Abstract Immigrant parents face unique challenges in getting involved in their children's education. Research is limited about how immigrant parents cope with these challenges in supporting their children's education. The purpose of this qualitative study, as reflected in the central research question, was to describe the lived experiences of Ghanaian and Nigerian immigrant parents in relation to their involvement in their children's education. The conceptual framework was based on Epstein's theory of parental involvement concerning how the school, family, and community relate to each other. A phenomenological design was used, and participants included 11 Ghanaian and Nigerian immigrant parents living in an urban city in the eastern region of the United States whose children were enrolled in public schools. Data were collected from participant responses to individual interviews that included 10 open-ended questions. Data were analyzed using the modified van Kaam method of analysis. Findings indicated that immigrant parents believed frequent communication with teachers was the most important component of Epstein's parental involvement model and that they should also support teachers in resolving disciplinary issues at school. This study contributes to positive social change by helping educators design and implement strategies that encourage immigrant parents to become actively involved in their children's education, which may lead to improved student achievement and socioeconomic mobility for students.

Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI guideline components were evaluated via a scoring sheet for pain control and self-management effectiveness for the OA patient. The panels assessed these treatment plans in terms of suitability, tolerance, and patient adherence for inclusion into the educational program. The panel members independently reviewed both sets of guidelines and then convened as a group to share their scores and reach a consensus on these guidelines, in the patient population served. Agreement of 85% among the panel members was needed for inclusion into the practice guideline. Based on the scoring results the panel concluded that the ASA and OARSI guidelines would likely improve pain control, functional ability, and psychological well-being essential to lifestyle modifications and OA symptoms management education program. The social impact of developing nursing practice guidelines for the self-management of OA pain in home-based settings will be manifested in better patient lifestyle and behavior modification leading to better symptom management.

Although the formation of an online home-based business may be a relatively simple and low-cost endeavor, entrepreneurial marketing researchers suggest that immigrant entrepreneurs must access appropriate resources to effectively market an online business for breakout from low-growth, ethnic enclave markets. The purpose of this qualitative narrative inquiry study was to explore the entrepreneurial marketing experiences of immigrant entrepreneurs in the United States operating online home-based businesses, and the implications of these experiences for supporting breakout from traditionally restricted markets. To address this gap, a narrative inquiry method was used to collect data from immigrant entrepreneurs. This study was framed by 2 key concepts focused on immigrant entrepreneurs in operating online businesses: Kloosterman's concept of postindustrial opportunities for immigrant entrepreneurs and Anwar and Daniel's concept of entrepreneurial marketing in online home-based businesses. Data was gathered using 6 face-to-face unstructured interviews and analyzed using thematic analysis and a critical events analysis approach. Five conceptual categories were revealed for answering the research question. The findings of the research showed that that online home-based business strategies can mitigate gender, racial, or social biases given strong family support and leveraging social capital, social networks, relationships, or ethnic community support. Results gleaned from this narrative study may help to promote social change by revealing to entrepreneurship educators and policymakers the challenges with which immigrants who own online home-based businesses must contend.

Thesis (M.Dev.) --University of Limpopo, 2011 / Refer to document.

Background: Among patients with multiple chronic conditions, care coordination and integration remains one of the major challenges facing the U.S. health care system. A home-based, patient-centered primary care program has been offered through the Veterans Health Administration (VHA) since the 1970s for frail veterans who have difficulty accessing VHA clinics. The VHA Home Based Primary Care (VHA HBPC) aims to integrate primary care, rehabilitation, disease management, palliative care, and coordination of care for frail individuals with complex, chronic diseases within their homes. Early research suggested that VHA HBPC was associated with positive outcomes (e.g., reduced resource use and patient satisfaction). However, evidence regarding the effect of the VHA HBPC program on health services use (especially hospital and nursing home use), expenditures, and other patient outcomes remains limited. The present study is designed to fill this gap as the rise in the number of veterans with complex health care needs will likely increase in the coming decades. Objectives: The current study aimed to examine the impact of VHA HBPC on health services use, expenditures, and mortality among a cohort of new VHA HBPC enrollees identified in the national VHA data system. The specific aims of this study were: 1) to examine the effect of VHA HBPC on major health service use (hospital, nursing home, and outpatient care) paid for by the Veterans Administration; 2) to examine the effect of VHA HBPC on total health services expenditures; and 3) to examine whether VHA HBPC enrollees experienced similar mortality and survival as compared to a matched concurrent cohort. Methods: This study used a retrospective cohort design. A new VHA HBPC enrollee cohort (the treatment group) and a propensity matched comparison cohort (the comparison group) were identified from VHA claims in fiscal years (FY) 2009 and 2010 and were followed through FY 2012. Data on health service use, expenditures, and mortality/survival data were obtained via the VHA administrative datasets (i.e., Decision Support System, Purchased Care, and Vital Status Files). Propensity scores of being enrolled in the VHA HBPC were generated by a logistic regression model controlling for potential confounders. After 41,244 matched pairs were determined adequate through several diagnostic methods, means tests, relative risk analyses, and generalized linear models were used to estimate the effect of VHA HBPC on outcomes. Additionally, a Cox proportional hazards regression model was used to estimate the effect of VHA HBPC on survival. Subgroup analyses were conducted stratifying by age (85 and older), comorbidities (2 or more), and the receipt of palliative care. Based on the results of the original analyses, a series of sensitivity analyses were conducted that modified the described sample selection criteria and matching algorithm. Results: Analyses of the original cohort revealed that VHA HBPC patients had significantly higher risks of being admitted into a hospital (RR 1.53, 95% CI 1.51-1.56) or nursing home (RR 1.65, CI 1.50 - 1.81). The average total expenditures during the study period were significantly higher for the VHA HBPC group as compared to the control group ($85,808 vs. $44,833, respectively; p < .001). In terms of mortality and survival, VHA HBPC enrollees had higher mortality (RR 1.45, CI 1.43 - 1.47), and shorter survival (HR 1.89, CI 1.86 - 1.93) as compared to those in the comparison group. Subgroup analyses found that these relationships generally remained when stratified by age 85 or older or having two or more comorbidities. However, for those who received palliative care, VHA HBPC participants had significantly lower risk of VHA hospitalization overall (RR 0.84, CI 0.81 - 0.87) and immediately prior to death. Finally, exploratory post-hoc analysis suggested that VHA HBPC recipients were at higher risk of VHA hospitalization at 30 (RR 1.11, CI 1.06 - 1.16), 60 (RR 1.16, CI 1.11 - 1.20), and 90 days (RR 1.16, 1.12 - 1.21) prior to death relative to the comparison group. After selecting only those that had a baseline hospitalization and refining the matching algorithm to account for time to death and additional comorbidities, VHA HBPC participants who had been enrolled in the program for at least six months had lower risks for hospital (RR 0.89, CI 0.88 - 0.90) and nursing home admissions (RR 0.74, CI 0.67 - 0.81). However, total expenditures remained significantly higher among those in VHA HBPC relative to the comparison group ($89,761 vs. $85,371, respectively; p < .001). Discussion: This study found that without accounting for important covariates such as initial hospitalization, time to death, and a range of comorbidities, VHA HBPC was associated with higher health service use, higher expenditures, higher mortality, and shorter survival as compared to a similar group of patients not receiving VHA HBPC. After accounting for these factors, VHA HBPC was associated with a lower risk of nursing home use, and after six months, VHA HBPC was associated with lower risk of both nursing home and hospital use. These findings suggest that while VHA HBPC may improve quality of life and patient satisfaction through patient-centered integrated primary care, it may not generate cost savings for the healthcare system. Future research is needed to understand variation in program implementation and how this affects the impact of VHA HBPC on service use and cost.

The long-term regular use of tobacco and hazardous alcohol use are responsible for significant mortality and morbidity as well as social and economic harm in Australia each year. There is necessary the more cost-efficient primary prevention strategies are equally, if not more important. Youth have been identified as an important primary prevention target group in public health initiatives designed to reduce drug-related harm. Strengthening parents' capacity to reduce children's risk of alcohol, tobacco and other drug-related harm is also recognised as an important strategy. The first chapter of this thesis introduces this public health issue, provides a summary of the present state of play regarding parent-training intervention research, and presents the research hypotheses. A comprehensive review of the epidemiological, empirical, and theoretical literature pertaining to this research is presented in Chapter 2. Recreational alcohol, tobacco and other drug (ATOD) use results in some 23 000 deaths (representing around 18% of all deaths) and the premature loss of some 160 000 person-years of life each year in Australia. The social consequences have been estimated to cost the Australian community almost $19 billion annually. The prevalence of young people in these data is also cause for concern. In Western Australia (WA), nearly one third of the alcohol-related deaths in the period 1993-1995 occurred in people aged less than 25 years. In 1995 in WA, alcohol use was responsible for almost two thirds of all drug-related deaths in those aged 15-34 years. Furthermore, road crashes accounted for almost half (45%) of the deaths among those aged under 25 years in WA and alcohol was a leading factor in these crashes. There is agreement that the use of ATODs is a learned behaviour and therefore broadbased psychosocial theories offer the most promising explanation for its onset. / Recent research addressing adolescent ATOD-use initiation has focused on the concepts of adolescent vulnerability and resilience. This Social Development Model identifies several social factors that are posited to predict or be protective of ATOD use (and other hazardous behaviours) during childhood and adolescence. While parents are not the only social influence on children, they provide the primary social learning environment for children and as such, can play an important role in whether or not their children initiate ATOD use. Four major groups of parenting risk and protective factors are evident from the literature. These include parental modelling of ATOD use, the normative standards parents set regarding ATOD use, their parenting style and family management techniques, and the nature of parent-child communication. The provision of skills training consistent with the concepts of 'authoritative parenting' is supported in the literature as a means to reduce the likelihood of children engaging in hazardous behaviours. Such training is promoted as being an effective and enduring strategy for reducing youth behaviours, such as regular use of tobacco and hazardous use of alcohol and/or other drugs, that have the potential to cause substantial health, social, and financial harm. Few ATOD programs focussing on parenting skills (particularly parent-child communication) were found to have been subjected to rigorous efficacy or effectiveness studies. Of those subjected to empirical investigation, most were constrained by methodological shortcomings and/or difficulties in recruiting and maintaining substantial parent participation. / Seeking ways to recruit and engage a high percentage of Australian parents in such a program is an important area for investigation because, while they may be difficult to reach, parents have persuasive and powerful influences on children's health behaviour. Potential predictors of parental participation were identified in the literature and a consultation process with parents was undertaken to determine their needs and preferences as well as strategies to recruit and engage a greater proportion of parents. The methodology of this research therefore comprised a small Exploratory Study followed by a larger efficacy trial. The Exploratory Study involved consultation with eight small groups of parents regarding the design and content of an ATOD educational intervention. The methodology of this consultation is presented in detail in Chapter 3. A questionnaire and structured group discussions of parents' responses were used to collect quantitative and qualitative data regarding their opinions and preferences regarding the frequency, intensity, time and type of an ATOD-related educational intervention. The results of the consultation with parents and a concurrent discussion of how each finding relates to previous research are presented in Chapter 4. Of the 213 parents/guardians invited, 110 responded, of which 72 indicated they would attend one of the discussion groups. While the attendance at the discussion groups was very low (response rate of 24% n=51), the total number of parents consulted exceeded or was equivalent to similar formative research. / Parents reported they worry about the potential harm associated with ATOD use by children and probably underestimate their own children's vulnerability and ATOD-use experiences. They wanted to be involved in the planning phases of parent-oriented ATOD-related educational interventions. Parents also identified numerous barriers for their participation in educational programs. They identified flexibility and convenience regarding intervention delivery as being essential and preferred interventions to be home-based. The parents reported that any intervention directed at parents should be supported by parents, non-judgemental, simple, time-efficient, easy to use, fun, colourful and interactive. Parents recommended that practical communication skills (such as how to talk with children, how to raise the topic and what topics to talk about) be addressed in the intervention. Parents also recommended a range and combination of strategies to promote and maintain parent involvement, such as rewarding children of parents who participate. The second part of this research involved merging the exploratory data with information from previous similar research to develop a drug-related educational intervention for parents. A parent-directed ATOD educational intervention, designed to assist parents to talk with their Year 6 children about smoking cigarettes and drinking alcohol, was developed and implemented. Its feasibility and impact on parent-child drug-related communication were evaluated in a randomised comparison trial. The methods utilised in this trial are detailed in Chapter 5. Seven data collection instruments were developed and standardised data collection procedures were established. Demographic, process and impact data were collected. Schools were randomly selected and randomly assigned to one of three study conditions. / Parents were recruited from schools. Intervention-group 1 was given a choice of learn-at-home drug education materials and Intervention-group 2 received learn-at-home drug education materials but were not given a choice. The Comparison-group parents were not exposed to the intervention. Completeness of the dissemination and implementation of the intervention were assessed, as were dose-response effects. Validity analyses of the parent-directed intervention indicated that the theoretical domains were adequately covered and the messages intended for parents were unambiguous. The student and parent questionnaires were also found to be valid and reliable. Data were obtained from 69.1% (n=830) and 24.5% (n=294) of the study sample (n=1201) at the first and second follow-ups respectively. Sample parents were successfully identified at both follow-ups and parent-child communication data were accurately matched (Chapter 6). At the first follow-up parents in Intervention-group 1 were more likely than parents in the Comparison Group, to have ever talked with their Year 6 child about smoking cigarettes; talked more recently; reported high parent-child engagement during such communication; and to have talked about more of the four specified tobacco-related topics in the two weeks prior to data collection. In addition, there were positive dose-response relationships for these dependent variables. While there were no significant differences between study conditions (Intervention- group 2 versus Comparison Group was marginally significant) regarding the duration of the last parent-child discussion about smoking cigarettes, there were positive dose-response effects. / Likewise, compared to Comparison-group parents, those in Intervention-groups 1 and 2 were more likely to have ever talked with their Year 6 child about drinking alcohol at the first follow-up, to Comparison-group parents, those in Intervention-group 1 were also more likely to have talked with their Year 6 children more recently about drinking alcohol. Parents in both of the Intervention Groups were more likely than parents in the Comparison Group, to have reported: talking about drinking alcohol for a longer duration; having higher parent-child engagement during such communication; and talking about more of the three nominated alcohol-related topics. Additionally, there were positive dose-response relationships for the alcohol-related dependent variables. Furthermore, while dose-response effects were evident between the high and/or middle intervention-dose categories and the low-dose category, there were no differences between the middle and high categories for any of the dependent tobacco- or alcohol-related dependent variables. No statistically significant differences were found between the responses of parents who were offered a choice of intervention materials (Intervention-group 1) and those who were not (Intervention-group 2). The overall agreement between parents and their children to equivalent parent-child communication variables, at both baseline and first follow-up was low. Furthermore, the range of parent-child agreement between the items varied considerably. At the first follow-up, however, there appeared to be slightly increased levels of agreement between Intervention-group parents and their children, than there was between Comparison-group parents and their children. / At the second follow-up the proportion of parents who had talked about none of the specified tobacco-related topics was low but there were no significant differences between the study conditions. There were, however, significant differences in the intended direction between study conditions with regard to how many of the specified alcohol-related topics parents reported discussing with their children. The likelihood of Type III error appeared to be minimal and indicators of parent and intervention itself and The findings of this study, discussed in Chapter 7, support the conclusion that parents of 10-11 year-old children are receptive to participating in a home-based drug-related educational intervention. The learn-at-home drug-related educational intervention implemented in this study appeared to have a significant impact on their drug-related communication with their Year 6 children. This study also identified strategies to enhance the recruitment and retention of participants in parent-training interventions, which are challenges inherent in parent-based intervention research. Despite identified limitations, this intervention appears to be a promising approach in the primary prevention of ATOD-related problems in Australia.

The outcomes of a child protection/family support programme, the Cottage Community Care Pilot Project, were evaluated in this study. The evaluation employed a non-equivalent comparison group design of 'at risk' consenting first-time mothers in the perinatal period with babies up to 6 weeks of age. Ninety-three families were recruited and 58 of these were matched with a trained volunteer home visitor. Analysis of assessment items and questionnaires, reviews of hospital records and the Department of Community Services Child abuse and neglect notification register and focus groups with mothers and volunteers provided the information used in this study. The CCCP had an impact on particular aspects of family function, certain infant and maternal health indices and the families' use of community services, but its contribution to reducing the incidence of child abuse and neglect is less clear. Client and volunteer feedback indicated support for the programme. While home visitation by trained volunteers is not proposed as the total answer for effective child protection or family support, the findings of this evaluation suggest that there is a place for similar programmes. / Master of Science (Hons)

Thesis (Ph.D.)--University of Delaware, 2006. / Principal faculty advisor: Donald G. Unger, Dept. of Individual & Family Studies. Includes bibliographical references.

Att befinna sig i ett terminalt skede i livet kan innebära en känsla av oro och ångest inför sjukdomen och döden. Möjligheten att då få tillbringa sin sista tid i hemmiljö med nära och kära kring sig genererar för många en trygghet. Syftet med denna uppsats är att belysa vuxna människors erfarenheter av att i livets slutskede vårdas av anhöriga i hemmiljö. Metoden som använts är systematisk litteraturstudie där aktuell forskning inom området sammanställts. Databaser som använts för sökningen var PsycINFO, Medline, Cinahl, Elin@kalmar och SweMed+. Artiklar som syftade till problemformuleringen kvalitetsgranskades och resultatet bygger på tio vetenskapliga artiklar. Resultatet visade att sociala relationer och stöd från familjen genererar livskvalitet och trygghet hos människan som vårdas i livets slutskede. Delaktighet i sin vård och känsla av att inte förlora kontrollen över sina symtom gjorde att människan kände hopp och att de klarade av situationen. Slutsatserna var att möjligheten att få bo kvar hemma ansågs mycket betydelsefullt. Sociala relationer bidrog till att människor hemma kände en lägre grad av symtom. Den sjuke uppskattade stödet från familjen men ville inte bli en börda för anhöriga. Information om stöd och en realistisk planering samt insikt i situationens allvar bidrog till att hon kände delaktighet och bättre kunde hantera situationen.

Flexibilisation of labour markets has been one of the significant outcomes of the neoliberal transformation processes in all over world. This development, which is indeed one of aims of the neoliberal reforms as well, has been comprehended differently by liberal Institutionalist and critical Marxist perspectives. According to the liberal Institutionalists, the flexibilisation of labour can generate positive results for labour, while for the scholars of Marxist tradition the flexibilisation of labouring processes has to be understood in relation to capitalist concerns to ensure better command of capital over labour. This thesis investigates the validity of these approaches by focusing on the working conditions of one of the most flexible parts of world labour, the home-based women workers. On the basis of ten in-depth interviews conducted with the home-based women labourers living in the Tuzlu&ccedil / ayir district of Ankara, it states that liberal Institutionalist arguments on the flexibilization of labour markets are hard to be approved. For the home-based woman labourers in Tuzlu&ccedil / ayir in no way represent a group with autonomy and enhanced skills though their gender has provided their employers with ample opportunities for exploitation, opportunities which are not available in the case of the male workers. In dialogue with the feminist approaches to home-based woman labourers, this thesis shows how in home-based working women&rsquo / s exploitation as labourers has become articulated with their gender-based social subordination vis-&agrave / -vis their husbands, brothers and/or fathers in their families.