The purpose of this study is to explore the barriers and opportunities that government-assisted refugee (GAR) women experience in settlement. Using a narrative inquiry approach, I elicited the stories of fourteen GAR women of diverse origins who have lived in Metro Vancouver for one to six years. Discourse analysis of the narratives shared within focus groups and individual sessions reveals a hierarchy of exclusory dimensions (barriers) and transformative dimensions (opportunities) of their adaptation process. The analysis also identifies settlement services and programs perceived as helpful by the women in overcoming identified barriers. The findings demonstrate how GAR women are active in their own cross-cultural adaptation and how this process is facilitated by intercultural communication competence and engagement in receiving communication activities. These findings provide insights for government and immigrant serving agencies concerned with tracking settlement outcomes for this population.

First year college student retention is important to colleges and universities nationwide (Bean, 2005). Most of the research on retention focuses on self-report data collected from students after they withdraw from the institution. The present study focuses, instead, on student stories about school, as well as at and about “home” during their first semester. The experiences of students who transition from high school to college are sometimes likened to those of individuals who enter a new culture for the first time. Thus, this dissertation is grounded in cross-cultural adaptation theory (Kim, 1988, 2001), which posits that successful adaptation occurs via a stress-adaption-growth dynamic and a gradual process of acculturation toward the new environment and simultaneous deculturation from the previous environment. Stories—in the form of in-class free writing assignments—were collected from 264 first-year college students three times during their first semester. These assignments were designed to capture students’ perceptions about their experiences and interactions at school, as well as their experiences and messages to, from, and about “home” as they evolved over the course of the semester. A thematic analysis revealed the majority of stories about events at school were negative and an overwhelming majority of the stories about events at home were positive. A longitudinal comparative analysis revealed no decrease in the percentage of negative stories about experiences and interactions at or about school. Moreover, stories focused on positive school related experiences decreased over time while stories about positive experiences at or about home gradually increased over the course of the semester. For students who did not enroll for spring semester, the results were similar but more dramatic. A large percentage of non-returners were female, about half were first generation college students, and a majority reported “home” as less than 100 miles from the university. More research ought to focus on what goes on during a student’s first year of college to better understand reasons for withdrawing. In doing so, college and university professionals will be able to work more effectively with high school officials, parents, and students to achieve success once they graduate from high school.

The aim of the present research study was to examine the cross-cultural adaptation experiences of overseas Chinese students studying on an International Foundation Course (hereafter IFC) at Luton University, in an attempt to: 1) gain a better understanding of the sociocultural adjustment difficulties and psychological adjustment problems experienced by the Chinese students and their perceived importance in adapting to sociocultural events in the new environment; 2) to examine factors that are related to the students' sociocultural adjustment, psychological adjustment and academic performance; 3) to explore the strategies used by the students for handling obstacles; 4) to integrate research perspectives from different fields (e.g. cultural adaptation, international education), and to re-assess current theoretical models in the light of this. To gain new insights into the dynamic and multi-dimensional nature of cross-cultural adaptation, this two-phase, sequential mixed method study was designed firstly to obtain quantitative results from a sample of the IFe Chinese students and then to follow up a few of the students and their teachers to explore those results in greater depth. In the first phase, a total of 126 of the students participated in the cross-cultural adaptation survey. In the second phase, twenty of the respondents of the earlier survey and seven of the IFC teachers were invited for a semi-structured in-depth interview. Results of the survey indicated that the IFC respondents regarded themselves as having "slight to moderate difficulty" in coping with the new culture, more specifically, interactions with people of other nationalities were perceived as more difficult than the academic demands, which in turn were seen as more difficult than daily life demands. With regard to psychological adjustment, most of the IFC students did not have clinical depression symptoms. Psychological adjustment was found to affect academic performance (measured by GPA). An examination of the students' GPA showed that more than half of the students had a GPA in the 'bare pass' category and half of the respondents had negative perceptions of the university, many of whom regarded the university to be worse than they expected. Results of the in-depth interviews from the students and teachers corroborated and added some further insights to the findings of the survey. After discussing the empirical findings in relation to the relevant theories and research studies, a number of recommendations are offered respectively for international students, for staff working with international students and for university authorities.

This study examines the impact of national culture on the content of corporate Web sites, and Web users’ attitudes and intentions toward culturally congruent or incongruent Web sites. In this work, culturally bipolar clusters based on Hofstede’s (1991) and Hall’s (1976) cultural dimensions are conceptualised. New Zealand and Korea are chosen as representatives of the respective bipolar clusters. This research utilises both content analysis and experimental research to provide deep insight into an area which has not yet been explored. Two studies are undertaken, Study One, focusing on the content analysis, examines how the use of visual communication and Web features differs between the two countries and between industry types. Study Two assesses Web users’ predispositions to respond favourably or unfavourably to the Web site. Web users’ perceptions, measured by experimental research with four culturally manipulated Web sites, are assumed to be the most suitable concept for studying the effectiveness of Web sites. Three ethnic groups are involved: Korean university students, New Zealand university students, and English-Korean bilingual university students. The findings reveal differences in the content of corporate Web sites from the two countries. However, these results do not support the findings of extant research. The results show that the corporate Web sites studied can be distinguished not only by the two national cultures, but also by other significant factors such as a company’s characteristics, its online presence strategy, national broadband infrastructure, and unique Internet culture. Additionally, the segment of young adults shows a convergence of cultural value systems which can be attributed to the fact that young adults in both countries have similar perceptions toward corporate Web sites regardless of their nationalities. Language structure and local terminology on the Web sites, however, are still important. This study contributes to knowledge by providing critical insights into the effectiveness and cultural congruence of Web sites. The results will benefit both academics and practitioners.

Made available in DSpace on 2015-07-22T20:50:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-26 / O “Behavior Rating Inventory of Executive Function” (BRIEF) é um instrumento de avaliação das funções executivas refletindo aspectos da vida diária de crianças e adolescentes entre 5 e 18 anos de idade. Consta de três versões, ou seja, a escala para pais, professores e versão pessoal. O objetivo do presente estudo foi traduzir e adaptar, para o português do Brasil, o BRIEF, assim como analisar as propriedades psicométricas iniciais. O processo de tradução e adaptação seguiu os passos recomendados na literatura e amplamente preconizados pelo International Test Commission (ITC). Para análise da adequação da adaptação, assim como das propriedades psicométricas, foram realizados dois estudos pilotos, sendo que a versão final foi administrada numa amostra constituída por 277 pais, sendo 59,6% do sexo feminino, 282 professores, sendo 57,4% feminino, 112 pessoal, sendo 63,4% feminino. Os valores dos Alfas de Cronbach, avaliando consistência interna para os principais índices do questionário dos pais oscilaram entre 0,901 e 0,945, do questionário dos professores oscilaram entre 0,915 e 0,959 e, os do questionário pessoal oscilaram entre 0,924 e 0,957, indicando adequados coeficientes de fidedignidade do teste. A análise fatorial de componente principal extraiu dois fatores (Fator 1 Metacognição; Fator 2 Regulação do Comportamento). No questionário dos pais, os dois fatores foram correlatos (r=0,56). No questionário dos professores, a correlação foi 0,400, e no questionário pessoal, a correlação foi 0,70. Os valores encontrados na versão brasileira se assemelham ao relatados na versão original, indicando boa consistência interna do instrumento nas 3 versões. / Behavior Rating Inventory of Executive Function (BRIEF) is an instrument that assesses executive functions, reflecting daily life aspects of children and teenagers aged between 5 and 18 years old. It has three versions, that is, the parenting scale, the teachers’ scale and a personal version. The purpose of this study was to translate and to adapt, into Brazilian Portuguese, BRIEF, as well as to analyze the initial psychometric properties. The translation and adaptation process followed the steps recommended in literature and widely endorsed by International Test Commission (ITC). To analyze the adaptation’s adequacy, as well as the psychometric properties, two pilot studies were carried out, and the final version was administered to a sample comprised of 277 parents, being 59.6% female, 282 teachers, being 57.4% female, 112 personal, being 63.4% female. The Cronbach’s Alpha values, assessing internal consistency for the main items of the parents’ questionnaire ranged from 0.901 to 0.945, the ones concerning the teachers’ questionnaire ranged from 0.915 to 0.959 and those concerning the personal questionnaire ranged from 0.924 and 0.957, showing proper coefficients of test’s trustworthiness. The factorial analysis of main component extracted two factors (Factor 1: Metacognition; Factor 2: Behavior Regulation). In the parents’ questionnaire, both factors were correlated (r=0.56). In the teachers’ questionnaire, correlation was 0.400, and in the personal questionnaire correlation was 0.70. The values found in the Brazilian version are similar to those reported in the original version, showing good internal consistency of the instrument in the three versions. / TEDE / BV UNIFESP: Teses e dissertações

Objetivo: Desenvolver um questionário em português que avalie letramento em saúde e verificar a possível associação entre letramento em saúde e adesão à terapia medicamentosa. Métodos: Entrevistas foram realizadas enquanto os indivíduos esperavam seu atendimento em postos de saúde da cidade de Bagé, na região sul do Brasil. O letramento em saúde foi avaliado pelo Teste de Letramento em Saúde (TLS). O TLS foi desenvolvido baseando-se na tradução e adaptação do TOFHLA (Test of Functional Health Literacy in Adults) para a realidade brasileira, considerando-se aspectos de linguagem e culturais. A adesão à terapia medicamentosa foi avaliada pelo Morisky e as dificuldades para adesão foram avaliadas pelo BMQ (Brief Medication Questionnarie). Resultados: A consistência interna do TLS foi alta (0,789). Sua pontuação média foi de 87,4 ± 10,2 e mais de dois terços da população (73,7%) tinha no mínimo o ensino médio completo. Aproximadamente 87% dos participantes possuíam letramento em saúde adequado, 10,5% limitado e 2,6% inadequado. Houve diferença estatisticamente significativa entre as pontuações médias obtidas entre as diferentes faixas etárias e de escolaridade. Os indivíduos com baixo letramento em saúde apresentaram mais do que o dobro de probabilidades de encontrarem dificuldades para aderir ao tratamento medicamentoso quando comparados aos indivíduos com letramento em saúde adequado (RP=2,19; IC95%=1,30 – 3,67). Conclusão: O TLS demonstrou ser uma medida adequada de letramento em saúde para indivíduos com alto nível de escolaridade. Porém, necessita maiores avaliações entre aqueles com menor escolaridade. Através do TLS, o impacto do baixo letramento em saúde na população brasileira pode ser avaliado, bem como a identificação dos indivíduos que necessitam de instruções especiais Além disso, o baixo letramento em saúde demonstrou estar associado com maiores dificuldades para aderir ao tratamento medicamentoso. Portanto, intervenções que proponham melhorar a adesão, devem, antecipadamente, verificar o nível de letramento em saúde destes, para assim elaborar estratégias capazes de atingir o entendimento dos pacientes em cada grau de letramento. / Title: Association Between Health Literacy and Medical Treatment Adherence. Objective: To develop a test to evaluate health literacy in Brazilian Portuguese and assess the association between health literacy and adherence to medical therapy. Methods: Interviews were carried out while participants waited for consults in primary care facilities in Bagé, south Brazil. Health Literacy was evaluated through the Teste de Letramento em Saúde (TLS). The TLS was based on translation and adaptation of the Test of Functional Health Literacy in Adults (TOFHLA) to the Brazilian scenario, considering cultural and language aspects. Adherence to medical therapy was evaluated by Morisky and difficulties for adherence were evaluated through Brief Medication Questionnaire (BMQ). Results: Internal consistency was high (0.789). Average score was 87.4±10.2, and over two thirds of the population (73.7%) had finished high school. Approximately 87% of participants had adequate health literacy, 10.5% had marginal health literacy, and 2.6% had inadequate health literacy. There was a statistically significant difference in average scores between groups with different age and education. Individuals with low health literacy (LHL) presented over twice as much chance of finding difficulties in adhering to medical treatment than individuals with good health literacy (PR=2.19; 95%CI= 1.30 – 3.67). Conclusion: TLS provides a proper way of accessing health literacy in individuals with high education level. However, further evaluation is needed among those with lower education. Through TLS, the impact of low health literacy in the Brazilian population can be assessed and the identification of individuals who need special instruction.Moreover, low health literacy has proven to be associated with greater difficulties to adhere to drug treatment. Therefore, interventions that propose improve adherence, should in advance determine the level of literacy in of health, in order to develop strategies capable of understanding of patients in each degree of literacy.

The Chinese government has announced the 2013 Guidelines for developing a national system for early detection of disability among children under 6 years of age. However, given limited resources, challenges exist with developmental measures required in the 2013 Guidelines. In order to meet the needs for a more accurate and cost-efficient measure for developmental assessment, the Ages & Stages Questionnaires:INVENTORY was translated into Simplified Chinese, and validated on a regional sample of 812 Chinese children ages from 1-25 months. Psychometric properties were examined; data from previous studies on the ASQ:INVENTORY in the U.S. were compared to identify differences between the two countries. Results indicated that the Chinese ASQ:INVENTORY was an instrument with sufficient internal consistency, reliability and validity. It was well accepted by parents and professionals in China. Findings suggested that the Chinese ASQ:INVENTORY provides a promising alternative measure for screening and diagnosing developmental delays in young children in China. Implications for future research and implementation are discussed.

A intolerância à incerteza (IU) é considerada um traço transdiagnóstico referente a crenças negativas sobre a incerteza e suas consequências. Ultimamente, a IU vem sendo associada com diversos transtornos relacionados à ansiedade. A presente dissertação teve o objetivo de realizar a adaptação transcultural e investigar propriedades psicométricas da Intolerance of Uncertainty Scale (IUS-12, Versão Abreviada) para uso no Brasil. O processo de adaptação transcultural foi dividido em sete etapas discutidas no primeiro estudo, onde também são apresentadas evidências de validade de conteúdo da escala. O segundo estudo teve como objetivo acumular evidências de validade de construto através de análise fatorial confirmatória e análise da consistência interna da IUS-12. Além disso, a validade convergente da escala foi avaliada através de suas correlações com instrumentos que medem construtos relacionados. Adicionalmente, são apresentadas normas e diretrizes para interpretação dos escores da escala. Os resultados da Análise Fatorial Confirmatória indicam que a IUS-12 possui estrutura fatorial semelhante a escala original contendo dois fatores: Intolerância à Incerteza Inibitória e Intolerância à Incerteza Prospectiva. Discute-se os demais resultados relativos às propriedades psicométricas da escala no segundo estudo e considera-se a IUS-12 como uma medida válida para a avaliação da intolerância à incerteza na população brasileira. / Intolerance of Uncertainty (IU) is considered a transdiagnostic factor reflecting negative beliefs about uncertainty and its consequences. IU has been associated with several anxiety-related disorders. The aim of this dissertation was to perform a cross-cultural adaptation and to investigate psychometric properties of the Intolerance of Uncertainty Scale (IUS-12, Short Version) for use in Brazil. The Cross-cultural adaptation process was divided into seven steps which are discussed in the first study, along with evidence of content validity of the scale. The second study aimed to accumulate evidence of construct validity throughout Confirmatory Factor Analysis and internal consistency analysis. In addition, a convergent validity was assessed through its correlations with measures of related constructs. Furthermore, norms and guidelines for scores interpretation are presented. The results of the Confirmatory Factorial Analysis indicate that the IUS-12 has a factorial structure similar to the original scale comprising two factors: Inhibitory IU and Prospective IU. Further results regarding psychometric properties of the scale are discussed in the second study. The IUS-12 appears to be a valid measure for assessment of intolerance to uncertainty in the Brazilian population.

As demências têm um impacto importante em saúde pública. O diagnóstico desta síndrome é essencialmente clínico. A seção A do Cambridge Examination for Mental Disorders of the Elderly revised version (CAMDEX-R) é uma entrevista estruturada com o paciente para o diagnóstico de demência, composta pela investigação do estado clínico atual e pregresso do paciente e sua história familiar. Realizar a adaptação para o Português e avaliar a confiabilidade teste-reteste e inter-aferidor da versão-final da seção A do CAMDEX-R. Adotou-se a abordagem universalista. Uma ampla revisão bibliográfica foi realizada inicialmente. Duas traduções do original em inglês para o português e duas retrotraduções para o inglês foram realizadas e, finalmente, após a análise independente das quatro versões e da original, a versão-síntese foi desenvolvida por uma tradutora juramentada. Foram realizados dois encontros com especialistas, com o objetivo de avaliar quais itens necessitavam de adaptações que iam além da equivalência semântica até então desenvolvida. Os vinte itens considerados mais difíceis foram discutidos com idosos da população-fonte através da técnica de grupos focais. Posteriormente, um grupo multidisciplinar de geriatria analisou esta versão, sob o foco do contexto sócio-cultural dos idosos brasileiros e elaborou a versão pré-teste. O pré-teste foi aplicado a trinta e cinco indivíduos, estimulados a comentar e a parafrasear as questões, com foco naquelas consideradas de maior dificuldade para adaptação. Os problemas identificados retornaram ao grupo de especialistas, que produziu a versão-final. Para a análise da confiabilidade, a versão-final foi aplicada a cento e sessenta pacientes atendidos no Serviço de Geriatria Prof. Mario A. Sayeg, da Policlínica Piquet Carneiro, da Universidade do Estado do Rio de Janeiro. Foi calculada a estatística kappa (k) para cinco sub-seções do instrumento, cujo diagnóstico foi definido através dos critérios do Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), da Associação Americana de Psiquiatria (APA, 1994). Nas questões relativas ao histórico médico passado, foi calculado o k item-a-item. A versão final brasileira foi elaborada visando manter as equivalências conceitual, de itens e semântica com o instrumento original. A confiabilidade inter-aferidor foi avaliada em cento e trinta entrevistas; e noventa e três indivíduos foram reentrevistados para a confiabilidade teste-reteste. A confiabilidade inter-aferidor foi quase perfeita nas sub-seções e nos itens individuais avaliados. A confiabilidade teste-reteste foi substancial em três sub-seções e moderada em duas delas. O Índice K foi quase perfeito ou substancial em 70% dos itens individuais do histórico médico passado. A versão brasileira da seção A do CAMDEX-R apresenta bons níveis de confiabilidade e foi considerada adequada para uso clínico. / Dementias cause an important impact in public health. The diagnosis of this syndrome is essentially clinical. The Cambridge Examination for Mental Disorders of the Elderly revised version (CAMDEX-R), Section A, is a structured interview with the patient for dementia diagnosis, composed by questions related to present state, past medical history and family history. To adapt cross-culturally and assess test-retest and inter-observer reliability of Section A of CAMDEX- R. An universalist approach was adopted. An extensive bibliographical review was carried out initially. Two translations of the original in English into Portuguese and two back translations into English were made and, finally, after analyses of the four independent versions and the original, a synthesis version was developed by a sworn translator. Two meetings with specialists on the theme subject were done, with the objective of evaluating which items needed adaptation. The twenty most difficult items were discussed with elders of the source population through the focal groups technique. Later, a multidisciplinary geriatric team analyzed the version, with focus on socio-cultural context of Brazilian elderly, and elaborated the pretest version. The pretest was applied to thirty-five individuals, who were asked to comment and paraphrase the questions, with focus on those with greater difficulty to adapt. The identified problems returned to the group of specialists, who elaborated the final version. For the reliability analysis, the final version was applied to one hundred and sixty patients attended at the Serviço de Geriatria Prof Mario A. Sayeg, Pedro Ernesto University Hospital. Kappa statistic (k) was calculated to five sub-sections of the instrument, whose diagnosis was defined through the standard of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), of the American Psychiatric Association (APA, 1994). The Kappa statistic was calculated for each item of the questions related to past history. The Brazilian final version was elaborated after modifications of the literal translation, aiming at keeping semantic equivalence to the original. The inter-observer reliability was assessed in one hundred and thirty interviews; and ninety and three individuals were re-interviewed to evaluate test-retest reliability. The inter-observer reliability was almost perfect in all sub-sections and each items assessed. The test-retest reliability was moderate or higher in the five sub-sections. Kappa statistic showed substantial or almost perfect agreement in 70% of all individual items of past history. The Brazilian version of CAMDEX-Rs Section A has good levels of reliability and was considered suitable for clinical use.

Objetivo: Desenvolver um questionário em português que avalie letramento em saúde e verificar a possível associação entre letramento em saúde e adesão à terapia medicamentosa. Métodos: Entrevistas foram realizadas enquanto os indivíduos esperavam seu atendimento em postos de saúde da cidade de Bagé, na região sul do Brasil. O letramento em saúde foi avaliado pelo Teste de Letramento em Saúde (TLS). O TLS foi desenvolvido baseando-se na tradução e adaptação do TOFHLA (Test of Functional Health Literacy in Adults) para a realidade brasileira, considerando-se aspectos de linguagem e culturais. A adesão à terapia medicamentosa foi avaliada pelo Morisky e as dificuldades para adesão foram avaliadas pelo BMQ (Brief Medication Questionnarie). Resultados: A consistência interna do TLS foi alta (0,789). Sua pontuação média foi de 87,4 ± 10,2 e mais de dois terços da população (73,7%) tinha no mínimo o ensino médio completo. Aproximadamente 87% dos participantes possuíam letramento em saúde adequado, 10,5% limitado e 2,6% inadequado. Houve diferença estatisticamente significativa entre as pontuações médias obtidas entre as diferentes faixas etárias e de escolaridade. Os indivíduos com baixo letramento em saúde apresentaram mais do que o dobro de probabilidades de encontrarem dificuldades para aderir ao tratamento medicamentoso quando comparados aos indivíduos com letramento em saúde adequado (RP=2,19; IC95%=1,30 – 3,67). Conclusão: O TLS demonstrou ser uma medida adequada de letramento em saúde para indivíduos com alto nível de escolaridade. Porém, necessita maiores avaliações entre aqueles com menor escolaridade. Através do TLS, o impacto do baixo letramento em saúde na população brasileira pode ser avaliado, bem como a identificação dos indivíduos que necessitam de instruções especiais Além disso, o baixo letramento em saúde demonstrou estar associado com maiores dificuldades para aderir ao tratamento medicamentoso. Portanto, intervenções que proponham melhorar a adesão, devem, antecipadamente, verificar o nível de letramento em saúde destes, para assim elaborar estratégias capazes de atingir o entendimento dos pacientes em cada grau de letramento. / Title: Association Between Health Literacy and Medical Treatment Adherence. Objective: To develop a test to evaluate health literacy in Brazilian Portuguese and assess the association between health literacy and adherence to medical therapy. Methods: Interviews were carried out while participants waited for consults in primary care facilities in Bagé, south Brazil. Health Literacy was evaluated through the Teste de Letramento em Saúde (TLS). The TLS was based on translation and adaptation of the Test of Functional Health Literacy in Adults (TOFHLA) to the Brazilian scenario, considering cultural and language aspects. Adherence to medical therapy was evaluated by Morisky and difficulties for adherence were evaluated through Brief Medication Questionnaire (BMQ). Results: Internal consistency was high (0.789). Average score was 87.4±10.2, and over two thirds of the population (73.7%) had finished high school. Approximately 87% of participants had adequate health literacy, 10.5% had marginal health literacy, and 2.6% had inadequate health literacy. There was a statistically significant difference in average scores between groups with different age and education. Individuals with low health literacy (LHL) presented over twice as much chance of finding difficulties in adhering to medical treatment than individuals with good health literacy (PR=2.19; 95%CI= 1.30 – 3.67). Conclusion: TLS provides a proper way of accessing health literacy in individuals with high education level. However, further evaluation is needed among those with lower education. Through TLS, the impact of low health literacy in the Brazilian population can be assessed and the identification of individuals who need special instruction.Moreover, low health literacy has proven to be associated with greater difficulties to adhere to drug treatment. Therefore, interventions that propose improve adherence, should in advance determine the level of literacy in of health, in order to develop strategies capable of understanding of patients in each degree of literacy.