This interpretive description qualitative study explores the perceptions of alcohol use among South Asian (SA) Punjabi affected family members (AFMs) and their experiences with problem drinking from a Canadian community context. It is important to recognize the SA Punjabi community’s perceptions of alcohol use in order to develop a foundational understanding of this phenomenon from a socio-cultural perspective, an area of research that remains poorly understood. This preliminary investigation provides relevant contextual information to deepen our understanding of the experiences of SA Punjabi AFMs. Fourteen SA Punjabi AFMs were interviewed in both English and Punjabi. Analysis of participant narratives reveals five major themes: normalization of the SA Punjabi drinking culture; socio-cultural gender norms of alcohol consumption; socio-cultural gender related tolerance towards problem drinking; my relative’s drinking is the elephant in the room and I feel helpless and stuck. One of the themes, my relative’s drinking is the elephant in the room, had three sub-themes: fear of social judgement; fear of causing additional problems and fear of the relative. Interpretation of the participant experiences was facilitated through the use of the Stress-Strain-Coping-Support model (SSCS) (Orford, Velleman, Natera., et al., 2013). Participant stories highlight the unique socio-cultural experiences of SA Punjabi AFMs impacted by problem drinking. Findings from this study suggest a need for culturally and linguistically appropriate mental health and addictions supports for this community as they navigate the challenges of problem drinking within their families. / Thesis / Master of Science (MSc)

Master of Science / Department of Family Studies and Human Services / Sandra Stith / The Rutgers Alcohol Problem Index (RAPI) is a well-known instrument used as a primary outcome measure in intervention studies with college students. It has been used in studies assessing the developmental trajectory of high-risk drinking and also used in studies which address the predictors of alcohol-related problems among college students (Carey & Correia, 1997; Ham & Hope, 2005; Levy & Earleywine, 2003). Martens et al. (2006) found that the RAPI individual items were able to be grouped in three distinct subfactors (Abuse/Dependence, Personal Consequences, and Social Consequences). The objective of this study was to examine the relationship between various mental health problems (depression, posttraumatic stress disorder, physical abuse victimization, physical abuse perpetration, sexual coercion victimization, sexual coercion perpetration, and self-esteem) and the three subscales of the RAPI. It was anticipated that the mental health problems explain more of the variance on Abuse/Dependence than on Personal or Social Consequences. Results indicated that even though mental health problems explain more of the variance on Abuse/Dependence than on Personal or Social Consequences, the difference did not appear large enough to suggest that the subfactors represent unique domains. In conclusion, it cannot be assumed that the three subfactors measure distinct and exclusive types of consequences. A student that scores high on Abuse/Dependence also may be experiencing Personal and Social Consequences.

The purpose of our qualitative study is to investigate how the caretakers, in the elderly care, interpret and manage the issue of alcohol problems in elderly people. We have been performing semi-structured interviews on 9 people, on different levels in the elderly care. There were 3 elderly care managers, 1 nurse, 1 assistance administrator and 4 auxiliary nurses, who all, at some level, work with alcohol problems in elderly people. Those interviews were performed singularly, with one exception: we interviewed an elderly care manager and her 2 auxiliary nurses at the same time. To analyse our empirics, we have used the theories of Power and Ageism. Our study shows that the auxiliary nurses, who are the ones who must deal with these problems, have great difficulties to perform their work because they have no qualified knowledge about alcohol problems. In addition, they almost never get the proper information, they don’t have access to guidelines about handling people with alcohol problems and they don’t receive support from their superiors. They have to make the most difficult decisions for themselves without any resources or other guidance.

Although alcohol consumption among the elderly is rising this is still modestly noted. Care managers in elderly care come in contact with elderly people. The purpose with the study was therefore to examine how care managers experience the work with elderly people with alcohol problems and six qualitative interviews have been conducted. Empirical data has been analyzed with thematic analysis and linked to previous research and Hasenfelds theory about people-processing, people-sustaining and people-changing. The results show that care managers experience routines regarding elderly with alcohol problems, does not differ much from traditional elderly cases. These cases demand a higher level of cooperation between different departments, because they lack resources to help the elderly. Important factors in the work are considered to be motivational work, building a trust and a functioning interaction. They request more knowledge about elderly and alcohol, support from colleagues and the substance abuse unit are considered important. / Även om alkoholkonsumtionen bland den äldre generationen stiger är detta fortfarande blygsamt uppmärksammat. Biståndshandläggare inom äldreomsorgen kommer i kontakt med många äldre i sitt arbete. Syftet med studien var därför att undersöka hur biståndshandläggare upplever arbetet med äldre som har en alkoholproblematik. För att besvara studiens syfte har kvalitativa intervjuer genomförts med sex biståndshandläggare i skilda kommuner. Empirin har analyserats med tematisk analys och kopplats till tidigare forskning samt Hasenfelds teori om people-processing, people-sustaining och people-changing. Resultatet visar att biståndshandläggare upplever att det som skiljer ärenden rörande äldre med alkoholproblematik rutinmässigt från traditionella äldreomsorgsärenden är att de kräver en högre grad av samverkan mellan olika funktioner då biståndshandläggare inte besitter resurser att hjälpa dessa äldre. Viktiga faktorer i arbetet anses vara motivationsarbete, skapa en förtroendefull relation och uppnå en fungerande samverkan. Biståndshandläggarna efterfrågar mer kunskap om äldre och alkohol och stöd från kollegor samt missbruksenheten upplevs vara viktigt.

Aims: The purpose is to investigate how occupational health care professionals, trained in the 15-method, experience the impact of the internal organisational context when implementing the method. Methods: The study is a qualitative semi-structured interview survey with 12 practitioners. A deductive content analysis was used, based on the PARIHS framework. Main results: The respondents experienced that an organizational culture that includes knowledge about alcohol problems promotes implementation. Developing local routines, collaborating with competent colleagues and involvement of a respected physician who supports the method were essential. A committed leadership, supporting implementation in concrete action, was valued. Evaluation was rarely performed; more knowledge and materials were requested. The customers' needs and preferences were emphasized. Conclusions: The study supports the notion of implementation as a complex process that is unique to its context. The results provide insight into the professionals' experiences of influencing factors in the internal context when implementing the 15-method. The factors that recurred in all three perspectives (strengthening, weakening, suggestions for improvement) can possibly be attributed a special weight. Further studies are needed to confirm the consistency of the results when implementing other methods, as well as the effect of the internal context on the implementation process. / Syfte: Syftet är att undersöka hur företagshälsovårdspersonal som genomgått 15-metodutbildning upplever betydelsen av den inre kontexten vid implementering av 15-metoden. Metod: Studien är en kvalitativ semistrukturerad intervjuundersökning med 12 praktiker inom företagshälsovården. Bearbetningen gjordes med en deduktiv innehållsanalys utifrån det teoretiska implementeringsramverket PARIHS. Resultat: Respondenterna upplevde att en organisatorisk kultur som innefattar kunskap om alkoholproblem på alla nivåer främjar implementering. Det framhölls väsentligt att det finns lokala rutiner framtagna, att ha kollegor att samarbeta med samt att det finns en kunnig och betrodd läkare som förespråkar och stödjer användning av metoden. Ett engagerat ledarskap som ger stöd i konkret handling värderades högt. Utvärdering visade sig utföras sällan, mer kunskap och material efterfrågades. Beställarnas kunskapsbehov och preferenser framhölls centrala. Slutsats: Studien ger stöd för att implementering är en komplex process som är unik för sitt sammanhang. Resultatet ger insikt i företagshälsovårdspersonals upplevelser av inverkande faktorer i den inre kontexten på den egna arbetsplatsen vid implementering av 15-metoden. De faktorer som återkom i alla tre perspektiven (förstärkande, försvagande, förbättringsförslag) kan möjligen tillskrivas en särskild tyngd. Ytterligare studier behövs för att undersöka om föreliggande studies resultat återfinns vid implementering av andra metoder. Kvantitativa studier om den inre kontextens effekt på implementering behövs också.