Disability and arthritis in Mexico are important public health problems. There is a need to develop rehabilitation interventions aimed at reducing the prevalence and disabling effects of arthritis in low socioeconomic communities in this country. This thesis reports findings from the initial execution of a mixed-methods participatory research program. This program was designed to develop, implement and evaluate a community-based rehabilitation program to decrease disability of people living with arthritis in the municipality of Chankom, a low-income rural Mayan community located in Southeast Mexico. Epidemiologic results showed a high prevalence of arthritis in Chankom associated with low levels of wealth and high body mass index. In addition, arthritis was associated with a higher prevalence of disability in this municipality. Further results showed that people who live with osteoarthritis in Chankom perform standardized and real-life activities with significant levels of disability. This disability was associated with levels of wealth, pain, muscle strength, self-efficacy, and physical activity. Ethnographic results showed that: a) arthritis reduces the health-related quality of life of people in Chankom through a process of disablement, b) people living with arthritis need access to culturally sensitive healthcare, and c) there are availability, attainability and acceptability barriers to accessing culturally sensitive health services in this municipality, which result from power imbalance between indigenous and non-indigenous people. The work presented in this thesis is the extensive examination of the problems associated with arthritis in Chankom, using quantitative and qualitative methods. Our findings justify the need to develop health policies and interventions to prevent and decrease the disabling effects of arthritis in this marginalized community. Moreover, these findings will support the creation of a culturally sensitive, community-based rehabilitation program, as a multi-level strategy to promote social development and improve health-related quality of life of people living with arthritis in the municipality of Chankom. / Thesis / Candidate in Philosophy / There is a need to develop rehabilitation interventions aimed at reducing the onset and disabling effects of arthritis in poor areas of Mexico. This thesis reports findings from the initial implementation of a research project designed to decrease disability of people living with arthritis in Chankom, a poor rural Mayan community located in Southeast Mexico. These findings show that arthritis is common in Chankom and it is related to having problems performing usual activities, which reduce people’s quality of life. People living with arthritis in Chankom need culturally appropriate healthcare services; however, they don’t obtain these due to different barriers associated with their indigenous background. Consequently, it is necessary to design health policies and interventions to decrease the disabling effects of arthritis in Chankom. The findings of this thesis will help creating a rehabilitation program that increases access to appropriate healthcare, improving function and quality of life of Chankom’s inhabitants.

Introduction: In a mixed-methods study I assessed the role of social networks as predictors and outcomes of the implementation of an intervention to promote evidence-informed decision-making (EIDM) in three public health departments in Ontario, Canada. The quantitative strand included the analysis of the role of staff’s position in networks on the adoption of EIDM, the longitudinal evolution of networks, and the association between the name generators’ position in surveys and respondents’ motivation to answer survey questions. The qualitative strand aimed to explain and contextualize the quantitative findings. Methods: A tailored intervention was implemented in the public health departments, including the mentoring of staff through the EIDM process by a knowledge broker. The staff participated in three online surveys before and after the 22-month intervention, providing the names of peers to whom they turned to seek information, whom they considered as experts, and their friends. I assessed the dynamic evolution of social networks, and the role of local opinion leaders (OL) in promoting the adoption of EIDM. I interviewed key network actors about their interpretation and experience regarding the quantitative findings. Results: Overall, there was no statistically significant impact on EIDM behavior and skill in health departments. However, the analysis of the role of OLs in behaviour change showed that non-engaged staff who were connected to highly engaged OLs, and those OLs who communicated with each other improved their EIDM behavior. Social networks became more centralized around already popular staff due to selective training of recognized experts. Highly engaged staff tended to connect to each other, and to limit their connections within organizational divisions over time. In the department where multiple activities were being implemented to support EIDM, the highly engaged staff became more popular due to department-wise presentations and informal information spread. I also found that when name generator questions are asked later in surveys then respondents are more likely to refuse, indicate they do not know anyone, or provide fewer names than when these questions are asked earlier Conclusion: Social network analysis showed the structure of information-seeking relations, the impact of opinion leaders on the EIDM behavior of their peers, and underlying social changes through implementing an EIDM intervention. These findings can inform the design and tailoring of EIDM interventions in public health organizations. / Thesis / Doctor of Philosophy (PhD) / In three public health departments in Ontario, where we offered an intervention to a group of staff on how to use more research evidence in practice, I studied how the pattern of communication among staff influenced their use of evidence, how those communications changed over time, and how the staff themselves viewed those changes. In the department that largely promoted staff engagement in the intervention, the staff who were engaged became more popular over time. In all departments, already popular staff became more popular. The staff who sought information from popular people engaged in the intervention, and those popular people who communicated with each other used more research evidence over time. Network analysis helped reveal the social structure and identify popular staff and could be used to inform similar interventions. It also showed how selecting and training a group of staff can change the way people communicate in health departments.

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Background: There is significant concern about nurse burnout in nursing homes. There has been little research to investigate whether training in person-centred care and supervision can reduce nursing home nurses’ burnout. Aims: To adapt training to be suitable for nursing home nurses and evaluate the impact of training and supervision on burnout and related outcomes. Study Design: Focus groups with nursing home nurses were used to inform adaptation of the training. Mixed methods were used to evaluate the impact of training and supervision employing a convergent parallel design, including a Randomised Controlled Trial with quantitative measures (primary outcome measure: the Maslach Burnout Inventory) to assess effectiveness and exploration of subjective experience using qualitative interviews. The findings of the RCT and qualitative interviews were then compared to determine the convergences and divergences. Findings: The training was adapted to include content on leadership and stress management. Hypotheses that the interventions would reduce burnout and impact on other quantitative outcomes were not supported. Qualitative interviews with nursing home nurses about training indicated that the nurses reported reduced burnout, enhanced self-efficacy, reduced isolation, better team working, more informed person centred dementia care and enhanced leadership. Nurses’ views on the impact of supervision included a range of benefits. There was convergence between quantitative measurement and subjective experience indicting significant levels of burnout, but divergence in terms of the impact of training in person-centred care and supervision. Conclusions: My study demonstrates that burnout is a significant issue for nursing home nurses in the UK. There was divergence in my findings in terms of the impact of training in person-centred care and supervision. The hypotheses about training and supervision having positive impact on burn-out were rejected. However, the qualitative findings suggest that nursing home nurses experienced positive benefits from the person-centred training and supervision, in particular on their sense of burnout, their approach to care and leadership skills. Recommendations are made regarding research, training and policy to address burnout in nursing home nurses. / Burdett Charitable Trust of Nursing

Internet och sociala medier har revolutionerat människors sätt att umgås och kommunicera. Nackdelen med den digitala utvecklingen är att den möjliggör för snabb etablering och spridning av rasistiskt innehåll. I digitala forum förekommer idag rasistiska uttryck som inte modereras bort och som bryter mot många av sociala medieplattformarnas användarvillkor. I denna studie undersöks i vilken utsträckning som olika kategorier av rasistiska uttryck som förekommer, samt hur vanligt det är med rasistiska kommentarer då minoritetsgrupper omnämns. Studien fokuserar på tre minoritetsgrupper: muslimer, judar och öst- och sydostasiater, och på kommentarer från två diskussionsforum: Flashback och svenskspråkiga Reddit. Metoden mixed methods tillämpades, en forskningsmetod som kombinerar både en kvalitativ och kvantitativ ansats. Metoden för hur data inhämtades var via dokumentundersökning. Utifrån en ordlista med rasistiska uttryck mättes förekomsten av omnämnanden av minoriteterna med hjälp av ett program. Ett urval av kommentarer som innehöll omnämnanden analyserades med hjälp av tematisk analys. Flashback utmärkte sig både när det kommer till antalet omnämnanden av minoriteterna och antalet rasistiska kommentarer. Detta kan bero på att Flashback inte modereras lika mycket som Reddit, men även på att forumet har en hårdare samtalston där grövre språk oftare tolereras. Muslimer är den grupp som nämns mest och har flest antal rasistiska kommentarer i urvalet. Vad detta beror på kan vara att muslimer utgör den största gruppen av minoriteterna men även på tidsperioden som data publicerades, vilket inföll samtidigt som koranbränningarna och påskupploppen. Med en tematisk analys identifierades fyra olika teman i kommentarer som nämnde de olika minoritetsgrupperna: fördomar, fientlighet, konspirationsteorier och hot mot väst. De ingående kategorierna skiljer sig markant, vilket beror på att de rasistiska uttrycken är djupt rotade i negativa stereotyper och fördomar som finns om respektive minoritetsgrupp. Att data är begränsat till endast två forum och en viss tidsperiod gör att resultatet inte kan representera alla svenska sociala medier. Däremot kan konstateras att liknande kategorier som identifieras i denna studie har identifierats i tidigare studier från Totalförsvarets Forskningsinstitut om muslimer och judar. Forskning om rasistiska uttryck mot öst- och sydostasiater i Sverige med hjälp av en ordlista har däremot inte tidigare gjorts. För att få en mer representativ bild av vilka typer av rasistiska uttryck som förekommer på svenska sociala medier, hade ett mer omfattande urval av data behövt analyseras. / The internet and social media have revolutionized our way of communicating with each other. However, the downside of digital development is that it enables the rapid establishment and dissemination of racist content. In digital forums today, racist expressions that go unmoderated and violate the user terms are published. In this study, the extent to which various categories of racist expressions occur is examined, as well as how common racist comments are when minority groups are mentioned. The study focuses on three minority groups: Muslims, Jews and East and Southeast Asians, and two discussion forums: Flashback and Swedish Reddit. Mixed methods was applied, a research method that combines both qualitative and quantitative approaches. The method used for data collection was through survey of documents. By creating a list of racist expressions, the occurrence of mentions of minorities is measured by using a program. Thematic analysis is then applied to analyse a sample of comments containing these mentions. Flashback stood out both in terms of the number of mentions of minorities and the number of racist comments. This may be due to Flashback being less moderated than Reddit, and that the forum has a harsher conversational tone where coarser language is more often tolerated. Muslims are the most mentioned group and have the highest number of racist comments in the sample. This could be because Muslims make up the largest group of minorities and due to the time period the data was published, coinciding with the Quran burnings and Easter riots. From thematic analysis, four themes were identified for the minority groups: prejudice, hostility, conspiracy theories, and threats to the West. The categories involved differ significantly, as racist expressions are deeply rooted in negative stereotypes and prejudices about each minority group. The fact that the data is limited to only two forums and a specific time period means that the results cannot represent all Swedish social media. However, it can be noted that similar categories identified in this study have been identified in previous studies from Swedish Defence Research Agency on Muslims and Jews. Research on racist expressions against East and Southeast Asians in Sweden using a word list has not been done before. To obtain a better representation of the types of racist expressions prevalent on Swedish social media, a broader selection of data would have been required for analysis. / Internet, Social media, Racism, Minorities, Mixed methods, Thematic analys

Background: Fear of falling has significant adverse physical and psychological effects for the community-dwelling older adult. Objective: The purpose of this study was to assess fear of falling in community-dwelling older adults and explore participant perceptions of fear of falling assessments and interventions. Methods: A mixed methods case study was utilized to gain an in-depth understanding of older adults' perceptions. It consisted of quantitative data collection by objective measures and qualitative data collection by four individual in-depth interviews. A sample of four community-dwelling adults aged 65 years and older and living in Orlando, Florida, completed the study in their home environment. To combine quantitative and qualitative data for each participant, a case-specific analysis was used, resulting in narratives with a storytelling approach aiming to explore each participant independently. This was followed by a cross-case analysis to gain a more comprehensive understanding of the participants in relation to one another. Results: Four themes emerged: 1) Feedback from an objective measure is valuable; 2) Family experiences with fear of falling drive personal interventions; 3) Fundamental assessments for fear of falling are missing, and 4) Fluctuating definitions of "fear" contribute to difficulty in assessments and interventions. Conclusion: Clear perceptual themes developed to provide a comprehensive understanding of community-dwelling older adults' perceptions of fear of falling assessments and interventions. Future research is needed to determine how to best combine feedback-oriented assessments with established interventions, such as exercise. Standardization of a subjective measure for fear of falling to use in combination with objective measures is also needed. Keywords: assessment, intervention, fear of falling, older adults, community-dwelling, mixed methods

Higher education institutions are facing a major challenge in retaining 1st-year college students and engaging them in meaningful activities and programs to promote their sense of belonging (Strayhorn, 2012; Astin, 1993). Though a few belonging intervention practices have been studied (Perrell, 2018; Peck, 2011), there is a lack of understanding on the dynamic mechanisms of developing belongingness through a combination of belonging enhancement practices (Yob, 2014). Moreover, there is an urgent need to examine which belonging enhancement practice has the most impact on students' academic performance (Slaten, Elison, Hughes, Youg, & Shemwell, 2015). This study used convergent, parallel mixed-methods design to make meanings from both qualitative and quantitative data on the effect of the service-learning leadership program (SLLP) for 1st-year students at a large, public university on perceived sense of belonging and related academic performance, and the mechanism of the dynamic process. Quantitative data contained 2 parts: the 1st part is university student record data from 2007 to 2018 with total of 2,762 students, and the 2nd part of the data were collected through pre-and post-surveys from total of 262 students in treatment and control groups. Qualitative data were collected from 9 participants through individual interviews, focus group and weekly journals. Quantitative datasets were analyzed through mixed-design MANOVA, mixed-design ANOVA and hierarchical (logistic) multiple regressions, and qualitative data was analyzed through spiral approach. The findings demonstrated that the studied program protected against the decline of sense of belonging in the 1st semester of college year, and it brought more benefits to male and racial minority students as compared to female and racial majority students. Moreover, the findings indicated mentorship and living-learning community practices had the most impact on students' sense of belonging and academic performance, and suggested further improvement for performance feedback, social media and service-learning practice. The results of the study have implications for future institutional interventions and provide comprehensive practical guidelines for belonging enhancement programs for 1st-year students. The conclusions provide recommendations for designing and implementing belonging intervention programs that bring maximum outcomes on students' sense of belonging, retention and academic performance.

In this thesis, applying an innovative postmodern equal-weight/sequential QUAN→PHEN Mixed-Methods Phenomenological Research (‘MMPR’) approach to study an Olympics’ impact within its two-cluster socio-demographic footprint forms its main contribution to knowledge. Facilitating between-methods triangulation is a novel eclectic pragmatic approach that is used to capture the richness of thematic data flowing from in-depth, open-ended interviews with most – 62 in all – senior Hoteliers spread evenly between distinct urban Metro-Vancouver and rural alpine-Whistler, whilst concurrently capitalizing on the availability of a unique BC Stats proprietary micro-municipal-level secondary data source, i.e., British Columbia’s ‘Additional Hotel Room Tax’ (‘AHRT’). Typically, traditional mono-method-positivist neo-classical economic syntheses are used to quantify an Olympic Games’ ex-ante or ex-post impact. This study’s findings confirm that such syntheses attempts, at the micro-municipal level, lead to inevitable dead-ends. At a sub-national level of micro-granularity, using available economic models is an impossible task due to the insurmountable practical problem of complete lack of, or paucity, of data. When applied to assess mega-events, such modelling is shown to lack credibility; models are insufficiently comprehensive or its users consciously engage in ‘shenanigans’ by force-fitting input/output to produce pre-ordained outcomes for political expedience and meeting agency interests. The ‘MMPR’ approach acknowledges and respects the established and ‘current-thinking’ paradigmatic epistemological and ontological perspectives. ‘Hotel Activity’, measured via ‘AHRT’, is substituted as a ‘Proxy’ for ‘Tourism’ following empirically establishing these three variables as highly correlated. Prevalent academic findings of negative impacts from Winter Olympics are not borne out. Phenomenological issues of ‘illusory correlations’ and ‘data saturation’ are addressed.

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