This thesis has sought to examine the conceptualisation(s) of the field of Olympic education identified in the English language literature, and to evaluate the planning of Olympic education in practice, specifically in relation to the preparation of Olympic education programmes and systems for the Tokyo 2020 Olympics and Paralympics. When Pierre de Coubertin introduced the modern Olympic Games, one of the ideas for the revival of the Games was to educate young people through sport. Despite Coubertin s educational philosophy, the Olympic Games have long failed to represent ideals of fair play, equal opportunity, and international harmony but being replaced by bribery, corruption, commercialism, drug use and gender discrimination instead. The IOC has strengthened the roles and mission of the Olympic bodies in particular relation to the promotion of Olympic values and Olympism through the implementation of Olympic education. As a policy aim for the Olympic Movement, the development of Olympic education programmes has become a key goal for the IOC and thus host cities/nations. Providing a concept of Olympic and Paralympic education programmes in preparation for staging the Olympic Games is a compulsory requirement for host cities and nations. However, in spite of the IOC s recent explicit and intended commitment to the development of Olympic education policies in practice, explanation of Olympic education as a concept and a set of practices is imprecise and relatively underdeveloped in the Olympic related area. In addition, there is a lack of understanding of how universal values and concepts of Olympic education are perceived and communicated in culturally diverse contexts. The thesis is divided into two related parts, which seeks to provide two fundamental contributions to knowledge in this field. Part One is focused on a meta-narrative review of the English language literature on Olympic education. The methodology of a meta-narrative review is an extension of the systematic review process and facilitates the identification of the contribution of research traditions to the phenomena under review, in this case the conceptualisation and operationalisation of Olympic education. Through the process of meta-narrative review, six research traditions were identified: educational philosophy; critical sociology; curriculum development; education psychology; development of evaluation measures; and policy analysis and evaluation. II The results of the review identified how Olympic education has been conceptualised with various unfolding storylines in different research traditions, and this analysis subsequently provided the basis for the second key element of the study in the form of templates against which to evaluate the Olympic education programmes and systems associated with Tokyo 2020. Part Two employs a case study approach and is focused on the analysis of six cases using a realist evaluation methodology, employing analytic logic models and analysis of Context-Mechanism-Outcome (CMO) configurations. This facilitates the development of explicit and/or implicit causal claims about changes brought about by Japanese Olympic education programmes. The research has also contributed to developing a critical review of Olympic education programmes in a culturally specific, non-western context. Provision of Olympic education, within the context of national legislation requiring its introduction into the school curriculum developed by various stakeholders, represents a unique and culturally specific context for its study. Not only its education system, but also the cultural and historical values embedded within Japanese Olympic education programmes derive from the Japanese understanding of Olympism and universal Olympic values based on the Japanese values such as harmony, in particular applied in the effort in the recovery from national disasters, moral values learned from Judo and physical education, and Japanese ways of expressing hospitality. Thus, this case study of Tokyo 2020 acts as an exemplar in the diffusing of ways of developing and delivering the benefits of Olympic education programmes in culturally specific context.

The present study reviewed existing literature on the effects of treatment and recovery costs on the multidimensional wellness of testicular cancer (TC) survivors. Peer-reviewed and scholarly articles were systematically searched and analyzed to determine the extent and impact of the overall financial effects of a TC diagnosis. This study aimed to uncover evidence indicating the possible decline in overall health-related quality of life (HRQoL) due to the potential deleterious effects on TC survivors’ financial well-being. We found that TC survivors’ HRQoL is affected due to the damages of high out-of-pocket treatment costs, possible loss of employment, disability, and any other related financial events for a patient or survivor of cancer, which refers to financial toxicity (FT). Further, FT does not affect all cancer patients in the same capacity. Considering the number of individuals affected by the adverse effects of FT, more research is needed to better comprehend FT’s impacts on TC survivors’ well-being. We conclude that every patient should be educated on the effects of FT resulting from their cancer experience. Furthermore, they should be informed that an early return to work may not be feasible. This will enable them to adequately prepare for the long-term effects and learn how to adjust their wages and lifestyle habits.

Text in English / Scrum is the most adopted and under-researched Agile methodology. The research conducted on Scrum adoption is mainly qualitative. Therefore, there was a need for a quantitative study to investigate Scrum adoption challenges. The general objective of this study was to investigate the factors that have a significant relationship with Scrum adoption as perceived by Scrum practitioners working within South African organisations. To achieve this objective a narrative review to synthesise the existing challenges was conducted, followed by the use of these challenges in the development of a conceptual framework. After that, a survey questionnaire was used to test and evaluate the developed framework. The research findings indicate that relative advantage, complexity, and sprint management are factors that have a significant linear relationship with Scrum adoption. The findings are generalisable to the population, and the author recommends that organisations review the findings during their adoption phase of Scrum. / Council for Scientific and Industrial Research (CSIR) / University of South Africa (UNISA) / School of Computing / M.Sc. (Computing)

Il presente progetto di ricerca si occupa degli interventi di gruppo per figli di genitori separati, con la finalità di operare una riflessione di stampo metodologico sui dispositivi che sono stati analizzati e studiati in letteratura, per poi approfondire alcuni aspetti dell’intervento Gruppi di Parola, attivo in Italia. L’articolazione in tre studi, di carattere qualitativo, ha permesso di avvicinare l’oggetto di ricerca secondo prospettive e metodologie differenti. Il primo studio coincide con una rassegna sistematica narrativa, condotta al fine di sistematizzare la letteratura di livello internazionale relativa agli interventi di gruppo per figli di genitori separati che sono stati analizzati attraverso un impianto di ricerca rigoroso. Gli altri studi approfondiscono rispettivamente due aspetti del dispositivo Gruppi di Parola: gli elementi teorico-pratici che lo fondano attraverso una prospettiva etnografica focalizzata (secondo studio) e le dinamiche interattive messe in movimento durante una specifica fase rituale del processo (l’accoglienza) per mezzo di una metodologia osservativa complessa (terzo studio). / The present research project deals with group interventions for children having separated parents. Its aim is a methodological reflection about the programs analyzed and studied in the literature in order to later deepen some aspects of the Italian intervention Gruppi di Parola. The organization in three qualitative studies has allowed the researcher to approach the research object according to different perspectives and methodologies. The first study corresponds to a Systematic Narrative Review, carried out in order to systematize the international literature about the group interventions for children having separated parents which have been analyzed through a rigorous research design. The other studies respectively deepen two aspects of the intervention Gruppi di Parola: the theoretical and practical underpinnings through a focused ethnographic perspective (second study) and the interactive dynamics activated during a specific ritual phase of the process (welcoming) by means of a complex observational methodology (third study).

Le contexte de pénurie de personnel infirmier doublée d’une organisation du travail sous optimale a pour conséquence d’augmenter le risque d’un bris de service qui est souvent contré par l'usage du Temps Supplémentaire Obligatoire (TSO). Cette méthode de gestion impose des pressions grandissantes sur les infirmières. L’usage du TSO entraine des effets néfastes pour les usagers, les infirmières ainsi que les organisations de santé. Le but de cette étude est d’identifier des interventions ayant le potentiel de réduire l’usage du TSO et faire une analyse critique des effets potentiels ou démontrés de celles-ci. Méthode Une revue narrative de la littérature a été réalisée afin d’identifier les interventions présentées comme ayant le potentiel de réduire l’usage du TSO. La revue narrative a suivi le modèle Scale for the Assessment of Narrative Review Articles. Nos recherches ont permis d’identifier 12 interventions rapportées pouvant réduire l’usage du TSO. Elles sont applicables à l’un ou plusieurs de 4 différents niveaux dans l’organisation des services de santé, soit le niveau législatif, le niveau systémique, le niveau organisationnel ainsi que le niveau d’une unité de soins. Cette étude permet de mettre en lumière plusieurs interventions ayant le potentiel de réduire le TSO, mais il existe peu de données probantes les appuyant. Il semble que plusieurs interventions concomitantes pourraient avoir un effet plus fort sur le TSO. D’autres interventions ayant un effet sur des facteurs déterminants du TSO pourraient également avoir un effet potentiel sur celui-ci. Notre étude met en évidence le besoin de recherches étoffées sur les interventions pouvant enrayer le TSO des systèmes de santé. / The context of nursing staff shortage added to a sub-optimal management of resources has the consequence of increasing the odds of a break in service which is often countered by the use of mandatory overtime. This management method places increasing pressure on nurses. The use of mandatory overtime has harmful effects on patients, nurses and healthcare organizations. The aim of this study is to identify and critically analyze interventions that reduce mandatory overtime. Method A narrative review of the literature was performed to identify interventions used to reduce the use of mandatory overtime. The narrative review followed the Scale for the Assessment of Narrative Review Articles (SANRA) model. Our research identified 12 interventions that were reported as having the potential to reduce the use of mandatory overtime. They are applicable at 4 different levels in the organization of health services, namely the legislative level, the systemic level, the organizational level as well as the level of a care unit. Among these interventions, some seem to stand out, but few have been the subject of rigorous studies. We found several interventions that seem to have the potential to reduce mandatory overtime, but there exists very little evidence-based literature to support them. It seems that multiple concomitant interventions have a greater effect on mandatory overtime. Other interventions having an effect on determinant factors of mandatory overtime could have a potential effect on mandatory overtime. Even so, a need for studies showing the impact of interventions on mandatory overtime seems evident in light of our review.

As mental health care increasingly embraces recovery principles, the role of peer support workers (PSWs) has gained recognition. The work that mental health PSWs do became particularly important during the COVID-19 pandemic, when increased needs for mental health care became apparent but were often unmet. This article-based doctoral thesis adopts an interdisciplinary perspective that combines research on management and organization with research on health care and systems. The thesis examines the mental health peer support role and its integration within teams, organizations and health systems. It also considers the peer support role as it was enacted in a virtual space, which became a requirement due to pandemic work-from-home mandates. Within the context of the virtual space, PSWs confronted work-life boundaries that they had to navigate as they enacted their work roles. The virtual space also presented technological and social challenges to and opportunities for peer support, which are examined in this thesis from the points of views of PSWs and peers. Overall, this thesis attends to the PSW role more generally, and to peer support work in the specific context of a virtual environment. The thesis is composed of three studies, the second and third of which had to be adapted to the unexpected challenges and opportunities posed by the COVID-19 pandemic. Study 1 (presented in Chapter 2) is a narrative review that synthesizes the literature on factors influencing formal PSW role implementation in mental health systems. The findings are synthesized in a multilevel framework consisting of macro, meso and micro level influences. The analysis reveals that macro-level influences on PSW role implementation include socio-cultural, regulatory, political and economic factors, most of which act as obstacles. At the meso level, organizational culture, leadership, and human resource management policies play a significant role. Micro-level influences center around PSWs' relationships with team members. Interlevel interactions are also discussed. This study is co-authored with Professor Samia Chreim and was published in Administration and Policy in Mental Health and Mental Health Services in February 2022. For Studies 2 and 3, qualitative data were collected from members of a peer support organization situated in Ottawa. This organization is a publicly funded, not-for-profit organization that provides services free of charge to people experiencing mental health and addictions challenges. Due to the pandemic, all services and operations of this organization transitioned to remote services involving virtual platforms. Study 2 (presented in Chapter 3) is a qualitative case study that delves into the work-life boundary challenges and management of PSWs who were providing virtual mental health support during the pandemic. The study identifies temporal, physical, and task-related boundary challenges in work-life domains. Strategies employed by PSWs to manage these boundaries include segmenting and integrating work and personal domains. The study highlights the importance of self-care and the need for training on work-life boundary management for mental health workers. This research is co-authored with Professor Samia Chreim and is published in BMC Public Health. Study 3 (presented in Chapter 4) focuses on the transition from in-person to virtual mental health peer support services. Through semi-structured interviews with PSWs and service users (or peers), the research examines how technological factors act as bridges and boundaries to mental health peer support services, and whether and how a sense of community can be built or maintained among PSWs and peers in a virtual space when connections are mediated by technology. The findings highlight the mental health peer support needs that were (un)met through virtual services, the technology-based boundaries that were manifested and the steps taken to remove some of these boundaries, and the strategies employed by the organization and its members to establish and maintain a sense of community in a virtual environment marked by physical distancing and technology-mediated interrelations. The manuscript pertaining to this study is co-authored with Professor Samia Chreim and will be submitted soon to an academic journal. Overall, this thesis presents a unique and multi-faceted exploration of the implementation of peer support worker roles in mental health systems and their adaptation to virtual environments. It makes a number of contributions. The multilevel framework developed in Study 1 not only advances knowledge in the field but also offers a structured approach for policymakers and organizations to enhance the formal incorporation of PSW roles into mental health systems. Study 2 provides valuable insights into the nature of work-life boundaries in a virtual space, an important topic at a time when peer support workers and organizations are considering whether and how to maintain some form of virtual work post-pandemic. Study 3 adds to knowledge by highlighting the significance of virtual peer support beyond pandemic conditions. It also enhances understanding of the need for technological adaptation in mental health services and for community building regardless of the model of service. Limitations and implications for research, practice and policy are addressed.

Introduction : Le cadre de la gouvernance clinique a été développé afin d’atteindre de hauts standards de qualité de soins et de services, en conjuguant les notions d’amélioration continue de la qualité, d’excellence clinique et d’imputabilité corporative. La présente démarche doctorale avait pour objectif de comprendre le processus d’institutionnalisation de la gouvernance clinique dans un centre de réadaptation. Méthodologie : Une synthèse méta-narrative de 65 documents répertoriés dans 4 bases de données bibliographiques sur la conceptualisation et la mise en œuvre de la gouvernance clinique a été menée. Une étude qualitative de cas unique a été menée dans un centre de réadaptation en déficience intellectuelle et en troubles du spectre de l’autisme, au Québec (Canada). En mobilisant les cinq construits du cadre conceptuel basé sur théorie du processus de normalisation (cohérence, participation cognitive, action collective, suivi réflexif et contexte organisationnel), une analyse thématique des entrevues individuelles auprès de 22 participants (5 administrateurs, 11 gestionnaires et 6 cliniciens) et de 3 groupes de discussion auprès de 8 cliniciens et de 4 proches d’usagers a été menée. Enfin, une analyse d’une centaine de documents administratifs du Centre a été effectuée. Résultats : L’analyse de la littérature a permis de constater que le cadre de la gouvernance clinique est un concept en évolution et encore perçu comme une avenue intéressante pour l’amélioration de la qualité des soins. Toutefois, la confusion autour de sa définition et de sa conceptualisation ainsi que les difficultés de sa mise en œuvre demeurent des enjeux pour les organisations. Par la mobilisation du cadre de gouvernance clinique, la haute direction du centre de réadaptation à l’étude a souhaité systématiser le processus d’amélioration continue de la qualité des services offerts aux usagers et à leurs proches par l’adoption des bonnes pratiques de gouvernance. Ce virage a été bien reçu par les administrateurs et les gestionnaires, résultant sur une participation active et un fort engagement aux activités de leur part. La complexité du cadre et l’absence d’implication des cliniciens dans le processus de mise en œuvre ont créé chez ces derniers une appréhension quant à l’apport de la gouvernance clinique pour la pratique clinique et le bien-être des usagers. Les cliniciens ont dénoncé l’absence d’arrimage entre la théorie et les réalités de la pratique clinique ; la grande vitesse d’implantation et une approche décisionnelle de type top-down comme des enjeux de l’institutionnalisation de la gouvernance clinique. Pour les gestionnaires, les défis ont été la mise en place des moyens de communication efficaces ; l’arrimage des mécanismes de gestion et la disponibilité des ressources humaines. Pour les administrateurs, l’enjeu principal a été l’instabilité des contextes organisationnels interne et externe qui a ralenti la mise en œuvre et freiné l’élaboration d’un processus évaluatif. Conclusion : L’institutionnalisation de la gouvernance clinique dans les établissements non hospitaliers offrant des services sociaux passe par la valorisation de ce concept comme un projet commun au bénéfice de l’usager en vue de renforcer la participation et l’engagement de tous et l’adoption d’une approche de partenariat entre les usagers, leurs proches et les autres acteurs de l’organisation. / Introduction: Clinical governance framework was developed in order to achieve high standards of quality of care and services, by combining the concepts of continuous quality improvement, clinical excellence and corporate accountability. The aim of this doctoral thesis was to understand the implementation process of clinical governance in a rehabilitation center. Methods: A meta-narrative synthesis on the conceptualization and implementation of clinical governance was conducted. 65 tittles screened in 4 international databases were analysing. A qualitative single case study was conducted in a rehabilitation center for intellectual disabilities and autism spectrum disorders, in Quebec (Canada). By mobilizing the five constructs of the conceptual framework based on normalization process theory (coherence, cognitive participation, collective action, reflexive monitoring and organizational context), a thematic analysis of individual interviews with 22 participants (5 administrators, 11 managers and 6 clinicians) and tree focus groups with 8 clinicians and 4 relatives of users were conducted. Finally, an analysis of around hundred administrative documents from the Center was conducted. Results: The literature revealed that the clinical governance framework is an evolving concept and still seen as an interesting avenue for improving the quality of care. However, confusion over its definition and conceptualization, and the difficulties of its implementation remain challenges for organizations. By mobilizing the clinical governance framework, the senior management of the rehabilitation center under study wished to systematize the process of continuous improvement of quality of services offered to users and their families, by adopting good governance practices. This shift was well received by administrators and managers, resulting in active participation and a strong commitment to activities. The complexity of the framework and the absence of involvement of clinicians in the implementation process have created in them an apprehension regarding the contribution of clinical governance to clinical practice and the well-being of users. Clinicians have criticized the lack of alignment between theory and the realities of clinical practice; the high speed of implementation and a top-down decision-making approach as issues of the implementation of clinical governance. For managers, the challenges have been the establishment of effective communications; the alignment of management mechanisms and the availability of human resources. For administrators, the main issue was the instability of the internal and external organizational contexts which slowed down the implementation and the development of an evaluation plan. Conclusion: The implementation of clinical governance in non-hospital facility requires the promotion of this concept as a joint project for the benefit of the user with a view to strengthening the participation and commitment of all and the adoption of a partnership approach between users, caregivers and other actors in the organization.