The purpose of this doctoral dissertation was to investigate the relationships between mental health and physical activity participation of medical students, as well as their confidence, motivation and frequency in recommending physical activity in future medical practice. Moreover, this thesis involved the implementation and evaluation of a peer support walking intervention aimed at improving the mental health and physical activity participation of medical students. Two separate studies were conducted, including a cross-sectional correlational survey administered to medical students in all four years at three Canadian Universities (Study One; Articles One, Two and Three) and a single-subject study testing the impact of a two-month peer support walking intervention delivered to first and second year medical students at two Canadian universities (Study Two; Articles Four and Five). Article One examined relationships between physical activity, including mild and moderate-to-vigorous physical activity (MVPA), and mental health profiles in a sample of Canadian medical students using latent profile analysis. Three distinct mental health profiles emerged (low, moderate and high ratings of mental health) and individuals in the high mental health profile reported engaging in more mild physical activity than MVPA. Article Two investigated the underlying mechanism(s) contributing to frequency in recommending physical activity, to provide insight into how we can increase physical activity recommendations in future practice as physicians. Findings showed positive relationships between medical students’ physical activity levels and their frequency recommending physical activity to patients. Results also revealed that medical students are significantly more motivated than they are confident to recommend physical activity to patients and only 52% of student participants were aware of and accurately able to recall the Canadian physical activity guidelines. Article Three examined demographic differences in medical students’ motivation and confidence to recommend physical activity to future patients. Results revealed differences according to gender, year of study and academic background. For instance, second year students were more motivated to assess a patients’ level of physical activity compared to third and fourth year students. Article Four evaluated the impact of a two-month peer support walking intervention aimed at improving the mental health and physical activity participation of first and second year medical students using the RE-AIM framework. Findings showed that the peer support walking intervention was delivered as intended and may be an important proactive strategy for maintaining mental health and physical activity levels of medical students during stressful situations, including the COVID-19 pandemic. Finally, Article Five offered evidence-based strategies for conducting mental health research in medical professionals to optimize recruitment, engagement and retention. Ten strategies were provided to help inform the planning of future research aiming to support the mental health of medical professionals, including students. Taken altogether, findings from this dissertation show that peer support and incorporating mild physical activity may be an effective strategy to offer within medical student wellness programs. Additionally, results highlight the need to expand the medical curriculum to include physical activity education in order to prepare students to recommend physical activity to patients in future medical practice as an important preventive and therapeutic strategy for several chronic illnesses.

No description available.

Women engaged in street prostitution are among the most vulnerable populations, due to the conditions they work in, their often disadvantaged backgrounds, and their limited choices and agency. In order to surmount the multiple barriers that they encounter when trying to exit prostitution, both at the structural and the individual level, women need holistic support that addresses their diverse needs (Hester & Westmarland, 2004). Extant theoretical frameworks of exiting prostitution failed to incorporate this important element of support into the exiting process. Some of these frameworks are based on mixed samples of women in indoor and street prostitution, despite their different situations and needs. Furthermore, while researchers generally agree on the need for wrap-around holistic support of a range of services, it has not been sufficiently explored, neither in depth nor systematically. Questions remain as to what support looks like, what is its influence, and what is the best timing for offering support to women exiting street prostitution. This study set out to better understand the patterns of exiting street prostitution, to explore the role of support in facilitating successful and long-term disengagement from prostitution, and to determine the more effective time to offer support in the exiting process. The study employed a mixed-method design combining qualitative interviews with an Agent-Based Model (ABM), an innovative computerized simulation tool that has never been applied to street prostitution. In-depth interviews with 29 women from five recovery programs for women with substance abuse disorder who have exited prostitution were analyzed in ATLAS.ti to provide thorough responses to the research questions about support and helped refine the ABM. The ABM was designed based on the theoretical framework offered by Baker, Dalla, and Williamson (2010), enhanced by support and some additional elements incorporated into this framework. This framework conceptualizes exiting as a staged process, starting when women are immersed in prostitution, moving on to the Awareness stage, then to Deliberate Planning, then to Initial Exit and at last to the Final Exit stage. A simplified structure of the stages was applied in the ABM, whereby virtual agents representing women immersed in street prostitution made a series of decision to determine whether they eventually exited prostitution, first to the initial exit stage and later to the final exit stage. The ABM model was a computerized representation of a 10-year virtual longitudinal study, during which a support intervention was offered, first consistently to all agents and then in a second model only to agents who enter the Initial Exit stage. Two more interventions, suggested by the women’s narratives, were tested to determine the influence of spirituality on exiting and the impact of offering women more support when they were ready to exit. street prostitution. The qualitative findings of the study indicated the importance of peers over professionals as facilitators of women’s exiting journeys. Peers provided women with hope and a nonjudgmental understanding of women’s experiences in prostitution; helped alleviate guilt and shame by normalizing these experiences; and allayed women’s loneliness. Another important source of support for women was discovering their spirituality. Women often spoke of God in similar terms to their peers, as an entity that offers knowledge, love and experience. The qualitative findings informed the operationalization of several variables in the ABM and contributed a new variable, Spirituality, to the model. Another important qualitative finding was the importance of offering support at the moment women were ready to exit, which resulted in an interaction between women’s intention to exit and support in the ABM. Additional qualitative findings highlighted the importance of treating both substance abuse and prostitution to unravel the prostitution-drugs nexus in order to achieve a successful exit. Women described their relapse into drugs, which almost always preceded a return to prostitution, as a gradual internal process of a growing desire to use drugs which culminated in an opportunity to use drugs. Such a process mirrored their readiness to exit– an internal process of despair which ended with reaching out for support, or a “hook for change” (Giordano et al., 2002). However, while women were fully aware of both the moment of relapse and the moment of readiness to exit and could easily identify what had led to their relapse, the elements that led to being ready to exit remained nebulous. More research is warranted on this issue. The quantitative findings clearly demonstrated that once virtual women received support in the exiting process, more of them exited, their exit was more permanent (in other words, more of them moved from the Initial to the Final Exit stage and stayed there), and they exited earlier in the process. The more support we offered, the more these findings were pronounced. The best model fit to the data was the one including all support types– continuous support, additional support for the Initial Exit stage, spirituality, and the interaction between readiness and support. While the model without support was characterized by oscillating exiting trajectories regardless of the final outcome, offering support helped smooth the curve and prevented the back and forth movement that characterized women’s journeys in and out of prostitution, both in the quantitative and the qualitative data. This research elaborates the theoretical foundation of the process of exiting prostitution, and specifically, the impact of support, and what support means, in the exiting process. The findings of this study have important implications for service providers and policy makers in deciding on how much, when, and what type of support to offer women who are exiting street prostitution—for example, incorporating peer support in programs that assist women. The quantitative inquiry revealed the impact and benefits of offering support in the exiting process; the qualitative inquiry revealed the multidimensional nature this support. The ABM may be further applied to other exiting processes in related fields, such as recovery from substance abuse. The mixed-method design combining ABM with qualitative interviews should serve as a model to study vulnerable populations with simulation tools. / Criminal Justice

Preloading student satisfaction and success factors into an online program orientation course can strengthen the potential for student retention and success. A 100% online graduate nursing orientation and guidance program was developed. Access to peer support, faculty advisor, and university resources were provided within the course using the same learning management system as the program. Students were taught the basic structure of courses (including discussions, quizzes, and dropbox) to ease the stress of the first few weeks of class. Graduate study requirements and expectations were explained along with the differences between online and face-to-face study. Guidance was provided to assist students in balancing work, life, and study. Students report decreased anxiety and increased comfort with graduate online education, increased self confidence, and feelings of support.

Traditional help services have problems reaching out to people with substance abuseproblems. Some individuals choose to seek help for recovery from anonymous others online.This study examines the social support within an online support group for individualssuffering from drug abuse, specifically, the drug rehabilitation forum on the Internetcommunity Flashback forum. By looking at the social support in the forum through aqualitative content analysis nine forum threads have been examined. To seek help from otherswithout the pressure of going straight edge as well as an easily accessible tool for differentstages of the process of recovery, the Internet community and forum is an alternative helpchannel and/or complement to traditional services and support. The study also shows that, aswell as social learning theory can explain how individuals begin drug abuse, the theory canalso shed light on how individuals learn to stop their drug abuse.

This project emerges from engaging and studying the lives, including mine, of the many who go—and stay—crazy. Here, I explore the kinds of existences that those impaired by severe and persistent mental illness(es), what I refer to henceforth as “chronic mental illness”— have had (or been able) to forge and leverage, as well as some of the resources and structures they have developed/manipulated in order to do so. This thesis explores one way in which chronically mentally ill people exact agency over their own embattled personhood. The term “personhood” draws from existential traditions in philosophy and theology (Strawson 1959; Taylor 1989, 127-142; Rosfort 2018), though I understand and use it here as it is relevant to phenomenological psychopathology. By “personhood”, I mean the normative traits of a society wherein individuals are recognized by seemingly “common” traits of humanity. While there is not, as philosopher Robert Spaemann contends, “a [single] characteristic that can be called ‘being a person’” (Spaemann 1996, 14), to understand human beings (being) is to also grapple with the ethical demands of intentionality, autonomy, experience, and subjectivity. By “subjectivity”, I refer to the innumerable and descriptive components that comprise individual, relational, and intersubjective experience(s). These components, and how they are known and described, emerges from a self-awareness in maneuvering the world and, consequently, developing a particular lifeworld. My interests in personhood and subjectivity emerge from the assumption that “the fragility of human identity is rooted in the various ways in which our biology challenges our experience of being an autonomous self” (Ricoeur 1966; Ricoeur 1970, 472; Rosfort 2018, 5). Part of what complicates personal identity is the impossibility of grounding personhood in either biological otherness or an intrinsic, pre-reflective selfhood. Being a person is “the task of becoming […] concrete […] through the constant encounter with the otherness that is an inescapable part of one’s identity” (Rosfort 2018, 6). Seeing a person, Ricoeur believes, requires the perpetual examination of experiential tensions among identity traits that go beyond biological reductionism and constancy. Illness narratives are useful tools for understanding the extent to which disability incites a fundamental interrogation of the self, as well as a reckoning of practices of self-recognition and phenomenological metamorphosis. This multi-field site investigation engages self-identifying psychiatrically disabled people via participant-observation at three peer support networks within the greater Boston area. Data, by way of stories recounted and collected, is framed by my own lived experience participating in similar structures, both in-person and online. Stories from both occasions, including interview data and media analysis, are relayed as means of triangulation. This project relies on sociologist Noman Denzin’s concept of “cumulative epiphanies” (Denzin 1989), or, moments wherein ill authors/speakers recognize the extent to which their personhood was honed through the medium of the illness itself (Frank 1993, 46). In large part, this project explores ways that people experiencing disabling effects of mental illness learn to take care of themselves. It pays particular attention to how the personal views of people with such illnesses shape the construction and layout of varied peer support networks. Although it considers general psychiatric practice involving prescribing clinicians (e.g., physician or nurse practitioner) and non-prescribing clinicians (e.g., talk therapists), the central objective is to consider the emergence of mutual support, or “self-help” models, as a mode of constructing a new sense of self/advocating for unmet needs within traditional medical practice. More broadly, this project maps the reflexive transformation(s) of person into patient and the varied methods of healing and treatment that the chronically mentally ill utilize in such contexts. It considers the emergence of PSNs as a counter/cultural borderland (Kleinman 1980; Garcia 2016) between the social “psy”ences (Matza 2013; Raikhel & Bemme 2016) and psychiatry. As a theoretical fusion of history of psychiatry, sociology of mental health, and phenomenology, I trouble the parameters within which PSNs and their participants help craft, shape, and directing a particular kind of experience of mental illness, suffering, and/or convalescence.

Pastors whose congregations are inadequate sources of meaningful fellowship and social support often experience the negative impact of one-way relationships, role overload, pedestal positioning, ministry stress, adrenaline exhaustion, isolation, burnout, and loneliness in their context. Grounded in Gary Kinnaman and Alfred Ell’s model of Pastors in Covenant Friendship, this thesis articulates the potential for free, online clergy peer groups to serve as hospitable spaces for African American, Seventh-day Adventist pastors to experience positive emotions, positive affirmation, safe places for vulnerability, peer support, friendship, and flourishing in mutually-supportive, positive relationships beyond their congregations.

This multiple-article dissertation explores institutional support for student academic engagement through the lens of the Academic Communities of Engagement (ACE) framework. A literature synthesis explores the current research on teaching assistant (TA) support in online and blended environments in higher education, with a special emphasis on their role in providing support for affective engagement, in addition to supporting cognitive and behavioral engagement. The review suggests that additional research needs to be done in this area to better understand the role of TAs in online environments and how institutions can prepare them for this role through meaningful training. The second article provides insight into students' barriers to learning online and how the institution can support these students. Researchers gathered survey results of 1295 university students regarding the barriers they experience and the support they receive from the institution to support their academic engagement. Descriptive statistics and thematic coding revealed specific practices institutions could implement to help students overcome barriers to fully engaging in their learning. The third article presents how online teaching assistants (OLTAs) interact with students to support their engagement in online and blended learning courses and how a training course may influence their interactions. Researchers gathered data from a tracking instrument that documented OLTA-student interactions over a 2-week period and conducted interviews with 10 OLTAs. Descriptive statistics and thematic coding indicated that TAs supported students in several ways and that their training program most likely influenced how they approached these interactions.

No description available.

No description available.