Master of Public Health / Department of Kinesiology / Emily Mailey / INTRODUCTION: Research has focused on the relationship between socioeconomic status and physical activity, yet there are limited examinations which directly address social groups dealing with major issues associated with insufficient income. Studies have neglected the role of psychosocial stressors, such as financial stress, food insecurity, availability of government assistance programs, as well as psychological distress relative to the relationship between physical activity and low-income status. The purposes of this study were threefold: 1) to describe the multidimensional characteristics of life among low-income populations; 2) to examine how psychosocial stressors and health conditions vary across subsets of low-income groups; and 3) to examine the relationship among income, psychological distress and physical activity within low-income populations. METHODS: Data from the 2015 National Health Interview Survey (NHIS) were analyzed for the purposes of this investigation. Descriptive statistics were calculated for the low-income status individuals who provide complete data for all variables of interest to this study. A series of chi-square analyses were conducted to determine whether key psychosocial stressors, health behaviors, and health conditions differed by low-income (FIPR) groups. Two stepwise logistic regression analyses were conducted to examine these factors and their relationships with moderate-intensity (MPA) and vigorous (VPA)-intensity physical activity. RESULTS: Overall, women made up 58.5% of the sample size. Blacks/African Americans accounted for 20.6% of the sample, yet 28.0% of FIPR Group 1 identified as Black/African American. FIPR Group 1 was disproportionately unemployed, with 63.5% unemployed compared to 46.9% for the sample. One-quarter (25.9%) of the entire sample reported severe psychological distress, yet 33.9% of FIPR Group 1 and 30.8% of FIPR Group 2 reported severe distress. Nearly three-quarters (70%) of the sample was overweight or obese and 44.2% lived with at least one chronic disease at the time the survey was taken. Overall, 67.9% of the sample reported zero minutes of VPA and 51.3% reported zero minutes of MPA. Both psychological distress and income showed significant relationships with VPA. Psychological distress remained significantly associated with VPA after controlling for all covariates; however, income was no longer related to VPA after demographic and health-related variables were added to the model. Income was not related to MPA. Psychological distress demonstrated a weak relationship with MPA before the other covariates were added to the model, at which point the relationship became non-significant. Only the relationship between psychological distress and VPA was significant in the final models. Although some of the psychosocial stressor, demographic, and health-related variables contributed to the relationships between income, physical activity, and psychological distress, these variables explained only a small portion of the variance in both MPA and VPA. CONCLUSION: Low-income individuals are faced with difficult decisions and are limited in the choices they can make to improve health. It is important to understand the multidimensional characteristics of life under limited income to better serve and improve the health of low-income populations. Further study of the relationships among income, physical activity and psychological distress is needed to further this understanding.

Made available in DSpace on 2014-06-11T19:29:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-11-24Bitstream added on 2014-06-13T19:07:18Z : No. of bitstreams: 1 caldeira_lrm_me_assis.pdf: 678437 bytes, checksum: 1e322abe13c16a84432253ecab8d3096 (MD5) / O objetivo do presente estudo é refletir sobre alguns impactos que uma oficina de teatro – desenvolvida com usuários de um Hospital-Dia, localizado na cidade de Presidente Prudente-SP, Brasil – tem produzido em um grupo de teatro, denominado Trupe Maluko Beleza. No contexto da Reforma Psiquiátrica brasileira e, mais especificamente, no campo da Atenção Psicossocial, o objetivo da atenção e das ações de cuidado é voltado para a existência-sofrimento do sujeito. O cuidado da pessoa que sofre é realizado por intermédio de uma multiplicidade de ações e de estratégias diferenciadas, nos espaços sociais, com a finalidade de propiciar sua emancipação e autonomia, isto é, seu reposicionamento como sujeito, considerado em sua dimensão subjetiva e sociocultural. Desse modo, os serviços de saúde mental têm-se utilizado das oficinas terapêuticas, entre as quais a oficina de teatro, como um valioso recurso no atendimento clínico-institucional. No contato com a arte cênica, o ator vive diversos personagens e, por meio deles, experimenta outras possibilidades de vida. Pensamos que os encontros dessa oficina têm ampliado a oportunidade de trocas dos usuários e, portanto, ela se tornou um dispositivo para romper com os efeitos do modelo hospitalocêntrico, porque proporciona aos seus participantes um lugar, um espaço de convivência e de continência ao desejo e à autonomia, metas aspiradas pela Atenção Psicossocial. Em síntese, observamos que esse recurso é uma potente estratégia para a construção do acolhimento do usuário, de modo a proporcionar-lhe a habitação de novos territórios existenciais, a produção de cuidado de si, contribuindo na constituição de sua subjetividade e na ruptura do estigma de loucos, improdutivos, irracionais e incapazes. / The aim of the present study is to discuss what some impacts of a theater workshop - developed with patients in a Day-Hospital in the city of Presidente Prudente-SP, Brazil – has produced in a theater group called Maluko Beleza Troupe. In the context of Brazilian psychiatric reformation and more specifically in Psychosocial field, the purpose of attention and actions care is focused on the existence and suffering of the subject. The care of a suffering person is done through a multiplicity of actions and strategies in different social spaces aiming to promote emancipation and autonomy, in other words, his or her repositioning as a subject, considered in his/her subjective and social-cultural dimension. That way, the mental health services have been used in therapeutic workshops, including a theater workshop, as a valuable resource in clinical and institutional treatment. In contact with scenic art, the actor lives several characters and through them he or she tries other ways of life. We believe that these workshop meetings have expanded the possibility of users’ exchanges and therefore it became a device to break the effects of hospital-centered model. That offers its participants a place, a living space, continence and the desire for autonomy, which goals are aspired by Psychosocial Care. In summary, we observed that this resource is a powerful strategy for the construction of the user´s refuge in order to provide him housing for the new existential territories and the production of self-care, helping with the constitution of the users´ subjectivity and disruption of crazy, unproductive, irrational and incapable stigma.

Orientador: Maria Alice Ornellas Pereira / Banca: Renata Curi / Banca: Magda Cristina Queirós Dall'Ácqua / Resumo: Considerando o evoluir histórico da atenção em Saúde Mental, vê-se que essa tem se transformado e caminhado para a busca da inclusão social e se apresentado como campo de conhecimento complexo, que solicita práticas que contemplem a diversidade de demandas de muitas ordens. Nessa perspectiva, o presente estudo teve como objetivos compreender como os pacientes egressos de um Hospital Dia de Saúde Mental vêem o serviço, conhecer se este contribuiu para mudanças em suas vidas e apreender se estas pessoas têm continuidade ao tratamento. Para tanto, utilizamos a abordagem qualitativa de pesquisa. Os dados foram coletados por meio de entrevistas semi-estruturadas realizadas durante visitas domiciliares e busca documental. Adotamos a Análise Temática para a ordenação e análise dos dados obtidos. Esses foram analisados a partir do referencial da reabilitação psicossocial. Participaram do estudo nove pacientes, residentes no município de Botucatu que concluíram o tratamento proposto no Hospital Dia de Saúde Mental - UNESP - Botucatu, no ano de 2008. Os resultados demonstram que o sofrimento causado pelo adoecimento psíquico é um fator marcante e desagregador na vida dos participantes desta investigação, solicitando uma assistência que considere as necessidades complexas dos indivíduos e o acolhimento do sofrimento. Para os sujeitos, o serviço ofereceu o acolhimento, mostrando-se continente ao sofrer psíquico, contribuiu para o processo de retomada da autonomia e inserção social, possibilitando a efetivação de mudanças na vida dessas pessoas. O estudo, também, aponta que os sujeitos dão continuidade ao tratamento após a alta do serviço e valorizam a pluralidade terapêutica oferecida. Por outro lado, evidencia-se a necessidade de ações que considerem a integralidade e a intersetorialidade, uma vez que foi observada restrita comunicação entre serviços ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Considering the historical development of mental health care in Brazil, it is observed that such care has changed, headed towards the search for social inclusion and shown to be a field of complex knowledge, as it requires practices that can contemplate a diversity of demands of many orders. In this perspective, the present study aimed at understanding how patients who have been discharged from a Mental Health Care Day Hospital view the service, at learning whether such service contributed to changes in their lives and at apprehending whether such individuals continued treatment. To that end, the qualitative research approach was used. The data were collected by means of semi-structured interviews conducted during home visits and by documental research. Thematic analysis was adopted for organization and analysis of the information obtained, which was analyzed according to the psychosocial rehabilitation framework. Nine patients who resided in the city of Botucatu and had completed the treatment proposed by the Mental Health Day Hospital - UNESP - Botucatu in 2008 participated in the study. Results showed that the suffering caused by psychic illness was a remarkable and disaggregative factor in the lives of the participants in this investigation, thus requiring care that takes into account the individuals' complex needs as well as suffering admittance. To the subjects, the service received them well by showing to be attentive to their psychic suffering, contributed to the process of autonomy resumption and social inclusion, thus producing effective changes in these individuals' lives. The study also shows that the subjects continued their treatment after hospital discharge and valued the plurality of the therapy provided. On the other hand, it shows the need for actions that will consider integrality and intersectoriality, since limited communication between the services ... (Complete abstract click electronic access below) / Mestre

Recent policy analysis has had a growing interest in examining the everyday practices of policy work. Despite this, conceptions of what policy can and should encompass tend to be focused on its tangible outputs and products, in particular the texts and documents of policy and governance. Policy’s legitimacy is commonly considered to rest on its participants’ ability to make rational decisions motivated not by private reasons but by the public good. This has had serious implications for scholars’ ability to discuss the non-purposive, nonverbal and non-rational content in policy work. This thesis presents an ethnographic study of emotion in the context of policy work. Starting from informants’ own understandings of what emotion means in policy and politics, it focuses on a fifteen month period in the policy practices of a Scottish NGO and its stakeholders and participants. From the perspective of a participant observer policy worker, it uses observation, documents, and interviews to explore the way traditionally “rational” models of governance based on apparently objective knowledge and other non-rational, “caring” ways of knowing are brought to bear upon policy work through detailed examination of practice. Analysis of these practices begins by examining the way that informants described the anxieties caused by competing understandings of “good” governance. Emotion and rationality were considered mutually exclusive but equally essential components of policy making. This thesis proposes that the way these anxieties were managed by the Partnership’s policy participants was to split these incommensurable expectations of governance between two self-identifying groups: activists such as community organisers and professionals such as civil servants. Splitting knowledge in this way helped the wider policy making community to maintain their own sense of legitimacy and moral integrity while making use of “dangerous” knowledge.

While there is extensive research on medical doctors and their mental health, little is known about the specific barriers which prevent them from accessing psychological services. Numerous studies have shown that rather than asking for help from other professionals such as counselling psychologists and therapists, doctors would rather turn to drugs and alcohol to cope with their psychological distress. Junior Doctors (JDs) specifically are at particular risk of mental ill-health but feel prevented by their profession from seeking psychological treatment. Little research has been conducted on this particular subject area focusing specifically on JDs. This study readdresses the empirical evidence available for the issue and informs more clearly how counselling psychology and related professions can provide a more effective service to this client group. A constructivist grounded theory approach using eight participants allowed for a detailed examination of the participants’ subjective experiences of the research phenomenon and the generation of new theory on the barriers which prevent JDs from accessing psychological help. Of the eight participants, seven were from an Asian background and one was of Caucasian origin. Further, seven were male with the remaining one participant being female. A core category was uncovered from the analysis of the data which apply to the research participants: psychosocial barriers to accessing psychological services by JDs. This core category was informed by three main themes: 1) medical identity 2) the development of coping strategies in the British medical culture, and 3) the unacceptability of difference. This core category and its themes make up the grounded theory of the research. In light of the findings it may be suitable to adapt the usual process of therapy and negotiate a more appropriate method of delivering psychological support to reduce barriers and to promote credibility and effectiveness of counselling psychology among this client group.

This study was undertaken in order to research on the trauma caused by the Matebeleland Massacre of 1982-87 in Tsholotsho Zimbabwe. This dissertation is two pronged: one part is to ascertain the trauma in the community twenty years after and the second aspect is to suggest interventions that can be applied. The history of the country and the political background to the conflict is the most rational way to explain why this may have happened. This history has been used to justify the Massacre and is being used continuously even today by those in power. If people do not learn from their history they are bound to repeat it, (interview with Phineahs Dube 4/8/20080). Trauma has been investigated using a qualitative social reconstruction narrative theory by way of cultural world view and not medical psychological means. Investigating people’s painful experiences and emotions has not been easy. A suitable framework and trauma measure which are scientifically approved had to be found and used in order to validate and verify the results in a manner that the outcome can be accepted scientifically and internationally. Chronic ‘on going’ trauma or Long-term Psycho-social Crisis is the kind of trauma that the researcher has come up with if conventional medical jargon is to be avoided. The survivors can not fully comprehend what happened to them but the greatest injury and pain is caused by how the community as a whole was under threat of annihilation by the Gukurahundi, The name itself is infamous and points to the brutal nature of the operation of this North Korean trained army battalion known simply, as the 5th Brigade. The interventions suggested are psycho-social since the context is rural Tsholotsho Matebeleland, culturally, a socio-centric set up with in an African world view, (Mbiti 1969) and (Mugambi and Kirima 1976). The Church is proposed as the agent for change in the community as light and salt due to its proximity to the community. The interventions include funerals services and rituals, testimonies, and archival processes for the sake of prevention and collective memory. The psycho-social cultural approach takes the survivor from being just an individual with a personal problem to a collective memory of experience. (Becker 2000: 18) This gives practical theology an opportunity for a logical conclusion of all theologizing which is a theology of praxis or engagement. / Dsecription (PhD)--University of Pretoria, 2010. / Practical Theology / Unrestricted

Information has been sparse on the hospice psychosocial support offered through the American hospice system. This study examined the hospice psychosocial services that are available and utilized within the United States. In addition, the characteristics of patients and families who utilized these services were comprehensively assessed. Data from the 2007 National Home and Hospice Care Survey (NHHCS) was analyzed in this cross-sectional study (National Center for Health Statistics [NCHS], 2007). Hierarchical linear regression, hierarchal logistic regressions as well as chi-square test of independence were used to analyze the data. It was hypothesized that for profit hospice ownership status would predict less availability and utilization of psychosocial services when agency size, chain status, and patient total activity of daily needs are controlled. Ownership status was a significant predictor of medical social service availability where for profit agencies were more likely to have this service available. Conversely, hospice patients at for profit agencies were less likely to utilize medical social services as well as bereavement services. Overall, patient and caregiver utilization rates of psychosocial services were low with the exception of medical social services, bereavement services, spiritual care services, & safety training services. The majority of individuals that used these services were married, White, non-Hispanic, 74-75 year old cancer patients with no cognitive impairment. Most were Medicare recipients with advanced directives in place and had 4 ADL needs. Routine home care patients with an average care continuum of about 2-2 ½ months accounted for most of those who used these services. The majority of these patients lived in a private residence with family members and had spousal caregivers. These results suggest that the psychosocial services that are being provided have an overall low utilization rate despite availability regardless of ownership type. Further, psychosocial services are disproportionately underutilized by racial and ethnic minorities. In addition, these results highlight the disparity that exists between racial groups that are admitted under hospice care. Further interdisciplinary research needs to be conducted in order to address this disparity in order to determine alternative forms of care that are specifically tailored to a diverse patient population.

It is commonly believed that breast cancer dragon boating benefits survivors in a range of psychosocial areas, but there have been few empirical studies to investigate such relationships. An interpretive description design and a critical health promotion approach were used to explore the psychosocial experiences of women who breast cancer dragon boat. In-depth interviews with six participants were analyzed. Themes that arose from the data are: (1) moving past isolation — networks of like-minded support, (2) taking control,(3) journey into adventure, (4) affirmative outlook, (5) confronting painful experience, (6) rebuilding identity, (7) and spiritual engagement. The findings illustrate that dragon boating provides breast cancer survivors with a significant venue for change and the opportunity to move beyond traumatic elements of cancer. / Arts, Faculty of / Social Work, School of / Graduate

Cancer incidence is increasing and so are survival rates. The aftermath of cancer includes multi-dimensional and long-lasting effects that prevent individuals from recovering and re-integrating into their daily routines. Cancer systems attend to patients during diagnosis and treatment, but often fall short in providing continuity of care afterward. This results in a considerable number of individuals living with the effects of cancer, with little support care. While there are evidence-based recommendations to improve follow-up cancer care, the extent to which they have been implemented remains unknown. To support the needs of cancer survivors The Ottawa Regional Cancer Foundation developed a Cancer Coaching Program (CCP). As life and health coaching interventions have been shown to benefit this population, this study aimed to explore the impacts of the CCP on the lives of cancer survivors. Using a grounded theory approach, the experiences of (n=12) cancer survivors who had previously participated in the program were explored, to create an explanatory model. Descriptive results depicted various beneficial outcomes to participating in the CCP. The dominant role of the CCP is to support survivors by “bridging the gap” to survivorship, through tailored coaching services. This study provides insight into the mechanisms that work for this cancer coaching program, which may be helpful for other programs exploring strategies to assist this population.

This study examined peer relationships and psychosocial functioning as a function of maternal and paternal involvement and nurturance along with the moderating effects of gender, family form, and ethnicity. Prior research has shown the influence of mother’s involvement on peer relationship quality but not of fathers. Further, previous studies did not examine moderation by family form, gender, or ethnicity. The sample consisted of 1359 students who identified their biological mother and father as the most influential parental figures in their lives. Their ages ranged from 18 to 26; Sixty–one percent of the sample was Hispanic, 13% non-Hispanic Black, 25% non-Hispanic White; 76% female and 70% from intact families. The analytical strategy included using bivariate correlations and structural equation modeling to examine these relationships. All dimensions of maternal and paternal nurturing and involvement were positively related to positive characteristics of peer relationships, self-esteem and life satisfaction consistent with the multicultural findings of PARTheory (Rohner, Khalique, & Cournoyer, 2005). A structural model was developed that was able to adequately account for the relationship between parental influence, peer relationships, and psychosocial functioning. These effects of both maternal and paternal influence were strongly moderated by culture, family form, and gender. Finally, a differential effect was found among parental influence with fathers having a greater influence on friendship quality and importance than mothers, despite greater maternal involvement. These findings have theoretical, clinical, and social implications as they call for a socially based theoretical perspective within which to study these relationships. Such a perspective would better inform clinicians when using impaired social functioning as indicative of axial diagnosis, and for the implementation of social policy to encourage paternal involvement.