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.

In a rapidly growing global economy businesses must effectively manage their assets to remain competitive and promote company growth. Many companies are only now beginning to realize that employee knowledge is a valuable asset to their business and also needs to be managed. Organizations are exploring different ways to improve the sharing of knowledge within a business and how to keep employee’s with key knowledge within the business. This study investigates social media and the impact of business hierarchy on knowledge sharing within an organization. The use of social media, in our particular case, wikis, within an organization is investigated as part of the broader term Enterprise 2.0. This study is based on the theoretical understanding of wikis as tools that enable internalization, externalization and objectification of knowledge. This study investigates what may be the contributing factors that affect an employee’s use of a centralized wiki for knowledge sharing. This study focuses on the employees of a British software development and training company, SoftX, and used a mixed method research strategy based on the use of online surveys and face-to-face interviews. We used an online tool, SurveyMonkey, to register and correlate responses to our survey. In total, 99 responses were received and semi-structured, face-to-face interviews were conducted with five employees.   Correlations were used in establishing foundation for the analysis of the variables. Finally, the causality between the assumed factors affecting the use of the SoftX wiki is tested using multiple linear regression analysis. Several important factors presented themselves as a result of our study at SoftX which could explain the apparent lack of use of their wiki as a means of knowledge sharing within the business. The analysis demonstrates that the use of the SoftX's wiki by employees was influenced by organizational, personal and technological factors.

The role of the library is changing to meet the demands of a technology-driven society. Yet the impact of new media, such as e-books, has not always been viewed favourably. The aim of this thesis has been to map the debate that took place between 2010 and 2015 concerning the status of e-books within the public library system. The study focused on several key areas: attitudes expressed within Swedish library press; the issues raised within discussions; aspirations and concerns of participants; and how opinions changed over time. The 99 issues of Biblioteksbladet, Biblioteket i Samhälle, and Framsidan published during the years of study constituted the source material. Computerised content analysis targeted keywords: e-, elektronisk, and digital. Results were logged chronologically, and coded to record any opinion expressed in relation to e-books: either positive, negative, or neutral. Raw data analysis was enhanced by the critical theories of LIS-professor Kristen Drotner. Her concept of media panic describes the emotional reactions professionals experience in response to new forms of media and technology. This was used to assess whether criticisms of the new medium were part of an emotional response. The results of our analysis suggest a cycle of debate that only partially fit Drotner's concept of media panic: initial discussions focused on technical considerations, the debate intensified and moved to economic concerns and the changing role of the library as the rate of e-book loans proliferated. The final years of study were characterised by calls for national co-operation regarding the implementation of e-books.

Study Purpose: Ovarian cancer, the most lethal gynecologic cancer, has had a relatively stable mortality rate since 1975, despite a decrease in mortality for all gynecologic cancers combined. Standard-of-care advances are needed to reduce ovarian cancer morbidity and mortality. Advances must, however, undergo a long, rigorously controlled research process that can take more than ten years before becoming available to the public. Further, few women with persistent or recurrent ovarian cancer are offered or enrolled in the clinical trials that do exist at select sites throughout the nation. The purpose of this multiple-case study is to identify necessary and/or sufficient factors associated with enrollment in ovarian cancer clinical trials, and to identify facilitators and barriers within the practice setting that, in the longer term, can be used to inform targeted interventions to improve trial access and accrual. The multilevel factors that were explored were aligned with the Consolidated Framework for Intervention Research (CFIR). The study sought to answer two research questions. (1) Based on Qualitative Comparative Analysis [QCA (Ragin, 1989)], what necessary and/or sufficient factors would enable a woman with recurrent or persistent ovarian cancer to enroll in a clinical trial in Florida? (2) What barriers and facilitators, practitioner and patient-specific, exist with regard to enrolling women with ovarian cancer in clinical trials? Materials and Methods: This multiple case study used online surveys to obtain quantitative and qualitative data from two populations: women with ovarian cancer and nurses at various referring practice sites. Data from Moffitt Cancer Center’s Total Cancer Care protocol was requested to conduct chart reviews that would identify prospective participants. Qualitative comparative analysis (QCA), which is useful for determining causality in small sample sizes, was used to determine necessary and/or sufficient factors associated with enrollment by women with ovarian cancer in clinical trials, as well as barriers and facilitators related to clinical trial enrollment. Results: Women with ovarian cancer who participated in clinical trials were stage III/IV, wanted information, and engaged in discussion about clinical trials, making those factors necessary for enrollment in a study. Facilitators for participation were discussion with the provider of care, to some extent the existence of patient-accessible clinical trial literature in the practice, knowledge that health insurance covers standard of care costs, and having a provider who offers clinical trials. Absence of those factors thus constitutes a barrier. For nurses, the impact of having a practice team plan was related to enrolling women with ovarian cancer in clinical trials, and feeling informed and comfortable with questions women might ask about trials. Conclusion: Clinical trials are an underutilized priority for improving the standard of care and reducing the high rate of morbidity and mortality associated with ovarian cancer. The data show deficits and needs within two key interrelated populations: medical oncology practice nurses and women with ovarian cancer. Opportunities exist within each level of the Consolidated Framework for Implementation Research (CFIR); interviews should be used to confirm the findings, which can be used to establish an interventional protocol to increase clinical trial enrollment by women with ovarian cancer.

Proposing marriage is one of the few rituals that many people engage in world-wide, and yet many aspects remain a mystery. For example, there is currently no research on rejected marriage proposals, despite their potential impact on the self and well-being. The purpose of the present research was to compare and contrast rejected and accepted marriage proposals. Because the traditional proposal script is well known in Western society, I hypothesized that all proposals would be high rather than low in traditionalism. But, men whose proposal is rejected may not know that women prefer private proposals (Hoplock, 2015), and so I hypothesized that rejected proposals would be more likely to occur in public compared to accepted proposals. Additionally, I hypothesized that couples would distance themselves from each other during rejected proposals. I also predicted that couples would remain close to each other during accepted proposals compared to during rejected proposals. Finally, I hypothesized that couples experiencing rejected proposals would be less likely to talk about marriage in advance than couples experiencing accepted proposals. I tested these hypotheses in two studies. I conducted a content analysis of 285 marriage proposal videos (36 rejected proposals, 249 accepted proposals; Study 1), and of 374 first-person written accounts of marriage proposals (180 rejected proposals, 194 accepted proposals; Study 2). Trained coders rated the proposals for traditionalism (e.g., offering a ring), the presence of others, and couple members’ approach and avoidance goals. I also used inductive coding to derive themes from the data. Additionally, in Study 2, trained coders noted men’s motivation for proposing and women’s reasons for their response, the relationship status before and after the proposal, and whether couples discussed marriage in advance of the proposal. In Study 1 but not Study 2, proposals were high rather than low in traditionalism. In both studies, rejected proposals were less traditional than accepted proposals. Some traditional behaviors were particularly strong as distinguishing between proposals: The odds of a proposal being accepted were 8 – 20 times higher if the proposer presented a ring. Expectedly, rejected proposals were more likely to occur in public than accepted proposals. Moreover, women were particularly affected by the proposal, distancing themselves from their partner during rejected proposals and drawing close to their partner during accepted proposals. Providing insight into the proposers’ motivations, men often proposed for reasons such as a desire to commit to their partner, but, unlike men whose proposal was accepted, men whose proposal was rejected were also likely to propose out of desperation. Furthermore, women most commonly declined a proposal because they thought they were too young or not ready to get engaged. Unfortunately, some of the heartache of rejected proposals may have been avoided if the couple members had discussed marriage in advance: Only 29% of couples experiencing rejected proposals discussed marriage in advance, compared to 100% of couples experiencing accepted proposals. The rich nature of this data brings to life the proposal experience and highlights many potential directions for future research. / Graduate / 0621 / 0451

This paper contributes to the discussion on the effects of single motherhood on happiness. We use a mixed-method approach. First, based on indepth interviews with mothers who gave birth while single, we explore mechanisms through which children may influence mothers' happiness. In a second step, we analyze panel survey data to quantify this influence. Our results leave no doubt that, while raising a child outside of marriage poses many challenges, parenthood has some positive influence on a lone mother's life. Our qualitative evidence shows that children are a central point in an unmarried woman's life, and that many life decisions are taken with consideration of the child's welfare, including escaping from pathological relationships. Our quantitative evidence shows that, although the general level of happiness among unmarried women is lower than among their married counterparts, raising a child does not have a negative impact on their happiness.

Sickle cell disease (SCD) and depression are each major public health issues globally. Nigeria currently has the largest proportion of people with SCD worldwide, with up to 150,000 annual births. This study highlights the limitations of previous studies, which only utilize the biomedical model in explaining SCD, and which pay insufficient attention to the lived experiences of people with SCD. Extant literature reports strong associations between SCD and depression, and locates the problem ‘only’ in terms of disease severity, levels of service utilization or alleged psychological maladjustment to SCD condition. Biomedical research tends to treat stigma as a predicament that automatically correlates with SCD. Data collected was guided by a modified three-staged theoretical framework derived from Arthur Kleinman, with the use of questionnaires (incorporating Patient Health Questionnaire) to describe depression in persons with SCD; 15 in-depth interviews to explore the illness experience of SCD, and a series of six focus groups to examine depression and stigma in SCD as a form of ‘societal sickness’. In the first stage, questionnaires were administered to 103 outpatients at an SCD clinic in Lagos, Nigeria, and findings revealed an association of depression with age, and severity of SCD as indicated by symptoms such as leg ulcers. The first stage enabled those with moderate depression to be identified and invited into the subsequent stages (two and three) of the research. In the second stage, fifteen in-depth interviews with adults living with SCD were conducted and analysed using interpretive phenomenological analysis (IPA), also drawing on the influences of Herbert Blumer and Erving Goffman. Testimonies suggested that people with SCD face overwhelmingly negative criticisms from a wide range of significant others, including close family members; that the discrimination they face arises not from their condition per se but from the societal norms and expectation that they are assumed to break; and that they themselves identify pathways from the negative experience they endure to their own depression and mental distress. In the third stage, a series of three focus groups, each with five participants, found that people with SCD began to reject negative labels, identify challenges in their own terms, gain a sense of confidence and identity from their participation in groups, and began to identify social barriers to their full participation in society that they wished to challenge. The overall findings of the research suggest that by coming together in groups, people with SCD themselves suggest that rigorously researched social interventions may be considered an important adjunct to medical interventions in improving the lives of those living with SCD in Nigeria and throughout sub-Saharan Africa.

China’s rural-urban migration has resulted in 61 million children living apart from their parent(s) in rural communities. Previous studies have failed to examine the long-term effects of parental migration on left-behind children’s nutritional health, and have not examined the gender differences (of parents and children) in those associations. This research uses a mixed-methods design that incorporates quantitative and qualitative techniques to explore links between parental migration, care-giving arrangements and left-behind children’s nutritional health in rural China. The quantitative analyses draw on a longitudinal dataset – the China Health and Nutrition Survey (CHNS) (1997, 2000, 2004, 2006, and 2009) to examine the relationships between children’s nutritional outcomes and different patterns of parental migration including being left behind in different stages of childhood, and being left behind by the father or the mother. The qualitative component consists of analyses of interviews with 32 caregivers (21 grandparents, 9 mothers, and 2 uncles/aunts), and children’s diaries (26 children aged 6-12, 21 left-behind children and 5 non-left-behind children) to explore the care-giving practices for left-behind children from the perspectives of a group of children and their caregivers in rural northern central China. Results of the quantitative analyses show negative associations between parental migration, especially maternal migration, and left-behind children’s nutritional outcomes indicated by anthropometric measures and macronutrient intakes, and this is particularly true for boys left behind during early life in rural China. The qualitative findings highlight the importance of socio-cultural factors, since there seems to be a paradox of intergenerational obligations for boys in a culture where sons are more valued than daughters. This is because parents migrate to save for their sons’ adult lives, reducing the remittances sent to support their sons who stay behind. There is less pressure to save for daughters’ adult lives and so more potential for remittances to support their nutrition. The research also recognizes the importance of grandparents as carers, and their experiences and beliefs about healthy eating for children. Grandparents, particularly on the paternal side, are expected to fulfil social obligations to care for left-behind grandchildren even without immediate financial returns. Inadequate financial support from the migrant parents of left-behind boys in rural China, in particular boys cared for by paternal grandparents, may result in greater risk of poor nutrition during the early childhood. This potentially renders such left-behind boys vulnerable to developmental delays. These findings are important for policy-makers to develop effective interventions to improve left-behind children’s nutritional well-being in rural China.

The purpose of this study was to examine how the intersection of gender scripts, gender identity, and sexual orientation impact perceived narratives and power hierarchies in sexual relationships. To drive participants to verbalize their underlying views about sexual scripts, two highly sexualized and controversial sexual cultures will be examined: casual sex and pornography. Feminist academics and advocates have long argued for a restructuring of sexual politics by implementing feminist principles into personal relations and public life (Connell, 1997). Therefore, competing feminist ideologies will also be assessed to gauge the campus’s feminist climate regarding self-identified feminists’ views on the exploitation and/or the empowerment of women within pornography. Findings from this study indicated that respondents view women’s participation in hookups or pornographic situations similar to how they viewed men’s participation. However, internalized homophobic messages were discovered, particularly from male respondents. The findings also suggest that feminists in this sample were generally accepting of pornography, but that feminism did not play a key role in shaping respondents beliefs.