Thesis (Ph.D.) -- McMaster University, 1999. / Includes bibliographical references (p. 176-180). Also available via World Wide Web.

Thesis (M.A.)--University of Central Florida, 2010. / Adviser: Kerstin Hamann. Includes bibliographical references (p. 100-106).

Thesis (M.P.A.)--University of Hong Kong, 1998. / Includes bibliographical references (leaf 112-117).

Thesis (M.P.A.)--University of Hong Kong, 1998. / Includes bibliographical references (leaves 112-117). Also available in print.

Objectives: To develop and evaluate the effectiveness of a school-based intervention for preventing the uptake of smoking among adolescents in the State of Sabah, Malaysia Methods: The study design was a pilot randomised controlled trials with 7 months follow-up. A total of 1971 Form 1 students mostly aged 13 years old involved in the questionnaire. Eight secondary schools were randomly allocated equally to four intervention and control arms. The intervention schools received the health promotion activities as usual care and the peer educator intervention whereas the control schools received just the usual care of the health promotion activities. A total of 73 selected students were trained to be peer educators and given tasks to have an informal conversation and giving opinion about smoking issues and advocating not smoking norms. Individual-level analyses (relative risk and chi square analyses) and multilevel analyses which account for the clustering of students in schools were conducted. Three data sets were used from the complete data set, a data set that was comprised on students who could be matched at both baseline and follow-up and two data sets that were based on one of two assumptions. The first assumption was that baseline participants who could not be matched at follow-up retained their baseline smoking behaviour at follow-up. The second assumption was that baseline participants who could not be matched at follow-up were all regular smokers. Results: The main finding was that the intervention had a significant positive effect on the smoking behaviour of baseline current smokers. That is baseline current smokers were less likely to have continued to be current smokers if they attended an intervention school. Five out of the nine tests supported this proposal including the most rigorous analyses which were all based on multilevel models. The impact of the intervention on baseline never smokers was less obvious as only one of the nine tests of significance indicated that the intervention had a significant positive effect on follow-up smoking behaviour. In relation to baseline occasional smokers only two of the nine analyses indicated that the intervention had a significant positive effect on the smoking behaviour at follow-up. The analysis on interactions with friends in school showed that the intervention schools (43%) had a significantly higher proportion of students than in control schools (38%) who had a conversation about smoking issues. Conclusion: The peer educator intervention is a promising approach in the smoking prevention programmes for adolescents in Malaysia.

Bullying is a widespread public health problem. While its prevalence, key correlates and major health outcomes have been well researched, important gaps or controversies remain. In particular, the association between bullying and both socioeconomic status and ethnicity remains unclear. Furthermore, other areas are under-researched, such as sibling aggression and its relationship to peer bullying. Finally, while there is evidence of the adverse effects of bullying on mental health, there is still uncertainty whether any experience of being bullied, or only sustained, chronic victimisation, will lead to adverse consequences. Do those who escape bullying fare better? This thesis comprises five studies. Study 1, a meta-analysis, explored the relationship between bullying and socioeconomic status, finding victims and bully-victims, but not bullies, more often came from low socioeconomic backgrounds. Study 2 examined sibling aggression, identifying a strong homotypic association with roles taken in school bullying. Study 3 explored ethnic differences in bullying, finding ethnic minority children were not more likely to be victims, but in some cases were more often bullies. Study 4 identified individual, social and sociodemographic correlates of school bullying. Distinct profiles were observed for each bullying role. Finally, Study 5 examined the timing of bullying in relation to individual and social outcomes. Stable and concurrent victimisation was associated with more negative outcomes, while escaping bullying reduced the adverse consequences. The findings are considered in relation to ecological systems theory. Distant environmental factors, such as socioeconomic status, were only weakly associated with school bullying, while more immediate socio-ecological influences, including sibling relationships and individual characteristics, predicted victim, bully and bullyvictim roles. Further research should focus on the association with sibling aggression, and identify characteristics which can explain why some children escape being bullying, thereby limiting the adverse consequences. The findings have implications for interventions, which should take account of children’s home environments.

Self-help groups in the United Kingdom continue to grow in number and address virtually every conceivable health condition, but they remain the subject of very little theoretical analysis. The literature to date has predominantly focused on their therapeutic effects on individual members. And yet they are widely presumed to fulfil a broader civic role and to encourage democratic citizenship. The thesis uses qualitative data derived from individual and group interviews with 33 groups in order to provide an outline of the ethos, aims, activities and structural arrangements of a broad range of self-help groups in Nottinghamshire, UK. It then uses these findings as the foundation on which to construct a model of self-help groups’ democratising effects in the public sphere and as a means of differentiating them from other types of ‘health citizenship’ organisation such as new social movements. In order to do this it broadly follows the work of Jurgen Habermas, making use of his concepts of communicative action; system-lifeworld integration; lifeworld autonomy and collective identity as an appropriate framework against which to account for these groups in civic terms. It was found that in their pursuit of personal and collective identities the groups were augmenting individual autonomy through increasing mutual recognition and understanding in the lifeworld. Although at first sight the groups appeared to be structured hierarchically, leaders tended to use their influence to foster a type of communicative equality that sustained the democratic negotiation of these identities. In addition, through their two-way communicative links with the system the groups were adding to the complexity and quality of discourse in the public sphere and increasing the possibility of attaining social consensus. Unlike new social movements who are believed to operate at the protest end of civil society, the self-help groups were oriented to its enabling sector.

In spite of the fact that services for deaf people have been provided since Victorian times, there is no "philosophy of deafness" and services are based upon the subjective observation of deaf people by "hearing" people. This study seeks to formulate such a philosophy, for those unable to hear spoken communication from birth or early childhood, based upon acceptance of the social limitations of being unable to hear in a society where the ready use of that sense is taken for granted. In order to base this philosophy upon the objective assessment of deaf people's needs, deaf respondents were interviewed and observed and their referrals to specialist agencies for deaf people and the work of a group of social workers with deaf people were examined. The study re-defines deaf "community" and deaf "culture" as the deaf social group and the deaf way of life, arguing that the former concepts marginalise deaf people and stressing that although deaf people need to make sub-cultural adaptations in order primarily to satisfy their social-psychological needs and for fellowship, the deaf sub-culture is an extension of "hearing" culture and deaf people would benefit by becoming effectually bi-cultural. It is suggested that "deafness" rather than membership of the deaf "community" is ascribed to deaf people. The study sees the uniqueness of the deaf sub-culture in the means of inter-personal communication, Sign Language, and in its members' self-identification as "deaf". The idea of individual autonomy is developed and it is used as a framework within which to formulate a philosophy of deafness which recognises the need for sub-cultural adaptations by deaf people, because of the inevitability of impediments to fluent inter-personal communication between deaf and "hearing" people. The philosophy also recognises the need for "hearing" people to accommodate to deafness in order to reduce deaf people's marginal status in society, principally through the use of Sign Language, either directly, or through interpreters. Finally, implications for policies of service provision are considered, in particular the need for deaf people to be involved with planning and provision of services for deaf people based upon a social rather than a social work/pathological model.

Addressing criticisms of the routine-driven, task-oriented, depersonalising nature of conventional services, and reflecting a broader trend across health and social care, person-centred care has become the watchword for quality in long-term care for older people in recent years. Person-centred care requires recognising the unique personhood of each individual regardless of their physical or mental capacity. Efforts to realise this approach depend largely on the non-professional nursing staff who deliver the majority of direct care in this context. However, little is known about how new knowledge, including ideas and evidence about person-centred care, translates into the daily practices of this cadre of staff, who have little formal training, low job status, and limited access to traditional forms of research dissemination and knowledge exchange. Building on the existing knowledge-translation literature, therefore, the aim of this study was to explore the mechanisms of knowledge translation about person-centred care among care assistants in long-term care. The objectives were to examine how these staff develop their understanding of person-centred care; identify the personal and contextual factors involved; and explore what can be learned about person-centred care from their current practices. The study used ethnographic methods, including 500 hours of participant observation, in-depth interviews, and document analysis, to conduct case studies of two private nursing homes located in the East Midlands and the north-eastern United States. Without claiming to demonstrate causality, extending the research across two policy settings did facilitate the identification of pertinent issues within and beyond each individual facility. Data analysis was informed by practice theory, which provided an alternative to the individualist assumptions which characterise popular representations of long-term care, on the one hand, and, on the other, structural explanations that renounce individual agency altogether. From this theoretical perspective, drawing in particular on Bourdieu‘s theory of practical logic and the neo-institutional concept of institutional logics, this study identified how the interconnection of particular practices within each setting produced different situated understandings and implementation of person-centred care. A key finding was that care assistants' individualised knowledge about each resident, obtained through their direct daily care, represented an important form of symbolic capital in this field. Their willingness or reluctance to share such knowledge, consequently, corresponded to the extent to which other practices, including communication and teamwork, supported or threatened this limited source of power. The second, related finding was that care assistants derived from this individualised knowledge a certain amount of autonomy, or discretion, over the organisation and delivery of daily care. This discretion, together with the agency that care assistants exercised in navigating different institutional logics in this context of care – which was the third main finding – signified a potential nexus of practice change. Conversely, new knowledge or ideas that undermined this limited discretion and agency tended to engender denial or resistance. As the population ages, demand for long-term care for older people is increasing exponentially, prompting concerns about the capacity and sustainability of this sector. One significant area of concern is workforce recruitment, retention, and competence. This study, located at the intersection of research on long-term care and knowledge translation, contributes to efforts to address these concerns by identifying opportunities for intervention in education, training, and support, in order to build a workforce that is equipped to provide high-quality, evidence-based, person-centred care for older people throughout the years ahead.

This action research study reports on the development of a process for dialogic learning underpinned by Person Centred Thinking and the use of Person Centred Planning Tools (PCPTs). This learning occurred in three separate but associated teams delivering family support services to children and their families. The aim of this study was to explore and attain an understanding of how the use of these tools and processes would affect the process of organisational learning in the three settings. It is believed to be the first time PCPTs have been used in this context. Facilitated action learning supported the use of Person Centred Thinking to attend to and decipher the challenges of the daily working practices and collaborative relationships of the three teams. This appreciative and inclusive methodology supported the development of a ‘common language’, which, where successful, helped to embed a system of whole service dialogic learning. This model of change management distinguishes the process used in this study from other interventions. Where successful, leadership was central to successful implementation of dialogic learning in the teams and their ambition to become learning organisations. The importance of the individual actions taken by the leaders and their use of power was influential to the outcome of the study. The synergy created by the synthesis of Person Centred Thinking and dialogue in the teams with good leadership, suggests that the dialogic learning emanating from it has perceptible and noteworthy connections for, and to, organisational learning. The original contribution to knowledge from this study is the development of a theoretical understanding of how person centred practices when embedded into teams can transform and positively augment ways of working. Specifically it posits how dialogic learning practices provide the culture and context to facilitate individual and team growth and understanding through organisational learning.