The aim of this study was to explore how the Black Lives Matter movement was constructed on Instagram by American television channels the week after George Floyd was killed. The purpose was to answer the following questions; (1) What proportion of the posts were dedicated to the Black Lives Matter movement during the chosen week? (2) How was George Floyd and Derek Chauvin portrayed on the media ́s Instagram? (3) What words and images were used to describe the Black Lives Matter movement? (4) What similarities and differences can be found between the channels ́ portrayals of the Black Lives Matter movement? The approach chosen was a multi-method research, thus using a both qualitative and quantitative design. Based on this method 112 Instagram posts uploaded between May 27th and June 2nd, 2020 were analyzed. CNN, Fox News and MSNBC are the largest news channels in the United States and therefore chosen for this study. Our study concluded that the overall presentation of the Black Lives Matter movement was positive, in terms of the total reporting from all three channels. Observing the channels separately, CNN and MSNBC mostly portrayed it positively, while Fox News mostly negatively. According to our analysis, the reason why the posts could be perceived in this way was based on the words used and images displayed. The words death, looter, and violence provided a negative understanding of the situation. Whereas the words such as loving, solidarity and freedom created a positive appearance. Overall the study found that the proportion of reporting on Black Lives Matter was vast in comparison to other news stories on all three channels. However, one of the substantial differences between them was the portrayal of the offender Derek Chauvin and the victim George Floyd.

Using a mixed-methods approach, the current study examined the relationship between early childhood preservice teachers' cultural awareness and their self-efficacy in equitable science education. It further aimed to determine if the relationship between these two constructs was moderated by their race/ethnicity or the number of languages they speak. Finally, it sought to identify preservice teachers' understanding of equity in science education, as well as how they planned to incorporate the equity concept into their future science teaching practices for diverse learners in early childhood classrooms. Data for this study were drawn from 380 preservice teachers who self-enrolled in a science methods course as part of a teacher preparation program. To measure the preservice teachers' cultural awareness and self-efficacy in equitable science education, two Likert-scale instruments, Cultural Diversity Awareness Inventory (CDAI) and Self-Efficacy Beliefs about Equitable Science Teaching and Learning (SEBEST), were employed. Qualitative data were collected by administering six open-ended questions. For quantitative results, statistically significant findings indicated that when the participants were more aware of creating a multicultural environment and instruction and/or when they were less biased and were more sensitive/knowledgeable about diversity of students and families, their expectations about science learning of students from diverse backgrounds would be higher. Furthermore, when the participants were more aware of creating a multicultural environment and instruction and/or when they felt more comfortable about confronting students or parents whose cultures and languages were different from their own, they tended to have a stronger sense of efficacy in teaching science to those students. In addition, when the participants were less biased and were also sensitive and knowledgeable about students' and families' diverse backgrounds, they were more likely to have a strong sense of science teaching efficacy. Along with these findings, participants' race/ethnicity was a statistically significant moderator affecting the relationship between their sense of science teaching outcome expectancy and awareness of creating a multicultural environment and instruction. When the awareness of creating a multicultural environment and instruction of both White and non-White participants were increased at an equal level, White participants' expectations for science learning of students from diverse backgrounds were higher than those of non-White participants. Measurement challenges were identified through the analysis process that compromised the validity of the quantitative findings. Thus, they should be interpreted with caution. For qualitative results, three predominant themes related to the participants' conceptualization of equity in science education were identified. First, the participants harbored alternative understandings of the definitions of equity in science education. One third of the participants understood equity as providing appropriate access and support based on the levels of students' needs whereas another one third defined equity as providing identical teaching services and resources to all students regardless of their backgrounds. They also conceptualized equity in science education as an issue independent of their future students' racial/ethnic backgrounds; instead, they regarded it as a subject associated with their students' English proficiency.

Diaconia research in the Nordic countries 2015-2019 This master thesis is a systematic literature review of the field of diaconal research in the Nordic countries during the period 2015 - 2019. I have conducted a Mixed Methods Research Synthesis on 134 selected titles, corresponding to the search protocol. Diaconia is sometimes defined as the social work or social care performed by the Christian church, but as my report shows, the concept of Diaconia can be defined in several ways, from narrow to wide delimitations. As a research field, Diaconia research is not clearly defined. One of the findings of my study is that Diaconia research draws from and contributes to ecclesiology, sociology and psychology of religion, systematic theology, church history and patristic studies. The main Nordic research site for diaconal studies is VID Specialized University in Norway. Other major contributors to the field are Uppsala University (CRS), Ersta Sköndal Bräcke University, University of Eastern Finland and MF Norwegian School of Theology, Religion and Society. My report shows recent developments in the theology of Diaconia, and makes visible differences and similarities in the understanding of the Deacon’s office in the Nordic majority churches. Deacons in Finland, Norway and Sweden struggle with similar challenges of mandate and responsibilities, which is shown by comparison between several referenced studies. These challenges appear to be connected to gender, a low over all appreciation of social care in society and church alike, and not the least, outdated theological interpretations of the Deacon’s office as humble or lowly service. Contributions from an international research project at University of Eastern Finland are aiming to correct some of these misunderstandings by retranslating texts from the patristic era. All in all, the referenced studies show, that diaconal works in the Nordic countries are making important contributions to society, expanding beyond the concept of care, engaging in theological development, social innovation, social mobilisation and interreligious cooperation. My study makes a theoretical contribution by adapting the concentric model for Diakonia developed by Erik Blennberger (1946 – 2018), based on this empirical finding.

The aim of this mixed-methods research study is to investigate the effectiveness of a Municipal Skills Development Programme (MSDP) in the improvement of service delivery in a District Municipality (DM) in South Africa. A concurrent embedded mixed-methods strategy was used, as it uses one data collection phase during which both qualitative and quantitative data are simultaneously collected and treats both qualitative and quantitative research data gathered on an equal basis. Collected data were not integrated or triangulated but resided side-by-side as two different pictures of the effectiveness of the MSDP. From a total population of 80 managers in the DM and its five Local Municipalities (LMs) who had attended the MSDP, qualitative data was gathered by conducting individual interviews with a convenient sample of 10 managers (Sample 1). Quantitative data was gathered by means of a self-designed questionnaire from a convenient sample of 50 managers (Sample 2). The audio-recorded and transcribed qualitative data obtained from the 10 semi structured interviews were analysed by means of content analysis, while the scores obtained from the 50 survey questionnaires were used to calculate the frequency of responses and then represented by figures and tables. Qualitative findings indicated that the majority of participants (90% of 10 managers interviewed) are of the opinion that the implementation of the MSDP within the DM was successful and has led to improved service delivery. Quantitative results indicated that the total sample of 50 managers rated the MSDP as having improved service delivery in the DM. The overall mixed-methods assessment indicated that the MSDP is a successful way of improving the service delivery in a DM in South Africa and that the attendance of the MSDP by all managers is essential for improving the service delivery of local governments in South Africa. A limitation of the study was that the study was conducted in only one DM and may not represent the views of all local government employees in South Africa. Recommendations were that the relationship between the MSDP and other organisational variables such as productivity, efficiency and effectiveness should be studied, while all managers of the DM who have not yet attended the MSDP should be encouraged to do so. / Industrial and Organisational Psychology / M. Com. (Industrial and Organisational Psychology)

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Medication adherence in patients with asthma and chronic obstructive pulmonary disease (COPD) is notoriously low and is associated with suboptimal therapeutic outcomes. To intervene effectively, family physicians need to assess medication adherence efficiently and accurately. Otherwise, failure to detect nonadherence may further reduce patient disease control and result in unnecessary treatment escalation that can increase the risk of adverse events and lead to more complex and costly drug regimens. The overarching goal of this thesis was to investigate how the use of secondary healthcare data can be leveraged to optimize medication adherence in clinical practice. Methodological considerations to facilitate our understanding of treatment escalation in asthma using secondary healthcare data were also examined. In the first part of my doctoral research program, I led a project which aimed at developing e-MEDRESP, a novel web-based tool built from pharmacy claims data that provides to family physicians with objective and easily interpretable information on patient adherence to asthma/COPD medications. This tool was developed in collaboration with family physicians and patients using a framework inspired by user-centered design principles. As part of a feasibility study, e-MEDRESP was subsequently implemented in electronic medical records across several family medicine clinics in Quebec (346 patients, 19 physicians). Findings showed that its integration within physician workflow was feasible. Physicians reported that the tool helped to: 1) better evaluate their patients’ medication adherence; and 2) adjust prescribed therapies, with mean ± sd ratings (5-point Likert scale) of 4.8±0.7 and 4.3±0.9, respectively. A pre-post analysis did not reveal improvement in adherence among patients whose physician consulted e-MEDRESP during a medical visit. However, significant improvements in adherence for inhaled corticosteroids (Proportion of days covered (PDC): 26.4% (95% CI: 14.3-39.3%)) and long-acting muscarinic agents (PDC: 26.4% (95% CI: 12.4-40.2%)) were observed among patients whose adherence level was less than 80% in the 6-month period prior to the medical visit. The second part of this research program consisted of two studies which laid the groundwork to estimate the association between medication adherence and treatment escalation in asthma using Canadian healthcare administrative data, a phenomenon that is currently under-explored in the literature. Prior to embarking in this study, it is important to ensure that healthcare administrative databases can be used to identify asthma patients and treatment escalations in an adequate manner. First, a systematic review was conducted to obtain an overview of the available evidence supporting the validity of algorithms to identify asthma patients in healthcare administrative databases. The algorithm developed by Gershon et al. (Canadian Respiratory Journal, 2009;16(6):183-188) comprising ≥2 ambulatory medical visits or ≥1 hospitalization for asthma over two years had the best trade-off between sensitivity (84 %) and specificity (77%). Second, an operational definition of treatment escalation was developed through a Delphi study that incorporated an expert consensus process. This definition includes 7 steps and was inspired by the 2020 Global for Initiative for Asthma treatment guidelines. I plan to integrate the definitions obtained from these two studies in a future cohort study which aims to examine the association between medication adherence and treatment escalation in asthma. My research provides compelling evidence on the importance of developing and evaluating the feasibility of implementing tools which can aid physicians in assessing medication adherence in clinical practice and extends the literature on treatment escalation in asthma. / L’adhésion aux médicaments chez les patients présentant un asthme ou une maladie pulmonaire obstructive chronique (MPOC) est reconnue pour être faible. Pour intervenir efficacement, les médecins de famille doivent évaluer de manière précise l’adhésion aux médicaments. Ne pas détecter la non-adhésion peut réduire davantage la maîtrise de la maladie, entraîner une intensification non-nécessaire du traitement, mener à des schémas pharmacologiques plus complexes et coûteux et par conséquent, augmenter le risque d’événements indésirables. La présente thèse vise à approfondir les connaissances sur l'usage secondaire des données médico-administratives afin d’optimiser l’adhésion et l’usage des médicaments chez les patients atteints de maladies respiratoires chronique, au moyen d’une approche méthodologique mixte de recherche. Plusieurs questions méthodologiques cruciales concernant l’étude de l’intensification du traitement en asthme ont également été abordées. Le premier axe porte sur le développement de l’outil e-MEDRESP, qui s’appuie sur les renouvellements d’ordonnances et qui est conçu pour donner rapidement accès aux médecins de famille à une mesure objective et facilement interprétable de l’adhésion aux médicaments utilisés dans le traitement de l’asthme et de la MPOC. L’outil a été développé en collaboration avec des médecins de famille et des patients à l’aide de groupes de discussion et d’entrevues individuelles. Dans le cadre d’une étude de faisabilité, l’outil e-MEDRESP a été par la suite implanté dans les dossiers médicaux électroniques de plusieurs cliniques de médecine familiale au Québec (346 patients, 19 médecins). Les résultats ont montré que l’intégration de d’e-MEDRESP dans le flux de travail des médecins était faisable. Les médecins ont indiqué que l’outil leur a permis de : 1) mieux évaluer l’adhésion aux médicaments de leurs patients (cote moyenne et écart-type sur une échelle de Likert à 5 points [perception d’accord] de 4,8±0,7); et 2) ajuster les traitements prescrits (4,8±0,7 et 4.3±0,9). Une analyse pré-post n’a pas révélé d’amélioration au niveau de l’adhésion aux médicaments chez les patients dont le médecin a consulté e-MEDRESP lors d’une visite médicale. Toutefois, une amélioration statistiquement significative a été observée chez les patients dont le niveau d’adhésion était inférieur à 80 % au cours de la période de six mois précédant la visite et qui étaient traités par des corticostéroïdes inhalés (Proportion of days covered (PDC) = 26,4 % (IC à 95 % : 14,3-39,3 %) ou des antagonistes muscariniques à action prolongée (PDC = 26,9 % (IC à 95 % : 12,4-40,2 %)). Le deuxième axe présente des travaux préparatoires à la conduite d’une cohorte qui sera réalisée à partir de bases de données médico-administratives et qui aura comme objectif d’estimer l’association entre l’adhésion aux médicaments et l’intensification du traitement de l’asthme, une question peu explorée à ce jour. Avant de débuter une telle étude, il est important de s’assurer que les bases de données médico-administratives peuvent être utilisées pour identifier de manière adéquate les patients asthmatiques et l’intensification du traitement. Dans un premier temps, une revue systématique a été effectuée pour identifier les données probantes disponibles concernant la validité des algorithmes permettant d’identifier les patients asthmatiques dans les bases de données médico-administratives. L’algorithme qui a été développé par Gershon et coll. (Revue canadienne de pneumologie, 2009; vol. 16, no 6, p. 183-188), qui comprenait deux visites médicales ambulatoires ou une hospitalisation pour asthme sur deux ans, présentait le meilleur compromis entre la sensibilité (84 %) et la spécificité (77 %). Dans un second temps, une définition opérationnelle de l’intensification du traitement a été élaborée dans le cadre d’une étude Delphi qui incorporait un processus consensuel d’experts. Cette définition comprend sept étapes et s’inspire des lignes directrices 2020 de l'initiative mondiale de lutte contre l'asthme. Les définitions obtenues à partir de ces deux études seront intégrées dans l’étude de cohorte. Les études constituant cette thèse démontrent l’importance de développer des outils qui permettent aux médecins d’évaluer l’adhésion aux médicaments dans leur pratique clinique, en plus d’enrichir la littérature scientifique médicale sur l’intensification du traitement chez les patients asthmatiques.

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Thèse en cotutelle / Thesis under joint supervision / Les Peuples autochtones à travers le monde sont disproportionnellement touchés par le diabète. Parmi ces peuples, les Cris d’Eeyou Istchee et les Pekuakamilnuatsh, au Québec (Canada), ainsi que les Parikwene, en Guyane française (France), recourent à leur médecine locale pour soigner cette maladie. En 173 entrevues semi-dirigées, 208 participants venant de ces communautés et/ou travaillant dans leurs services de santé ont décrit ces médecines. Une méthode de recherche mixte, combinant des analyses thématiques à des statistiques multivariées, est développée pour analyser ces descriptions. Ces analyses ont montré que les participants cris, ilnu et parikwene décrivent leurs médecines en lien avec le diabète tant par les différents éléments du monde naturel, que les pratiques et coutumes locales qui en découlent, que les concepts les liant au territoire. Les pharmacopées à base animales et végétales font parties des thèmes les plus discutés. Plus de 381 espèces (109 animaux, 267 plantes, cinq lichens et champignons) lient les systèmes médicinales et alimentaires ensemble via des notions associées au bien-être ou aux propriétés organoleptiques. Au Québec, là où la population autochtone est plus impliquée dans les services de santé, il existe un rapprochement de la description des médecines locales entre le secteur de la santé et ses usagers. De façon générale, la place de l’alimentation dans les médecines locales ne peut être négligée dans le contexte du diabète. De plus, ces médecines sont indissociables du territoire qui offre un espace de guérison, de subsistance, et de continuité culturelle. Cela renvoie, in fine, à des questions importantes sur la reconnaissance des droits autochtones et des droits fonciers. / Indigenous Peoples around the world are disproportionately affected by diabetes. Amongst them, the Cree of Eeyou Istchee and the Pekuakamilnuatsh, from Québec (Canada), and the Parikwene, from French Guiana (France), resort to their local medicines to treat this disease. In 173 semi-structured interviews, 208 participants from these communities and/or working in their healthcare services described these medicines. A mixed-methods research approach, combining thematic analyses with multivariate statistics, was developed to analyse these descriptions. These analyses showed that Cree, Ilnu and Parikwene participants described their medicines related to diabetes through different elements of the natural world, the local practices and customs which result from them, as well as concepts linking them to the Land. Animal and plant-based pharmacopoeias are among the most discussed topics. In total, more than 381 species cited, including 109 animals, 267 plants, as well as five lichens and mushrooms, link the local dietary and medicinal systems together via notions associated with well-being or their organoleptic properties. In Québec, where Indigenous Peoples are more involved in their healthcare services, the representation of local medicines is much closer between healthcare workers and users. In general, the place of food in local medicines cannot be neglected in the context of diabetes. In addition, these medicines are inseparable from the Land which offers a space for healing, subsistence, and cultural continuity. This brings up important questions about the recognition of Indigenous rights and land rights.