Thesis (Ph. D.)--Ohio State University, 2006. / Title from first page of PDF file. Includes bibliographical references (p. 210-229).

Many depressed patients attend primary health care, and minority-group patients often see general practitioners for depressive symptoms. The diagnosis and classification criteria of depression and guidelines for management are based on symptoms. However,expressions of depression can vary with culture and gender but the diagnostic tools and guidelines are not adapted to gendered or cultural context and have shown to be poorly applicable in clinical practice. The purpose of this thesis was to analyse how socio-cultural factorswith focus on gender and ethnicity and their intersections- could influence the concept of depression from the perspectives of the patient and patient descriptions, of medical experts as well as general practitioners. By viewing these different perspectives I have tried to illustrate how depressive symptoms are expressed and interpreted in different gendered socio-cultural contexts and how they become a disease entity. Furthermore, I want, in particular, to illustrate a variety of difficulties that GPs may face during the process of care when meeting and treating men and women from different countries showing symptoms which may indicate depression. Study I. The aim of the study was to explore the reasons for and patterns of attendance among Roma women in primary health care and to shed light on health problems of the Roma. Four Roma women were interviewed in-depth. The data were audiotaped and analysed according to Grounded Theory. The resuIts showed that the daily life of women was characterized by marked hierarchical order and rules formed by gender, age and the collective culture. Young women had most rules to follow and if the rules were broken it was easy to end up outside the collective and display depressive symptoms or pain. The gendered, collective culture could both construct and/or form the concept of illness among the Roma women. Study II. The aim of the study was to highlight the gendered representations of lay persons´ experiences of depression by drawing on personal stories of depression that appeared in Swedish newspapers. The data were then subjected to a Qualitative Content Analysis. The mediated accounts of depression both upheld and challenged traditional gender stereotypes. The women’s stories were more detailed, relational, emotionally oriented, and embodied. The portrayal of men was less emotional and expressive, reflecting hegemonic patterns of masculinity. The media representations of gendered healthrelated beliefs and behaviours may influence the way patients, physicians and other health care professionals understand and communicate about issues of mental health and depression. Study III. The aim of the study was to explore how authors of medical articles wrote about different symptoms and expressions of depression in men and woman from various ethnic groups as well as to analyse the meaning of gender and ethnicity for expressions of depression. Through a search in the medical database PubMed 30 scientific articles were identified and included in the analysis. The result and the discussion section of each article was analysed with Qualitative Content Analysis. The analysis showed that culture and gender formed the expressions of depression, how depression was interpreted and the diagnosis of depression. The analysis of the articles identified a western point of view, which could lead to “cultural or gender gaps” and which could also influence the diagnosis of depression. Study IV. The aim of the study was to make a qualitative analysis of medical research articles in order to get a broader view of explanations of depression in men and women in various ethnic groups. Through a search in the medical database PubMed 60 scientific articles were identified and included in the analysis. The result and the discussion section of each article was analysed with Qualitative Content Analysis. The explanations for depression in our study have a strong emphasis on socio-cultural causes with focus on depressed persons from non-western minority groups. Even so, discussion about cultural or gendered explanations for depression was almost missing. We interpreted that the view of minority groups in the articles could be described as a view of “others”. The view of “othering” increases risks for cultural and gender gaps, such as biased scientific knowledge, medicalization of social problems, cultural stereotypes, risk for misdiagnosis of men´s depression, and affects the quality and care of depressed patients. Studv V. The aim of the study was to explore and analyse how GPs think and deliberate when seeing and treating patients from foreign countries who display potential depressive symptoms. The data were collected in focus group and individual interviews with GPs in northern Sweden and analysed by Qualitative Content Analysis. The study showed that patients’ early life events of importance were often unknown which blurred the accuracy. Reactions to trauma, cultural frictions and conflicts between the new and old gender norms made the diagnostic process difficult. The patient-doctor encounter comprised misconceptions, and social roles in meetings were sometimes confused. GPs based their judgement mainly on clinical intuition. Tools for management and adequate action were diffuse. There is a need for tools for multicultural, general practice care. It is also essential to be aware of the GPs’ own conceptions to avoid stereotypes and not to under-or overestimate the occurrence of depressive symptoms. Conclusion: The concept of depression is always situated. The gendered socio-cultural norms, beliefs and behaviours can both construct the concept of illness and influence patients’ experiences and expressions of depression as well as form the patient-doctor encounter. The knowledge of medical “experts” is based on a dominating, western view of knowledge, which defines diagnosis and classification criteria of depression as well as guidelines for management. GPs are struggling for clarity between the medical and the clinical practice. The multicultural appearances of depressive symptoms are a challenge for GPs but it is a challenge for society to improve the life circumstances which can lead to a depressed mood and suffering.

Jürgen Habermas’ The Structural Transformation of the Public Sphere has been described as outdated and incompatible with 21st century democracies. Among other things, Habermas’ initial formulation excluded the state from the public sphere. Recently, a revised model of the public sphere has emerged that positions the state and other law-making bodies at its centre. Although some theorists have embraced this revised model, others continue to exclude the state or oversimplify its role. While some research has examined how parliaments fit into this revised model, no research has been published on this in a Canadian context. This thesis attempts to fill this gap by answering the research question: Does the Canadian House of Commons constitute a form of the public sphere? To answer this question, the Canadian House of Commons is explored along three dimensions of the public sphere – structure, representation, and interaction. This system of classification conforms to the essential function and institutional criteria of classical theory and also accounts for revised models of the public sphere. Ultimately, this work argues that the Canadian House of Commons satisfies the structural and representational dimensions of the public sphere. Its interactional dimension, however, is found to be inconsistent with public sphere theory due to a lack of real deliberation and the pervasiveness of party politics.

This thesis is about the effects of online game addiction on both Swedish and Chinese undergraduate students at University of Gävle, Sweden. It aims at investigating the impact that online games have on undergraduate students at University of Gävle, Sweden. As most of the previous researchers in this area conducted a quantitative research, we decided to do a qualitative research which can help us to get a deeper and better understanding of online game addiction.

Over the last two decades the incidence of overweight and obesity among children and adolescents has reached epidemic proportions in both developed and developing nations. Reducing the incidence of childhood overweight and obesity is of particular importance in countries undergoing social and cultural transitions, such as Trinidad and Tobago, where chronic diseases, such as childhood obesity may have severe social and economic impacts on public health. Although there are a number of studies that have investigated the health and lifestyle behaviours of school aged children, very little information exists about health and lifestyle behaviours of school age children in Trinidad and Tobago. Also, little information exists on the development of questionnaires to address health related issues within this culture and age group. The purpose of this study was to describe the development and pre-test of a knowledge, attitude, belief and practice (KABP) questionnaire to assess healthy lifestyle outcomes of school aged children in Trinidad and Tobago. Three data sources were used for the design and pre-testing of the questionnaire: content analysis of the literature, interview of key stakeholders, and onsite observations. An in-depth review of the literature was conducted for insights about questionnaire development. Interviews (individual and focus groups) were conducted of key stakeholder groups (school staff, the national school feeding program and curriculum officers) and children to determine current policies and practices, beliefs, barriers, and attitudes towards promoting health lifestyles (nutrition and fitness) in Trinidad and Tobagos elementary schools. Site observations provided insight into the school food environment, class room practices, and food services offered at school. Observations were recorded using field notes and interviews were tape recorded and transcribed verbatim. Interview data from each participant was analyzed separately for dominant themes and recurring topics. The interviews were then compiled to establish the main issues which the questionnaire needed to address. The KABP questionnaire addressed general knowledge about healthy eating and activity, screen time, physical activity, snack and food choices, and self efficacy. The KABP questionnaire consisted of question items that were developed to fit the issues unique to Trinidad and Tobago, and items from previously validated questionnaires which were modified to fit the context of Trinidad and Tobago. The questionnaire was then pre-tested with a sample group of the target population. Pre-testing was done one-on one, in small groups and in the classroom setting. Based on pre-test results the questionnaire was then modified to form version 1.0 of the KABP questionnaire. Version 1.0 of the KABP questionnaire consisted of 30 questions divided into four categories. This culturally sensitive age appropriate questionnaire was the foundation of the KABP questionnaire which was used to collect baseline, midpoint and endpoint of the larger project.

Mindfulness has been defined in cognitive-behavioural terms in the mental health literature despite its broader application by many practitioners. Mindfulness is a complex and often ambiguous concept that has historically been understood and applied in myriad ways depending on the context; thus its application to psychotherapy outside the cognitive-behavioural tradition is not necessarily straightforward, and has not been addressed. This study addressed this gap in the literature through interviews with 9 experienced psychotherapists who integrate mindfulness with non-cognitive-behavioural psychotherapeutic modalities or eclectic psychotherapy. Interviews addressed how participants a) define mindfulness, b) apply it to psychotherapy, and c) the aims of that integration. Data were analyzed via the grounded theory approach. The results depicted mindfulness and its potential applications as broader than its presentation in the mental health literature, and emphasized the role of contexts in shaping conceptualization and application. A broad, context-based model of mindfulness/psychotherapy integration is proposed.

Mindfulness has been defined in cognitive-behavioural terms in the mental health literature despite its broader application by many practitioners. Mindfulness is a complex and often ambiguous concept that has historically been understood and applied in myriad ways depending on the context; thus its application to psychotherapy outside the cognitive-behavioural tradition is not necessarily straightforward, and has not been addressed. This study addressed this gap in the literature through interviews with 9 experienced psychotherapists who integrate mindfulness with non-cognitive-behavioural psychotherapeutic modalities or eclectic psychotherapy. Interviews addressed how participants a) define mindfulness, b) apply it to psychotherapy, and c) the aims of that integration. Data were analyzed via the grounded theory approach. The results depicted mindfulness and its potential applications as broader than its presentation in the mental health literature, and emphasized the role of contexts in shaping conceptualization and application. A broad, context-based model of mindfulness/psychotherapy integration is proposed.

Childhood exposure to family violence is a risk factor for dysfunctional intimate relationships in adulthood (e.g., Fagan & Browne, 1994). Family violence research has commonly utilized Social Learning Theory to explain cross-generational patterns of family violence. However, not all individuals who experience a violent home environment become abusers or victims in their parental or marital roles (e.g., Duffy & Momirov, 1997), which illustrates resiliency - positive adaptation or development in spite of serious threats or significant adversity (Masten, 2001). Considering strengths and resources, rather than risks and vulnerabilities, is relatively new in the field of family violence. Consequently, a basic interpretive qualitative research design (Merriam, 2002) was utilized to investigate the experiences of three heterosexual women who self-identified as (a) having observed a pattern of interparental violence in childhood and (b) currently being in non-violent intimate adult relationships. The studys purpose was to describe and understand this phenomenon, with special attention given to identifying possible resiliency and protective factors. Interviews were conducted on multiple occasions and transcripts were analyzed in terms of Kearneys (2001) shared meaning and descriptive categories. The shared meaning involved the role of emotional work required, and the descriptive categories included five themes (i.e., Diverse Experiences of Family Violence, Family Violence is Always with You, Complex Daughter-Mother Relationships, Understanding and Making Sense of Healthy Relationships, and Sources of Strength and Positive Influences). Findings are described alongside implications for counselling practice and future research.

Existing research suggests that illness can have profound implications for the family. The purpose of this thesis is to explore mothers and daughters experiences of the mothers breast cancer in order to determine how their lives were affected by the illness. In particular, I focus on shifts that occurred in their family roles, responsibilities, and relationships. Twelve qualitative interviews were performed with four mother-daughter dyads. Each mother and daughter participated in an initial interview together, as well as a separate follow-up interview. Interview data was analyzed thematically using a blended feminist-interpretive approach. The major themes emerging from the analysis pertained to: shifts in family roles and responsibilities, coping with breast cancer, and growth in family relationships. These themes identify specific aspects of mothers and daughters lives that were affected by breast cancer. Specifically, the findings contribute to the overarching theme that mothers and daughters experienced biographical disruption as a result of the mothers breast cancer, in that the illness required the women to re-assess their everyday lives and expectations for the future. However, the range of experiences described by the mothers and daughters suggest that the degree to which biographical disruption occurred varied depending on the extent to which their lives were altered by breast cancer. Therefore, I conclude that mothers and daughters experienced varying degrees of biographical disruption as a result of the mothers breast cancer. This conclusion indicates that the breast cancer diagnosis has an array of significant implications for mothers and daughters, some of which continue well beyond the completion of acute care. Recognizing that mothers and daughters family roles, responsibilities, and relationships were affected to some extent by the breast cancer experience will help to improve the types of support offered to women in the future.

Friendship matters. Practical support, caring, moral guidance, enjoyment, improved health and greater life expectancy are but a few of its benefits. Despite living in a stigmatizing social environment where isolation is common among disabled youth, some disabled teens establish strong friendships. A nuanced understanding of these meaningful friendships from the perspective of disabled teens was constructed through this qualitative study. Teens aged 15 to 20 who self-identified as experiencing stigma due to disability were recruited from urban, suburban and rural areas of Nova Scotia, Canada. Each teen was involved in a friendship of at least six months duration and had a close friend (with or without a disability) who was also willing to participate. Seven boys and seven girls, all but one of whom were disabled teens, took part in the study. These seven sets of friends engaged in research interviews and participant observation sessions. Nine adults who witnessed the friendships develop over time were also interviewed. Preliminary coding was completed using Atlas.ti. This was followed by a deeper, critical approach to analysis which generated three inter-connected themes. The first theme outlines how stigma disrupts the friendships of disabled youth though a range of processes (labeling, stereotyping, status loss, separation) that arise from and contribute to ableism discrimination against disabled people. The second theme, finding a balance between adult support and surveillance, emphasizes the crucial role adults play in facilitating the friendships of disabled youth. The final theme, disrupting oppression to create enduring friendship, highlights the strategies used by these disabled teens to make and keep friends in a stigmatizing society. Strategies most often used that appeared to be effective for participants were disrupting norms about friendship, coming out as disabled, connecting through stigma, and choosing self-exclusion. Two strategies horizontal hostility and passing as nondisabled were potentially harmful to disabled youth and in some ways limited friendship opportunities. Ideas to counter the harmful effects of ableism while creating lasting friendships are addressed to disabled teens, to their families, to allies in the education system, and to the broader community.