The dissertation thesis aims to identify and describe the key theoretical and methodological problems related to the study of conversation markers and to the collection of authentic data for such an analysis. To illustrate the whole research process, the Argentinian conversation marker boludo as a model example is used. The starting point of the analysis is located at the intersection of conversation analysis, discourse analysis and sociolinguistic paradigms, while taking into account the omnipresent background of pragmatics as well. We try to assess the contribution of such an interdisciplinary approach when studying conversation markers. As for the methodology, the thesis seeks to show what difficulties arise when carrying out a sociolinguistic research of conversation markers, which are understood as units typical of spontaneous conversation, i.e. without external manipulation, in comparison with the variationist research at other language levels. In addition, we also clarify why it is important to evaluate their character not only on the grounds of qualitative and functional perspective (in relation to analysing the socially-indexed interaction markers), but also quantitatively with regards to selected social variables that appear to be relevant for the recurrent use of the given marker. The outcome of the method assessment is an attempt to design a model approach to be applied in practice. In sum, the core of the research consists in analysing the Argentinian marker boludo from different perspectives; namely, within the pragmatic, functional-positional, interactional-sociolinguistic and variationist-sociolinguistic frameworks. Its nature is subsequently compared to the behaviour of another recurrent Argentinian conversation marker, che, since some authors regard them as equivalents. The analyses of naturally-occurring conversation data collected in situ are complemented by introspective judgements of several native speakers.

本研究之目的是以個人與環境契合理論探討青少年的能力與外在要求是否契合，以及其需求與外在資源問的契合，由契合狀態顯示青少年的適應。而父母教養態度又與青少年的適應有關聯，因此，研究目的又欲呈現在青少年與外在環境的互動中，其所知覺之父母教養態度對其個人與環境之契合有何影響，如何影響，而此一影響結果是否會改變孩子對父母教養態度的知覺，父母教養態度在孩子的適應上扮演什麼角色。 　　首先根據父母管教態度問卷將受訪者區分為正向父母管教態度組以及負向父母管教態度組，再利用深度訪談收集資料。從十個個案分析結果發現，父母教養態度係經由孩子的主觀知覺影響孩子的契合狀態，亦即，當孩子面對一環境事件，他對此事件的知覺與對自己的知覺決定其個人與環境是否契合，契合狀態以及對事件、對自己的知覺影響孩子選擇之因應或防衛方式，因應或防衛的結果，可能會改變孩子的契合狀態；而父母親對於此事的態度，孩子對父母親態度的知覺，亦如同一環境事件，形成外在要求或外在資源，影響孩子在此事件上的契合。其中孩子知覺之父母教養態度、孩子對事件與對個人的知覺以及因應與防衛均會相互影響，又共同作用於孩子的契合。 　　父母教養態度經由上述歷程影響孩子的適應，而不同的父母教養態度也會對孩子的適應造成不同影響。研究結果顯示，當孩子知覺父母的教養態度是關懷、寬嚴適中、適中限制、民主、協助、建議、愛護、誘導、獎勵、一致、親子認同等積極性教養態度，會促使孩子之個人與環境契合，有利於孩子的適應；當孩子知覺父母的教養態度是嚴格、控制、忽視、矛盾、獎懲無常、期待、紛歧等消極性教養態度時，會擴大孩子的不契合，不利於孩子的適應。正向父母管教態度組之個案知覺到較多積極性父母教養態度，負向父母教養態度組知覺到較多消極性父母教養態度。 　　整體而言，本研究累積十位個案的資料，藉以呈現父母教養態度對青少年期孩子生活適應影響之面貌，其中以正向與負向父母管教態度組相對照，有助於了解那種父母教養態度有利於孩子的適應，那些父母教養態度不利於孩子的適應，同時顯現其作用歷程。

Aquest estudi avalua els efectes de la musicoteràpia en dones amb càncer de mama que reben tractament de quimioteràpia adjuvant sobre simptomatologia d’ansietat, depressió, qualitat de vida i fa una anàlisi qualitativa basada en els informes de les pacients sobre l’experiència musicoterapèutica. Investigació experimental. Es separa en grups consecutius a tractament de quimioteràpia i musicoteràpia (GE) o tractament de quimioteràpia estàndard (GC) a 88 dones diagnosticades amb càncer de mama en diferents estadis que reben quimioteràpia. És un disseny simple de pre-post test (cicles 1,2 i 3) i seguiment (cicle 4). La musicoteràpia consisteix en tres sessions de musicoteràpia individuals, durant el tractament. Els instruments de mesura són: escales HADS (ansietat i depressió) i EORTC QLQ C-30 (qualitat de vida) en els cicles 1 i 4; termòmetre de distrès i pregunta oberta de manera pre-post en els cicles 1,2 i 3. L’anàlisi qualitativa del discurs es realitza mitjançant el programa Atlas.Ti (5.2). Completen les dades 69 pacients. En distrès psicològic (HADS), l’ansietat es redueix significativament en el GE (p<.0001) i baixa en depressió (p=0.2189). El GC es manté estable o augmenta significativament. La qualitat de vida global (EORTC QLQ C-30) millora en el GE (p=0.1960), amb diferència significativa en subescales de rol (p=0.0073), funcionament emocional (p=0.0006) i cognitiu (p=0.0483), mentre que el GC empitjora significativament. En termòmetre del distrès, el GE frega la diferència significativa en quasi tots els cicles en ansietat i l’assoleix en depressió. L’anàlisi del discurs del GE reflecteix benefici de la musicoteràpia en una major relaxació, tranquil•litat i millora de l’estat d’ànim. La musicoteràpia modifica la percepció del temps durant la sessió. Les pacients del GE reporten menys simptomatologia d’ansietat i depressió post sessió. També més capacitat i recursos d’afrontament actiu, capacitat de fer/crear música i gaudir en l’ara i aquí, que les del GC. La musicoteràpia és percebuda com un recurs per a les pacients del GE i es recomana la seva aplicació. Conclusions: Els nostres resultats recolzen l’ús de la musicoteràpia com a eina de suport i tractament complementari durant el tractament amb quimioteràpia. La combinació de metodologia quantitativa i qualitativa complementa i reforça els resultats. / Este estudio evalúa los efectos de la musicoterapia en mujeres con cáncer de mama que reciben tratamiento de quimioterapia adyuvante sobre sintomatología de ansiedad, depresión, calidad de vida y hace un análisis cualitativo basado en los informes de las pacientes sobre la experiencia musicoterapéutica. Investigación experimental. Se separa en grupos consecutivos a tratamiento de quimioterapia y musicoterapia (GE) o tratamiento de quimioterapia estándar (GC) a 88 mujeres diagnosticadas con cáncer de mama en diferentes estadios que reciben quimioterapia. Es un diseño simple de pre-post test (ciclos 1 a 3) y seguimiento (ciclo 4). La musicoterapia consiste en tres sesiones de musicoterapia individuales, durante el tratamiento. Los instrumentos de medida son: escalas HADS (ansiedad y depresión) y EORTC QLQ C-30 (calidad de vida) en los ciclos 1 y 4; termómetro de distrés y pregunta abierta de manera pre-post en los ciclos 1, 2 y 3. El análisis cualitativo del discurso se realiza mediante el programa Atlas.Ti (5.2). Completan los datos 69 pacientes. En distrés psicológico (HADS), la ansiedad se reduce significativamente en el GE (p<.0001) y baja en depresión (p=0.2189). El GC se mantiene estable o aumenta significativamente. La calidad de vida global (EORTC QLQ C-30) mejora en el GE (p=0.1960), con diferencia significativa en subescalas de rol (p=0.0073), funcionamiento emocional (p=0.0006) y cognitivo (p=0.0483), mientras que el GC empeora significativamente. En termómetro de distrés, el GE roza la diferencia significativa en casi todos los ciclos en ansiedad y la consigue en depresión. El análisis del discurso del GE refleja beneficio de la musicoterapia en mayor relajación, tranquilidad y mejora del estado de ánimo. La musicoterapia modifica la percepción del tiempo durante la sesión en el GE. Las pacientes del GE reportan menos sintomatología de ansiedad y depresión post sesión. También más capacidad y recursos de afrontamiento activo, capacidad de hacer/crear música y disfrutar en el aquí y ahora, que las del GC. La musicoterapia es percibida como un recurso para las pacientes del GE y se recomienda su aplicación. Conclusiones: Nuestros resultados apoyan el uso de la musicoterapia como herramienta de apoyo y tratamiento complementario durante el tratamiento con quimioterapia. La combinación de metodología cuantitativa y cualitativa complementa y refuerza los resultados. / This study evaluates the effects of music therapy in women with breast cancer receiving adjuvant chemotherapy treatment on symptomatology of anxiety and depression, quality of life, and qualitative analysis based on the patient’s report of music therapy experience. Experimental research with a simple design of pre-post test (cycles 1,2,3) and follow-up (cycle 4). Groups were consecutively completed to chemotherapy treatment and music therapy (EG) or treatment of standard chemotherapy (CG) to 88 women diagnosed with cancer of breast in different stadiums who receive chemotherapy. It is a simple design of pre-post test (cycles 1 to 3) and follow-up (cycle 4). Music therapy consisted of three individual sessions during the chemotherapy treatment. Symptomatology of anxiety and depression measured with HADS and quality of life with EORTC QLQ C-30, at cycles 1 and 4. Pre-post distress (anxiety and depression) measured with Thermometer of Distress) and an open question at cycles 1, 2 and 3. Qualitative data categorized using Atlas.Ti software. 69 patients completed data collection. Experimental group (EG) decreased significant on anxiety (p <.0001) and low depression level (p=0.2189) measured with HADS, whereas control group (CG) kep stable or increased significant. Global quality of life (EORTC QLQ C-30) improved in the GE (p=0.1960) and obtained significant difference in role (p=0.0073), emotional function (p=0.0006) and cognitive function subscales (p=0.0483), whereas the GC deteriorated significant. With Thermometer of distrés, GE rubed the significant difference in almost all cycles in anxiety and obtained it in depression. The narrative of patients in music therapy group related more relaxation, tranquility and improvement of mood. There’s a different perception on time during the session. They reported also less symptomatology of anxiety and depression post session. Compared with patients of control group, patients of music therapy group tended to have more resources of active confrontation, capacity to enjoy making music and being in present (here and now). They emphasized that music therapy had been a useful resource and recommended his application. Conclusions: Our results support music therapy as a helpful tool and a complementary treatment during chemotherapy. The combination of quantitative and qualitative methodology complements reinforce the results.

This study investigated the relationship between student ratings of teaching and the mindfulness attributes of teaching assistants in freshmen courses consisting mostly of discussion. Regression analyses were run to determine whether teaching assistant data (n = 19), related to their teaching efficacy, trait mindfulness, mindfulness practices, self-compassion, and teacher concerns, were predictive of student ratings of teaching assistants' combined scores on three concatenated Likert-scale evaluation items--the teaching assistant is kind and respectful of me, is patient with my questions, and is receptive to my questions. As modeled, there was no significant relationship between these teaching assistant characteristics and the components that were examined. A subset of the population (n = 6), participated in follow-up interviews. A comparative and interpretative analysis of the interview data followed, which examined the teaching assistant narratives using the following variables as filters--teaching efficacy, trait mindfulness, mindfulness practices, self-compassion, and teacher concerns--in addition to the metacognitive constructs of Knowledge of Cognition and Regulation of Cognition. Overall, the interview component of the study found that teaching assistants who could better articulate their teaching processes and instructional goals reported purposefully engaging in the internal and external dialogic processes of instruction. Moreover, interview analysis suggests that teaching assistant evaluations were a poor means of assessing instructional skills, aptitude, or performance. In addition, while the tools used in this study, the Five Facet Mindfulness Questionnaire, the Mindfulness Process Questionnaire, the Self-Compassion, Scale, the Teacher's Sense of Efficacy, and the Teacher's Concerns Checklist, might reliably assess attributes of good instructors, they do not appear to capture the whole essence of one's instructional narrative. Whether it is through interviews, or intricate scenarios, instructional evaluation, especially when its purpose is to improve instruction, should have a qualitative and reflective component. / text

A scoping study of the published literature was used to describe the concept and practice of ecosystem approaches to health (ecohealth) in the context of public health. Analysis of commentaries identified 24 themes, expressed in a mind map showing interconnections between themes, with a table of explanations. Most (27 of 29) primary research articles did not explicitly explain how ecohealth was applied in their research, suggesting a need for some standardization in reporting ecohealth. Additionally, a case study approach was undertaken to identify enablers and impediments of ecohealth and how concepts were integrated into a research project of health and environmental sanitation in Vietnam. The project’s conceptual framework was aligned with ecohealth concepts, but in practice, a variety of challenges were identified. In future, ecohealth research teams should include a self-investigation of their ecohealth process to facilitate a comparison of theory-to-practice; this may serve as a best practice for ecohealth. / Public Health Agency of Canada (PHAC), Community of Practice in Ecosystem Approaches to Health - Canada (CoPEH-Can)

La téléréadaptation, tout comme d’autres champs en télésanté, est de plus en plus interpelée pour la prestation de services. Le but de ce projet de thèse est d’enrichir l’évaluation de la téléréadaptation afin que les connaissances qui en découlent puissent venir soutenir la prise de décision d’acteurs impliqués à différents niveaux en téléréadaptation. Le premier article présente une revue systématique dont l’objectif était de faire synthèse critique des études en téléréadaptation. La revue rassemble 28 études en téléréadaptation, qui confirment l’efficacité de la téléréadaptation pour diverses clientèles dans différents milieux. Certaines des études suggèrent également des bénéfices en termes de coûts, mais ces résultats demeurent préliminaires. Cette synthèse critique est utile pour soutenir la décision d’introduire la téléréadaptation pour combler un besoin. Par contre, les décideurs bénéficieraient aussi de connaissances par rapport aux changements cliniques et organisationnels qui sont associés à la téléréadaptation lorsqu’elle est introduite en milieu clinique. Les deux autres articles traitent d’une étude de cas unique qui a examiné un projet clinique de téléréadaptation dans l’est de la province de Québec, au Canada. Le cadre conceptuel qui sous-tend l’étude de cas découle de la théorie de structuration de Giddens et des modèles de structuration de la technologie, en particulier de l’interaction entre la structure, l’agent et la technologie. Les données ont été recueillies à partir de plusieurs sources (groupes de discussion, entrevues individuelles, documents officiels et observation d’enregistrements) suivi d’une analyse qualitative. Le deuxième article de la thèse porte sur le lien entre la structure, l’agent et la culture organisationnelle dans l’utilisation de la téléréadaptation. Les résultats indiquent que les différences de culture organisationnelle entre les milieux sont plus évidentes avec l’utilisation de la téléréadaptation, entraînant des situations de conflits ainsi que des occasions de changement. De plus, la culture organisationnelle joue un rôle au niveau des croyances liées à la technologie. Les résultats indiquent aussi que la téléréadaptation pourrait contribuer à changer les cultures organisationnelles. Le troisième article examine l’intégration de la téléréadaptation dans les pratiques cliniques existantes, ainsi que les nouvelles routines cliniques qu’elle permet de soutenir et la pérennisation de la téléréadaptation. Les résultats indiquent qu’il y a effectivement certaines activités de téléréadaptation qui se sont intégrées aux routines des intervenants, principalement pour les plans d’intervention interdisciplinaire, tandis que pour les consultations et le suivi des patients, l’utilisation de la téléréadaptation n’a pas été intégrée aux routines. Plusieurs facteurs en lien avec la structure et l’agent ont contraint et facilité l’intégration aux routines cliniques, dont les croyances partagées, la visibilité de la téléréadaptation, le leadership clinique et organisationnel, la disponibilité des ressources, et l’existence de liens de collaboration. La pérennité de la téléréadaptation a aussi pu être observée à partir de la généralisation des activités et le développement de nouvelles applications et collaborations en téléréadaptation, et ce, uniquement pour les activités qui s’étaient intégrées aux routines des intervenants. Les résultats démontrent donc que lorsque la téléréadaptation n’est pas intégrée aux routines cliniques, elle n’est pas utilisée. Par contre, la téléréadaptation peut démontrée certains signes de pérennité lorsque les activités, qui sont reproduites, deviennent intégrées aux routines quotidiennes des utilisateurs. Ensemble, ces études font ressortir des résultats utiles pour la mise en place de la téléréadaptation et permettent de dégager des pistes pour enrichir le champ de l’évaluation de la téléréadaptation, afin que celui-ci devienne plus pertinent et complet, et puisse mieux soutenir les prises de décision d’acteurs impliqués à différents niveaux en téléréadaptation. / Telerehabilitation, like other telehealth applications, has been increasingly used to provide health services. The goal of this thesis is to enrich the field of telerehabilitation evaluation such that it can better contribute to informed decision making of those involved in telerehabilitation at different levels. The first article is a systematic review of telerehabilitation studies and it was conducted in order to provide a critical synthesis of the current telerehabilitation literature. The revue included 28 studies of telerehabilitation, which, overall, confirmed the efficacy of telerehabilitation when used with a variety of clienteles in different settings. Some of the studies also suggest that there may be some cost benefits associated with telerehabilitation although the findings remain preliminary. Such a synthesis of the literature can contribute to some decisions regarding the pertinence of introducing telerehabilitation. However, decision makers also need information regarding the clinical and organizational changes that are associated with telerehabilitation when implemented in a clinical setting. The next two articles contain the results of a single case study that was centered on a telerehabilitation clinical project implemented in the eastern part of the province of Quebec, in Canada. A conceptual model was developed to guide this study, and it was based on Giddens’ Theory of Structuration and on models of technology structuration, in particular drawing upon the notion of the interaction between structure, agent and technology. Data was collected from several sources (focus groups, interviews, official documents and observation of recordings) and was analyzed using a qualitative analysis approach. The second article in this thesis examined the relationship between structure, agent and organizational culture with respect to telerehabilitation use. The results indicate that differences in organizational culture between the centres are more visible when telerehabilitation is used, which can in some cases lead to conflicts, while in other cases create opportunities for change. In addition, organizational culture also played a role in shared beliefs linked to the technology. Lastly, the results suggest that telerehabilitation could be used to bring about changes in organizational culture. The third article examined how telerehabilitation became integrated into existing clinical practices, how it contributed to the development of new routines and explored the sustainability of telerehabilitation. The results indicate that some activities, namely interdisciplinary care plans were integrated into clinical routines, while consultations and patient follow-up were not. Several factors related to the structure and agent were found to facilitate or hinder the integration of telerehabilitation into routine practices, including shared beliefs, the visibility of telerehabilitation activities, the clinical and organizational leadership, the availability of resources and the existence of collaborations. Sustainability was also observed when telerehabilitation use became more generalized and novel applications were developed, although this was only found to occur for activities which had integrated into routine practice. The results therefore suggest that when telerehabilitation is not integrated into routine practices, it will not be used, but that, on the other hand, telerehabilitation may be sustainable for activities which are repeated and then integrated into routine day-to-day clinical activities. Together, these studies put forth findings which can be useful when implementing new telerehabilitation programs. They also help elucidate directions for future research in order to enrich the field of telerehabilitation evaluation so that it may become more pertinent and comprehensive to support decision-makers involved at all levels of telerehabilitation.

Cette thèse pose un premier regard sur l’expérience subjective de la violence manifestée par les individus atteints d’un trouble de santé mentale grave et persistant et d’un trouble lié à une substance. À partir d’une recension des écrits, elle présente, dans le premier chapitre, une adaptation des volets psychopharmacologique et économico-compulsif du modèle tripartite de Goldstein (1985), à la population aux prises avec une telle comorbidité. Dans les deuxième et troisième chapitres, elle présente l’analyse qualitative d’une série d’entrevues effectuées auprès de détenus incarcérés dans une unité de santé mentale d’un pénitencier canadien pour cause de délits violents. Elle explore, dans ces chapitres, les représentations de l’influence de la consommation sur les différentes sphères de la vie de ces détenus ainsi que l’importance qu’ils attribuent à celles-ci quant au passage à l’acte responsable de leur incarcération. L’analyse démontre que presque la moitié des personnes interrogées attribue la responsabilité du délit violent aux effets directs de la substance sur les symptômes liés à la maladie mentale ou aux effets directs de celle-ci sur leur comportement et leurs cognitions. Les autres attribuent plutôt la responsabilité de leur acte violent à la détérioration de leur fonctionnement psychosocial (c’està- dire à leur incapacité graduelle à maintenir un emploi, à se nourrir, se loger et à entretenir des relations sociales, amoureuses ou familiales), qui résulte des conséquences sociales et économiques associées à l’usage répétitif et/ou excessif de substances intoxicantes. À la lumière de ces résultats, le deuxième chapitre vérifie l’applicabilité du volet psychopharmacologique à cette population, et le troisième, celle du volet économico-compulsif. Les trois chapitres de cette thèse sont présentés sous forme d’articles scientifiques. / This thesis offers a first look at the subjective experience of violent behaviour manifested by individuals who present a severe mental disorder and a substance abuse disorder. The first chapter presents an adaptation of Goldstein’s psychopharmacological and economic-compulsive models (1985), based on a literature review. The second and third chapter present a qualitative analysis of a series of interviews conducted with mentally disordered offenders from a Canadian penitentiary who are incarcerated for violent crimes. These chapters explore the inmates’ perceptions of the influence of the substance abuse on the various aspects of their lives and of its contribution in the realization of their crime. The results show that almost half of the subjects were of the opinion that their violent crime resulted from the direct influence of the substance abuse on their mental illness, on their behaviour or on their cognitions. The others attributed the responsibility of their violent crime to the gradual deterioration of their general psychosocial functioning (meaning their gradual inability to hold a job, to feed themselves, to maintain housing accommodations, as well as social, familial and love relationships) that results from the social and economical consequences of substance abuse. Based on these results, the second and third chapter discuss the applicability of the psychopharmacological and economiccompulsive models to this population. All three chapters are presented in the form of a scientific article.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Ageing populations and the unique challenges they pose are characteristic of the accelerating demographic transition evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). The influx of the baby boomer generation will inevitably lead to an exponential increase in the numbers of white older people within the next two decades. Regardless of integration policies in post-apartheid South Africa, 90% of all residential care facilities are still occupied solely by white older people. Such facilities are described as buildings or other structures used primarily for the purposes of providing accommodation and of providing a 24-hour service to older persons. The increasingly larger segment of white older people holds considerable implications for the future of these facilities since more individuals will turn to this living arrangement. The Older Persons Act of South Africa was inaugurated by the government in 2006 and its key objectives are aligned with the recommendations of the Madrid International Plan of Action on Ageing (2002). Amongst many other objectives, the Older Persons Act emphasises practices that enhance the wellbeing and quality of life (QoL) of all older persons. However, the reigning circumstances in most residential care facilities have been described as challenging. A national audit of residential care facilities in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undefined and unspecific. The purpose of the study was to explore the construction of QoL, from the perspective of the older people living in residential care facilities. A purposive sample of 54 participants (male, n=10; female, n=44) with ages ranging between 62 and 95 years was drawn. The participants were able to communicate congruently and understood the research purpose. Participants resided in four similar facilities situated in urban areas in two South African provinces. A multiple-context inquiry was conducted to gather rich data and collateral information. The study made use of interviews, focus groups, journals, and the Mmogo-method® to collect qualitative data. Interpretative Phenomenological Analysis (IPA) and visual analysis methods were used to analyse the data. Interactive Qualitative Analysis (IQA) was conducted with 19 participants, resulting in a conceptual model of QoL. Member-checking was performed by the participants. Ethical approval was granted by the Ethics Committee of the North-West University (Potchefstroom Campus), as part of a larger project, namely “An exploration of enabling contexts (05K14)”. The findings revealed that the nature of QoL is informed by spiritual worldviews, interpersonal contexts and the maintained ability of older people to regulate aspects of their own lives. The nature of QoL was also revealed as transitional throughout the ageing process and that the dimensions of QoL may be found on a continuum. Six domains were elicited in the construction of QoL, namely spirituality, health, relationships, meaningfulness, autonomy and sense of place. Each domain presented with certain contributors and inhibitors influencing the older person’s ability to experience QoL. Findings revealed the strengths of older people to deal with adversities associated with later life. The inhibitors of QoL are emphasised for the attention of policy makers, the managers of residential care facilities, care givers and family members. The study provided insight into the causal influences between the domains of QoL. A conceptual model with systemic properties is proposed. The theoretical implications of this systems model are that QoL domains are mutually informing and exercise a particular influence on the relational states of older people. It is hoped that new knowledge in the area of QoL might direct future research efforts and put resources channeled to residential care facilities to better use. / Thesis (PhD (Psychology))--North-West University, Potchefstroom Campus, 2013.

Ageing populations and the unique challenges they pose are characteristic of the accelerating demographic transition evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). The influx of the baby boomer generation will inevitably lead to an exponential increase in the numbers of white older people within the next two decades. Regardless of integration policies in post-apartheid South Africa, 90% of all residential care facilities are still occupied solely by white older people. Such facilities are described as buildings or other structures used primarily for the purposes of providing accommodation and of providing a 24-hour service to older persons. The increasingly larger segment of white older people holds considerable implications for the future of these facilities since more individuals will turn to this living arrangement. The Older Persons Act of South Africa was inaugurated by the government in 2006 and its key objectives are aligned with the recommendations of the Madrid International Plan of Action on Ageing (2002). Amongst many other objectives, the Older Persons Act emphasises practices that enhance the wellbeing and quality of life (QoL) of all older persons. However, the reigning circumstances in most residential care facilities have been described as challenging. A national audit of residential care facilities in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undefined and unspecific. The purpose of the study was to explore the construction of QoL, from the perspective of the older people living in residential care facilities. A purposive sample of 54 participants (male, n=10; female, n=44) with ages ranging between 62 and 95 years was drawn. The participants were able to communicate congruently and understood the research purpose. Participants resided in four similar facilities situated in urban areas in two South African provinces. A multiple-context inquiry was conducted to gather rich data and collateral information. The study made use of interviews, focus groups, journals, and the Mmogo-method® to collect qualitative data. Interpretative Phenomenological Analysis (IPA) and visual analysis methods were used to analyse the data. Interactive Qualitative Analysis (IQA) was conducted with 19 participants, resulting in a conceptual model of QoL. Member-checking was performed by the participants. Ethical approval was granted by the Ethics Committee of the North-West University (Potchefstroom Campus), as part of a larger project, namely “An exploration of enabling contexts (05K14)”. The findings revealed that the nature of QoL is informed by spiritual worldviews, interpersonal contexts and the maintained ability of older people to regulate aspects of their own lives. The nature of QoL was also revealed as transitional throughout the ageing process and that the dimensions of QoL may be found on a continuum. Six domains were elicited in the construction of QoL, namely spirituality, health, relationships, meaningfulness, autonomy and sense of place. Each domain presented with certain contributors and inhibitors influencing the older person’s ability to experience QoL. Findings revealed the strengths of older people to deal with adversities associated with later life. The inhibitors of QoL are emphasised for the attention of policy makers, the managers of residential care facilities, care givers and family members. The study provided insight into the causal influences between the domains of QoL. A conceptual model with systemic properties is proposed. The theoretical implications of this systems model are that QoL domains are mutually informing and exercise a particular influence on the relational states of older people. It is hoped that new knowledge in the area of QoL might direct future research efforts and put resources channeled to residential care facilities to better use. / Thesis (PhD (Psychology))--North-West University, Potchefstroom Campus, 2013.