Prior literature has investigated the connection between school shootings and factors of familial trauma and mental health. Specifically, experiences related to parental suicide, physical or sexual abuse, neglect, marital violence, or severe bullying have been associated with a propensity for carrying out a mass shooting. Given prior research has shown common histories among school shooters, it follows that a person's violent tendencies can be revealed by their previous communications with others, thus aiding in predicting an individual's proclivity for school shootings. However, previous literature found no conclusions were drawn from online posts made by the shooters prior to the mass shootings. This thesis applies NVivo-supported thematic analysis and Natural Language Processing (NLP) to study school shootings by comparing the online speech patterns of known school terrorists versus those of non-violent extremists and ordinary teenagers online. Findings indicate that out of all the possible NLP indicators, conversation, HarmVice, negative tone, and conflict are the most suitable school shootings indicators. Ordinary people score eight times higher than known school shooters and online extremists in conversation. Known shooters score more than 14 times higher in HarmVice, than in both ordinary people and online extremists. Known shooters also score higher in negative tone (1.37 times higher than ordinary people and 1.78 times higher than online extremists) and conflict (more than three times higher than ordinary people and 1.8 times higher than online extremists). The implications for domestic violence prediction and prevention can be used to protect citizens inside educational infrastructure by linking the flagged accounts to the schools or colleges that they attend. Further research is needed to determine the severity of emotional coping displayed in online posts, as well as the amount of information and frequency with which weapons and killing are discussed.

För studenter på universitet och högskolor med funktionsnedsättningar i form av lässvårigheter, såsom till exempel dyslexi och ADHD, kan tillgången till kurslitteratur i form av talböcker innebära att de får samma möjlighet som övriga studenter att delta fullt ut i studierna och slutföra sina studier. I Sverige har studenter med funktionsnedsättningar på universitet och högskolor rätt till särskilt stöd under studierna, såsom att få kurslitteratur inläst i talboksformat.  Denna uppsats tittar närmare på hur studenter med läsnedsättningar vid Jönköping University (JU) upplever att de får tillgång till talböcker givet hur JU kommunicerar tillgängligheten till dessa böcker. I uppsatsen används en kvalitativ forskningsansats. Åtta intervjuer har genomförts med studenter på JU som använder talböcker. Uppsatsen ger en ögonblicksbild och bygger på de personliga upplevelserna hos de intervjuade studenterna.  Studenterna som intervjuades i denna uppsats uttrycker att de upplever att kommunikationen om talböcker brister och därmed bidrar till att försvåra tillgängligheten. I vissa fall menar studenterna att de inte i tid kunde få tillgång till kurslitteraturen som de behövde för kurserna på grund av bristande kommunikation eller på grund av hur deras förfrågningar hanterades, inte till följd av den faktiska tillgången till talböckerna.  Trots att relevant information om talböcker finns lättillgänglig för studenterna på JUs hemsidor menade studenterna att JU inte kommunicerar tillgängligheten till talböcker på ett sätt som underlättar tillgången. De upplevde att kommunikationen från JUs sida är otillräcklig. Det framkom även att studenterna saknade information och dialog om rättigheterna att få tillgång till kurslitteratur i form av talböcker. För att förbättra så att studenterna får tillgång till kurslitteratur i talboksformat i tid tror de att JU skulle kunna göra mer för att kommunicera tillgängligheten till talböcker.  Med avstamp i filosofen Foucaults synsätt skulle studenter med funktionsnedsättning kunna sägas påverka och utöva makt över sin situation när de förklarar och kommunicerar sina behov av talböcker till JU. Det är viktigt att komma ihåg att det är först då, när det sker, som tillgängligheten till talböcker blir relevant i förhållande till studenternas behov. Möjligen kan slutsatserna i denna uppsats vara ett första steg för att anpassa JUs kommunikation om tillgänglighet till talböcker för att bättre spegla studenternas behov. Uttryckt i Foucaults anda skulle en sådan åtgärd bidra till att skapa ett mer jämlikt maktförhållande mellan JU och studenterna med läsnedsättningar. / For students at university and college level with special needs in relation to reading, such as dyslexia and ADHD, the availability of course literature in the form of audiobooks can enable this group to have the same opportunity as other students to study as well as complete their studies. Indeed, students at university and college level in Sweden, with certain challenges, have a right to special support, including to have any course literature recorded in audiobook format.  This study examines how students with impeded reading capability at Jönköping University (JU) assess their own access to audiobooks given how JU is communicating the availability of audiobooks. A qualitative research method is used in this study. Eight interviews was conducted with students at JU who uses audiobooks. Building on personal experiences from the interviewed students, this study gives a snapshot picture.  Students interviewed in this study expressed that they found that communication on audiobooks were insufficient, thus contributing to making these less accessible. Students argued that they in some cases had not been able to access needed course literature in time, due to the lack of communication or due to how their requests had been handled, not because of the actual lack of audiobooks.  Despite relevant information on audiobooks being available on JU’s homepages, students argued that JU was not communicating the accessibility of audiobooks in a way to allow students ease of access to them. Students argued that communication from JU was insufficient. The study also found that some student lacked information and a dialogue on their rights to have course literature in the format of audiobooks. To enhance students’ access to course literature in the format of audiobooks, these students believe that JU could do more to communicate the accessibility of audiobooks.  Using Foucault’s theory, it could be argued that students with disabilities would be able to utilize their own power over their situation as they explain and communicate their need of audiobooks to JU. It is only as this is done that access to audiobooks will be relevant in relation to student’s needs. Possibly, the conclusions of this study could be a first step to adjust JU’s communication on the access of audiobooks to better mirror student’s needs. Expressed in the spirit of Foucault, such action could contribute in creating a more equal power relation between JU and students with reading disabilities.

Bakgrund: Under de senaste årtiondena har det växt fram en trend, både nationellt och internationellt, där hållbarhet har hamnat i fokus. Sedan 2017 har vi i Sverige lag på att vissa företag ska upprätta en hållbarhetsrapport men det är enbart 0,1 procent av alla svenska företag som omfattas av lagen. Även om ett bolag inte har ett lagstadgat krav på sig att upprätta en hållbarhetsrapport finns det trots detta företag som frivilligt delar med sig av icke-finansiell information. Denna benägenhet hos företag att frivilligt synliggöra hållbarhetsinformation leder till ett intresse av att närmare studera vilken frivillig hållbarhetsinformation som företag anser är väsentlig att dela med sig av när det inte finns några lagstadgade regler för detta. Syfte: Syftet med denna studie är att kritiskt analysera hållbarhetsinformation som ges ut frivilligt av företag för att jämföra innehållet och utformningen av informationen samt att ge en förståelse för vad som kan förklara eller påverka informationen. Metod: I studien tillämpas en kvalitativ innehållsanalys med komparativ design för att göra en jämförande studie av tio svenska företags hållbarhetsinformation. Vid granskningen har vi utgått från olika teman för att identifiera hur innehållet och utformningen av hållbarhetsinformationen ser ut och vilka likheter och skillnader som finns. Slutsats: Jämförandet av företagens frivilliga hållbarhetsinformation har visat att det finns stora variationer gällande både innehållet och utformningen. Bland annat finns variationer kring vilket format som används, antalet sidor och hur ingående hållbarhetsarbetet beskrivs. Förklaringar till dessa variationer ges utifrån företagens branschtillhörighet, standardiserade ramverk, Corporate Social Responsibility (CSR) och företagsekonomiska teorier. / Background: During the last decade a trend has developed, both nationally and internationally, where sustainability has become highly relevant. Since 2017 thereis a law in Sweden that stipulates that some companies are required to create a sustainability report, but only 0,1 percent of all Swedish companies are covered by the law. Even though a company does not have a legal requirement to create a sustainability report, there are still companies that voluntarily share non-financial information. This tendency for companies to voluntarily share sustainability information leads to an interest to study what kind of voluntary sustainability information companies considers to be essential to share when there are no lega lrequirements. Purpose: The purpose of this study is to critically analyze sustianability information that is being shared voluntarily by companies to compare the content and design of the information and to provide an understanding for what can explain or influence the information. Method: In this study a qualitative analysis of content was applied together with acomparative design to carry out a comparative study of sustainability information at ten Swedish companies. The analysis was based on different themes to identify the content and design of the sustainability information and to determine if there are any similarities or differences. Conclusion: After comparing the sustainability information shared by ten companies it is clear that there are large variations regarding both the content and design. For example there are variations in what format that is being used to present the information, the number of pages and how detailed the work with sustainability is described. These variations can be explained by the companies industry affiliation, standardized frameworks, Corporate Social Responsibility(CSR) and theories of business economics.

The aim of this thesis is to examine what ideas of unhealthy lifestyle are prominent in the recently published national care protocol for unhealthy lifestyle habits in Sweden, henceforth Vårdprogrammet. These ideas will further be examined in relation to older systems of ideas/ideologies within health care, based on previous research. The empirical material consists mainly of Vårdprogrammet. Aiming to deepen the understanding of this material, I have further perused current official reports regarding public health, related guidelines from the National Board of Health and Welfare as well as related regional care protocols. The method used is inspired by the model developed by Mats Lindberg for qualitative analysis of ideas and ideological content. The analysis of the empirical material shows that the health concept is defined by pointing out its negation, i.e. what unhealthy lifestyles look like. Vårdprogrammet expresses a line of political, cultural and ethical values. They can analytically be summarized as (1) democracy and equality, (2) climate awareness, (3) demands of evidence-based knowledge (4) political cooperation, and (5) ethical principles. The work with unhealthy lifestyle is related to the UN global aim for sustainable development. Agenda 2030 can be viewed as an overall societal hygienic programme, within which the large health problem that lifestyle habits constitute, will be solved. Similar views were held within social hygiene in the mid-19th century, where health and disease were seen as a societal matter. Vårdprogrammet is stated to be based on the ethical principle of person-centred approach. One can however also discern other ethical principles, such as the autonomy, care and justice principles. A health-promoting approach, salutogenesis, pervades the view of the patient/human in the prescribed interaction with patients.

Mémoire de maîtrise présenté en vue de l’obtention de la maîtrise en psychoéducation, option recherche et stage (M. Sc.) / La littérature montre que les personnes autistes sont plus à risque de vivre des événements potentiellement traumatiques. Toutefois, les études sur le trauma chez les personnes autistes portent majoritairement sur des aspects cliniques, tels que la symptomatologie et les outils d’évaluation. On en connait peu sur les sources de traumas auxquelles elles sont confrontées, les mettant ainsi à risque d’y être exposées à répétition. Nous en savons encore moins sur la perception des personnes autistes elles-mêmes sur ce qu’elles considèrent comme traumatique. Certains événements pouvant être considérés traumatiques ne font pas partie des sources reconnues par le DSM-5-TR pour l’obtention du diagnostic de trouble de stress post-traumatique (TSPT). Ces événements sont nommés « low magnitude » et réfèrent à des événements de moindre sévérité, tels une rupture ou de la victimisation. Une récente étude qualitative s’est intéressée à la perception de personnes autistes sur les événements considérés traumatiques à l’enfance (Kerns et al. 2022). Les entrevues de cette étude ont fait émerger 16 sources, dont les expériences sensorielles et les transitions. Dans la même optique, la présente étude vise (1) à explorer les sources de traumas exprimées par des personnes s’identifiant comme étant autistes; (2) à déterminer la proportion des catégories soulevées entrant dans la définition du DSM-5-TR pour le TSPT ; puis (3) à déterminer dans quelle proportion la catégorisation des sources traumatiques de Kerns et al. (2022) est reproduite dans la présente étude. Les données du mémoire proviennent de deux forums permettant aux personnes autistes et leur famille de converser sur divers sujets. Une analyse thématique à l’aide du logiciel QDA Miner a permis l’émergence des sources de traumas, puis un codage manuel a permis le calcul de la proportion des sources définies par le DSM-5-TR et la proportion des sources reproduites par Kerns et al. (2022). Les messages extraits ont été composés par des personnes s’identifiant autistes et abordant le trauma. Les résultats suggèrent la présence de 64 sources traumatiques, soit 18 définies par le DSM-5-TR et 46 non définies par le DSM-5-TR pour le diagnostic de TSPT. Les sources recensées sont donc, pour 71,9% d’entre elles, absentes de la définition d’une situation traumatique par le DSM-5-TR. L’ensemble des sources rapportées sont présentes dans la catégorisation de Kerns et al. (2022) et huit s’y ajoutent. Cette étude vise à mettre l’accent sur le point de vue des personnes autistes concernant les éléments traumatiques qu’elles peuvent vivre, dans le but de faciliter la prévention et l’intervention. / Research shows that people with autism are at a greater risk of experiencing potentially traumatic events. Studies on trauma in autistic people focus mainly on clinical aspects, such as symptomatology and assessment tools. However, little is known about the sources of the trauma they face, putting them at risk of repeated exposure. Even less is known about autistic people's perceptions of what they consider traumatic. Some events that may be considered traumatic are not among the sources recognized by the DSM-5-TR for the diagnosis of post-traumatic stress disorder (PTSD). These events are termed “low magnitude” and refer to events of lesser severity, such as a break-up or victimization. A recent qualitative study focused on how people with autism perceive events considered traumatic in childhood (Kerns et al. 2022). Interviews in this study revealed 16 sources, including sensory experiences and transitions. Similarly, the present study aims to: (1) explore the sources of trauma expressed by people identifying themselves as autistic; (2) determine the proportion of categories raised falling within the DSM-5-TR’s definition of PTSD; and (3) determine the proportion of Kerns et al.'s (2022) categorization of traumatic sources replicated in the present study. The data in this report originates from two forums, where autistic people and their families can discuss a variety of subjects. A thematic analysis using QDA Miner software enabled the emergence of trauma sources, followed by manual coding to calculate the proportion of sources defined by the DSM-5-TR and the proportion of sources reproduced by Kerns et al. (2022). The extracted messages were composed by people identifying themselves as autistic and addressing trauma. The results suggest the presence of 64 traumatic sources, 18 defined by the DSM-5-TR and 46 not defined by the DSM-5-TR for the diagnosis of PTSD. Thus, 71.9% of the sources identified were not included in the DSM-5-TR’s definition of a traumatic situation. All but eight of the sources reported in the current study are present in the categorization of Kerns et al. (2022). The aim of this study is to focus autistic people’s point of view regarding traumatic experiences they may encounter, with an aim to facilitate prevention and intervention.

Bakgrund: Psykolog är ett dokumenterat bristyrke i de flesta svenska regioner, trots att antalet utexaminerade ökat. Samtidigt finns intention att lämna yrket för en knapp femtedel av psykologer tre år efter examen. Tankar på att lämna yrket är den tydligaste prediktorn för att lämna yrket. Forskning har visat att en rad faktorer påverkar tankar på att lämna yrket. Syfte: (1) Undersöka faktorer som relateras till processen att lämna yrket hos psykologer, samt hur dessa relateras till varandra. (2) Undersöka vad de som lämnat yrket ser som bidragande till sitt beslut. Metod: Kvantitativ enkätdata som insamlats från nyexaminerade psykologer (n = 603) analyserades med korrelations- samt regressionsanalys, med tankar på att lämna yrket som beroende variabel. Kvalitativ enkätdata (n = 35) analyserades med innehållsanalys. Resultat: Regressionsanalys visade att övergång mellan studier och arbete, arbetstillfredsställelse samt arbetstempo påverkade tankar på att lämna. Även stressymptom tillförde viss förklaringsgrad. Bilden som växte fram i den kvalitativa analysen var att beslutet att lämna var komplicerat med blandade känslor. Främst arbetsmiljö, emotionell påverkan och engagemang för yrket angavs bidragande till beslutet att lämna. Anledningar att stanna kretsade i stället kring trygghet, kärnan i yrket samt belåtenhet. Slutsats: En fungerande övergång mellan studier och arbetsliv med tillräckligt mellanmänskligt stöd hade relevans för tankar på att lämna, så väl som andra arbetsmiljöfaktorer. / Background: Psychologist is an in-demand job in most Swedish regions, despite an increase in graduates. Simultaneously, three years after graduating a scant fifth of psychologists had intentions to leave the profession. Thoughts of leaving the profession is the clearest predictor of actually leaving. Research has shown a multitude of factors to be affecting thoughts of leaving the profession. Aim: (1) Examine factors related to the process of leaving the profession, as well as how these factors can be related to each other. (2) Examine what those who have already left the profession view as contributory to their decision. Method: Quantitative survey data that was collected from psychologists up to three years post-graduation (n = 603) was analyzed using correlation- and regression analysis, using thoughts of leaving the profession as the dependent variable. The qualitative survey data (n = 35) was analyzed using content analysis. Results: The regression analysis showed that work-study transition, work satisfaction and work tempo affected thoughts of leaving the profession. Symptoms of stress also added some explained variance. The picture that emerged from qualitative analysis was that the decision to leave was complicated with mixed emotions. Mainly work environment, emotional impact and engagement for the profession were contributing factors regarding the decision to leave. Reasons to stay in the profession referenced security, core of the profession as well as contentment. Conclusion: An adequate work-study transition, with sufficient interpersonal support was of relevance to thinking about leaving, as well as additional aspects of work environment.

Syftet med avhandlingen är att beskriva akademikers bana mot att bli professionella då de kommer ut i arbetslivet med en magisterexamen i psykologi eller statsvetenskap. The study has a longitudinal design where Political Science and Psychology graduates’ have been interviewed on three consecutive occasions; the last semester before graduation, the first year and then, in the third year of professional work. The theoretical frame of reference comprises a situated and social learning theory and a gender perspective. These theories were chosen since they elaborate on concepts such as identity, practice, participation and learning. The results indicate that becoming a professional is not an isolated phenomenon merely learned and nurtured in higher education and/or in working life. It is emphasised as a dynamic learning process between a reflective individual, the interaction with a professional practice as well as a relationship between other spheres of life, e.g. the personal and the private. The graduates’ professional trajectories can be characterised by a movement from appropriating new knowledge to a need to change direction, e.g. new work tasks or professional fields. This is also a process of professional identity formation. The graduates’ professional identity is emphasised as being both closely related to a gender identity and influenced by the individuals’ belonging to and participation in other practices. The results thus indicate that professional identity formation is an interplay between different spheres of life that changes over time. By using a longitudinal design, it can be claimed that becoming a professional requires balancing one’s whole life situation. / Syftet med avhandlingen är att beskriva akademikers bana mot att bli professionella då de kommer ut i arbetslivet med en magisterexamen i psykologi eller statsvetenskap. Avhandlingen baserar sig på en longitudinell studie där statsvetare och psykologer har blivit intervjuade vid tre olika tillfällen; sista terminen innan examen samt efter första och tredje året i arbetslivet. Den teoretiska referensramen utgörs av begrepp från situerat och social lärteori samt från ett genusperspektiv. Dessa teorier valdes då de fokuserar på begreppen identitet, praktik, deltagande och lärande.Resultaten visar att utvecklingen mot att bli professionell inte är ett isolerat fenomen förvärvat och underhållet i högre utbildning och/eller arbetslivet. Det uttrycks snarare som en dynamisk lärprocess mellan en reflekterande individ, interaktion med en professionell praktik samt med olika sfärer i livet, den professionella, den personliga och den privata. Akademikernas professionella bana kan karakteriseras som en rörelse mellan att utveckla ny kunskap och göra den till sin, till ett behov av förändring i form av nya arbetsuppgifter eller byte av professionellt fält. Att bli professionell innebär även en utveckling av en professionell identitet. Statsvetarnas och psykologernas professionella identitet skapas i relation till en genusidentitet och är influerad av individernas tillhörighet och medverkan i olika praktiker. Resultatet visar därför utveckling av professionell identitet som ett samspel mellan olika sfärer i livet som är föränderligt över tid. Utifrån den utförda longitudinella studien är det möjligt att hävda att utvecklingen mot att bli professionell är ett sätt att skapa ett samspel och balans i individens livssituation.

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.