The transition from adolescence to adulthood can bring with it mental health problems, resulting in reduced mental well-being among young women and an increasing public health issue. Perceived mental health problems can be a major obstacle to personal development and opportunities for becoming established in society. Thus, promotive interventions are needed. The overall aim of this thesis was to explore women’s experience of mentoring relationships as health promotion from the perspectives of both parties in the dyad: the young woman transitioning from adolescence to adulthood (the protégé), and her ten-year-older female mentor. This thesis used a practice-based approach to investigate a group of participants involved in a Swedish non-governmental organization, the Girls Zone. Data collection was conducted including interviews (n = 5) and surveys (n = 52) with female protégés, and interviews with female mentors (n = 12). Study I explored the characteristics of the female protégés and the development of the mentoring relationship, and used mixed methods. Study II, which investigated mentors’ initial motives and the organizational context which enabled the mentors’ engagement, used an explorative qualitative method. This thesis showed that female mentoring relationships seem to have potential to be a health-promoting intervention. A variety of young women were attracted to the mentoring program, and mentorships in line with the perspectives of relational-cultural theory could meet the relationship needs expressed by the female protégés. Further, mentors’ motivations for engaging as mentors were linked to the fulfillment of basic psychological needs for autonomy, competence, and relatedness, in accordance with the perspective of self-determination theory.

The American Association of Intellectual and Developmental Disabilities (AAIDD, 2011) assert that individuals with intellectual disabilities, irrespective of gender, have an equal right to learn about and experience their own sexuality. A review of the extant literature indicated that the voices of women with intellectual disabilities on the topic of familial culture, as it relates to sexuality, are rarely included (McCarthy, 1993; Shakespeare, 2000; Siebers, 2012). The purpose of this qualitative study was to examine the role of familial culture and lived experiences of women with intellectual disabilities, ages 21-35, in understanding their own sexuality. Eight women participated in individual and three repeated focus group interviews. The questions that guided this study included: (1) What is the role of familial culture in addressing sexuality for young women with intellectual disabilities and (2) How do young women with intellectual disabilities describe their understanding of sexuality? The findings of this study suggested that familial culture played a significant role in the women's decisions regarding accessing their own sexuality. In addition, data collected indicated that women's lived experiences highly influenced in their understanding of sexuality and as a women with intellectual disabilities. Data from a thematic analysis were used to develop a person-centered theoretical model for understanding sexuality. In addition, these data were used to create a research-based theatrical script, known as an Ethnodrama (Saldana, 2005) to bring forward the voices of these women affirming their understanding of sexuality.

Le cancer du sein est le cancer le plus fréquent chez la femme et malgré une baisse de la mortalité ces dernières années, attribuable à une détection précoce et une meilleure prise en charge, il reste la première cause de mortalité par cancer et demeure donc un problème majeur de santé publique. La mortalité par cancer du sein s’avère être plus élevée dans le cas des cancers dits agressifs ou de mauvais pronostic tels que le cancer du sein de la femme jeune et le cancer du sein triple négatif (CSTN). Mes travaux de thèse portent sur ces deux types de cancer du sein avec comme objectifs l’étude des conséquences de la ménopause chimio-induite (MCI) chez les femmes jeunes atteintes d’un cancer du sein non métastatique d’une part et l’analyse des facteurs pronostiques de la rechute du cancer du sein triple négatif d’autre part. Le premier axe de ma thèse concerne l’étude clinique MENOCOR dont le but est d’évaluer chez les femmes jeunes atteintes d’un cancer du sein non métastatique l’impact de la MCI sur la qualité de vie (QdV). L’incidence de la MCI et l’étude des variations hormonales font également partie des objectifs secondaires. Dans le cadre de cette thèse, l’analyse intermédiaire, prévue dans le protocole, a été réalisée sur 59 patientes avec un recul de 18 mois post-chimiothérapie. Ces premiers résultats ont tendance à montrer une altération de la QdV évaluée par le QLQ-BR23 chez les patientes ménopausées vs les non ménopausées (p=0.17). A ce stade de l’essai, le QLQ-BR23 semble donc être plus adapté que le QLQ-C30 pour évaluer la QdV dans le contexte de cette étude. Nous avons également observé une prédiction possible de la MCI par le dosage de l’AMH initial et l’âge des patientes. Ainsi, ces résultats doivent être comparés à ceux de l’analyse finale et nous supposons qu’avec une puissance plus importante (effectif total prévu de 240 patientes et suivi de 30 mois post-traitement) les résultats concernant la QdV pourraient être significatifs.Le deuxième axe de ma thèse a consisté à la création d’une base de données sur le CSTN. Cette étude rétrospective s’inscrit dans la continuité des travaux réalisés au Centre Jean PERRIN et a pour but d’évaluer la dynamique et les facteurs prédictifs de la rechute du CSTN. Les analyses ont montré que l’atteinte ganglionnaire, la présence d’emboles et la taille tumorale sont les principaux facteurs pronostiques de la rechute. Les résultats présentés dans cette thèse confirment également l’hétérogénéité des CSTN avec l’existence d’une disparité des réponses à la CTNA (allant de la réponse complète à la chimiorésistance) et d’une diversité des rechutes (précoces (< 1 an), standards (1 à 5 ans) et tardives (> 5 ans)) soulignant la nécessité de poursuivre la recherche de nouveaux biomarqueurs pouvant prédire la réponse ou encore permettant de prévenir les rechutes afin d’améliorer la prise en charge des patientes. En conclusion, ces résultats permettent d’ouvrir de nombreuses perspectives de recherches. Nous prévoyons de comparer les résultats finaux de l’étude MENOCOR à ceux de l’analyse intermédiaire présentés dans cette thèse. A l’issu de l’essai, nous espérons avoir une meilleure compréhension de la MCI, de son impact sur la QdV et du rôle de l’AMH dans la prédiction de la ménopause. Concernant le CSTN, il est prévu de mener une autre étude rétrospective sur une cohorte plus large, avec cette fois-ci, l’analyse des paramètres hématologiques. En fonction des résultats, une étude prospective pourra être mise en place afin d’étudier le rôle du microenvironnement tumoral ainsi que des paramètres hématologiques et génétiques dans la rechute des CSTN. / Breast cancer is the most common cancer among women and despite a decline in mortality in recent years, due to early detection and better treatment management, it remains a major public health issue. Breast cancer mortality has been found to be higher in the case of aggressive or poor prognostic cancers such as breast cancer in young women and the triple negative subtype of breast cancer (TNBC).This PhD focuses on these two types of breast cancer and aims to study the consequences of chemotherapy-induced menopause (CIM) in young women with non metastatic breast cancer and evaluate the prognostic factors of TNBC relapse. One of the aspect of my PhD is based on the clinical study MENOCOR. The main objective of this study is to evaluate the impact of CIM on the quality of life (QoL) of young women with non metastatic breast cancer. The incidence of CIM and the study of hormonal variations are also a part of the secondary objectives. As a part of this PhD work, the interim analysis planned in the study protocol was conducted on 59 patients with a follow-up of 18 months post-chemotherapy. These first results tend to show a QoL decrease, evaluted by the QLQ-BR23, in menopausal women vs non menopausal women (p=0.17). At this stage of the trial, the QLQ-BR23 seems to be more appropriate than the QLQ-C30 to evaluate QoL. We also underline the possible prediction of CIM by the inital AMH level and age. Thus, these results should be compared to the final analysis and we expect that with a greater power (240 patients and a follow-up of 30 months post-chemotherapy) the QoL results will reach significance.The second axis consists of a database on TNBC. This retrospective study follows the work carried out in Jean PERRIN Cancer Center and aims to evaluate dynamics and pronostic factors of TNBC relapse. The analysis showed that the main pronostic factors are the node metastasis, the presence of emboli and the tumor size. The variability of response to chemotherapy (pCR to chemoresistance) and the diversity of relapses (early relapse (<1 year), standard relapse (1 to 5 years) and late relpase (> 5 years)) confirmed the heterogeneity of TNBC highlighting the need to continue the research of new biomarkers. In conclusion, these results open up many research perspectives. We plan to compare the final results of the MENOCOR study with those of the interim analysis presented in this PhD work. At the end of the study, we expect to have a better knowledge of CIM, its impact on QoL and the role of AMH in predicting menopause. Regarding the TNBC, it is planned to conduct another larger retrospective study focused in hematologic parameters evaluating the role of hematologic and genetic parameters. Depending on the results, a prospective study could be promoted in order to evaluate the role of tumoral micro-environment, and hematologic and genetic parameters in TNBC relapse.

Drawing upon data from a qualitative interview study on the life stories of young women, the aim of this study is to analyze young womens experiences of difficult life events. Special interest is directed to how cultural frameworks are reflected in young women’s stories about themselves and the family and school worlds they have lived in. During a period of almost four years, I conducted deep interviews with ten young women on two to four occasions. They were between the ages of sixteen and twenty at the time of the first interview and of different classes and local origins. The young women were recruited to the study through leaders of a youth detention home and of a girl group activity. Methodologically, the thesis is based in the general field of narrative research and more specifically in the field of feminist life story research. I employed a holistic and thematic content analysis inspired by hermeneutic interpretation and the mainly focus has been on what was told in the stories. The thesis is written in a context of feminist epistemology and from a critical perspective (cf. Harding, 1986, 2004). It includes, among other things, an assumption that there is a social, cultural and historically created imbalance of power between different groups in society (cf. Anderson, 2003). The theoretical concepts that form the basis of this part of the theoretical framework are social worlds (cf. Shibutani, 1955), exclusion (cf. Goffman, 1963; Young, 1990, 2000), belonging (cf. Molin, 2010; Spånberger Weitz, 2011), agency (cf. McNay, 2003, 2004), space of agency (cf. Eduards, 2002) and social positions (cf. Anderson, 2003). The young women´s stories about family gathered around experiences of parents’ separation, family violence, parental substance abuse and the separation from parents. Their stories of school life gathered mainly around experiences of being different and othered, and these experiences of otherness and alienation were closely linked to bullying, school difficulties and to a general unhappiness at school (cf. Andersson, 1995). In contemplation of life as a series of life events, the young womens stories highlight the importance of difficult life events and the impact they have had on their ability to live their lives. The results portray the importance of considering life as a series of moving events, instant and recurring, and of understanding the consequences of social structures on how life and its conditions change and are linked across borders, between different worlds and different times. In a consideration of the life events as variable, instantaneous and sometimes recurring and changing, every life event has to be viewed as new and important to pay attention to, both as an event in itself and also how this event spreads to other moments and contexts than the time and world in which it occurred. In the assumption of life as moving and of life events as essential elements in a changeable life course, available positions and spaces of agency are made visible in the young womens stories. The cultural frameworks of the good family, the real schoolgirl and an authentic I represent structuring principles for how the events are possible to understand and talk about for the young women. They can be considered as ideal images that both increase and limit their opportunities to make difficult life events and their own actions in relation to the events understandable. In this thesis, it becomes visible that, in order to understand young women’s experiences of difficult life events, we need to place experiences in a context where the different circumstances, such as social positions and local structures, are made visible, analyzed and reflected upon.

Young women with breast cancer have been found to experience their disease more negatively and more intensely than their older counterparts. However 'young' is not uniformly defined within the literature. Studies have reported on a wide range of ages considered to be 'young', such as samples simply divided by menopausal status or other researcher-defined parameters. For the purpose of this study, young women with breast cancer were defined as those diagnosed at 40 years of age or younger. The overarching aim of the study was to explore the problems faced by this group of young women using qualitative methodology, guided by constructionist epistemology, and grounded in symbolic interactionism and social constructionism. The study was conducted longitudinally, with data collected three times over a 12-18 month period using one-to-one in-depth semi-structured interviews. Baseline data were collected in the first phase of the study (n=35). A sub-group of participants (n=13) were chosen to be followed twice more approximately six months apart, which made up the next two phases. Themes derived from the literature guided the first phase of the study, data collection and analysis. Data analysis was performed after each data collection phase, with findings informing the next phase/s of the study. Thematic and content analysis were utilized in regards to the analysis of the first phase of the study, providing a framework identifying the most pressing concerns, such as those centred around children and partners, emotional aspects and negative physical consequences of treatment. Interrelationships between these themes were apparent. Findings suggest that the emotional support needs of this group of young women remains a challenge. Basic analytical principles of data reduction, data display and drawing conclusions guided the following phases of the analysis. NUD*IST (N6) software was utilized to help undertake in-depth analysis of all follow-up data. The literature concentrates on infertility as a concern for young women with breast cancer, however the study found that fertility per se was a concern for this group of women. Issues of maintained and regained fertility were reported, i.e., concerns surrounding suitable, safe and reliable contraception, pregnancy and breastfeeding after breast cancer. Over time, perceptions of fertility changed. Decisions related to unplanned pregnancies and breastfeeding were particularly onerous. The study also provided other insights into the participants' lives. Body image is suggested to be of greater concern for younger women with breast cancer than their older counterparts. Perceptions of breast symbolism, societal and personal, were explored, as were perceptions of the external portrayal of their bodies. In addition, the participants reported how their experience of breast cancer differed from that of older women with breast cancer, e.g., to be and dress more sexually. Theories and notions of social constructionism and the social construction of the body helped explain the participants' experiences. The women were acutely aware of the sexual importance society placed on women's breasts. Social norms and expectations and cultural trends, that is the youth and beauty culture, were found to greatly influence the participants' perceptions and hence decisions made. Prosthesis use and breast reconstructive surgery were viewed as normalising efforts undertaken by participants to reduce stigma related to breast loss/disfigurement and to enhance body image. The findings from this study provide a greater understanding of the issues, concerns and experiences of young women with breast cancer and provide information that could be utilized in the redesign of educational/information resources to provide these women with relevant information. Currently available support services may also benefit from these findings as greater understanding of these women's experiences may facilitate and promote the provision of more age-appropriate support for young women with breast cancer diagnosed in the future.

Thesis (M.Ed) Stellenbosch University, 1938. / Bibliography / VOORWOORD: In hierdie verhandleing het ek my dit ten doel gestel om die Geskiedenis van die Opvoeding van Meisies in Suid-Afrika te probeer weer. Daar egter die Kaapprovinsie die voorbeeld vir die opvoeding van meisies in Suid-Afrika gestel het, het ek my alleen tot genoemde provinsie bepaal. Die tydperk in die verhandeling omvat strek van ongeveer 1800 tot 1910, omdat in 1804 vir die eerste keer in die Geskiedenis van Suid-Afrika spesiale voorsiening vir die opvoeding van meisies gemaak is. Om die rede het ek my hoofsaaklik bepaal by die wer van Ds. A. Murry en die N. G. Kerk omdat ons e.g. as die baanbreker van gevorderde onderwys vir meisies kan beskou.

The purpose of this research study was to explore successes and challenges of Vhutshilo 2 HIV Prevention Programme in reducing HIV Infections amongst Adolescent Girls and Young Women [AGYW] in Alexandra. Qualitative, narrative research design was conducted to explore the experiences of the adolescent girls and young women in the Vhutshilo 2 programme. In order to obtain the data for this research the researcher used focus group interviews. Since the current study did not seek to generalize findings, a purposive sampling approach was seen as appropriate to use for this study. Two groups of respondents participated in the study. The first group of 7 participants were from Ratang Bana Organisation from Alexandra and the second group of 12 participants was from Friends for Life from the Mayibuye site. The data of this research project was analyzed using thematic analysis. Findings revealed that Vhutshilo was successful in achieving its desired results of helping adolescents to adopt healthy sexual behavior, developing positive values and behavior through exploring options, promoting assertiveness, understanding different influences on their lives and coming to their own views and decisions, rather than being told what to do. Recommendations made included taking the Vhutshilo 2 to other places like rural areas as the adolescent girls in the rural areas are at high risk of getting infected by HIV mostly due to cultural practices that expose them to such risks together with ignorance and limited access to health facilities. / Health Studies / M.P.H.

Background AIDS remains one of the world’s most serious health challenges affecting more females than men. The differences in the spread of Human Immunodeficiency Virus (HIV) among gender groups stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power. It could also be due to the females’ status in society which could be justified by lower economic and decision making ability. Purpose The purpose of this study was to explore and describe the role of gender in the spread of HIV among women of reproductive age in Ethiopia; with the view of developing gender sensitive HIV and AIDS prevention strategies. Methods The study used sequential mixed method with quantitative and qualitative paradigm. During first phase of the study, health facility based descriptive cross-sectional study design was used. Data was collected from 422 respondents using a structured questionnaire. Forty participants were recruited by purposive sampling from representatives working in reproductive health or related fields. Results About 83.2% of respondents reported that sexual intercourse discussion should be initiated by male partners. This showed that majority of respondents were dependent on their male partners in decision-making regarding sexual matters in their relationship. Multiple sexual partners were common among the respondents. One third of the respondents reported to have had intercourse with more than one partner during the past twelve months of the study period. Higher proportion of respondents (61.4%, n=259) had never used condom during sexual intercourse with their partner/s. As a result these risky sexual practices are a potential threat for spread of HIV and AIDS among women. Thus developed guidelines would alleviate the existing problems through implementation of strategies of HIV and AIDS prevention to enhance women’s status at household and different administrative structure level. Conclusion Gender disparities in relation to negotiating sexual relations among the study respondents were found to be still relevant. The culture that has placed men at the helm of leadership in sexual matters is strongly upheld and that includes who recommends use of preventive measures and who regulates when and how to enter into a sexual relationship. Guidelines for gender sensitive prevention strategies if applied appropriately would educate women and men to make decision about what directly affects their health / Health Studies / D. Litt. et Phil. (Health Studies)

This thesis reports on an analysis of the discursive construction of female and male physical identity in children’s literature and explicitly combines corpus linguistic methods with a critical discourse approach. Based on three novels from each of the Chronicles of Narnia and the Harry Potter series, it shows clear gendering of body parts, not only in terms of the purely quantitative preferences for certain body parts to be associated with one or other gender, but in terms of discourse prosody, or the uses to which the body parts are put. Human body parts in these series are mostly used in the following four ways, all of which show differences in realisation in terms of gender: · to describe individuals, physically, in order to distinguish one from the other; · to convey emotion, unintentionally as well as consciously; · for physical interaction between people and · for interaction with the world more broadly: responses to danger and agency, i.e. the ability to act on the world and the nature of what is achieved. The use of body parts by characters to express emotion and act agentively on the world is revealed to be strongly gendered in the two series. I characterise the most prominent patterns in terms of the bodily products blood, sweat and tears, of which the last is strongly connected to female characters, who are generally associated with emotion. The other two, referring to active participation in fighting and injury, as well as agency, are almost exclusively reserved for males, with female characters rendered unable to act on the physical world as a result of overwhelming feelings. The females’ response to danger suggests stereotyped discourses of inequality which see women and girls as requiring protection and being physically incapable. Thus gender is still a particularly salient aspect in these widely-read examples of children’s literature, despite plots which appear to be fairly positive towards women. The strength of the inclusion of a corpus approach in this study lies in its capacity to reveal objective, and often fairly covert, trends in language use. These in turn enrich the critical analysis of discourses in these influential texts, which facilitates social change through linguistic analysis.

Studien byggde på associationen mellan att de som främst använde sociala medier, målgruppen unga kvinnor i åldrarna 16 till 25 år, även var den samhällsgrupp som dominerade i psykisk ohälsa. Forskning kring varför målgruppen lider av psykisk ohälsa mer än andra samhällsgrupper är bristande. Det är samtidigt känt att ungas uppväxtmiljö spelar en betydande roll för deras psykiska hälsa. Sociala medier inkluderas inte som en sådan miljö, trots att unga kvinnor idag spenderar minst 3 timmar där dagligen. Detta motiverade studiens syfte, att undersöka unga kvinnors upplevelser kring sociala medier som uppväxtmiljö i relation till sin identitet och hälsa. Kvalitativ metod möjliggjorde insamling av material genom semistrukturerade intervjuer i fokusgrupper. Studiens resultat fann att unga kvinnor upplever sociala medier som en miljö lika verklighetstrogen som andra fysiskt anknutna uppväxtmiljöer. Studiens resultat redogör även för upplevelser av psykisk ohälsa i samband med sociala medier, men att en hög självkänsla fungerar som en skyddande faktor. Konklusionen redogör för om det finns bestämningsfaktorer för hälsa på sociala medier, bör dessa kunna betraktas som påverkbara förutsatt att de upptäcks och dokumenteras. Därför föreslås framtida hälsoarbete med fokus på säker navigering för unga på sociala medier. Konklusionen påvisar vikten av att folkhälsovetenskapens forskning fortgår i linje med den rådande samhällsutvecklingen som i studien förstås som digitaliserad, detta för att inte missa värdefull kunskap kring vad som leder eller avbryter kurs mot psykisk ohälsa. / The study’s background was based on the association between those who mainly used social media, young women between the ages of 16 and 25, were also the group that dominated in mental illness. Current research on why young women suffers from mental illness more than others is inadequate. Although, it is well-known that environments that young people integrates with growing up plays a significant role in youths mental health. Despite that young women spend at least 3 hours there daily, social media is not included as such environment. This motivated the study's purpose, to investigate young women's experiences about social media as an emerging environment in relation to their identity and health. Qualitative methodology enabled the collection of material through semistructured interviews in focus groups. The study found that young women perceive social media as an environment as realistic as any other environments they interact with growing up. The results of the study also describe the experiences of mental illness associated with social media, but that a high self-esteem serves as a protective factor. The conclusion explains whether there are determinants of health on social media, these should be considered as impactable provided they are discovered and documented. Therefore, future health work is proposed focusing on safe navigation for young people on social media. The conclusion demonstrates the importance of public health science research continuing in line with current social development, which in the study is understood to be digitized, in order not to lose valuable knowledge about what leads or interrupts courses against mental illness.