Philosophiae Doctor - PhD / The Human immunodeficiency virus (HIV) and acquired Immunodeficiency syndrome (AIDS) are serious health issues that continue to affect many nations. Specifically, the sub-Saharan African region has the highest prevalence of HIV and AIDS worldwide. Africans living in informal settlements or townships have the highest prevalence of HIV in South Africa. Persons of low socioeconomic status (SES) in general become socialised into unhealthy behaviours and risk factors at early ages, and experience poor health outcomes. Physical activity (PA) is one cost-effective, non-pharmacological approach that has been reported as conjunctive therapy for HIV to effectively address these impairments. Aim: The aim of the study was to develop a contextualized intervention that promotes PA among persons living with HIV and AIDS (PLWHA) of low SES. Methods: A mixed methods approach was used. Studies included (1) a systematic review which assessed (a) specific and useful intervention techniques that were previously used in successful PA interventions (b) relevant behaviour change theories used to develop the intervention content, (2) a narrative review which examined the available literature on PA, social support and SES with a view to inform the design of effective PA interventions for PLWHA of low SES, (3) a cross sectional study which aimed at determining if age, body weight, height, gender, waist-to-hip ratio (WHR), educational attainment, employment status, CD4+ cell count, and body mass index (BMI) could predict overall PA among PLWHA of low SES in Cross roads Township in the Western Cape Province, South Africa (4) a cross-sectional study which (a) examined the PA profile of PLWHA of low SES based on PA domains and intensity and (b) determined whether employment status and level of education can predict PA among PLWHA of low SES in Cross roads Township in the Western Cape Province, South Africa (5) a mixed methods study which investigated the benefits and barriers of PA for HIV-positive women of low SES using the Exercise Benefits/Barriers Scale and focus group discussions, (6) a study which sought to develop a contextualised intervention for promoting PA among PLWHA of low SES and (7) a crossover study conducted at a community centre caring for HIV positive Black African Xhosa-speaking women of low SES in Nyanga Township in the Western Cape Province in South Africa. Results: The systematic literature review showed that the following techniques, namely, ‘provide feedback on performance’, ‘goal setting (behaviour)’, and ‘plan social support/social change’ were the most frequently used behavioural change techniques in interventions focusing on promoting PA for the management of chronic diseases amongst individuals of low SES. The review also showed that the Transtheoretical model of behaviour change and the Social Cognitive theory were the common theoretical frameworks of most study interventions.

Smoking remains a leading cause of disability and mortality worldwide. Despite declining rates of smoking in developed countries, smoking prevalence remains high, and there is evidence that it has plateaued in recent years. Individuals with a comorbid psychiatric diagnosis represent a disproportionate percentage of those who continue to smoke and are particularly at-risk given they smoke at higher rates and consume more cigarettes compared to those with no diagnosis. Moreover, these individuals are often excluded from clinical trials of smoking cessation, making it difficult to generalize results of previous intervention studies. In the general literature of smoking cessation, smoking cessation self-efficacy, or one’s confidence in their ability to abstain from smoking, is a consistent predictor of positive abstinence outcomes. The overall purpose of this dissertation was to investigate smoking cessation self-efficacy as a predictor of abstinence outcomes in a population of treatment-seeking smokers with and without a history of psychiatric illness. To accomplish this, articles 1 and 2 investigated the psychometric properties of a multi-item measure of cessation self-efficacy. This entailed comparing the measure to other indices of smoking, and conducting a confirmatory factor analysis to ensure factor invariance and equivalence of the measure regardless of psychiatric status. We found a moderate correlation between our multi-item scale to a single-item measure of confidence to quit, as well as support for both the original two-factor model as well as a three-factor model, which explained 79.3% of the variance. Our results also supported the measure as being factor invariant across psychiatric diagnoses. Next, articles 3 and 4 investigated how this measure of cessation self-efficacy predicted several smoking outcomes (10-, 22- and 52-weeks following target-quit date), and whether this relationship was mediated by concurrent smoking and other interpersonal-indices of smoking cessation (nicotine withdrawal, negative affect). In article 3, we found support for a bidirectional and reciprocal relationship between smoking cessation self-efficacy and smoking status. While changes in concurrent behavior (smoking or abstinent) did impact subsequent evaluations of self-efficacy, the inverse was also true. Moreover, both concurrent smoking and cessation self-efficacy predicted outcomes at week 10. Article 4 built on this framework and investigated this relationship at 22- and 52-weeks post-target quit-date. Our results highlight the robust association between cessation self-efficacy and abstinence. Higher cessation self-efficacy was positively associated with better abstinence outcomes, even after controlling for concurrent smoking, withdrawal, and negative affect. Further, there was evidence that cessation self-efficacy partially mediated the impact of withdrawal and negative affect. In our fully adjusted model (adjusting for demographic characteristics, baseline smoking levels, withdrawal and negative affect), cessation self-efficacy along among the interpersonal-determinants predicted abstinence outcomes (Odds ratio = 1.078, 95% confidence interval (1.068 - 1.089). This was true for those with either a current, past, or no lifetime psychiatric diagnosis, and despite the finding that individuals in the lifetime (current or past diagnosis) category experienced overall lower self-efficacy. Overall, our results support the value of cessation self-efficacy as an important indicator of abstinence outcomes, and particularly highlight its potential utility for at-risk populations of comorbid psychiatric smokers.

The purpose of this qualitative study was to examine the perceptions of novice teachers in 1 school district regarding their professional experiences. Novice teacher was defined as someone with 5 years or fewer in the teaching profession. The study was of an emergent design using phenomenological qualitative methods that included face-to-face interviews, triangulation of information, and analyzation with specific adherence given to understanding the social phenomena of the lived experience from the participants’ perspectives. Specifically, the study addressed possible relationships between novice teachers’ experiences and perceptions of success and self-efficacy that contribute to their choice of continuing in the profession of teaching. Participants in this study ranged from 23-55 years of age, represented male and female gender, encompassed all levels of grade configuration within the school district (elementary, middle, high school), and covered experiences within each of the 5 years of defined novice work. Information was collected through individual one-on-one interviews covering preparatory programs, individual school sites, district induction programs, and the relationships developed within each spiraled experience. This study identified reasons for retention in the population of novice teachers and possible obstacles that might cause a novice teacher to leave the profession during or at the end of the 5 year apprenticeship. Information collected revealed that age, timing of entrance into a teaching career and preparatory programs had an effect on novice efficacy and job success. In addition data suggested that job support, job fulfillment, as well as future career choice were influenced by experiences a novice lived through within a school culture including type of administrative support, peer mentoring, collegial socialization, district expectations, and induction involvement.

Background: Science poses a unique challenge to the elementary curriculum landscape, because traditionally elementary teachers report low levels of self-efficacy in this subject. Instructional leadership in elementary science therefore, becomes important for a successful integration of a new science education agenda. The Next Generation Science Standards (NGSS) are K-12 science content standards available for adoption by states and school districts in the U.S. Principals are important actors during policy implementation since they are charged with assuming the role of an instructional leader for their teachers in all subject areas. Purpose: This study gathered self-reported survey data from public elementary principals that pertain to their background and experiences in science, and then relate these data to their levels of self-efficacy and instructional leadership capacity for science. The study answers the following three research questions: (1) What type of science backgrounds do elementary principals have? (2) What indicators predict if elementary principals will engage in instructional leadership behaviors in science? (3) Does self-efficacy mediate the relationship between science background and capacity for instructional leadership in science? Data Collection and Analysis: A questionnaire was created by combining two existing subscales to measure instructional leadership practices and self-efficacy in science, and also a series of objective questions to address principals’ background experiences and demographic information. Public school elementary principals serving in 13 states that formally adopted the NGSS through legislative action provided the data analyzed in this study (N = 667). The survey data were analyzed quantitatively for descriptive statistics to answer the first research question, inferential statistics through an Ordinary Least Squares (OLS) hierarchal regression analysis to answer the second, and a mediation analysis to answer the third research question. Findings: The sample data show that 21% of the elementary principals have a formal science degree and 26% have a degree in a STEM field. Most principals have not had recent experience teaching science (75.86%), nor were they every strictly a science teacher (86.66%). The hierarchical regression analysis suggests that there is evidence that both demographic and experiential variables predict instructional leadership practices in science. The analysis also suggests that self-efficacy is a mediating variable for principals’ science teaching experiences related to instructional leadership behaviors. Conclusions: The data from this research reveal potential (a) leadership development opportunities, (b) training and recruitment needs of school districts, (c) areas in need of attention in principal preparation programs, and (d) directions for policy implementation to leverage principal capacity. The findings provide evidence to assist in identifying ways elementary principals could be better prepared to be instructional leaders for their teachers, especially in those settings where the implementation of the NGSS is underway.

Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) students report higher levels of harassment and assault, exposure to prejudiced language, and diminished feelings of safety at school compared to their non-LGBTQ counterparts. Due to the difficulties these young people experience at school as well as their increased risk for psychological distress and suicidality, these students may need additional support to be successful. Although professional organizations support school psychologists acting as advocates to support LGBTQ students, research suggests that practitioners’ knowledge about issues faced by LGBTQ students as well as training related to their needs may lag behind this appeal for best practice. Given this information, it is valuable to investigate how well school psychologists believe themselves capable of fulfilling responsibilities related to working with and advocating for LGBTQ youth in schools. The purpose of this project was to create a comprehensive scale measuring school psychology practitioners’ self-efficacy in working with LGBTQ youth. The proposed scale was created by reviewing existing scales and literature related to LGBTQ student needs. The proposed scale was then sent to three expert panelists who provided feedback that was incorporated to make revisions to the original scale. A finalized scale is presented, which may assist in expanding the knowledge base regarding school psychologists’ self-efficacy in working with this vulnerable student population.

Classroom-based physical activity is a newly explored avenue for providing physical activity opportunities to children within the school, but it is one that is showing academic gains in areas such as on-task behavior. The purpose of this study was to explore the impact of pedal desks placed in high school classrooms. Three main objectives were examined: 1) The possible increase in physical activity self-efficacy among high school students in the classroom, 2) the effectiveness of pedal desks on increased physical activity among high school students, and 3) the impact of pedal desks on increasing classroom on-task behavior. Participants included 114 high school students in a traditional high school setting. All of the students were enrolled in two Junior Reserve Officers’ Training Corps (JROTC) teachers’ classrooms. The design was quasi-experimental. Two teachers and their respective classes were randomly assigned to a treatment or wait list control group. The study included a baseline and 2 waves. Researchers gathered demographic information of students, as well as pre- and post-data on self-efficacy and physical activity participation. On-task behavior of students was also collected daily by researchers via momentary time sampling. Results indicated lower self-efficacy confidence for the treatment group compared to the control group at the end of the study after controlling for initial scores. Significance was also found for heart rate. Limitations and implications are discussed.

Objective: The purpose of this pilot study was to examine the effect of an online social network used as an adjunct to a behavioral weight loss intervention on participants’ perceived social support and perceived self-efficacy using constructs of Social Cognitive Theory as a basis for website development. Methods: 13 adult women (mean age: 43 years of age, range: 25-63 years) participated in a 12-week behavioral weight-loss intervention with the option to access the Transformation Challenge Online Community (TCOC), an internet-based support and informational website. The TCOC was developed using constructs of the Social Cognitive Theory. Data analyzed included online site usage software and pre- and post-questionnaire results. Time spent online, unique visits to the webpage, and pre and post-intervention data were analyzed using a mixed methods approach. Results: Average time spent on TCOC was 95.6 minutes over the entire three month intervention (range: 0 – 287 minutes). Website usage varied widely ranging from a participant who never accessed the site to another participant who logged on daily and commented a total of 27 times. Perceived self-efficacy to maintain a learned health behavior without the aid of a professional, as well as overall perceived social support were statistically significantly greater post-intervention. Confidence in the TCOC’s ability to aid in making healthy lifestyle changes decreased significantly from pre- to post-intervention while website usage also decreased over time. Conclusions: The internet may be a valuable tool for improving perceptions of social support and increasing access to reliable information and education. A web-based intervention can be used as an adjunct to a face-to-face intervention to provide additional support and information, as well as used to reach groups who may not have access to a face-to-face option. Considerations should be given to the structure of the online program; the potential for dynamic, aesthetically pleasing self-regulation tools; and content that is tailored to the individual. Decreased usage of the website over time may reflect similar difficulties in maintaining participation in face-to-face weight loss interventions. Attention should also be given to the target audience as participant comfort levels and feelings towards using the internet may differ significantly between users and therefore impact outcomes.

Project-based learning is a multifaceted approach to teaching in which students explore real-world problems and challenges while working in small collaborative groups. Project-based learning is active and engaging and drives students to obtain a deeper knowledge of the subjects they're studying, and students develop confidence and self-direction as they move through both team-based and independent work. This project endeavored to assess the effect of participation in a project-based learning (PBL) activity of the Wind and Oar Boat School's curriculum on the self-efficacy of at-risk high school students. Twenty students participated in the program for both math and applied arts credits needed to complete their high school graduation requirements. Data were collected using a retrospective pre-then-post survey, participant observations, and semi-structured interviews. To assess student Self-efficacy, the researcher observed six constructs of self-efficacy, those being motivation, problem- solving, resilience, teamwork, confidence, and course skills. The findings were utilized to create student narratives that documented the experiences of the students in the program and provide the student side of the program and the changes that happened because of their participation in the program. Analysis of the retrospective survey confirmed that the students had statistically significant increases in all the constructs of self-efficacy, which was congruent with literature citations, researcher observations, and student interviews.

Perceived quality of care and burnout affects psychiatric care workers profession-ally and physically. Psychiatric caregivers working in forensic facilities encounter negative changes with perceived quality of care and burnout when working with offender patients. Recognizing the variables that lead to burnout and perceived quality of care may assist professionals and organizations with the information needed to prevent burnout and poor perceived quality of care among psychiatric caregivers. Using self-efficacy theory as a framework, this correlational design examined whether years of experience, self-efficacy, and caseload complexity predict burnout and perceived quality of care. A total of 148 psychiatric caregiver participants completed questionnaires comprised of the Maslach Burnout Inventory-HSS, General Self-efficacy Scale, and Quality of Care Measures (staff-form), along with demographic questions. Multiple regression determined that self-efficacy and years of experience significantly predicted personal accomplishment, which is a subscale of burnout. However, self-efficacy did not predict of depersonalization or emotional exhaustion the other 2 subscales of burnout. Self-efficacy was also found to be a positive predictor of perceived quality of care. The research findings have the potential to influence social change by providing professionals and organizations a better under-standing of the factors that influence burnout and perceived quality of care when work-ing with offender patients. In relation, improvements in trainings, interventions, and strat-egies for positive employee well-being and increased patient care could possibly reduce burnout and increase perceived quality of care.

Despite years of attention, gender inequity persists in science, technology, engineering, and mathematics (STEM). Female STEM faculty, positive social interactions, and enrollment in advanced STEM secondary coursework are supportive factors in promoting female students' persistence in STEM fields. To address the gap in understanding these factors, this study employed a sequential mixed method design using a framework of social cognitive theory. Research questions focused on how levels of self-efficacy and perception of personal and social factors among female secondary students related to their enrollment in advanced STEM coursework and extracurricular activities in a rural New England school where gender parity exists. All 18-year-old female students (N = 82) were invited to complete the self-efficacy subsection of the Science Motivation Questionnaire II (SMQII). Self-efficacy and enrollment in advanced STEM courses and extracurricular activities were analyzed using a Pearson correlation (N=35). Self-efficacy levels did not correlate with the participants' enrollment in advanced STEM courses and extracurricular activities. In addition, a purposeful sample of participants (N = 7) who completed the SMQII was used to conduct individual interviews investigating how the community of practice contributed to female students' decisions to pursue advanced STEM coursework. Two themes emerged: the roles of the personal landscape (e.g., resilient mindset) and the social landscape (e.g., peer interactions). Professional development materials to support staff in implementing a cognitive apprenticeship were created in response to the emergent themes. In addressing the lack of understanding of female secondary students' engagement in advanced STEM coursework, positive social change may be achieved by supporting a greater percentage of women who can pursue STEM career opportunities.