Background. The continuation of eating disorders from adolescence into adulthood often requires youth to undergo a healthcare transition from pediatric to adult eating disorder services. This transition is difficult, uncoordinated, and puts affected adolescents at an increased risk of relapse. Although transition barriers and recommendations have been identified, no known interventions exist to support youth and families transitioning to adult eating disorder services. Methods. Over a three-month period, ten 17-year-old adolescents and their parents (n=9) completed up to five intervention components designed to prepare them for the transition out of pediatric eating disorder treatment in Hamilton, Ontario. A convergent parallel mixed methods design was used to assess intervention feasibility, the nature of transition, and other outcomes, with equal emphasis on the quantitative data, where measures were collected using a single arm pre-post design, and qualitative data, which comprised of written reflection entries and interview data, was informed by Qualitative Description, and analyzed using qualitative content analysis. Results. Quantitative data pertaining to chosen feasibility indicators showed that adolescents and parents completed an average of 73% and 78% of expected components respectively, all within the three-month intervention period. Findings generated from the qualitative data indicated that participants found the intervention helpful, convenient, and easy to navigate. Of the seven adolescents interviewed, most were planning to transition to their family doctor, a private therapist, or both, while awaiting entry to specialized adult mental health care. Conclusions. This intervention is acceptable, feasible, and highlights likely care pathways among transition-age youth with eating disorders. These findings support the continuation of this research using more rigorous study designs to examine the effectiveness of this intervention in larger and more diverse samples. / Thesis / Master of Science (MSc) / Most programs that specialize in treating children with eating disorders discharge patients when they turn 18. This sudden change often leaves youth without a solid plan to continue this care as an adult. Currently, no known interventions exist to help with this problem. In our study, ten adolescents and their parents completed five activities designed to improve their transition into adult mental health care. Interviews, reflections, and questionnaires were used to explore multiple outcomes, such as how many or the duration to complete these activities and where they plan to go for adult mental health treatment. Adolescents and parents completed most of the supports, described them as easy and helpful, and set up a plan for their future care. The activities in this study have the potential to improve this difficult transition for youth and families affected by eating disorders and should be further studied.

With the significant growth of purpose-oriented networks in the realm of public affairs, the challenges for public and nonprofit organizations in deciding which networks to engage with have also increased. This work explores whether organizations with different collaborative motivations prefer networks with different sets of characteristics. By bridging organizational theory and social network literatures, this study proposes a conceptual framework regarding the connections between organizational collaborative motivations and network characteristics. The conceptual framework is then further investigated using a two-phase exploratory sequential mixed-methods design and data from both local and statewide public and nonprofit organizations with experience working in networks. The first phase is a qualitative exploration of the conceptual framework using interview data, and the second phase draws on survey data and crisp-set qualitative comparative analysis (cs-QCA) to refine the theoretical framework. The two-phase study indicates that organizations with different collaborative motivations indeed prefer different kinds of networks. The results also identify multiple pathways for each motivation and which network characteristics need to be combined for each motivation, as well as offer some universal combinations that work for different motivations. The findings are valuable for both network managers' efforts in recruiting members and public and nonprofit organization managers' attempts at seeking beneficial collaborations. / Doctor of Philosophy / Public and nonprofit organizations are often expected to work with others through different collaborative entities, such as organizational networks, to solve complex problems. Given the significant growth of networks in the field of public affairs and the limited time and resources that organizations have available, however, it can be challenging for organizations to decide which networks to participate in. To help make this decision easier, this study sets out to find combinations of network features that match with different collaborative motivations. A framework linking organizational and social network theories is first created, and then examined through a two-phase mixed-methods approach. The first phase involves interviewing a selection of local public and nonprofit organizations and using their feedback to improve the framework. The second phase is an online survey targeting public and nonprofit organizations across Virginia, which further investigates the refined framework. The framework developed from this study not only finds connections between organizational collaborative motivations and network characteristics, but also offers a tool for organizations to identify networks that better match their goals for collaboration and a roadmap for network managers to design networks that better meet the needs of their participants.

Despite the recent popularity of digital game-based learning (DGBL), far too little evidence exists concerning its benefits in mathematics. The purpose of this research study was to: (a) determine whether or not DGBL is a viable tool in helping students to improve achievement in middle school mathematics and (b) gauge their perceptions regarding the use of DGBL. This study consisted of a convenience sample of sixth-grade students enrolled at a large suburban middle school in a school division in the Commonwealth of Virginia. This study followed a sequential explanatory mixed-methods approach using a one-group, pretest-posttest research design to collect data from participants before and after DGBL intervention to determine if a relationship existed with improved scores on the Ratios and Proportional Relationships Test. Ratios and Proportional Relationships Test scores were collected from the fall 2020 pre and post-test administrations. Students' Perceptions of Digital Game-Based Learning Survey (SPoDGBLS) responses were also collected from participants before (pre) and after (post) the intervention to determine the changes in student perceptions of DGBL. Small group, semi-structured, open-ended interviews were conducted to collect in-depth information regarding student perceptions of a digital game-based approach for learning mathematics. Results of the study found that on average student participants scored higher on the posttest than the pretest, albeit not significantly higher than the posttest cut score. Results also showed that student perceptions of the usefulness of DGBL improved over the course of the 5-week study. The study recommends that school and division leaders consider incorporating DGBL into mathematics instruction. / Doctor of Philosophy / The purpose of this research study was to: (a) determine whether or not digital game-based learning (DGBL) is a viable tool in helping students to improve achievement in middle school mathematics and (b) gauge their perceptions regarding the use of DGBL. A sequential explanatory mixed-method, one-group, pretest-posttest design was followed to compare 21 sixth-grade participants' Ratios and Proportional Relationships Test scores and Students' Perceptions of Digital Game-Based Learning Survey responses before and after a DGBL intervention. Small group interviews were conducted to collect in-depth information regarding participant perceptions of DGBL in mathematics. Results of the study found that participants scored higher on the posttest than the pretest and their perceptions of the usefulness of DGBL improved over the course of the 5-week study. The study concluded that DGBL is a viable tool that can be successfully integrated into regular math instruction and have a positive impact on middle school students' ability to learn and/or retain new math information.

With our country's unsustainable building practices in the residential sector, there is a need to explore new types of housing to mitigate the negative environmental impacts of current building customs. Recently, there has been a surge of interest in tiny homes characterized as livable dwelling units typically under 400 square feet. However, there is a gap in scholarly knowledge that formally examines how the environmental impact and behaviors of tiny home occupants change after downsizing from a larger home. The purpose of this study was to provide measurable evidence to explore the relationship between downsizing to a tiny home and the corresponding environmental impact. This study, which employed an exploratory sequential mixed design approach, was conducted to measure the ecological footprints of tiny home downsizers. Eighty individuals who have lived in their tiny homes for at least a year volunteered to take an online survey used to calculate their ecological footprints in prior larger homes and current tiny homes. Following the survey, nine interviews were conducted to create an inventory of noteworthy behaviors in each participant's lifestyles that potentially influence ecological footprint changes. Data collected from the survey and interviews were analyzed separately and then comparatively to explore relationships between tiny home living and environmental impacts. This study found that among 80 tiny home downsizers located across the United States, the average ecological footprint was 3.9 global hectares (gha). This footprint was substantially less than the average previous ecological footprint of 7.0 gha and the national average of 8.4 gha. All five footprint components were positively influenced, showing that downsizing can influence many parts of one's lifestyle. Over 100 behaviors were identified that could contribute to ecological footprint changes. The overall insights derived from this study indicate that positive environmental impact behaviors outweigh negative ones by approximately six to one when downsizing to a tiny home. In addition, 100% of participants demonstrated an overall positive ecological footprint. The findings and conclusions of this study provide important insights for the sustainable housing industry that can inform policy and practice, with implications for future research in the sustainable residential field. / Doctor of Philosophy / With our country’s unsustainable building practices in the residential sector, there is a need to explore new types of housing to mitigate the negative environmental impacts of current building customs. Recently, there has been a surge of interest in tiny homes characterized as livable dwelling units typically under 400 square feet. However, there is a gap in knowledge to understand how the environmental impact and behaviors of tiny home occupants change after downsizing from a larger home. The purpose of this study was to see whether there is a relationship between downsizing to a tiny home and a changing environmental impact. This study measured the ecological footprints of tiny home downsizers. Eighty individuals who have lived in their tiny homes for at least a year volunteered to take an online survey used to calculate their ecological footprints in prior larger homes and current tiny homes. Following the survey, nine interviews were conducted to identify noteworthy behaviors in each participant’s lifestyles that potentially influence ecological footprint changes. Findings were analyzed and compared to explore relationships between tiny home living and environmental impacts. This study found that among 80 tiny home downsizers located across the United States, the average ecological footprint was 3.9 global hectares (gha). This footprint was substantially less than the average previous ecological footprint of 7.0 gha and the national average of 8.4 gha. All five footprint components were positively influenced, showing that downsizing can influence many parts of one’s lifestyle. Over 100 behaviors were identified that could contribute to ecological footprint changes. This study indicates that positive environmental impact behaviors outweigh negative ones by approximately six to one when downsizing to a tiny home. In addition, 100% of participants demonstrated an overall positive ecological footprint. The findings and conclusions of this study provide important insights for the sustainable housing industry that can inform policy and practice, with implications for future research in the sustainable residential field.

The purpose of this study is to understand how engineering students perceive the patterns of culture at the disciplinary level using Hofstede's constructs (power distance, individualism, uncertainty avoidance, and masculinity). The methodology design for this study is mixed methods. More specifically, the design of this study is an explanatory sequential design that begins with the collection and analysis of quantitative data from a version of Hofstede's survey developed by Sharma (2010), followed by subsequent collection and analysis of qualitative data, with the qualitative analysis being informed by preliminary results from the initial quantitative phase. Results from the quantitative study led to a review of the literature regarding Hofstede's main critiques and how other authors have successfully implemented his model in different contexts, and qualitative data collection with semi-structured interviews with undergraduate students. There are three aims of this study, which are addressed and presented in three separate manuscripts. The first aim (Manuscript 1) was identifying if Hofstede's theory of dimensions of national culture can map to academic disciplines. Results from surveying 3388 undergraduate students provided scores on Hofstede's dimensions for each major. Responses matched the national culture of the students rather than the disciplinary culture; therefore, Hofstede's theory didn't map to explain cultural differences in academic majors. The second aim (Manuscript 2) of this study was to review the extensive available literature regarding the critiques of Hofstede's model and its implementation in different settings. Results provided with conceptual, and methodological critiques and misuse of his theory that allowed us to understand the value of his model to understand cultural differences at the national level, as well as the value of the dimensions to inform our qualitative research design. The third aim (Manuscript 3) of this study was to explore students' perceptions of disciplinary engineering culture and how it compared to other disciplines using a qualitative interview protocol that provided rich findings that complement the quantitative results. Results from interviewing 24 students in industrial and systems engineering, electrical and computer engineering, marketing, and industrial design provided with valuable information on how students perceive their disciplinary culture in terms of what it is valued, how they learn, how it is taught, why they learn, how it is going to be used in the workplace, and the reason for select the major. Implications for research and practice in the engineering education field are provided to inform how to make decisions on engineering curriculum, and engineering classrooms and try to find ways to improve some of the issues that engineering education has been facing for the last decades. / Ph. D.

Advances in science and computing technology have accelerated the development and dissemination of a wide range of big data platforms such as bioinformatics into the biomedical and life sciences environments. Bioinformatics brings the promise of enabling life scientists to easily and effectively access large and complex data sets in new ways, thus promoting scientific discoveries by for example generating, validating, and refining hypotheses based on in silico analysis (performed on computer). Meanwhile, life scientists still face challenges in working with big data sets such as difficulties in data extraction and analyses arising from distributed and heterogeneous databases, user interface inconsistencies and discrepancies in results. Moreover, the interdisciplinary nature of modern science adds to significant gaps in scientists' performance caused by limited proficiency levels with bioinformatics resources and a lack of common language across different disciplines. Although developers of bioinformatics platforms are slowly beginning to move away from function-oriented software engineering approaches and towards to user-centered design approaches, they rarely consider users' value, and expectations that embrace different user contexts. Further, there is an absence of research that specifically aims to support the broad range of users from multiple fields of study, including 'wet' (lab-based) and dry' (computational) research communities. Therefore, the ultimate goal of this research is to investigate life scientists' user experiences with knowledge resources and derive design implications for delivering consistent user experiences across different user classes in order to better support data-intensive research communities. To achieve this research goal, we used the theory of distributed cognition as a framework for representing the dynamic interactions among end users and knowledge resources within computer-supported and -mediated environments. To be specific, this research focused on how online bioinformatics resources can be improved in order to both mitigate performance differences among the diverse user classes and better support distributed cognitive activities in data-intensive interdisciplinary research environments. This research consists of three parts: (1) understanding user experience levels with current bioinformatics resources and key determinants to encourage distributed cognitive activities, especially knowledge networking, (2) gaining in-depth understanding of scientists' insight generation behavior and human performance associated with individual differences (i.e., research roles and cognitive styles), and (3) identifying in-context usefulness, and barriers to make better use of bioinformatics resources in real working research contexts and derive design considerations to satisfactorily support positive user experiences. To achieve our research goals, we used a mixed-methods research approach that combines both quantitative (Study 1 and 2) and qualitative (Study 3) methods. First, as a baseline for subsequent studies, we conducted an empirical survey to examine 1) user experience levels with current bioinformatics resources, 2) important criteria to adequately support user requirements, 3) levels of knowledge networking (i.e., knowledge sharing and use) and relationship to users' larger set of distributed cognitive activities, and, 4) key barriers and enablers of knowledge networking. We collected responses from 179 scientists and our findings revealed that lack of integration, inconsistent results and user interfaces across bioinformatics resources, and perceived steep learning curves are current limitations to productive user experiences. Performance-related factors such as speed and responsiveness of resources and ease of use ranked relatively high as important criteria for bioinformatics resources. Our research also confirmed that source credibility, fear of getting scooped, and certain motivation factors (i.e., reciprocal benefit, reputation, and altruism) have an influence on scientists' intention to engage in distributed cognitive activities. Second, we conducted a laboratory experiment with a sample of 16 scientists in the broad area of bench and application sciences. We elicited 1) behavior characteristics, 2) insight characteristics, 3) gaze characteristics, and 4) human errors in relation to individual differences (i.e., research roles such as bench and application scientists, cognitive styles such as field-independent and dependent people) to identify whether human performance gaps exist. Our results (1) confirmed significant differences with respect to insight generation behavior and human performance depending on research roles, and (2) identified some relationships between scientists' cognitive styles and human performance. Third, we collected a rich set of qualitative data from 6 scientists using a longitudinal diary study and a focus group session. The specific objective of this study was to identify in-context usefulness and barriers to using knowledge resources in a real work context to subsequently derive focused design implications. For this work, we examined 1) the types of distributed cognitive activities participants performed, 2) the challenges and alternative actions they faced, 3) important criteria that influenced tasks, and 4) values to support distributed cognitive activities. Based on the empirical findings of this study, we suggest design considerations to support scientists' distributed cognitive activities from user experience perspectives. Overall, this research provides insights and implications for user interface design in order to support data-intensive interdisciplinary communities. Given the importance of today's knowledge-based interdisciplinary society, our findings can also serve as an impetus for accelerating a collaborative culture of scientific discovery in online biomedical and life science research communities. The findings can contribute to the design of online bioinformatics resources to support diverse groups of professionals from different disciplinary backgrounds. Consequently, the implications of these findings can help user experience professionals and system developers working in biomedical and life sciences who seek ways to better support research communities from user experience perspectives. / Ph. D.

The primary purpose of this study was to compare academic variables from students participating in mixed teaching methods/course revitalization biology courses to those in traditional courses at two community colleges in Tennessee. A two-group comparison design using archived data was used, which evaluated differences in final grades, exam scores, and homework completion as indicators of the academic success between an urban institution and a rural college. A power analysis was performed using G*Power software to provide the needed sample size, indicating a size of 176. There were 227 students in the active teaching lecture classrooms, and 198 students in the lab classes. SPSS randomly selected matching numbers from those enrolled in Non-CR lab courses using the “select cases” function. As community colleges provide an essential service, meeting needs for students who may not be afforded the same opportunities to attend larger institutions, this research attempted to add to the available literature concerning student retention and academic success. In both the Introductory Biology lecture and lab courses, there was a statistically significant increase in lecture homework completion (p = .045) and lab homework completion (p < .001) in those students who participated in the course revitalization (CR) courses. There were also higher test scores on three of the five lecture unit exams, as well as all three of the laboratory unit exams (p < .001 for all three exams) for those students in the CR courses. The final grades for students in the mixed methods courses were significantly higher (p < .001 for lecture and lab) for those students than those in the traditionally formatted courses. There was no statistical difference in mean final exam scores for the two populations of students. Between the two institutions, there were more As and Bs in the mixed methods courses (p < .001). Finally, there were more As and withdrawals at the rural community college than the urban college. These findings show that students have academic success, measured by unit scores, final grades, and homework completion, in those courses presented in mixed-methods manner in Introductory Biology I courses at the community college.

While the Common Factors (CFs) model is becoming more popular it has been criticized for the lack of empirical evidence compared to empirically supported treatments and the lack of capacity to guide clinicians on what to do and when to do it in the course of therapy. This parallel mixed methods study addressed both of these critiques. In phase one, a Common Factors Questionnaire (Karimi-CFQ) was developed to collect empirical data of CFs. In phase two, the Karimi-CFQ was administered to 391 clinicians in the United States to survey the therapists' perspective regarding the contribution of common factors to therapy outcomes. In this phase data was also collected to assess the relationship between clinicians' demographic characteristics and their perceived contribution of common factors to therapeutic change. The CFQ Cronbach's Alpha and Split-half reliability were .84 and .87, respectively. Content Validity Index by expert panel, concurrent validity, and construct validity including Exploratory Factors Analysis (EFA) and Confirmatory Factor Analysis (CFA, χ²=797.96, df=326; RMSEA=.06; CFI=.83) evaluated the validity of the scale. Clinicians across five clinical orientations (Integrative, Cognitive Behavior Therapy, Humanistic, Psychodynamic, Postmodern) and three mental health disciplines (marriage and family therapy, psychology, counseling) attributed 69% of therapeutic change to common factors versus 31% to model-specific factors. Clinicians attributed different contributions to specific components of the CFs model: client (25%), therapist (20%), relationship (23%), hope (12%), non-theory specific (11%), and systemic (9%). Particular clinicians' characteristics (e.g., gender, year of experience) were found to be associated with contributions of specific components of CFs. In phase three, six CF experts were invited to respond to open-ended questions via Wiki that explored how and when experienced therapists use specific common factors in the course of therapy to reach to their therapy goals. Thematic Analysis (TA) generated a chronological map with specific themes that can guide clinicians on how and when specific CFs can be used in each of the three stages of therapy (i.e. Initial, Intermediate, Termination). Findings further indicated that CFs and model-specific factors can be operationally defined and empirically studied within the same evidence-based practice framework. Clinical and research implications of the results are also discussed. / Ph. D.

The study aimed to investigate through mixed methods how White parents approach race discussions with their children, the factors influencing the discussions, and the implications for promoting constructive conversations. The qualitative analysis of the race discussions revealed that White parents preferred ambiguous or scientific language and diverted the discussion to topics other than race, such as gender or general body characteristics. Discussions often involved referencing personal examples of individuals from racial minority backgrounds, even if they were not personally acquainted. The quantitative analysis expanded and clarified these findings, with parent characteristics, such as education level and the frequency of color-evasive messaging being negatively associated with avoidance of race discussions, while racial implicit biases positively related to parental nonengagement but not children's, suggesting that children may not be aware of their parents' discomfort or bias. The study concludes with suggestions for future research, including the need for larger and more diverse samples, longitudinal designs, and investigations into how racial implicit biases and frequency of racial messaging change over time.

Burnout is a psychological syndrome characterized by feelings of exhaustion, cynicism, and inefficacy, and is particularly prevalent in surgical specialties. Despite the widespread recognition that burnout is the result of exposure to chronic job stressors, research on burnout among physicians has primarily focused on individual correlates and solutions to this issue. We also have a limited understanding of what kinds of interventions have become available to physicians following the pandemic and what the most effective options are for those in independent practice. Thus, this thesis serves to fill a gap in the literature on physician burnout by using a validated organizational framework to identify the organizational drivers of burnout among surgeons and McMaster and update the literature on the state of burnout interventions in medicine. The first chapter explores the state of the literature on physician burnout, with a specific focus on surgical specialties and the theoretical gaps that exist in this field. Chapters two through four describe the design and findings of a mixed methods study exploring surgeons’ experiences with burnout and the workplace stressors associated with its symptoms. Chapter five consists of a systematic review and meta-analysis evaluating the effectiveness of interventions for physician burnout and provides a methodological critique of the available studies in this field. Finally, chapter six integrates the finding from the quantitative and qualitative strand of the mixed methods study while considering the findings in reference to available interventions. The findings presented in this thesis provide tangible recommendations to McMaster’s Department of Surgery on how to improve burnout symptoms with specific reference to the role of payment structures, tensions among leadership positions, patient care burden, moral injury, workplace incivility, and gender inequity. It also highlights opportunities for future intervention development focusing on health system stressors and organizational structures. / Dissertation / Doctor of Philosophy (PhD) / Burnout is a condition that results from issues in the workplace and is extremely common among physicians. Although we generally know where burnout comes from, what causes burnout tends to take different forms in different medical specialties and workplaces. Given the negative effects that burnout has on both physicians and the quality of patient care they are able to provide, it is important that we identify the specific stressors leading to burnout within different medical settings and identify effective interventions for the problems they face. Using a range of evaluation methods, including surveys, interviews, and reviews of the current research on this subject, this thesis looked to identify issues leading to burnout among surgeons at McMaster University, and provide specific recommendations on how to address them.