Problem: Financial strain has been reported by families of children with cancer. However, the specific costs and their impact on these families remain unknown. Objectives: (a) to identify the costs incurred by families of children newly diagnosed with cancer in Ontario, (b) to determine the variables that influence these costs, and (c) to explore the impact of these costs on families. Conceptual Framework: The conceptual framework incorporated the social, economic, disease, and treatment cost predictors with the direct and indirect cost of illness components. Setting: Two university-affiliated tertiary paediatric hospitals in Canada. Sample: English speaking parents of children newly diagnosed with cancer who were receiving treatment. Design: A prospective concurrent mixed method design. Instrumentation: The Ambulatory and Home Care Record © (AHCR) (Guerriere & Coyte, 1998) was used to record costs and an interview guide was developed to explore the impact of these costs on families. Procedure: Parents recorded the resources consumed and costs incurred during one week per month for three consecutive months beginning the 4th week following diagnosis and listed any additional costs incurred since diagnosis or between the face-to-face interviews. Parents also discussed the impact of these costs on their families in an audio taped interview. Data Analysis: Descriptive statistics and multiple regression modelling were used to describe families’ total costs (expressed in 2007 Canadian dollars) and to determine factors that influenced them. Descriptive qualitative content analytic methods were used to analyze the transcribed interview data. Results: In total, 99 parents including 28 fathers and 71 mothers completed three sets of cost diaries. The mean total three month expenditure was $28,475 (SD $12,670; range $2013 to $79,249) per family. There were no statistically significant factors that influenced families’ direct costs; however, 23% of the variance for indirect costs was explained by inpatient tertiary hospitalizations, language spoken at home, and distance to the hospital. Parents described the costs associated with their child’s illness and coping and management strategies used to lessen the financial impact including managing their expenses and seeking ways to increase their cash flow. Significance: Findings will inform health professionals and policy makers about families who are faced with potentially catastrophic costs following their child’s diagnosis with cancer.

Knowledge is a critical element for the provision of quality health care. Optimal clinical decision making incorporates multiple types of knowledge including patient knowledge, clinical experiential knowledge and research knowledge. Understanding how knowledge is shared and used in best practice is challenging as a number of factors can facilitate or impede the process. Several authors have highlighted the value of using a theoretical framework when examining knowledge in health care. A theoretical framework provides direction for the generation and testing of hypotheses which can contribute to building a comprehensive body of knowledge in a field of study. Although the majority of knowledge exchanged in practice settings occurs between clinicians, current knowledge exchange and utilization models in health care generally focus specifically on the exchange of research knowledge between the scientific community and the practice community. Acknowledging and understanding the knowledge seeking and sharing behaviours of clinicians is a key element in the larger knowledge translation puzzle. Emergency medicine is a clinical speciality where there is evidence of a knowledge to practice gap, however, there is limited understanding of the factors that contribute to the gap. Emergency practitioners must make decisions in a busy and often chaotic environment that is prone to multiple interruptions and distractions. The challenge for consistent and quality care is also more pronounced in rural and some suburban areas where emergency care needs are similar but resources are limited. The purpose of this program of research is to identify factors relevant to knowledge exchange and utilization in rural and urban emergency departments with the aim of developing a Model for Knowledge Exchange and Utilization in Emergency Practice. A series of studies were carried out using a mixed method research design to further develop and describe 3 key dimensions (individual, context of practice, knowledge) which were identified through a review of the literature. Data was collected using surveys, participant observations and interviews with nurses and physicians working in rural and urban emergency departments in Nova Scotia. Triangulation of results across the studies contributed to developing a comprehensive and rigorous description of the 3 dimensions of interest.

The ubiquity of Web 2.0 technologies has led to a seismic shift in the way educational services are delivered. It comes as no surprise then that e-tutoring—otherwise known as electronic or online tutoring—is quickly supplanting face-to-face tuition for reasons of both cost and convenience. While e-tutoring is an effective form of academic support for many students, its efficacy remains tenuous for those confronted with a digital divide that figures predominantly around geographic barriers, socio-economic status, and educational levels. Premised on diffusion research, this master's dissertation explores the implementation of an e-tutoring service known as Homework Help that has effected relatively low adoption rates. It uses a concurrent mixed-methods approach—including surveys, interviews, and focus groups—to examine the factors that have led to this low adoption rate. The results are presented via two journal articles situated within a larger meta-talk: The first article contrasts the adoption patterns apparent between rural and urban students, while the second article looks at the utility of diffusion research in examining educational technologies, as it explores the use of e-tutoring for applied stream students. The findings of this study suggest that rural and urban, as well as applied and academic student subgroups, differ in terms of their perception and adoption of e-tutoring. Implications for educational policy, especially in regards to rural education, are discussed.

Treatment acceptability and treatment integrity are essential constructs to consider when designing, implementing, and evaluating school-based interventions. Existing literature has described treatment acceptability and treatment integrity as separate constructs rather than investigating their interrelationships. Also, models of treatment acceptability and treatment integrity have not systematically included the perspectives of multiple stakeholders, have not addressed multiple time points in the intervention process, and have not emphasized multiple methods of data collection. This paper reviewed extant literature related to current definitions and models of treatment acceptability and treatment integrity and presented a comprehensive integrated model of these constructs that addressed the aforementioned gaps in the intervention literature. A mixed methods study exploring student, facilitator, and observer perceptions of treatment acceptability and treatment integrity of an eight-week bullying prevention intervention was conducted. The study investigated the role of cultural modifications (i.e., context-based procedural or curriculum changes employed to enhance the treatment acceptability or integrity of the intervention). Qualitative data were analyzed with an inductive-deductive approach (Nastasi et al., 2004). Deductive coding was used to illustrate components of treatment acceptability, treatment integrity, and cultural modifications salient to this research and an inductive approach was used to identify emerging themes. Consensus coding was conducted with greater than 90% interrater agreement. Quantitative data were analyzed using descriptive statistics. Qualitative and quantitative analyses revealed positive findings with respect to treatment acceptability and treatment integrity. Facilitator competence, behavior management, student engagement, and time management emerged as qualitative themes related to treatment integrity. Qualitative data suggested a positive relationship between student and facilitator perceptions of treatment acceptability. Qualitative findings revealed modifications to the curriculum content and delivery based on cultural factors (e.g., gender and age) to enhance treatment acceptability. Implications for school-based bullying research and applied practice were described. The results suggested that the use of mixed methods enhanced the comprehensiveness, depth, and quality of data regarding stakeholder perceptions of treatment integrity and treatment acceptability.

Background: Dementia diagnosis and management is increasing in importance in the training of future family physicians. This research evaluated the effects of a dementia education program on family medicine residents’ knowledge, attitudes and confidence with respect to dementia assessment and management. A questionnaire was developed and validated for these purposes. Additionally, a focus group was conducted with family physicians to generate recommendations for improving dementia education in family medicine residency programs. Methods: The questionnaire consisted of a knowledge-based component, a component ascertaining preferences working with various age groups, and an attitudinal/comfort component. Test-retest reliability was assessed, in addition to validity by way of cognitive interviews. A content validity matrix was also completed. Family medicine residents participating in the dementia education program were asked to complete the questionnaire at baseline, interim and following program completion. Willing residents also participated in program feedback interviews. After approximately three months, residents completed the questionnaire for long-term follow-up. Differences in scores were examined between the participants and a comparison group of family medicine residents without program exposure. Qualitative data from the feedback interviews and the focus group were transcribed and analyzed for common themes. Results: Each questionnaire component demonstrated high internal consistency (Cronbach’s α: 0.83-0.91) and high intraclass correlation coefficients (0.74-0.91). Residents who had participated in the program scored significantly higher on the knowledge component compared to residents who did not, in addition to reporting greater comfort. Qualitative data indicated that residents found the program to be a valuable part of their residency education. Focus group results indicate that family physicians recommend the provision of early positive experiences facilitated by mentors, through a competency-based curriculum. Discussion: The developed questionnaire is a reliable measure for assessing dementia knowledge, attitudes and confidence. Results from the dementia education program show that it is effective in improving family medicine residents’ knowledge on dementia diagnosis and management, as well as in increasing comfort levels. Qualitative data from feedback interviews indicate strong endorsement of the program by its participants. Recommendations generated from the focus group were found to be relevant to dementia education and potentially more broadly to geriatric education.

Increased prevalence rates of overweight and obesity (OW/OB) have been reported among Aboriginal women and while the literature suggests that changes in lifestyle (i.e. physical activity and diet) account for this trend, few studies have explored how the physical and sociocultural environments and individual attitudes and beliefs regarding physical activity (PA) and healthy eating may contribute to the increase. The purposes of this project were to: 1) Determine the current prevalence of OW/OB in the community, 2) assess changes in OW/OB from 1991 to 2005, 3) assess current PA and dietary practices, and 4) explore the influence of the physical and sociocultural environments as well as individual attitudes and beliefs regarding PA and healthy eating among the females in the community.<p> The prevalence of OW/OB was 26% among youth and 68% among adults. Overall, no significant difference in rates of OW/OB among youth or adults occurred over time, however there was a significant decrease in rates of OW/OB for adult males and a tendency towards a greater increase in OW/OB among female youth. A pattern of abdominal obesity among all age groups of females was noted. There was a significant increase in body mass index (BMI) classification over time among individuals with serial data. Walking and housework were the most frequently reported activities. Although the PA data suggests levels associated with health benefits, these results must be interpreted cautiously given housework was performed at a low intensity. Personal, community-specific and environmental factors were highlighted as barriers to PA, whereas organized, age-specific, women-only programs were highlighted as potential enablers for PA. Low intakes of fruits and vegetables and milk products across all age groups, with high intakes of foods high in fat, oil, sugar, salt, particularly among those under 25 years were reported. Traditional food use increased with increasing age, however was low even among women aged 55+. While food preference was influenced primarily by taste, barriers to healthy eating were largely related to geographic location. Collectively, the results of this study emphasize the importance developing community-based health promotion programs that focus on reducing identified barriers to PA and healthy eating to promote healthy body weights in the community.

Background: An understanding of the meaning of health is an integral component in the development of effective health promotion programs aimed at promoting health or preventing diseases such as childhood obesity. One group of Canadian children known to be at higher risk for obesity is those living in rural settings. The purpose of this current research was to explore the meaning of health of preadolescent children living in rural Saskatchewan. The following four research questions were addressed: (a) What are the general health characteristics of the study sample?, (b) What is the rural context of children participating in this study?, (c) What is the meaning (i.e. values, norms, beliefs, behaviors) of health from the perspectives of a group of preadolescent children?, and (d) Is the meaning of health thematically congruent from the perspectives of healthy weight and unhealthy weight children?. Study Design: Mixed methods explanatory sequential design (Participant selection model) with qualitative emphasis. Methods: Participants were recruited through classroom presentations and invitational letters sent out to all children attending a rural elementary school in Saskatchewan. Ninety-nine children (51.0% response rate) participated in the quantitative component [measurement of height and weight for purposes of determining healthy weight and unhealthy weight (overweight or obese) status and completion of health questionnaire examining dietary and physical activity patterns]. Of the children who met the selection criteria for qualitative follow up (Grade 4, 5, & 6 children who agreed to be interviewed and had a parent who agreed to be interviewed), twenty children and their parents were randomly selected to be individually interviewed for a total of 71 interviews. An observational assessment of the community was conducted by the researcher for the purpose of gaining a greater understanding of the rural context in which the study participants construct their meaning of health. Results: Prevalence of unhealthy weights in these rural children was high (34%) with gender differences evident at a very young age. Regardless of weight or health status, children described their cultural meaning of health as an integration of Knowing Stuff, Having a Working Body, and Feeling Happy. Of these three themes Feeling Happy was recognized as the most meaningful and children described that receiving encouragement and support from valued relationships contributed to their happiness and overall meaning of health. The rural environment appeared to provide a sense of safety, security, and freedom in which children frequently engaged. Significance of Findings: The high prevalence of unhealthy weights in this sample of rural children has the potential to negatively influence the present and future health of these children. Developing an understanding of the cultural meaning of health and how this culture may influence patterns of healthy behaviors may be a foundation to the development of successful interventions aimed at promoting healthy weights in rural children.

To address some remaining questions in the extant family caregiving literature, the present study examined a specific care-recipient (CR) problematic behavior that could be the most critical to family caregiver (CG) emotional and physical well-being--CR-resistance or uncooperative behaviors vis-à-vis the CG. In order to provide detailed descriptions of CR-resistance and to determine the impact of CR-resistance on CG emotional and physical well-being, the present study applied a sequential quantitative-qualitative mixed method design approach with 8-day diary survey data on 63 family CGs and follow-up semi-structured interview data from 19 of those CGs.The quantitative data documented and revealed significant within- and between-person variance in CR-resistance. Hierarchical Linear Modeling (HLM) analyses results further revealed that neither the mean level nor the daily fluctuation of CR-resistance across 8 survey days by themselves appeared to have a significant impact on CG emotional or physical health. However, the combination of having relatively high mean level and daily fluctuation of CR-resistance brought had a significant impact on CG physical health; when CGs with relatively high mean level CR-resistance faced more than their usual amount of CR-resistance on a given day, they reported increases in physical health symptoms.The qualitative inductive thematic analyses revealed that based on the context in which CR-resistance occurred and the occurrence patterns, CR-resistance experiences could be divided into four types, and these four types of CR-resistance seem to pose different types and/or magnitude of impact on CG emotional well-being.Furthermore, informed by Social Cognitive Theory and Stress Theory, the present study also examined CG personal, interpersonal, and social resources as possible moderators of the link between CR-resistance and CG emotional/physical well-being. HLM analyses results revealed that CG sense of efficacy, community/professional service utilization, and family disagreement regarding care played significant moderating roles. The qualitative thematic analyses clearly suggested that specific CG cognitive resources--particularly those that were transferred and/or generalized from the CG's past professional or personal experiences--have a strong influence on CG resilience in the face of CR-resistance. The moderating results were interpreted light of theoretical frameworks and extant literature. Implications and future directions are discussed.

Background: Dementia diagnosis and management is increasing in importance in the training of future family physicians. This research evaluated the effects of a dementia education program on family medicine residents’ knowledge, attitudes and confidence with respect to dementia assessment and management. A questionnaire was developed and validated for these purposes. Additionally, a focus group was conducted with family physicians to generate recommendations for improving dementia education in family medicine residency programs. Methods: The questionnaire consisted of a knowledge-based component, a component ascertaining preferences working with various age groups, and an attitudinal/comfort component. Test-retest reliability was assessed, in addition to validity by way of cognitive interviews. A content validity matrix was also completed. Family medicine residents participating in the dementia education program were asked to complete the questionnaire at baseline, interim and following program completion. Willing residents also participated in program feedback interviews. After approximately three months, residents completed the questionnaire for long-term follow-up. Differences in scores were examined between the participants and a comparison group of family medicine residents without program exposure. Qualitative data from the feedback interviews and the focus group were transcribed and analyzed for common themes. Results: Each questionnaire component demonstrated high internal consistency (Cronbach’s α: 0.83-0.91) and high intraclass correlation coefficients (0.74-0.91). Residents who had participated in the program scored significantly higher on the knowledge component compared to residents who did not, in addition to reporting greater comfort. Qualitative data indicated that residents found the program to be a valuable part of their residency education. Focus group results indicate that family physicians recommend the provision of early positive experiences facilitated by mentors, through a competency-based curriculum. Discussion: The developed questionnaire is a reliable measure for assessing dementia knowledge, attitudes and confidence. Results from the dementia education program show that it is effective in improving family medicine residents’ knowledge on dementia diagnosis and management, as well as in increasing comfort levels. Qualitative data from feedback interviews indicate strong endorsement of the program by its participants. Recommendations generated from the focus group were found to be relevant to dementia education and potentially more broadly to geriatric education.

Knowledge is a critical element for the provision of quality health care. Optimal clinical decision making incorporates multiple types of knowledge including patient knowledge, clinical experiential knowledge and research knowledge. Understanding how knowledge is shared and used in best practice is challenging as a number of factors can facilitate or impede the process. Several authors have highlighted the value of using a theoretical framework when examining knowledge in health care. A theoretical framework provides direction for the generation and testing of hypotheses which can contribute to building a comprehensive body of knowledge in a field of study. Although the majority of knowledge exchanged in practice settings occurs between clinicians, current knowledge exchange and utilization models in health care generally focus specifically on the exchange of research knowledge between the scientific community and the practice community. Acknowledging and understanding the knowledge seeking and sharing behaviours of clinicians is a key element in the larger knowledge translation puzzle. Emergency medicine is a clinical speciality where there is evidence of a knowledge to practice gap, however, there is limited understanding of the factors that contribute to the gap. Emergency practitioners must make decisions in a busy and often chaotic environment that is prone to multiple interruptions and distractions. The challenge for consistent and quality care is also more pronounced in rural and some suburban areas where emergency care needs are similar but resources are limited. The purpose of this program of research is to identify factors relevant to knowledge exchange and utilization in rural and urban emergency departments with the aim of developing a Model for Knowledge Exchange and Utilization in Emergency Practice. A series of studies were carried out using a mixed method research design to further develop and describe 3 key dimensions (individual, context of practice, knowledge) which were identified through a review of the literature. Data was collected using surveys, participant observations and interviews with nurses and physicians working in rural and urban emergency departments in Nova Scotia. Triangulation of results across the studies contributed to developing a comprehensive and rigorous description of the 3 dimensions of interest.