 76%, and 94% of patients not assessed for ulcer depth, foot circulation, or neuropathy (respectively); 75% and 93% did not receive wound debridement or hydrogel dressings. Receiving data to identify priority indicators for change and developing a leadership action plan were reported as useful to guideline implementation. The experimental group described using more relations-oriented leadership behaviours conducting audit and feedback, and sending reminders. Conclusion: Findings from this pilot study suggest that leadership is a team process involving relations, change, and task-oriented behaviours enacted by managers and clinical leaders. A leadership model is proposed as a beginning taxonomy to inform future leadership intervention studies.