The importance of health and quality health care in people’s daily lives is widely recognised. Physicians play a key role in delivering quality health care and improved patient outcomes. However, the evidence regarding physicians’ decision making and their perception of quality of health care delivery and its influencers is inconclusive. The overall aim of this thesis is to increase the understanding of quality in health care delivery and the factors that influence it from a physician’s perspective. This aim is fulfilled by conducting three interlinked research projects. The first research project comprises a systematic review of the literature that identifies the factors, contexts and theoretical underpinnings influencing physician decision making. The synthesis of 160 studies reveals two main categories of influencing factors. The first is ‘Contexts’, which refers to the set of circumstances or facts surrounding a particular event or situation. The second category is ‘Interventions’, which are the techniques, processes or actions introduced to create changes in how physicians make decisions while performing their clinical duties. Although extant literature provides ample evidence on factors influencing physician decision making the link to quality in health care is under researched. In the second research project, the author explores how physicians construct quality of health care delivery by means of investigating 162 clinical cases with 27 repertory gird interviews that yield eleven key constructs representing a classification of physicians’ conception of quality. The third research project examines physicians’ perceptions of enablers and barriers to quality in health care delivery, employing semi-structured interviews. Findings indicate that physician’s effort in delivering quality health care is largely influenced by factors affecting behavioural control (freedom to act). This research makes five contributions to knowledge. First, a novel classification of factors influencing physician decision making when prescribing is developed, providing new understanding of the link between these factors and quality of health care. Second, the systematic review shows an innovative application of factor analysis to structure the findings of a complex phenomenon. Third, the study presents a new conceptualisation of physicians’ construction of quality in health care. Fourth, the research provides a categorization of physicians’ perceived enablers and barriers to quality health care and the mechanisms by which they operate. Finally, this research develops a theoretically-grounded and empirically-informed conceptual model that incorporates three hitherto separate domains: agency, planned behaviour, and decision theories. This model provides a new integrated lens to better understand the complexities influencing quality in health care delivery. This study also makes two significant contributions to practice. First, the findings have helped initiate a transformation in the pharmaceutical industry’s business model, evolving from business-to-person to business-to-business. Second, the findings serve as a catalyst to drive organizational changes at Norway’s largest emergency hospital. As a result, a national debate was initiated, involving the Prime Minister and Minister of Health, on how hospital emergency care can best be provided at a national level.

This research is about the Social Networks and Social Capital of British-Bangladeshi Young Women in relation to their identity, cultural context and social aspects. It is a qualitative study based on the lives of a small sample of Bangladeshi young women, who are second or third generation British-born Bangladeshis between the ages of 16 and 29, living in London. They are British citizens and were born or grew up in Britain. The main area that the research takes place in is the London Borough of Tower Hamlets. Methods encompass in-depth interviews and focus group discussions. This research investigation has found that the social networks and social capital of Bangladeshi young women were impacted by their identity, ethnicity, social and cultural contexts, such as religious and gender identity, patriarchal practice within households and racism. Accordingly, for many women the construction of social networks was enabling; but for others, there were constraints in relation to their identity. On the other hand, the social networks through various places, especially places of study and work, significantly enabled the women to acquire their identity with regard to their social position, which has been helpful for agency and negotiation power. Consequently, their social networks were shaped based on their subjective experience, cultural expectations and social aspects. However, the women were active in order to create and maintain their social life, as well as to negotiate and develop their own ‘strategies to manage’ techniques to cope with the constraints. In this study, my main argument aims to emphasise how social networks are formed and maintained by the Bangladeshi young women in relation to their identity, cultural context and social aspects. I contend that these women actively negotiate a multitude of personal, familial and structural concerns in developing their social networks. I also argue that agency and negotiation power positively contribute to mitigate cultural constraints and inequalities with regard to the social networks of these young women; however social structures and inequalities create significant boundary conditions for these women to acquire negotiation power.

published_or_final_version / Computer Science / Doctoral / Doctor of Philosophy

published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

The recent decision handed down by the U.S. Supreme Court in Parents Involved in Community Schools v. Seattle School District No. 1 (2007) has forced school districts to begin thinking of new ways to integrate their schools without relying on race as the single factor in their assignment plans. While some school districts already have begun to implement race-neutral student assignments, others are just beginning the process and are looking to plans that have been able to maintain diversity despite the new limitations being placed on them. In order to learn more about what factors are most critical in shaping racial and socioeconomic diversity in school districts, I examined the interaction between the design and implementation of 3 different integration plans that rely on voluntary choice and socioeconomic status (SES). I wanted to determine whether these factors had any effect on the way such integration plans are employed and ultimately on school-level diversity outcomes. I was also interested in learning how the local sociopolitical context influenced outcomes. I used qualitative case methodology, which allowed me to focus on the processes and meanings behind the plans. I conducted a historical analysis of desegregation on each of the school districts and used data collected from documents and interviews to analyze how design interacted with context to produce particular outcomes. I situated my analysis in the education policy implementation literature as it tells us that people and places play integral roles in how a policy is designed, adopted, and implemented. The ultimate success of a policy is heavily influenced by the actors involved in the creation of the policy as well as the context in which the policy is implemented. I found that the success of these plans depends heavily on their context. Urban school districts that have high poverty levels and few White students have a difficult time maintaining diversity, whereas school districts that incorporate the city and surrounding suburbs are more likely to maintain diversity because White, middle-class families do not have the same opportunity to flee the district. Furthermore, school districts that use geographic zoning and regulated choice are able to maintain higher levels of diversity. Support from the community and local policymakers also can play a role in the success of integration plans. The findings suggest that geographic and political contexts matter in the shaping and adoption of integration plans based on voluntary choice and SES. I offer suggestions to maintain integration given the local sociopolitical context of the school districts. / text

<p>This thesis examines innovation and design processes in small established companies. There is a great interest in this area yet paradoxically the area is under-researched, since most innovation research is done on large companies. The research questions are: How do small established companies carry out their innovation and design processes? and How does the context and novelty of the process and product affect the same processes?</p><p>The thesis is built on three research papers that used the research method of multiple case studies of different small established companies. The innovation and design processes found were highly context dependent and were facilitated by committed resources, a creative climate, vision, low family involvement, delegated power and authority, and linkages to external actors such as customers and users. Both experimental cyclical and linear structured design processes were found. The choice of structure is explained by the relative product and process novelty experienced by those developing the product innovation. Linear design processes worked within a low relative novelty situation and cyclical design processes worked no matter the relative novelty. The innovation and design processes found were informal, with a low usage of formal systematic design methods, except in the case of design processes for software. The use of formal systematic methods in small companies seems not always to be efficient, because many of the problems the methods are designed to solve are not present. Customers and users were found to play a large and important role in the innovation and design processes found and gave continuous feedback during the design processes. Innovation processes were found to be intertwined, yielding synergy effects, but it was common that resources were taken from the innovation processes for acute problems that threatened the cash flow. In sum, small established companies have the natural prerequisites to take advantage of lead-user inventions and cyclical design processes. Scarce resources were found to be the main factor hindering innovation, but the examined companies practiced several approaches to increase their resources or use existing scarce resources more efficiently in their innovation and design processes. Examples of these approaches include adopting lead-user inventions and reducing formality in the innovation and design processes.</p><p> </p>

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Adolescence is a period of development when health-related behaviors can become rooted and subsequently contributes to leading causes of adult morbidity and mortality. The dissertation is based on three studies. The first is a cohort study (n=577) of sixth grade students followed for 2.5 years to assess changes in smoking susceptibility measured by intention to smoke. The second study applies a pre-post design to evaluate the outcomes of a 13-week after-school program and three-day, in-residence University camp on personal and familial factors among 37 sixth grade girls, most of whom were Mexican American. The third study is a cross-sectional study of depression among 80 sixth grade girls, the majority of whom were Mexican American. A survey measured depression severity and familial and individual factors that influence depression. Results showed smoking intention increased nearly six-fold from sixth grade to eighth grade (OR=5.8, 95% CI: 1.19, 3.05). The intervention study resulted in changes from pre to post test in familial and personal factors. The prevalence of depression was 50% among participants in the third study, 38% of girls reported moderate to severe levels. In sum, the greater prevalence of smoking intention over time suggests a norm of acceptance occurring as students' progress through middle school. Protective factors from such attitudes differ by gender and are influenced by the relationships surrounding the adolescent. Similarly, relationships were protective in the study of depression. The father's relationship with his daughter guards against depression as does positive peer relationships. These relationships can be strengthened through interventions as was suggested in the intervention study. Study findings emphasize the protective influence familial and peer relationships have on the developing adolescent.

Mobile applications can benefit from increased awareness of the device's context. Unfortunately, existing solutions for inferring context require special purpose sensors or beacons on the mobile devices or in the physical environment. This requirement significantly limits the deployment of these solutions. In this thesis, I argue that mobile devices can infer a substantial amount of their context by leveraging their existing wireless interfaces to monitor ambient radio sources, such as GSM cell towers or WiFi access points. I focus on two important problems in context-aware computing: localization of mobile devices and detecting proximity between mobile devices for authentication purposes. Specifically, I present an accurate localization system based on fingerprinting of GSM signals. I show that the key to more accurate GSM localization is the use of wide signal strength fingerprints that include readings from a large number of base stations. Next, I present a method that addresses the key drawback of fingerprint-based localization systems - the need to collect extensive measurements to train the system in every target environment. Finally, I show how radio environment sensing can be used to secure the communication of devices that come within close proximity. Removing the need for additional hardware on the mobile devices and in the physical environment renders the approach that I present amenable for widespread deployment.