Imposing the principles of sustainable development on medical tourism is vital to maintaining the three pillars of a strong nation, namely, the environment, the economy, and the local community. The three research objectives of this thesis are: 1) to determine the primary factors that motivate foreign patients to travel abroad for medical services; 2) to define the role that stakeholders play for developing the medical tourism sector; and 3) to develop an implementable framework for establishing a sustainable medical facility. These objectives help lay the foundations for a medical tourism facility that would respond well to the future demands of international patients, and would remain competitive with other medical facilities in the global market while also improving local quality-of-life and remaining within ecological constraints. Therefore, this research adopts a case study methodology to examine a framework developed through the literature review to determine how it fits in reality. In addition, this research provides a starting point to define further the primary roles of the medical tourism network for developing the medical tourism sector.

This study addresses the measurement of satisfaction. In doing so, it proposes a hypothetical conceptual framework for examining visitors’ satisfaction with their experiences in nature-based settings. Visitors’ overall satisfaction with their experiences was examined in terms of its relationships to visitors’ satisfaction with various site attributes, to visitors’ perceived importance of interpretive programs to learning, and how it is affected by visitors’ age, gender (male or female) and visitation pattern. The responses of 1309 Visitor Information Program (VIP) surveys returned by visitors to two national sites in Nova Scotia (Port Royal National Historic Site and Kejimkujik National Park and National Historic Site) provided the data for this study’s investigation. Secondary data analyses revealed that visitors’ satisfaction with the site attributes has the strongest effect on their overall satisfaction with their experiences. While visitors’ perceived importance to learning was also found to be positively correlated to overall experience satisfaction, when other variable are taken into consideration, its effect on overall satisfaction was found not to be statistically significant. Amongst these variables, gender was found to explain a significant amount of variance in visitors’ overall satisfaction with experiences in nature-based settings. Moreover, visitors of different age groups differ significantly in their perceptions of importance of interpretation to learning, and in their satisfaction levels. Although the findings show high levels of satisfaction at both sites, these are taken with caution. A discussion of the issues related to the measurement of satisfaction is provided, along with recommendations for a more discriminant, valid and reliable satisfaction measurement instrument.

Volunteer tourism, a sub-sector of the tourism industry, is growing at an accelerated pace subsequently creating socio-cultural, political, cultural, and environmental impacts. Current tourism literature suggests volunteer tourism provides opportunities for participants to facilitate building relationships with like-minded volunteers and encourages consciousness-raising experiences (McGehee & Santos, 2005). Furthermore, volunteer tourism has been shown to foster cross-cultural understanding between participants and hosts (Raymond & Hall, 2008; McIntosh & Zahra, 2008). However, researchers question the laudable aims of volunteer tourism; indicating the presence of this type of tourism creates social and power struggles within local destination communities (Guttentag, 2009, Sin, 2010). Higgins-Desbiolles (2006) claims the transformative capacities of tourism are overshadowed by industry attributes of tourism. To use tourism as a positive engine for social, cultural, environmental, and political change, it would be necessary to promote touristic experiences that encompass a transformative ethos. My exploration of organic volunteering within this thesis illuminates the transformative capacities of these touristic experiences and contributes to the expanding horizons of volunteer tourism literature. This hermeneutic phenomenological study explores experiences of organic volunteering and what these experiences mean to the volunteers. Gadamer’s (2004) hermeneutic phenomenology provided me the opportunity to develop a deep understanding of the meaning of organic volunteering experiences studied in Argentina. Using interviews and participation observation, I explored meanings of organic volunteering, while I also considered volunteers’ historicity, or pre-understandings, of these experiences. Data analysis revealed the emergent essential structure of “Opening to living in interconnectedness.” Interconnectedness within organic volunteering is embodied in six essences of reconnecting, exchanging knowledge, being in nature, bonding with others, consciousness-raising, and transforming. My research reinforces what many organizations’ claim; volunteer experiences improve global citizenship and participants desire to become more involved in future activism upon their return home.

This narrative inquiry explores therapeutic relationships in the practice of recreation therapy. Narratives were generated in Recreation Therapy’s self-reflective case review process at Sunnybrook Health Sciences Centre—a process developed to support team engagement in reflections on their therapeutic relationships. In total, three self-reflective case reviews were explored, and for each case review, four layers of analysis occurred. The first two layers used narrative analysis to restory reflections of the case review leader (layer one) and then reflections within the recreation therapy team (layer two). The third and fourth layers used analysis of narrative to explore theoretical ideas from person-centred care emerging inductively in the text (layer three), and then to restory the previous narratives using a relational theory lens (layer four). Exploration revealed the self-reflective case review process also strengthens therapeutic relationships within the recreation therapy team. In the recreation therapists’ narratives we hear relational notions of connection, disconnection, reconnection, mutuality, mutual empathy, authenticity, vulnerability, and support. This study engaged recreation therapists in an act of critical pedagogy as they engaged in critical self-reflection by exploring across layers of narrative that story their therapeutic relationships. The self-reflective case review process creates opportunity for the recreation therapy team to recognize, identify and name their experiences within therapeutic relationships, and to find their voices in the medical context of a hospital setting. When engaging in self-reflective processes, recreation therapy moves further away from treating individuals as objects, shifting practice toward connection and mutuality in therapeutic relationships.

Using a feminist, autoethnographic methodology and in depth interviews with twenty-three participants, I sought to better understand the meaning of family memory keeping for women and their families through this research, paying particular attention to the ways that dominant gender ideologies shape family memory and the act of preserving family memory. This research also endeavoured to explore those instances wherein families lose that memory keeper due to memory loss, absence, or death. Interviews revealed that, despite its absence from the literature, women’s family memory keeping is a valuable form of gendered labour – and leisure – that makes significant individual, familial, and social contributions, while simultaneously reproducing dominant gender ideologies and gendered constructions of fatherhood, motherhood, and the family. Through an exploration of the loss of a mother’s memory due to illness, death, or absence, this study also demonstrated the loss of a mother’s memory is both deeply felt, and deeply gendered. However, this study illustrated participants challenging these dominant gender ideologies, as well, and using family memory keeping as a way to resist, critique, and cope. As such, this study speaks to the absence of women’s family memory keeping from the gendered work, leisure studies, social construction, and loss literature, contributing a better understanding of both the activity itself and the gendered ideologies that shape the activity, as well. Not only does this study speak to gaps in existing literature, but findings make fresh theoretical contributions to this literature through three new concepts: the notion of the good mother as the “remembering mother”, the concept of “compliance leisure”, and the re-envisioning of women’s unpaid labour as contributing to “the homing of the home”. And with these contributions to the literature, this research also provides valuable insight for professionals working to improve policy and services surrounding postpartum care, individual and family therapy, caregiving, extended care, and palliative care.

Persons 65 years or older are the fastest growing demographic in Canada (Government of Canada, 2011) and the need for 24-hour care and LTC support will continue to rise. An association is typically drawn between death and dying and the movement into LTC homes. Leisure can alternatively be important for promoting “living” and supporting wellness in residents. The notion of “living” in LTC shifts emphasis away from illness and death to placing value on wellness. This participatory action research (PAR) study aims to understand wellness from residents’ perspectives and the role leisure plays in their wellness. PAR stakeholders (family/care partners, staff, and residents) collaboratively discuss how to best attain, interpret, and disseminate resident perspectives on wellness and required supports. The PAR process highlights the necessity for academics and practitioners to involve residents in decisions about their care experience. Guiding questions include: (1) What does wellness mean to residents living in LTC? (2) What does a ‘well’ LTC home look like to residents? (3) What is the nature of the relationship between leisure and wellness from a resident perspective? (4) How can those involved in LTC support resident wellness? From the perspectives of residents living in LTC homes, findings inform a resident wellness model and provide insights into how wellness and “well” LTC homes can be better supported. Thus, filling a gap in the literature and shifting focus to living ‘well’ in LTC.

The interaction between culture and consumption of immigrants is an important research area in a number of fields including consumer behaviour, marketing, and ethnic studies. This article offers a specific look at issues related to the impact of acculturation on dining-out behaviour of Chinese immigrants living in the Greater Toronto Area in Canada, and the influence of individual factor of acculturation process (i.e., ethnic identification, length of residence, and age at immigration). This study focused on the similarities and comparisons between recent Chinese immigrants who have been in Canada for ten years or less and established Chinese immigrants who have been in Canada for more than ten years, in terms of their dining-out behaviour in the Greater Toronto Area. There were two samples, the recent Chinese immigrants and the established Chinese immigrants in this study. Snowball sampling was applied to recruit the total 30 participants (15 of each sample). The author started to recruit from two participants of each sample among her friends and relatives and asked the interviewers to recommend another two qualified participants. Semi-structures, in-depth interviews were employed in this study to explore the impact of culture, levels of acculturation, ethnic identity, situational factors of ethnic identification and dining-out behaviour. The interviews were audio-recorded by permission and conducted in the participant’s preferable language (in English or in Mandarin Chinese). Data analysis was guided by several previous conclusions and model in the literatures and conducted in both qualitative (coding) and quantitative (SPSS) methods. The findings resulted in some major conclusions. In terms of similarities, it is found that recent Chinese immigrants and established Chinese immigrants obtained restaurants information mostly from friends and relatives. They also searched on internet for other’s reviews, menus, and printable coupons. Secondly, result showed that Chinese immigrants perceived that because they have a long history of food, Chinese people are more willing to try different types of food when immigrated to Canada. Thirdly, situational factors such as peer influences played more significant role on dining-out decision making and self ethnic identifications than parental influences. In terms of differences, data indicated that among Chinese immigrants living in the Greater Toronto Area, recent Chinese immigrants had stronger ethnic identity to their original culture, and dined out more frequently than the established Chinese immigrants. Future, the result suggested that the highest level of Chinese ethnic food purchasing behaviour were reported by highest ethnic identifiers (ones who identified themselves as more Chinese). However, there was another important factor that influenced the levels of acculturation in dining-out behaviour more greatly than the length of immigration: the age at immigration. The study found that Chinese immigrants who immigrated at early age had the highest level of acculturation and identified themselves as more Canadian, while ones who immigrated at late life had the lowest level of acculturation and identifies themselves as more Chinese. The findings reflected the impact of culture and consumer acculturation in dining-out among Chinese immigrants in the Greater Toronto Area and could potentially contribute to the marketing implications to both ethnic and mainstream restaurant marketers. This study also gives some future thoughts on the exploration of more variables at individual differences, as well as other perspectives of research conducting such as from psychological or economic perspective.

The presence of disability in the political sphere has increased with the enactment of the Accessibility for Ontarians with Disabilities Act (AODA) in 2005. In 2008, implementation of the first standard focused on Customer Service began in accordance with the AODA. While this legislation was in its early phase, it was crucial to conduct research to understand the ways the legislation was being expressed in practical terms. Research makes it possible to point to areas of unmet promises between theoretical and practice application of the AODA so that it may attain its full potential. The purpose of this study was to conduct a narrative policy analysis during the implementation phase of the AODA to identify the parallel and divergent stories that arise from policy actors. Using an interpretive stance, this study was conducted with key people who played a role in implementing the AODA in the municipal recreation context. Participants included both persons responsible for implementing the AODA (i.e., city employees) and people with disabilities who have been directly affected by this policy. This narrative policy analysis sought to uncover the stories (stories that are repeatedly told), counter-stories (those that run counter to dominant stories), and non-stories (stories that are not present) (Roe, 1994). Three groups of narratives arose from this study. Narratives about creating and implementing the AODA included stories about clear steps to implementation, enforcement guidelines, and proactive steps to achieve accessibility. Counter-stories described a need for more specific details, explicit enforcement guidelines, and a “deal with things as they come up” course of action. Narratives about disability examined meanings of disability present in the AODA for people with and without disabilities. Additional narratives explored discrimination against people with disabilities, links between accessibility standards and the removal of barriers for people with disabilities. Issues of accessibility were further explored in the context of leisure and recreation. Analysis revealed the diversity in leisure experiences of people with disabilities, and the need to expand the definition of accessibility for better inclusion in municipal recreation. These narratives were then contrasted and combined to form a metanarrative (alternative to consensus) to recast issues surrounding the AODA in a new light. The metanarrative highlighted a gap between the theory of the AODA and its practical applications. In theory, a policy was needed to improve the inclusion of people with disabilities in community; however, in practice, the AODA might not have the desired impact due in part to the interplay of policy and disability issues. This study suggests that the AODA is much more than what is written on paper in that it has the power to transform our society. The full intent of the AODA will be difficult to achieve until more people are aware of the legislation, its impacts, and its importance.

Leisure can provide a central context for the core adolescent issue of identity development. Given the importance of leisure in adolescents’ lives, it is imperative to understand the constraints to leisure and possible constraint negotiations. While extensive research exists on the leisure constraints and negotiations of adults, there is a notable paucity of similar research which addresses the potentially unique constraints and negotiations experienced by adolescents, with a particular lack of focus on adolescent girls from diverse races and ethnicities. As such, this research sought to explore the leisure constraints, negotiations and resistances of diverse adolescent girls. Guided by a feminist theoretical and methodological approach, the current research involved nine conversational interviews with immigrant adolescent girls, representing diverse races and ethnicities. It became clear that girls experienced numerous constraints, but also crucially negotiated constraints, and mobilized their leisure as resistance. As immigrant adolescent girls, participants each embarked on a personal journey, which spanned both the exterior geographies and interior landscapes of their two distinct cultures, back home and in Canada. Participants’ points of departure provided a mapping of some of the contours of their life back home, including structural constraints, gender constraints and gender resistances. As participants left home for Canada, they discovered a different world, fraught with its own leisure constraints. These Canadian leisure constraints encompassed all three major forms of constraints: structural, intrapersonal and interpersonal. Within this new world, participants also experienced racism and gender constraints. Significantly, participants discovered ways to navigate the Canadian constraints they encountered and resisted racism, sexism, and other forms of prejudice. Finally, beyond an articulation of constraints and negotiations, girls’ leisure experiences revealed the intersections of influences and identities. Participants also unpacked continuing and emerging leisure identities and embraced leisure as a cultural connection.

Leisure can provide a central context for the core adolescent issue of identity development. Given the importance of leisure in adolescents’ lives, it is imperative to understand the constraints to leisure and possible constraint negotiations. While extensive research exists on the leisure constraints and negotiations of adults, there is a notable paucity of similar research which addresses the potentially unique constraints and negotiations experienced by adolescents, with a particular lack of focus on adolescent girls from diverse races and ethnicities. As such, this research sought to explore the leisure constraints, negotiations and resistances of diverse adolescent girls. Guided by a feminist theoretical and methodological approach, the current research involved nine conversational interviews with immigrant adolescent girls, representing diverse races and ethnicities. It became clear that girls experienced numerous constraints, but also crucially negotiated constraints, and mobilized their leisure as resistance. As immigrant adolescent girls, participants each embarked on a personal journey, which spanned both the exterior geographies and interior landscapes of their two distinct cultures, back home and in Canada. Participants’ points of departure provided a mapping of some of the contours of their life back home, including structural constraints, gender constraints and gender resistances. As participants left home for Canada, they discovered a different world, fraught with its own leisure constraints. These Canadian leisure constraints encompassed all three major forms of constraints: structural, intrapersonal and interpersonal. Within this new world, participants also experienced racism and gender constraints. Significantly, participants discovered ways to navigate the Canadian constraints they encountered and resisted racism, sexism, and other forms of prejudice. Finally, beyond an articulation of constraints and negotiations, girls’ leisure experiences revealed the intersections of influences and identities. Participants also unpacked continuing and emerging leisure identities and embraced leisure as a cultural connection.