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Sex and gender considerations are influential on psychosocial and physiological determinants of cardiovascular health in individuals with and without stroke. The first study of this thesis explored gender-based differences in exercise self-efficacy, outcome expectations for exercise and motivation for exercise post-stroke. Gender identity was assessed using the Bem Sex-Role Inventory-12 and a gender role index was created using established gender-related roles. The Self-Efficacy for Physical Activity Scale was used to assess self-efficacy for exercise, the Short Outcome Expectations for Exercise Scale assessed outcome expectations for exercise and a Relative Autonomy Index was calculated to assess motivation for exercise. We found that masculine gender identity was associated with highest ratings of exercise self-efficacy, whereas feminine gender identity was related to the lowest exercise self-efficacy [F(3, 9)=5.36, p<0.05]. Gender identity was not associated with outcome expectations [F(3,8)=0.86, p=0.50) nor motivation for exercise [F(3,4)=0.67, p=0.61)]. Additionally, there were no associations between gender roles and self-efficacy (n=13, r=0.10, p=0.73), outcome expectations (n=13, r=-0.13, p=0.68), or motivation for exercise (n=8, r=0.09, p=0.83). The second study of this thesis examined the associations between global cognitive function (Montreal Cognitive Assessment, MoCA), arterial stiffness (carotid-femoral pulse wave velocity) and sex, and between global cognitive function, walking capacity (6-Minute Walk Test, 6MWT) and sex in older male and female adults with and without stroke. There was no association between global cognition and arterial stiffness, and sex did not moderate this association. However, cognitive function was positively associated with 6MWT, and with the addition of sex, Sex*6MWT, age and history of stroke, explained 21% of the variance of the MoCA score. Our findings provide insight into the importance of sex-and gender-based considerations in clinical research and may inform future larger-scaled studies aiming to increase the generalizability of their findings to males and females and individuals of all gender identities. / Thesis / Master of Science Rehabilitation Science (MSc) / The roles that an individual undertakes, and how they see themselves and are seen by others may be related to exercise participation. In addition, a person’s biological makeup may impact their health and ability to think. In the first study of this thesis, we found that individuals with stroke seeing themselves as women had lower beliefs about their abilities to exercise, but their beliefs about the benefits of exercise or their motivation for exercise were similar to individuals who identify as men. There were no differences in beliefs about exercise abilities, outcomes, or motivation between individuals with stroke who took on masculine vs. feminine roles. In the second study, we found that walking distance, but not arterial health, was related to the ability to think in males and females. Overall, this work provides information of the importance of biological, social roles and behaviours on health.

Au Liban, le taux d’abandon scolaire est élevé entre le primaire et le complémentaire(l’équivalent du collège en France). Notre objectif est d’identifier certains facteurspsychologiques et sociaux impliqués dans le risque d’abandon scolaire. Nous avons choisi lathéorie sociale cognitive d’Albert Bandura (2003) - qui étudie les interactions dynamiquesentre facteurs contextuels et facteurs individuels – comme cadre d’analyse systémique desfacteurs en jeu dans le risque d’abandon scolaire. L’étude a été menée auprès de 504 adolescents scolarisés (à un niveau équivalent à celui de la classe de 5e de collège en France) dans l’enseignement public libanais dans un quartier populaire. Les analyses multivariées effectuées sur les données de notre recherche ont montré que l’anxiété scolaire, les expériences d’apprentissages scolaires, les sentiments d’efficacité personnelle relatifs aux apprentissages scolaires, les attentes par rapport à l’école, les intentions d’avenir scolaire et professionnel, le soutien social dispensé par la famille et les professeurs, sont associés au risque d’abandon scolaire des collégiens au Liban.Notre enquête qualitative par entretiens individuels - conduite auprès de 26 élèves (dont huitd’entre-deux avaient abandonné l’école) - a corroboré les données quantitatives et a apportédes informations supplémentaires. En outre, d’autres facteurs en jeu dans l’abandon scolaireont été mis en évidence et, notamment, les représentations sociales des filles et des garçonsrelatives à la scolarité et à la vie professionnelle, représentations qui participent de façonimportante à leur construction identitaire. Nous avons mis en évidence le fait que les facteurscontextuels ont un peu plus de poids que les facteurs individuels. Ainsi, les résultats relatifs àla différence des sexes montrent que les filles et les garçons semblent avoir les mêmesparcours qui permettent d’expliquer le risque d’abandon scolaire. / In Lebanon, the dropout rate is high between the primary and supplementary school (theequivalent of college in France). Our goal is to identify certain psychological and socialfactors involved in the risk of dropping out. We chose Albert Bandura's social cognitivetheory (2003) – which studied the dynamic interactions between contextual factors andindividual factors - as a framework for systematic analysis of the factors involved in the riskof dropping out.The study was conducted among 504 adolescent students (equivalent to a fifth term class inFrench college) in Lebanese public school in a poor neighborhood. Multivariate analyzesperformed on the data of our research showed that school anxiety, school learningexperiences, feelings of self-efficacy related to classroom learning, the expectations of theschool, the future intentions school and work, social support provided by family and teachers,are associated to the risk of dropping out of college in Lebanon.Our qualitative survey by individual interviews - conducted over 26 students (eight of whomhad two-school dropouts) - corroborated the quantitative data and provided additionalinformation. In addition, other factors involved in the dropout were identified and, inparticular, social representations of girls and boys on education and working life,representations that have significant involvement in their construction identity. Wehighlighted the fact that contextual factors have a little more stress than individual factors.Thus, the results for gender differences show that girls and boys seem to have the same causesthat explain the risk of dropping out.

Background. The study was prompted by observation that failure to obtain a positive postsecondary destination is significantly more prevalent in young people living in areas of greater social deprivation, and in males rather than females. Previous studies have shown that this could be linked to differences in social cognitive factors. However, these studies have been mainly correlational and no comprehensive assessment instrument was found to assess preparedness for the postsecondary transition. Aims. The present study examines senior high school student’s perceptions of the personal, behavioural and environmental factors that affect them as they prepare to leave school. It reveals the structure of these factors and how they vary with regard to social deprivation and gender. Sample. The participants were 1044 senior high school students (573 males and 471 females) who attended six urban high schools. Method. A pre-empirical, 50-item assessment instrument was constructed based on the literature review to identify the wide range of factors previously shown to be relevant to achievement of a positive postsecondary destination. This was then administered to participants. Results. Factor analysis indicated that young people’s perceptions about leaving school were best represented by thirteen factors. An ANOVA model indicated that young people living in areas of higher deprivation reported significantly lower levels of positive postsecondary destination self-efficacy belief, less experience of vicarious career success, less performance of career development tasks, greater perception of career barriers, greater endorsement of a fixed career mindset, and fewer career scaffolding attachments. Males, compared to females, reported less experience of past career success, and fewer career scaffolding attachments. However, despite being at greater risk of a negative postsecondary destination, males reported higher levels of positive postsecondary destination self-efficacy belief, greater experience of positive career-related emotional arousal, greater ability to set career goals, and greater levels of career optimism. Conclusion. Twelve significant main effects on the measured social cognitive factors have the potential to contribute to an explanation of why failure to obtain a positive postsecondary destination is more prevalent in young people living in areas of greater social deprivation, and in males rather than females. A new assessment instrument has been produced to inform an ongoing exploratory process to design, target and evaluate educational interventions to improve postsecondary destinations for all. Increasing internal consistency, external validity and generalisability of findings are all desirable. Some future interventions are proposed on the basis of the results, including greater use of positive career role models in career development programmes, career mindset retraining for high school students, and psycho-education on attachment-fostering behaviours for parents and professionals.

Au Liban, le taux d’abandon scolaire est élevé entre le primaire et le complémentaire(l’équivalent du collège en France). Notre objectif est d’identifier certains facteurspsychologiques et sociaux impliqués dans le risque d’abandon scolaire. Nous avons choisi lathéorie sociale cognitive d’Albert Bandura (2003) - qui étudie les interactions dynamiquesentre facteurs contextuels et facteurs individuels – comme cadre d’analyse systémique desfacteurs en jeu dans le risque d’abandon scolaire. L’étude a été menée auprès de 504 adolescents scolarisés (à un niveau équivalent à celui de la classe de 5e de collège en France) dans l’enseignement public libanais dans un quartier populaire. Les analyses multivariées effectuées sur les données de notre recherche ont montré que l’anxiété scolaire, les expériences d’apprentissages scolaires, les sentiments d’efficacité personnelle relatifs aux apprentissages scolaires, les attentes par rapport à l’école, les intentions d’avenir scolaire et professionnel, le soutien social dispensé par la famille et les professeurs, sont associés au risque d’abandon scolaire des collégiens au Liban.Notre enquête qualitative par entretiens individuels - conduite auprès de 26 élèves (dont huitd’entre-deux avaient abandonné l’école) - a corroboré les données quantitatives et a apportédes informations supplémentaires. En outre, d’autres facteurs en jeu dans l’abandon scolaireont été mis en évidence et, notamment, les représentations sociales des filles et des garçonsrelatives à la scolarité et à la vie professionnelle, représentations qui participent de façonimportante à leur construction identitaire. Nous avons mis en évidence le fait que les facteurscontextuels ont un peu plus de poids que les facteurs individuels. Ainsi, les résultats relatifs àla différence des sexes montrent que les filles et les garçons semblent avoir les mêmesparcours qui permettent d’expliquer le risque d’abandon scolaire. / In Lebanon, the dropout rate is high between the primary and supplementary school (theequivalent of college in France). Our goal is to identify certain psychological and socialfactors involved in the risk of dropping out. We chose Albert Bandura's social cognitivetheory (2003) – which studied the dynamic interactions between contextual factors andindividual factors - as a framework for systematic analysis of the factors involved in the riskof dropping out.The study was conducted among 504 adolescent students (equivalent to a fifth term class inFrench college) in Lebanese public school in a poor neighborhood. Multivariate analyzesperformed on the data of our research showed that school anxiety, school learningexperiences, feelings of self-efficacy related to classroom learning, the expectations of theschool, the future intentions school and work, social support provided by family and teachers,are associated to the risk of dropping out of college in Lebanon.Our qualitative survey by individual interviews - conducted over 26 students (eight of whomhad two-school dropouts) - corroborated the quantitative data and provided additionalinformation. In addition, other factors involved in the dropout were identified and, inparticular, social representations of girls and boys on education and working life,representations that have significant involvement in their construction identity. Wehighlighted the fact that contextual factors have a little more stress than individual factors.Thus, the results for gender differences show that girls and boys seem to have the same causesthat explain the risk of dropping out.

Objective The aim of this study firstly, was to translate and test the validity and reliability of two diabetes-specific self-efficacy instruments (the Diabetes Management Self-Efficacy Scale; DMSES and the Perceived Therapeutic Efficacy Scale; PTES) in a Taiwanese population. The main aim of this study was then to develop an intervention based on self-efficacy theory that was appropriate for the Taiwanese population and to examine the effects of a self-efficacy enhancing intervention program (SEEIP). Background In Taiwan, the prevalence, mortality rate and healthcare cost of diabetes has dramatically increased. People with diabetes have low participation rates in performing self-care activities, with some two-thirds of diabetic patients not controlling their disease appropriately. Moreover, few studies in Taiwan have conducted randomised controlled trials or had improvement in patient self-care or self-management as their primary goal and no instruments that measure self-efficacy related to the management of diabetes (especially for outcome expectations) have yet been found and appropriately used to measure the effectiveness of self-management. Therefore, there is a particular need for research on self-efficacy enhancing intervention programs for people with type 2 diabetes. Design A convenience sample survey (n=230) was used in order to test the validity and reliability of C-DMSES and C-PTES in a Taiwanese population. Moreover, a randomised controlled trial (RCT) (n=145; the intervention group (72); the control group (73)) design was conducted in the main study with pre (baseline) and post-testing (undertaken at 3 months and 6 months following baseline collection). Intervention Both the control group and intervention group received the standard diabetic educational program in the outpatient clinic. The intervention group participants received the standard diabetic educational program and the following additional interventions: (1) viewed a 10-minute DVD (2) received a &quotDiabetes Self-Care" booklet (3) participated in four efficacy- enhancing counselling intervention sessions, and (4) participated in telephone follow-up. The self-efficacy model was adapted from Shortridge-Baggett & van der Bijl (1996). Diabetes self-management principles were used in program development and evaluation. Main outcome measures Instruments used in data collection included 1) Self-efficacy towards management of type 2 diabetes (as measured by the Chinese version of the Diabetes Management Self-Efficacy Scale; C-DMSES and the Chinese version of the Perceived Therapeutic Efficacy Scale; C-PTES); 2) self management behavior (as measured by the Summary of Diabetes Self-Care Activities; SDSCA); 3) health-related quality of life for diabetes (as measured by the Short Form-12; SF-12); 4) psychosocial well-being (as measured by the Medical Outcomes Study (MOS), Social Support Survey (SSS) tool and the Center for Epidemiology Studies Short Depression Scale; CES-D) and 5) health care utilisation (as measured by health care utilisation self report instrument). Data analysis Data were double-entered for verification using SPSS® statistical software. Study I: Descriptive statistics, regression analysis, Pearson's correlation, Cronbach's alpha-coefficients, factor analysis and Bland-Altman plots with 95% limits of agreement (LOA) were performed to evaluate validity and reliability of C-DMSES and C-PTES. Study II: Descriptive analysis was used to examine demographic variables and outcome variables. T-tests were used to analyse differences on continuous data between mean scores for the intervention and control groups. Categorical data were analysed using Chi-square statistics to test the significance of different proportions. To assess the group differences of dependent variable changes, repeated measures ANOVA/ ANCOVA were used. Results Study I: Convergent validity showed that C-DMSES correlated well with the validated measure of the General Self-Efficacy Scale (GSE) in measuring self-efficacy. Criterion-related validity showed that the C-DMSES was a significant predictor of the Summary of Diabetes Self-Care Activities (SDSCA) scores. Factor analysis supported the C-DMSES being composed of four subscales with good internal consistency (Cronbach's alpha=.77 to .93) and stability (ICC=.82). Similarly, significant criterion-related validity was demonstrated between the C-PTES and SDSCA scores. Convergent validity was confirmed as the C-PTES converged well with the GSE Scale in measuring self-efficacy. Construct validity of the C-PTES was confirmed through factor analysis and a single subscale formed. Internal consistency with a Cronbach's alpha was .95 and the test-retest reliability (ICC) was .77 and a Bland-Altman plot showed 97% of the subjects were within 2 standard deviations of the mean. Study II: The 3- and 6-month benefits of the intervention over usual care were increases in self-efficacy, outcome expectation, self-care activities, and social support. However, the results of the health-related quality of life and depression scores indicated that the change over time was not different in the two groups. A smaller proportion of the participants significantly in the intervention group, had been hospitalised and visited the emergency room than participants who were in the control group at the 6-month period. However, health-related quality of life and depression were not significantly increased in the intervention group at the 3- and 6-month compared to the control group. Conclusion Results of Study I support the psychometric properties of C-DMSES and C-PTES in providing a measure for self-efficacy specific to persons with type 2 diabetes in Taiwan. The main study revealed that the SEEIP for type 2 diabetes based on self-efficacy theory was culturally acceptable to Taiwanese people with diabetes and that the SEEIP was effective in the self-management of people with type 2 diabetes.

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Accelerated social change emphasises knowledge and innovation, creating a need for learners to excel at learning and thinking. The study’s purpose was to replicate previous cognitive research findings, which emphasise the positive influence of learning strategies on learners’ self-efficacy and academic achievement and to verify the validity of training learners in learning strategy-use to promote learner-autonomy and accountability. The research targeted a selected primary school in a Black township in Gauteng Province using quasi-experimental and qualitative methods. The sample comprised 152 4th - 7th graders assigned by quota system to the treatment group and the control group. Learners participated in pre-tests and post-tests for learning strategies, self-efficacy and academic achievement. Only the experimental groups received strategy instruction before the post-test. The experimental group’s improved performance compared to the control group’s lower performance suggests the effectiveness of strategy-training. Subsequent learner reports of improved self-efficacy beliefs and academic achievement confirm strategy-effect on these variables. / Psychology of Education / M. Ed. (Educational Psychology)

Accelerated social change emphasises knowledge and innovation, creating a need for learners to excel at learning and thinking. The study’s purpose was to replicate previous cognitive research findings, which emphasise the positive influence of learning strategies on learners’ self-efficacy and academic achievement and to verify the validity of training learners in learning strategy-use to promote learner-autonomy and accountability. The research targeted a selected primary school in a Black township in Gauteng Province using quasi-experimental and qualitative methods. The sample comprised 152 4th - 7th graders assigned by quota system to the treatment group and the control group. Learners participated in pre-tests and post-tests for learning strategies, self-efficacy and academic achievement. Only the experimental groups received strategy instruction before the post-test. The experimental group’s improved performance compared to the control group’s lower performance suggests the effectiveness of strategy-training. Subsequent learner reports of improved self-efficacy beliefs and academic achievement confirm strategy-effect on these variables. / Psychology of Education / M. Ed. (Educational Psychology)