abstract: This study uses the ontological lenses of discourse theory to conduct a critical mixed-methods analysis of state statutes related to prostitution and sex trafficking. The primary research question of the study was, "How do state laws communicate and reinforce discourses related to sex trafficking and prostitution and how do these discourses reinforce hegemony and define the role of the state?" A mixed methods approach was used to analyze prostitution and sex trafficking related annotated and Shepardized statutes from all fifty states. The analysis found that not all prostitution related discourses found in the literature were present in state statutes. Instead, statutes could be organized around five different themes: child abuse, exploitation, criminalization, place, and licensing and regulation. A deeper analysis of discourses present across and within each of these themes illustrated an inconsistent understanding of prostitution as a social problem and an inconsistent understanding of the legitimate role of the state in regulating or criminalizing prostitution. The inconsistencies in the law suggest concerns for equal protection under the law based upon a person's perceived deservingness, which often hinges on his or her race, class, gender identity, sexuality, age, ability, and nationality. Implications for the field include insights into a substantive policy area rarely studied by policy and administration scholars, a unique approach to mixed methods research, and the use of a new technique for analyzing vast quantities of unstructured data. / Dissertation/Thesis / Doctoral Dissertation Public Administration 2014

abstract: High performing and sustainable building certification bodies continue to update their requirements, leading to scope modification of certifications, and an increasing number of viable sources of environmental information for building materials. In conjunction, the Architecture, Engineering, and Construction (AEC) industry is seeing increasing demand for such environmental product information. The industry and certifications are moving from using single attribute environmental information about building materials to lifecycle based information to inform their design decisions. This dissertation seeks to understand the current practices, and then focus on strategies to effectively utilize newer sources of environmental product information in high performance building design. The first phase of research used a survey of 119 U.S.-based AEC practitioners experienced in certified sustainable building projects to understand how the numerous sources of environmental information are currently used in the building design process. The second phase asked two focus groups of experienced AEC professionals to develop a Message Sequence Chart (MSC) that documents the conceptual design process for a recently designed building. Then, the focus group participants integrated a new sustainability requirement for building materials, Environmental Product Declarations (EPDs), into their project, and documented the adjustments to their specific design process in a second, modified MSC highlighting potential drivers for inclusion of EPDs. Finally, the author examines the broader applicability of these drivers through case studies. Specifically, 19 certified high-performance building (HPB) case studies, for reviewing the impact of three different potential drivers on the design team’s approach to considering environmental product information during conceptual design of a HPB, as well as the projects certification level. LEED certification has changed the design of buildings, and the new information sources for building materials will inform the way the industry selects building materials. Meanwhile, these information sources will need to expand to include a growing number of products, and potentially more data as the industry’s understanding of the impacts of building materials develops. This research expands upon previous research on LEED certification to illustrates that owner engagement and commitment to the HPB process is a critical success factor for the use of environmental product information about building materials. / Dissertation/Thesis / Doctoral Dissertation Civil, Environmental and Sustainable Engineering 2018

abstract: An explanatory sequence mixed methods design was used to examine the effects of choice on the writing performance and motivation of college students (n = 242). The randomized control trial was followed by semi-structured interviews to determine the perceptions students (n = 20) held on the experiment as well the importance of choosing writing topics in college writing assignments. The effects of choice were tested as part of a real writing assignment that was included in nine sections of an introductory special education course. Results from hierarchical linear modeling (HLM) analyses found choice had a statistically significant negative effect on holistic writing quality, number of words written, and intrinsic writing motivation. Findings from the semi-structured interviews provided context for understanding the unexpected quantitative results. / Dissertation/Thesis / Doctoral Dissertation Learning, Literacies and Technologies 2018

abstract: This mixed methods research study explores the experiences of Board Certified music therapists who completed a university-affiliated (UA) internship as part of their education and clinical training in music therapy. The majority of music therapy students complete a national roster (NR) internship as the final stage in clinical training. Limited data and research is available on the UA internship model. This research seeks to uncover themes identified by former university-affiliated interns regarding: (1) on-site internship supervision; (2) university support and supervision during internship; and (3) self-identified perceptions of professional preparedness following internship completion. The quantitative data was useful in creating a profile of interns interviewed. The qualitative data provided a context for understanding responses and experiences. Fourteen Board Certified music therapists were interviewed (N=14) and asked to reflect on their experiences during their university-affiliated internship. Commonalities discovered among former university-affiliated interns included: (1) the desire for peer supervision opportunities in internship; (2) an overall perception of being professionally prepared to sit for the Board Certification exam following internship; (3) a sense of readiness to enter the professional world after internship; and (4) a current or future desire to supervise university-affiliated interns. / Dissertation/Thesis / M.M. Music Therapy 2013

Background: People with cancer are increasingly turning to the internet to find information and support. However, little is known regarding the use of the internet and how this impacts patients’ cancer experiences and their interactions with, and within, the healthcare system. Purpose and objectives: The overarching purpose of this dissertation is to explore the ways that patients newly diagnosed with cancer use cancer-related internet information (CRII) and the role it plays in interactions with the healthcare system. The specific objectives were to: (1) qualitatively explore the content of commonly searched websites from a critical nursing perspective; (2) explore patients’ prompts to use CRII and how CRII informs the ways in which patients interact with healthcare professionals and healthcare services, and (3) document what CRII is accessed and the patterns and frequency of use. Methods: An embedded mixed methods study was conducted using interpretive description as the overarching methodology. Date sources included: (1) a qualitative review of 20 cancer websites; (2) 19 individuals newly diagnosed with cancer, who each took part in two in-depth interviews and a brief survey; and (3) 21 healthcare professionals who engaged in three focus groups (n=17) and in-depth individual interviews (n=4). Results: The dominant discourse in the websites reviewed focused on empirical information about treatment, prognosis, and cure. A dearth of sociopolitical, ethical, personal, and esthetic information was noted. Thus, when seeking CRII, patients predominantly find empirical and biomedical information. The qualitative interviews with patients revealed three key themes that characterize how patients used CRII: (1) person in context, (2) management of information, and (3) managing relationships with healthcare professionals. These themes explain how patients mobilized CRII to manage their patient experience. Patients described CRII as an important resource to process information, make decisions about their illness, and make sense of their disease. Patients also sought CRII to complement and reinforce information and support provided by healthcare professionals. The interviews and focus groups with healthcare professionals revealed two key themes with respect to their views of CRII use. These themes relate to healthcare professionals’ perceptions of patient use of the internet to manage their pragmatic concerns and priorities as well as to navigate processes and practices of the healthcare system. Healthcare professionals found that CRII could modulate patients’ interactions with the healthcare system. Healthcare professionals also acknowledged key points in the cancer trajectory where information may be lacking or where patients may have less informational support; participants felt that CRII served as a beneficial resource to address these gaps. Although healthcare professionals were supportive of patient use of CRII to meet cancer information needs, they also described concerns regarding patients finding and using untrustworthy information. Conclusions: Together, the findings from this dissertation research inform an understanding of how people with cancer use CRII to manage their cancer experience and interact with healthcare professionals and services. Findings highlight the importance of information diversity in the midst of a lack of holistic and varied information presently online. There is also a need for nurses and other healthcare professionals to be aware of the information that is available online and to understand what patients are accessing. Communication about CRII between patients and healthcare professionals may also strengthen areas of patient education that are lacking as well as encourage healthcare professionals to raise key topics of interest. Implications for Practice: There is clearly a growing need for dialogue around pervasive technologies and the nursing role in assessing and directing patients to holistic information. Oncology nurses are well situated to take the lead in their multi-disciplinary care teams to engage patients about their CRII use and to explore the tensions experienced by clinicians surrounding CRII use. CRII use is a growing trend amongst patients across all healthcare settings, and nurses are well positioned to initiate discussions and be leaders in practice. Future research is warranted to expand on the link between CRII use and the utilization of health services, the role of CRII for those in rural areas compared to those in urban areas, and the role of the family in patients’ mobilization of CRII in their cancer experience.

The purposes of this study were to explore the preference of the Chinese undergraduate music majors (N = 27) for Chinese Xi-Qu and Western opera audiovisual examples, the reasons for preference, influence of familiarity on preference, and the relationship between preference ratings and the emotions as detected by FaceReader. The mixed research method, convergent parallel design, was used to explore this topic in depth. As Xi-Qu and opera integrate multiple art forms, eight audiovisual examples (Xi-Qu, n = 4, opera, n = 4) were selected as the stimuli to show the characteristics of the two genres. The participants watched the audiovisual examples individually and responded to a questionnaire meanwhile their facial expressions were recorded for FaceReader analysis. The semi-structured interviews were administered to collect qualitative data pertaining to participants’ general opinions about the musical examples, familiarity, reasons for preference, and the emotions encompassing when watching the musical examples. Descriptive and inferential statistics were used to analyze the data obtained from the questionnaire. The facial expressions video files were analyzed by FaceReader. The qualitative data obtained from interviews were coded to find themes. The quantitative findings suggested that the operatic examples received higher mean preference ratings than the Xi-Qu examples. The top three preferred examples were all operatic pieces while the three least preferred examples were Xi-Qu pieces. Results of one-way ANOVA showed that the difference among the preference mean ratings showed the statistical significance, F (7, 208) = 14.15, p < .01. The operatic examples also received higher familiarity ratings than Xi-Qu examples. The difference among the familiarity mean ratings also showed the statistical significance, F (7, 208) = 2.99, p < .01. The preference and familiarity ratings showed a modest but statistically significant relationship (r = .45, p < .01). A statistically significant relationship was found between the preference ratings and tempo (r =. 23, < . 01). Furthermore, singing was always among the top three most liked elements in the operatic examples, but singing was always among the top three most disliked elements in the four Xi-Qu examples despite that singing was also among the top three liked elements in two Xi-Qu examples. Numerical FaceReader results showed a strong negative relationship between “angry” and preference (rho = -.976, p < .01). The moderate relationship was found between “sums of negative emotions” and preference (rho = .741, p < .05). No statistically significant relationship was found between valence and preference and between arousal and preference. The results of temporal FaceReader analysis showed that the participants’ emotional response to the audiovisual examples changed with the unfolding visual and audio information. The qualitative analysis revealed a model of Xi-Qu and opera preference. The model contained the factors influencing preference for Xi-Qu and opera, including personal factors, cultural and environmental factors, visual factors, musical factors, and musical response. Formal voice training was the most reliable indicator of preference for operatic examples. Familiarity gained through guided listening instead of random repetition was positively related preference for Xi-Qu examples. The unexpected findings were the influence of religion and static perspective on preference for music. Implications and recommendations were discussed, and the suggestions for future research were included.

Abstract The aim of the study was to assess the application and suitability of managerialism, in reforming the organisation of public specialised care management and operations in Finland. Managerialism refers to the reforming of the public-sector administration, using business management models and practices originating from the private sector. The study combined a qualitative and quantitative research approach. The material consisted of annual reports from four university hospital districts (n = 59), regulations and administrative rules (n = 42) from 1991–2005 as well as a questionnaire (n = 157). Content analysis and statistical analysis were used as the methods of analysis. Managerialism is defined as an ideology, reform and change of management paradigm. As an ideology, managerialism emphasises good, professional management, which is achieved through training and education as well as the manager's right to manage. In terms of reform, managerialism includes decentralisation, results orientation and market orientation in the structural reform of public organisations. As a change of management paradigm, managerialism involves the breakdown of bureaucracy and professional management. According to the qualitative assessment, features complying with managerialism had been applied in varying degrees, between 1991 and 2005, in reforming the organisation of the management and operation of hospital districts. Reform, in accordance with managerialism, was manifested best in one hospital district; this was evident when looking at both sets of data. According to the quantitative assessment, hospital district management was a combination of bureaucratic, professional and managerialist management. Bureaucratic management was manifested in the hospital districts, as classic features of bureaucracy. There was continued support for professional management, evidenced by the requirement that leading positions at medical units be reserved for doctors. Among the features of managerialist management, human-centred and results-centred management and the preconditions of management were manifested in the hospital districts. According to the results of the study, the ideological features of managerialism, as management principles, were accepted in guiding the reform of public specialised care, whereas attitudes towards the reformist features, as service structure reformers, were more negative. The opinions of the topmost management of the hospital districts, and those of unit management, differed in terms of the assessment of the suitability for the specialised care reform of the features, emphasising the efficiency of manageralism and a market-oriented approach. Conflicting views of the suitability of managerialism for reforming specialised care in the public sector were associated with the position of the respondent within the organisation and the management's educational background. The findings of the study can be utilised in political decision-making and internal development work within the hospital districts, in reforming specialised care management and service structures and in the multi-professional management training of health care management personnel. The findings provide a new public management model for public-sector specialised care in Finland. / Tiivistelmä Tämän tutkimuksen tarkoituksena oli arvioida managerialismin soveltamista ja soveltuvuutta suomalaisen julkisen erikoissairaanhoidon johtamisen ja toiminnan organisoinnin uudistamisessa. Managerialismilla tarkoitettiin julkisen hallinnon uudistamista yksityissektorilta peräisin olevin liikkeenjohdon opein ja -käytännöin. Tutkimuksessa yhdistettiin samanaikaisesti kvalitatiivinen ja kvantitatiivinen tutkimusmetodi. Tutkimusaineistoina käytettiin neljän yliopistollisen sairaanhoitopiirin toimintakertomuksia (n = 59), johto- ja hallintosääntöjä (n = 42) vuosilta 1991–2005 sekä kirjallista kyselyä (n = 157). Analyysimenetelminä käytettiin sisällön analyysia ja tilastollista analyysiä. Managerialismi määriteltiin ideologiana, reformina ja johtamisparadigman muutoksena. Ideologiana managerialismi korosti hyvää, ammattimaista johtamista, johon kouluttaudutaan, sekä johtajan oikeutta johtaa. Reformina managerialismi sisälsi hajauttamisen, tulosorientaation sekä markkinaohjautuvuuden julkisten organisaatioiden rakenneuudistuksissa. Johtamisparadigman muutoksena managerialismi merkitsi byrokratian ja professionaalisen johtamisen murtamista. Kvalitatiivisen arvioinnin mukaan managerialismin mukaisia piirteitä oli sovellettu vaihtelevasti vuosina 1991–2005 sairaanhoitopiirien johtamisen ja toiminnan organisoinnin uudistamisessa. Yhdessä sairaanhoitopiirissä managerialismin mukainen uudistaminen ilmeni parhaimmin, ja molempien aineistojen perusteella. Kvantitatiivisen arvioinnin mukaan sairaanhoitopiirien johtaminen oli yhdistelmä byrokraattista, professionaalista ja managerialistista johtamista. Byrokraattinen johtaminen ilmeni sairaanhoitopiireissä byrokratian klassisina piirteinä. Professionaalista johtamista tuettiin edelleen sairaanhoidollisten yksiköiden johtotehtävien lääkärikelpoisuusehdoilla. Managerialistisen johtamisen piirteistä ilmenivät sairaanhoitopiireissä ihmiskeskeinen ja tuloskeskeinen johtaminen sekä johtamisen edellytykset. Tutkimustulosten mukaan managerialismin ideologiset piirteet johtamisen periaatteina hyväksyttiin ohjaamaan julkisen erikoissairaanhoidon uudistamista, kun taas reformistisiin piirteisiin palvelurakenteiden uudistajina suhtauduttiin kielteisemmin. Sairaanhoitopiirien ylimmän johdon ja vastuualueiden johdon arviot erosivat toisistaan managerialismin tehokkuutta korostavien piirteiden ja markkinaperusteisen toimintatavan soveltuvuuden arvioinnissa erikoissairaanhoidon uudistamiseen. Ristiriitaiset näkemykset managerialismin soveltuvuudesta julkisen erikoissairaanhoidon uudistamiseen olivat yhteydessä asemaan organisaatiossa ja johdon koulutustaustoihin. Tutkimustietoa voidaan hyödyntää sairaanhoitopiirien poliittisessa päätöksenteossa ja sisäisessä kehittämisessä erikoissairaanhoidon johtamisen ja palvelurakenteiden uudistamisessa sekä terveydenhuollon johdon moniammatillisessa johtamiskoulutuksessa. Tutkimustieto antaa suomalaiselle julkiselle erikoissairaanhoidolle uuden julkisen johtamisen mallin. / Sammandrag Studiens syfte var att utvärdera tillämpning och lämplighet av managerialism i reformering av organisering av ledning och verksamhet inom offentlig specialsjukvård i Finland. Med managerialism menades reformering av offentlig förvaltning med hjälp av modeller och tillvägagångssätt som härstammar från den privata sektorn. I studien användes både kvalitativ och kvantitativ forskning. Forskningsmaterialet omfattade verksamhetsberättelser (n = 59) från fyra universitetssjukhusdistrikt, ledningsinstruktioner och förvaltningsregler (n = 42) från 1991–2005 samt en skriftlig enkät (n = 157). Innehållsanalys och statistisk analys användes som analysmetoder. Managerialism definierades som ideologi, reform samt ändring av ledningsparadigm. Som ideologi betonade managerialismen god, professionell ledning, som man når genom att studera, samt ledarens rätt att leda. Som reform omfattade managerialism decentralisering, resultatorientering samt marknadsorientering när det gäller strukturella reformer av offentliga organisationer. Som ändring av ledningsparadigm betydde managerialism brytning av byråkrati och professionell ledning. Enligt kvalitativ utvärdering hade drag som påminner om managerialism tillämpats i varierande utsträckning mellan 1991 och 2005 i reformering av organisering av ledning och verksamhet inom sjukvårdsdistrikten. Reformering enligt managerialism manifesterades bäst inom ett sjukvårdsdistrikt; samma resultat nåddes med båda materialgrupper. Enligt kvantitativ utvärdering var ledning inom sjukvårdsdistrikt en blandning av byråkratisk, professionell och managerialistisk ledning. Byråkratisk ledning kom till uttryck i sjukvårdsdistrikten som klassiska byråkratiska drag. Professionell ledning stöddes fortfarande med kravet att personer i ledande ställning inom sjukvårdsenheter måste ha läkarutbildning. Av olika managerialistiska ledningsdrag manifesterades människocentrerad och resultatorienterad ledning samt ledningens förutsättningar i sjukvårdsdistrikten. Enligt forskningsresultateten godkändes managerialismens ideologiska drag som ledningsprinciper att styra reformering av offentlig specialsjukvård, medan attityderna var mer negativa gentemot reformistiska drag som förnyare av servicestrukturer. Den högsta sjukvårdsdistriktledningens och resultatenhetsledningens uppfattningar skiljde sig från varandra när det gäller utvärdering av hur väl managerialismens drag som betonar effektivitet samt en marknadsorienterad operationssätt lämpar sig för reformering av specialsjukvård. Motstridiga uppfattningar om managerialismens lämplighet för reformering av offentlig specialsjukvård var förknippade med position inom organisationen samt ledningens utbildningsbakgrund. Forskningens resultat kan tillämpas i politisk beslutsfattning inom sjukvårdsdistrikt, intern utveckling och reformering av ledning och servicestrukturer inom specialsjukvården samt inom multiprofessionell ledningsutbildning avsedd för personer i ledande ställning inom hälsovården. Studien erbjuder en ny offentlig ledningsmodell för offentlig specialsjukvård i Finland.

Abstract The purpose of the study was to describe and analyse the leadership styles of nurse managers as part of the leadership culture in health centre wards. The aim was to produce scientific knowledge about nurse managers’ leadership styles and the factors affecting them, and about the sufficiency of their leadership style knowledge and skills. The study was conducted using a mixed method approach. In the first phase, the leadership styles of nurse managers were examined systematically with the aid of a literature review. The material consisted of 45 scientific articles that focused on or touched upon leadership styles. The approach in the second phase of the study was qualitative. Data were collected from nurse managers (n&#160;= &#160;13), nurse directors (n&#160;= &#160;10) and nursing staff (n&#160;= &#160;11) using themed interviews. The data were analysed using inductive content analysis. The approach in the third phase was quantitative. Data were collected from nurse managers (n&#160;= &#160;252) in health centre wards using questionnaires. The data were collected using a stratified sample based on the number of nurse managers in the health centres. The data were analysed with descriptive statistics. The results indicated that nurse managers’ leadership styles were influenced by the flow of information, organisational values, previous supervisors, nurse managers’ training and values, the staff working under the nurse managers and collaboration. The nurse managers reported using four resonant leadership styles: visionary, coaching, affiliate and democratic leadership style, while commanding leaderhsip was used among dissonant styles. According to nurse directors and nursing staff, nurse managers also used isolating leadership style. Leadership styles affected collaboration, staff well-being and commitment to work, the operation of the work unit and development work as well as the atmosphere within the organisation. Nurse managers reported visionary leadership style as the most important and isolating leadership style as the least important leadership style. Through self-reflection, nurse managers could increase their knowledge on the use of different leadership styles and their effects and use them in an appropriate manner. Leadership styles where employees are seen as having a participatory and active role have become increasingly more common. Resonant leadership styles have a positive impact on staff work satisfaction, professional development and staff retention. These factors have a positive effect on the quality of patient care. The information generated by the study may be utilised in basic, continued and further nursing education. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja analysoida, mitä ovat hoitotyön osastonhoitajien johtamistyylit osana johtamiskulttuuria terveyskeskusten vuodeosastoilla. Tavoitteena oli tuottaa tieteellistä tietoa osastonhoitajien käyttämistä johtamistyyleistä ja niihin vaikuttavista tekijöistä sekä heidän johtamistyylitietojensa ja -taitojensa riittävyydestä. Tutkimuksessa on käytetty monimenetelmällistä tutkimusmenetelmää. Ensimmäisessä vaiheessa hoitotyön johtajien johtamistyylejä tarkasteltiin systemaattisen kirjallisuuskatsauksen avulla. Aineisto koostui 45 johtamistyylejä käsittelevästä tai niitä sivuavasta tieteellisestä julkaisusta. Toisen vaiheen lähestymistapa oli kvalitatiivinen ja aineistot kerättiin osastonhoitajilta (n&#160;= &#160;13), ylihoitajilta (n&#160;= &#160;10) ja hoitohenkilökunnalta (n&#160;= &#160;11) teemahaastatteluilla. Aineistot analysoitiin induktiivisella sisällön analyysilla. Kolmannen vaiheen lähestymistapa oli kvantitatiivinen ja aineisto kerättiin kyselylomakkeilla terveyskeskusten vuodeosastojen osastonhoitajilta (n&#160;= &#160;252). Aineisto kerättiin käyttäen ositettua otantaa terveyskeskusten osastonhoitajalukumäärittäin. Aineisto analysoitiin kuvailevan tilastotieteen menetelmillä. Tulosten mukaan osastonhoitajien johtamistyyleihin vaikuttivat tiedonkulku, organisaation arvot, aiemmat esimiehet, osastonhoitajien koulutus ja arvot, osastonhoitajien alaiset työntekijät sekä yhteistyö. Osastonhoitajat kuvasivat käyttävänsä neljää resonoivaa johtamistyyliä, jotka olivat visionäärinen, valmentava, välittävä ja demokraattinen, kun taas ei- resonoivista johtamistyyleistä he käyttivät komentavaa johtamistyyliä. Ylihoitajien ja henkilökunnan mukaan osastonhoitajat käyttivät myös eristäytyvää johtamistyyliä. Johtamistyylit vaikuttivat yhteistyöhön, työntekijöiden työhyvinvointiin ja sitoutumiseen, työyksikön toimintaan ja kehittämistyöhön sekä organisaation ilmapiiriin. Tärkeimpänä johtamistyylinä osastonhoitajat raportoivat visionäärisen ja vähiten tärkeänä eristäytyvän. Itsereflektion kautta osastonhoitajat voisivat vahvistaa tietojaan eri johtamistyylien käytöstä ja niiden vaikutuksista sekä käyttää niitä tarkoituksenmukaisella tavalla. Johtamistyylit, joissa työntekijät nähdään osallistuvassa ja aktiivisessa roolissa, ovat yleistyneet. Resonoivat johtamistyylit vaikuttavat positiivisesti työntekijöiden työtyytyväisyyteen, ammatilliseen kehittymiseen ja työssä pysymiseen. Nämä tekijät vaikuttavat potilaiden hoidon laatuun myönteisesti. Tutkimuksen tuottamaa tietoa voidaan hyödyntää hoitotyön johtamisen perus-, jatko- ja täydennyskoulutuksessa.

Aims: Exercise and physical activity have been found to be beneficial in managing disabilities caused by multiple sclerosis (MS). Despite the known benefits, people with MS (pwMS) are inactive. Research has focused on structured exercise programmes, rarely considering a broader range of activities, which pwMS integrate into everyday life. The aims of this study were to gain in-depth understanding of the priorities and meanings of exercise and physical activity from the perspective of pwMS and to explore how these might inform clinical practice. Methods: a mixed methods approach using three interconnected studies was adopted: Study 1: A four-round Delphi questionnaire scoped and determined consensus of priorities for exercise and physical activity and the reasons why pwMS (n=101) engaged in these activities. Content and statistical analyses were utilised. Study 2: Sixteen face-to-face, semi-structured interviews were conducted with pwMS to explore the meanings ascribed to exercise and physical activity in relation to the Delphi study. Study 3: Three focus groups involving 14 physiotherapists explored perceptions about exercise and physical activity. Data were analysed for studies 2 and 3 using Framework Analysis and themes developed. Results: outcome from each phase 1. Study 1 revealed that the prioritised exercise and physical activity practices and the reasons why pwMS (n=70) undertook these activities were diverse. Consensus was found for the exercise and physical activity practices (W=0.744, p < 0.0001) and the reasons why pwMS engaged in these activities (W=0.723, p < 0.0001). 2. Study 2 demonstrated that the meanings pwMS ascribed to exercise and physical activity was beyond ‘movement’ reflecting how they lived with a variable and progressive condition. Contextual factors, specifically personal factors were dominant influences. 3. Study 3 highlighted that physiotherapists shared similar views in some aspects to pwMS, however physiotherapists perceptions of exercise and physical activity were predominately influenced by their theoretical knowledge. Conclusion: The priorities and meanings ascribed to exercise and physical activity were ‘a matter of perspective’ and context driven. Understanding the strategies used by pwMS for prioritisation might help clinicians support pwMS more effectively in their decision making about exercise and physical activity. Taking this approach creates the opportunity to deliver a more focused patient-centred approach in the management of MS. Recommendations for clinical practice and further research were identified.

Men who have sex with men (MSM) are at increased risk of anal cancer as a result of anal HPV infection. Routine HPV vaccination is recommended for all MSM up through age 26; however, vaccine uptake among this population is low. The Integrative Model of Behavioral Prediction (IM) was used to identify, describe, and explain psychosocial factors related to HPV vaccine decision-making for young MSM. A sequential mixed-methods approach consisting of semi-structured interviews, a quantitative survey, and a qualitative open-ended survey was used to address the following aims: (1) Determine salient outcome, normative, efficacy, and control beliefs related to HPV-vaccination among young MSM; (2) Identify information needs and trusted sources of information regarding HPV vaccination among young MSM; and (3) Develop and test a structural equation model guided by the Integrated Model of Behavioral Prediction. The purpose and objectives of this research address priorities outlined in the Institute of Medicine's report on health disparities among lesbian, gay, bisexual, and transgender (LGBT) populations. Results highlight the lack of information and knowledge regarding HPV prevention in this population. The majority of respondents had heard of the HPV vaccine but generally perceived it as a women's health issue. Attitudes toward vaccination were generally positive, as was behavioral intention to get vaccinated within the next 12 moths. Salient behavioral beliefs described physical benefits such as lowering risk and promoting overall health. Psychological benefits were described as protecting sex partners and providing peace of mind. There was some concern regarding the risks of vaccination including contracting HPV from the vaccine, not knowing if it would be effective, and potential side effects. Normative influences on decision-making were minimal. Availability, cost, and convenience were among the most salient external control factors. Issues surrounding disclosure of sexual minority status influenced control factors including self-efficacy. Addressing the specific beliefs and concerns expressed by MSM can help to improve the effectiveness of health education interventions promoting vaccination. Empirical findings support the proposed behavioral model of vaccine decision-making.