Since 2018, the Provincial Government of Ontario has begun transformation within the public health sector, which emphasizes the increased application of a population health approach. The goal of this transformation is to maximize the contribution of public health in improving the health of Ontarians by moving from a reactive to a proactive model that is focused on prevention. To support this transformation the standards that guide the programs and services provided through public health units underwent modernization in 2018. The emphasis of the modernized standards is about expanding the scope and reach of public health, by supporting the role of population health in the development and delivery of programs and services. This thesis used quantitative data to examine the extent that a population health approach was implemented in sexual health programs and services in public health units across Ontario. Qualitative data was gathered to explore public health managers’ and supervisors’ perceptions of barriers and facilitators that influenced the implementation of this approach. A mixed-methods study was used to determine if the qualitative findings helped our understanding of the quantitative results. This multi-phase mixed methods study involved four sequential phases. Phase 1 and 2 involved instrument development which included a literature review, input from experts, and testing; in phase 3 instrument administration was conducted; and phase 4 involved interviews with sexual health managers and supervisors. A qualitative descriptive approach was used as part of phases 1, 2, and in phase 4 for data collection and analysis using focus groups and semi-structured interviews with sexual health managers and supervisors delivering sexual health programs and services. The instrument was developed based on Health Canada’s Population Health Key Elements Template with multiple activities listed under each element and was administered in phase 3. Descriptive statistics were used to analyze this data. The Consolidated Framework for Implementation Research (CFIR) guided the development of the interviews for phase 4 and the qualitative analysis. Quantitative data showed that some population health elements were implemented more than others. For example, Address Determinants of Health and their Interactions was implemented by most health units while Employ Mechanisms for Public Involvement was implemented by a few. Qualitative data revealed that most factors influencing the implementation of a population health approach fit within CFIR’s domains of the inner and outer setting. For example Address Determinants of Health and Their Interactions and Focus on the Health of Populations were highly implemented by health units, due to factors such as organizational culture, and access to data. On the other hand, the elements Collaborate Across Sectors and Levels and Employ Mechanism for Public Involvement were less often implemented which were influenced by resources (e.g., human and financial) that were available to the health unit. This study fills an existing gap in the research and offers evidence of how to implement a population health approach within sexual health programs and services in public health. / Thesis / Candidate in Philosophy / Traditionally, sexual health programs and services provided by Ontario public health units have focused on providing services for individuals, such as clinic services. More recently, there has been a shift in public health to apply a population health approach, which focuses attention on addressing the broader social and economic influences on health. This is viewed as important to improving the health of communities and disadvantaged groups within those communities. It is not known to what extent this shift in the approach to sexual health services or programs is being implemented within Ontario public health units. Therefore, it is important to understand how public health units have moved towards a broader approach in sexual health and what challenges they have faced. This thesis examines how much sexual health programs and services have implemented a population health approach within sexual health programs and services in public health units. It also explores what helped or hindered this change. Some key population health activities (e.g., using evidence to plan programs, offering clinic services) have been implemented but not all (e.g., working with community partners, participating in primary research). An example of a barrier to implementation is having a lack of resources (human and financial). New knowledge from this study can support public health organizations to apply a broader population health approach in sexual health programs and services.

Background: In the healthcare sector, many workers are believed to be “double duty carers” (DDCs) - individuals providing care both at work and home. DDCs often work in paid care work while providing unpaid care to family/friends outside of work. The COVID-19 pandemic places additional stressors on these vulnerable carers. Caring is an emerging global health issue involving the straining of roles due to the pandemic. Informal or unpaid caring is globally known to be a women's health issue given the gendered nature of caring, resulting in women shouldering greater physical, social, and emotional costs. Purpose: The aim of this study was to understand the impact of COVID-19 on DDCs through the perspective of employers and DDCs. The knowledge generated illuminates how the paid and unpaid caring has been affected by the pandemic, what supports, or coping strategies are being utilized by DDCs. Methods: This mixed-methods study comprises two phases; a quantitative survey for employers and qualitative interview for DDCs. The survey investigates how workplace supports have been impacted by the pandemic, while the interview investigates DDCs’ experiences/coping strategies during the pandemic. Finally, triangulation of the data from the two phases will be used to create evidence-based policy recommendations to enhance DDC supports. Results: Healthcare employers were observed to be cognizant of DDCs’ diminishing wellness during the COVID-19 pandemic; yet, less than half supported their carer-employees. DDCs had increased care demands both at work and at home and experienced a lack of access to their usual support system and support services. The data from both phases helped elucidate recommendations and areas of concern for DDC support that can serve as important implications for carer-friendly workplace policies (CFWP). Conclusion: By exploring the intersection of perspectives from employers and DDCs, this study will contribute to evidence-informed guidelines for CFWP during a pandemic. / Thesis / Master of Science (MSc) / The term ‘double duty carer’ (DDC) refers to individuals, often women, that are provide care both at home and at work. DDCs are an important workforce that are vulnerable to negative physical and mental health consequences which are exacerbated during the COVID-19 pandemic. The purpose of this study is to examine the impact of the pandemic on DDCs’ caring responsibilities and supports from the perspectives of healthcare employers and DDCs. Findings showed that the COVID-19 pandemic made paid and unpaid caring much more demanding, inflicted poor health consequences upon DDCs and made supports difficult to access. DDCs are experiencing increased role strain and having to invest more hours in paid and unpaid care. The findings of this study can be used to improve DDC support and strengthen the collaborative relationships among healthcare employers and DDCs.

The increasing use of information warfare by authoritarian states to promote a multipolar order, coupled with a growing rapprochement between Russia and China, can lead to synergies that undermine international security. In response to the problem, this thesis aims to unpack and examine the Russia-China disinformation nexus to address the implications of the relationship on international security. To do so, the thesis employs a mixed-methods approach to analyze Russian and Chinese disinformation on Twitter following the invasion of Ukraine in 2022, using the concepts of sharp power and policy transfer as a framework of analysis.  The results indicate that while joint aims to undermine US hegemony provides fertile grounds for synergetic effects, the aims and objective of each state is the driving factor behind overlapping disinformation. The primary process of convergence was China emulating some features of Russian disinformation, with some evidence suggesting that Russia and China engage in a reciprocal policy transfer of information warfare. The findings further indicate that China formats its disinformation to appear neutral in the Ukraine war, despite the declared no-limit partnership with Russia. These findings offer insights into the complex evolving ’no-limit’ partnership developing between Russia and China and are thus significant for policymakers to counter these states’ influence efforts.

No description available.

Clinical preceptorships that nurture virtual care competencies among family medicine residents or physicians in-training remain understudied. Guided by epistemological views of pragmatism and social constructivism, I designed and implemented a three-phase exploratory mixed-methods study to address the following research questions: • How is clinical preceptorship in virtual healthcare settings conceptualized within the field of postgraduate medical education? • What are the gaps in the way clinical preceptorship in virtual healthcare settings is conceptualized in the field of postgraduate medical education? • To what extent do preceptors involve, prepare, and assess family medicine residents in virtual healthcare settings? • How do preceptors assess and provide feedback to family medicine residents in virtual healthcare settings? In phase I, a scoping review identified 24 peer-reviewed articles (published before February 25, 2021) relevant to clinical precepting with postgraduate medical trainees in virtual healthcare settings. In a sequential manner, I then led a one-time online survey (phase II; n = 38) and key informant interviewing (phase III; n = 13) with preceptors of family medicine residents. National data confirmed that clinical precepting in virtual healthcare settings can be characterized by individual factors, preceptor-resident behaviors, and workplace artefacts. Additional insights supported preceptors’ ability to engage family medicine residents in virtual care activities, along with the constraints and strategies to supervise them effectively. Opportunities to assess competency are possible; however, preceptors identified gaps in assessment practices to identify underperformance in the virtual therapeutic frame. A key research deliverable is a thematic framework illustrating the experience of clinical precepting in virtual healthcare settings. Drawing on adaptive expertise, actor-network theory, and praxeology, the final article elucidates how this work contributes to educational solutions and research directions for competency-based family medicine education.

No description available.

The past three decades have seen a proliferation of research methods, both quantitative and qualitative, available to psychologists. Whereas some scholars have claimed that qualitative and quantitative methods are inherently opposed, recently many more researchers have argued in favor of "mixed methods" approaches. In this dissertation I begin with a review of the mixed methods literature regarding how to integrate qualitative and quantitative methodologies. Based on this review, I argue that current mixed methods approaches have fallen short of their goal of integrating qualitative and quantitative methodologies and I argue that this problem may be due to a problematic ontology. In response to this problem I propose and conduct an ontological analysis, which examines the writings of leading mixed methods researchers for evidence of an underlying ontology. This analysis reveals that an abstractionist ontology underlies current mixed methods approaches. I then propose that an alternative relational ontology might better enable mixed methods researchers to meaningfully relate qualitative and quantitative methodologies and I provide an exploration of what assuming a relational ontology would mean for mixed methods research.

Background: Many adolescents and young adults (AYAs) aged 15-39 years describe struggling with cancer-related cognitive impairment (CRCI) after treatment. CRCI (e.g., memory, concentration, and learning difficulties) often causes distress, diminishes quality of life (QoL), and impedes young adults' participation in academic, recreational, and social experiences. Yet, CRCI is poorly understood in AYAs and options to prevent or treat this burdensome side effect are lacking. Based on growing evidence suggesting that physical activity (PA) may enhance cognitive function in older adults, individuals with diseases of cognition, and breast cancer survivors, research exploring links between PA and CRCI in AYAs is warranted. Thus, the purpose of this observational, mixed methods thesis was to explore how AYA cancer survivors experience and cope with CRCI, taking into consideration potential predisposing factors (i.e., medical, psychological), interventional strategies (i.e., PA), and outcomes (i.e., QoL). Methods: Over a nine-month period, 90 AYAs who had completed primary cancer treatment self-referred; 49 were eligible and enrolled into the study. Of these, 46 participants (M_age=31.4±5.4; 91.3% female; 39.1% blood cancer) completed an online survey and three web-based neuropsychological tests; semi-structured interviews were conducted on a rolling basis with a sub-set (n=16) who reported clinically meaningful CRCI. Quantitative data were analyzed descriptively and qualitative data were analyzed thematically. Results: Overall, participants were active based on their self-reported moderate-to-vigorous intensity PA (MVPA; M=27.3±20.6) and relative to scale ranges, they reported moderate levels of depressive symptoms, stress, fatigue, and quality of life (M=12.1±5.5; M=21.1±7.2; M=25.2±11.5; M=68.8±18.3, respectively). On average, participants reported clinically meaningful CRCI (M=44.7±17.4), and as compared to normative values, their neuropsychological test scores indicated poor executive functioning and processing speed, but not working memory. Bivariate correlations between cognitive function (self-reported and objective) and medical characteristics (i.e., time since diagnosis, cancer stage, chemotherapy exposure) had small-to-moderate effect sizes. Small-to-large correlations were observed between cognitive function and psychological factors (i.e., depressive symptoms, stress, fatigue, QoL). Finally, correlations between cognitive function and MVPA were favourable, though effect sizes were small. Moreover, qualitative data provided insight into how AYAs experience and cope with their cognitive impairment, which was summarized within four themes: (1) descriptions and interpretations of the CRCI phenomenon, (2) effects of CRCI on day-to-day life and QoL, (3) cognitive-behavioural self-management strategies, and (4) recommendations for improving care. Conclusion: Results confirm that cancer can impact AYAs' cognitive function and have detrimental effects for their daily life and overall QoL. AYAs reported using various cognitive-behavioural self-management strategies, including PA; taken together with quantitative data, findings suggest that PA may be a promising strategy to cope with CRCI. However, high-quality experimental research is needed to confirm this association, test the processes by which this may occur, as well as to determine optimal PA dosages/contexts for managing CRCI.

Driven by individual influences such as beliefs, attitudes, personal norms, and abilities, as well as by social influences like community norms, mandates, and the market, suburban homeowners are motivated to select and maintain a turf grass landscape. In many areas of Florida, effective suburban lawn maintenance requires regular inputs of nitrogenous fertilizer, some of which is lost to the environment, contributing to water quality degradation and ecosystem dysfunction. Reducing nitrogen inputs to aquatic systems requires a better understanding of the links between residential landscape management and the potential for fertilizer loss. This dissertation examines the linkages between the human behaviors contributing nitrogen to the suburban landscape and the resulting environmental impacts. Framed in socio-psychological theory and social marketing research, the outcomes of this dissertation contribute much needed information to the growing realm of interdisciplinary science that expands integrative theory, develops mixed methods, utilizes spatial and temporal analyses, and conducts actionable research. Using a suite of research tools, this dissertation examines relevant urban ecology questions:  What behavioral and socio-demographic variables most strongly influence individual residential landscape design and management practices?  What types of communities are more likely to contribute more nitrogen inputs?  What social constraints prevent homeowners from implementing a more sustainable residential landscape? iv  What outcome measures can be used to evaluate the environmental impact associated with landscape maintenance behaviors? Social and environmental data were collected over five years from three distinct projects to advise environmental marketing strategies and targeted communications. The research questions provided important information for water quality stakeholders and environmental marketers to prioritize strategies and target audiences based on the power of forces that are influencing landscaping behaviors. The research drew on the methods of urban ecology to understand nutrient dynamics by spatially integrating social and environmental data. It used social-psychology theory to define influences that can motivate or deter landscape management behaviors and preferences. It applied the methods of social marketing to advise implementation strategies. Completing this research involved ethnographic, social survey, and environmental quality data collection. Suburban homeowners were recruited as research participants to collect important qualitative information about individual and social forces of suburban landscape management and the perceptions of environmentally-friendly landscaping. Questions were developed to operationalize the dimensions of individual and social influences and quantitative data were collected at two different scales, regional and statewide. Homeowners were defined in terms of their polluting potential, influences and mandates as well as their potential for adopting a more sustainable landscape. The research mapped behavioral and environmental data to understand human-ecosystem linkages and recommended environmental quality indicators to continue building future outcomes. This dissertation research was conducted in three distinct projects. v The Landscape Exchange project collected telephone survey data, interview data, and ethnographic information from project participants for three years in a subdivision in southwest Florida. In the Wekiva Basin of Central Florida, the Land-water Connection (LWC) project studied sources of nitrogen by examining the linkages between human behaviors, community land use patterns, and environmental quality. In the LWC project, patch dynamics of a suburbanizing watershed were mapped to link residential fertilizer frequency with water resource impacts. By collecting socio-economic information key to understanding the households and neighborhoods within the watershed, LWC attempted to better understand and characterize polluting potential and impact. This investigation of the human-ecosystem connection provided valuable insight to the potential source contributed by residential landscape management while demonstrating a tool for visualizing human-environment interactions. Integrating data and understanding processes that are being carried out at different spatial and temporal scales requires research that crosses interdisciplinary boundaries and extends beyond simple models to understand complex causal relationships (Young et al 2006). The LWC project integrated socio-demographic data like housing age and property values, household and lifestyle behaviors, and individual application rates with environmental data such as soil nutrients and groundwater NO3 - concentrations. Results demonstrated that significant relationships existed between structural features like Homeowners Associations (HOA) and golf courses and high fertilizer frequency, but that these areas did not consistently show patterns of elevated nitrogen concentrations in ground and surface water. vi Confounding geophysical features, limited data availability, and a temporal lag between land-based fertilizer activity and groundwater nitrogen concentrations are likely. In the Predicting Maintenance Intensity (PMI) project, I collected statewide survey data from Florida homeowners and used multivariate analyses to determine if the same variables that predicted landscape maintenance intensity also influenced the odds of adopting an environmentally-friendly landscape (EFL). The purpose was to see how landscape maintenance and EFL adoption related and which human psychological or socio-economic variables predicted them. I used the framework of the Theory of Planned Behavior and Normative Action Theory to measure the extent that individual beliefs or community influences predicted landscape maintenance intensity. Although most of the alternative hypotheses that I posed in the research were significantly related to landscape maintenance intensity and EFL adoption in the predicted direction, the findings were somewhat unexpected. This was particularly the case when comparing household’s position on environmentally-friendly landscaping (EFL) adoption and landscape maintenance intensity. I found that those who adopted EFL practices had similar landscape maintenance intensity scores as those who did not intend to ever change their landscape practices and that those who intended to do more EFL had the highest landscape maintenance intensity score. This indicated that landscape maintenance intensity was a useful measure of product inputs but did little to explain individual attitudes about EFL adoption. Similar to the findings of the Land-Water Connection in Wekiva referenced previously, the statewide PMI project also found that community norms, living in a HOA governed community and household income were significant positive predictors of high vii landscape maintenance and that environmental consciousness, awareness of consequences, and house age were significant negative predictors. Environmental consciousness and enjoying gardening significantly increased the odds of currently practicing or intending to practice EFL relative to never changing their landscape, but community norms only significantly influenced the likelihood to intend to do more EFL. Another interesting finding of this dissertation was the differences of predictive powers of variables over scales. For example, the individual scale versus the community scale of influence. EFL Adoption was related more to individual characteristics such as personal norms, attitudes about the garden, and awareness of consequences while landscape maintenance intensity was more influenced by structural differences like who was responsible for maintenance and socio-demographics like house age and income were strongly significant and community norms. The findings of this dissertation supported the concept of lawn anxiety described by Robbins (2007), regarding those who are aware of the environmental consequences, but still applied lawn care products. It would be interesting to explore the relationships further to understand why those who are environmentally aware are motivated to high maintenance regardless. From these results, it appears they are influenced by their community norms and HOA mandates. More investigation of the human dimensions of the suburban landscape is warranted. Further research on human life-history measures, perceived behavioral controls and normative influences of those who adopt alternative landscapes would help guide communications. Understanding more specifically what mechanisms are needed to enable a societal change to a sustainable landscape requires further exploration of the motives and barriers that will prevent it from happening. viii Further research is also needed to better understand suburban nitrogen system dynamics. Studies that focus at the community scale should be conducted to apply and trace residential fertilizes from the yard to the street and into aquatic systems. The use of labeled nitrogen fertilizer can be used identify fertilizer from background nitrogen. Lastly, land use planning and development must seek to rebalance the scale that promotes both environmental protection and economic growth back toward environmental protection. It has been too long tipped in favor of development pressure and short-term economic growth to the demise of our aquatic systems.

Quality of life (QoL) in cancer survivors is an important area of research. While data are available about QoL and breast cancer, there is a paucity of research regarding older breast cancer survivors. The purpose of this research was to examine QoL in older women with early stage breast cancer, within the first year of post-treatment survivorship. The specific aims of this study were to: 1) Describe the changes in overall QoL and the four QoL domains of Physical, Psychological, Social, and Spiritual well-being; 2) Examine the effects of a psychoeducational support intervention on QoL outcomes in older women; and 3) Describe nurses' perceptions of their interactions with older breast cancer survivors. A descriptive, longitudinal design was used to answer the research questions. Data for this study were drawn from the Breast Cancer Education Intervention (BCEI), a longitudinal psychoeducational support intervention for women with early stage breast cancer. Fifty women from the BCEI who were 65 years of age and older were included in this sample, of whom 24 were assigned to the Experimental (EX) Group and 26 were assigned to the Wait Control (WC) Group. Data were collected at three time points: baseline, three months, and six months after study entry. Measurement tools included the BCEI Demographics Form, the Quality of Life-Breast Cancer Survey (QoL-BC), and field notes of the BCEI Research Nurses. The QoL-BC survey is a 50-item scale that measures QoL in women with breast cancer. Descriptive statistics, Generalized Estimating Equation (GEE) methods and t-tests were used to answer research questions #1 and #2. Content analysis was used to answer research question #3. Subjects reported good overall QoL at baseline, but QoL declined over six months. Physical and Psychological well-being declined from baseline to six months later. Social well-being initially improved from baseline to three months but declined at six months. Spiritual well-being initially declined at three months and improved at six months. There was insufficient power to detect a difference in the effects of the BCEI Intervention between the two groups. However, the decline in overall QoL was less in the EX Group. Field notes focusing on nurses' perception of their interactions with older women revealed four themes. These themes include: continuing breast-related health, personal health issues, family health issues, and potential stressors. Results from this study suggest that: 1) changes in overall QoL and within the four QoL domains occur over time; 2) decline in overall QoL was lessened by the BCEI Intervention; and 3) concerns after treatment are both breast cancer and non-breast cancer related. Study findings can direct future research in the following areas: 1) identification of specific concerns within each QoL domain that could lead to an increase or decrease in well-being in older breast cancer survivors; 2) interventions tailored to the needs of older breast cancer survivors to maintain, improve, or lessen decline in QoL after treatment; and 3) reconceptualizing QoL in older breast cancer survivors to include non-cancer related factors.