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Prior to the coronavirus disease-2019 (COVID-19) pandemic people with chronic obstructive pulmonary disease (COPD) were already experiencing social isolation due to the complex intersection of symptoms, and perceptions towards the illness. COPD is a chronic lung illness characterized by progressive shortness of breath, and decreasing lung function, with influenza and other respiratory illnesses more likely to have fatal consequences for this population. Societal beliefs and assumptions around behavioural risk factors, and in particular smoking, contribute to perceptions that COPD diagnosis, outcomes and experiences are self-inflicted and an individual responsibility. This is a perspective that fails to take into the account the complex contextual factors of the social determinants of health, where structural inequities result in higher smoking rates among populations with lower socioeconomic status. Further, these underlying societal values may compound the isolation experienced with COPD in which ongoing stigma towards the illness discourages people from identifying with a COPD diagnosis. The lack of identity may discourage developing a community where people can share experiences and strategies in living with COPD, and form a collective group that can advocate for change. Digital technologies (DTs), such as Facebook and Zoom offer new avenues to support social connectedness. However, little focus has been given on how people with COPD may (or may not) be using DTs to support their illness. This study explored the role DTs could serve in addressing social connectedness and experiences and outcomes for the COPD community. The study was informed by Mertens (2003, 2007) transformative approach where the knowledge of people living with COPD was prioritized in finding out what DTs they may be using to maintain social connectedness and to support their illness. The three stage mixed methods research design consisted of interviews, patient-reported outcome measures, patient-reported experience measures and a DT survey. Bazeley's (2018) approach was used to guide the integrative mixed analysis on data collected across the three stages. The overall findings were: 1) Participants’ experiences in living with COPD had uniquely prepared them for the COVID-19 pandemic, and it was the community that lacked capacity; 2) Dominant discourse around technology may be creating further harms to the COPD population that extend beyond the digital world; 3) Current digital health monitoring strategies for other chronic illnesses do not fully translate to the interests and needs for people living with COPD; 4) People living with COPD are using DTs, but prefer to keep their virtual world separate from their illness world; and 5) Considerations for DTs for COPD should move beyond managing outcomes, and include supporting experiences of living. Conducted between December 2018 and July 2020, and concurrent with the COVID-19 pandemic, the study demonstrated even greater importance with the onset of the pandemic in understanding how DTs may support social connectedness for people living with life-limiting chronic lung conditions. / Graduate / 2022-02-07

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No description available.

Under the influence of Confucianism, Taiwanese people have always emphasized family values as an essential culture. The concept of relationship completion (Byock, 1996) was embodied as the core belief for end-of-life care in Taiwan, known as the Four Expressions in Life: Love, Gratitude, Forgiveness, and Farewell. The palliative care team in Taiwan advocates the Four Expressions in Life to help patients at the end of life strengthen bonds with their families. However, the traditional and conservative culture in Taiwan often impedes relationship completion. The purpose of this study was to examine the effects of music therapy to facilitate relationship completion for patients at the end of life and their families, and to understand the perceptions of patients at the end of life and families about their relationship completion during music therapy. This study took a further step in exploring how the perceptions of patients at the end of life, and their families about their relationship completion during music therapy helped to explain the effects of music therapy intervention.This study employed a convergent mixed methods design in which qualitative and quantitative data were collected in parallel stages, analyzed separately, and then the findings were merged. For the quantitative phase, a convenience sample of 34 patients at end-of-life care at a large teaching hospital in southern Taiwan and 36 of their family members were recruited in a single music therapy intervention with a one-group pretest-posttest design. Measures included the “Life Completion” subscales of the Quality of Life at the End of Life (QUAL–E) survey and a single-item global QoL indicator for patients as well as the QUAL-E (Fam) survey and a question of Overall Quality of Life for family members. In the qualitative phase, a nested sample of five patients and nine family members completed the semi-structured interviews about their experiences of the music therapy sessions. There were significant differences (p<.001) between the pre and post session scores for the Life Completion subscale of the QUAL-E and between pre-post scores for the global QoL Indicator for patient participants. The results also showed a significant difference (p<.001) in the scores for the Completion subscale of the QUAL-E (family) and a significant difference (p<.001) in the scores for Overall Quality of Life for families from before music therapy session to after music therapy session. Four themes emerged from the qualitative results: music therapy provides the opportunity for exploration, music therapy provides the opportunity for connection, music therapy provides the opportunity for expression, and music therapy provides the opportunity for healing. The integrated findings suggested that music therapy facilitated relationship completion and improved quality of life for both patients and their families. The use of songs in music psychotherapy had a significant contribution to relationship completion. Song interventions can accommodate a patient's physical weakness and life-limiting obstacles at the very end of life to achieve the ultimate goal to improve quality of life, by assisting relationship completion. The results suggested that the transformative level of music therapy within a single session for end-of-life care in Taiwan is both feasible and culturally acceptable. / Music Therapy

This study, which is focused on addressing the rising prevalence of gestational diabetes mellitus (GDM) in South Asians begins from the perspective that the development of diabetes has scope across public health and anthropology. The onset and progression are rooted within social determinants of health and cultural practices. Similarly, pregnancy—which is a crucial component of the life course—is a time where not only nutrients are shared between mother and child, but also when knowledge is exchanged, and cultural ways are imparted to the pregnant person from their friends and family. Within the South Asian community of Southern Ontario, recent public health evidence demonstrates a high rate of GDM where 1 in 3 South Asians will develop the condition. Babies born to GDM mothers are of higher birthweight and percent body fat than those of non-GDM mothers. Interventions to prevent GDM are important because GDM itself is a risk factor for postpartum obesity, diabetes, and atherosclerosis in the mother, and also because infants with more adipose tissue are more likely to become insulin resistant in adolescence and develop diabetes and cardiovascular disease as adults. Discussions to strengthen the public health response to this challenge can incorporate evidence-based counselling tools (e.g., easily scalable knowledge translation (KT) tools) that can be used by prenatal clinicians providing primary care. Given that diet and physical activity can be influenced not only by an individual locus of control, but also by familial interactions/networks and cultural/traditional foods and expectations, there is a need to better understand and weave in these experiences. I sought to better understand 1) the prenatal lifestyle counselling experiences of South Asians and their family doctors; and 2) the KT tools that have been designed and used in this population; then I used these learnings to develop and evaluate a conceptually-informed, evidence-based KT tool for pregnant South Asians and their family physicians. This dissertation begins with an introduction of patient and provider experiences with lifestyle change. I then present a systematic review and narrative synthesis of prenatal KT tools designed for South Asians. This is followed by a case report that outlines the process taken to develop a patient-facing and provider-facing KT tool (‘SMART START’). Next, I include the design and evaluation of a mixed methods pilot evaluation study of ‘SMART START.’ Finally, I culminate with an epilogue that ties in lessons learned and challenges that were overcome throughout the conduct of this work. The concluding chapter also includes a link to a video that captures the story behind this dissertation and the documentation of how all the aforementioned pieces are nested within and built upon one another. / Dissertation / Candidate in Philosophy

Background: The transition from pre-school to kindergarten can be complex for children who need special assistance due to mental or physical disabilities (children with “special needs”). We used a longitudinal mixed-methods approach to explore parents’ experiences with service provision as their children transitioned to school. Methods: Parents (including one grandparent) of 37 children aged 4 to 6 years completed measures assessing their perceptions of and satisfaction with services, as well as their perceptions of the children’s behaviour. Teachers completed measures indicating children’s school readiness and school adjustment. Semi-structured interviews were conducted with parents to understand their experiences with services. Findings: Post-transition, parents reported lower perceptions of services and decreased satisfaction than pre-transition. Pre-transition perceptions of services and satisfaction with services were associated with some of the children’s outcomes important for school success. Socio-economic characteristics of parents did not predict change in their perceptions of services or satisfaction with services post-transition. The following themes emerged from the qualitative data: qualities of services and service providers, communication and information transfer, parent advocacy, uncertainty about services, and contrasts and contradictions in satisfaction. The qualitative findings indicate parents were both satisfied and concerned with aspects of the post-transition service provision. Conclusions: While the quantitative results suggested that parents’ experience with services became less positive after their children entered school, the qualitative findings illustrated the variability in parents’ experiences and components of service provision that require improvements to facilitate a successful school entry. / Thesis / Master of Science (MSc)

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No description available.