Background: Fear of falling is now recognized as an independent fall risk factor due to its prevalence in older adults. Objectives: The purpose of this study was to gain a better understanding of fear of falling levels in community-dwelling older adults before and after attending a fall prevention clinic. Methods: An explanatory sequential mixed methods design was used. The Falls Efficacy Scale-International (FES-I) tool assessed fear of falling levels before and after attending a fall prevention clinic (n=32). Semi-structured interviews were then conducted in a sample of these participants (n=12). Results: There was no statistically significant difference in the before (M=30.44, SD=9.8) and after (M=31.72, SD=8.3) FES-I scores. Three themes emerged from the qualitative analysis: 1. Concerns about falling, 2. Decreased concerns about falling and 3. An increased self-awareness of fall risks. Conclusion: Further use of cognitive-behavioural therapy should be considered in falls risk reduction interventions for community-dwelling older adults with fear of falling.

Background: Fear of birth (FOB) is becoming increasingly recognised as a clinical issue that can have profound effects on the mother and her experience of pregnancy and birth. Failure to identify women with FOB could potentially lead to them feeling isolated and unsupported, and impact on their psychological health and the health of their baby. Aim: The main aim of this study was to gain an understanding of FOB and the associated impact on health professional practice, clinical outcomes and women's experiences of birth. The objectives were to: identify the most effective way of measuring FOB in clinical practice; investigate the most appropriate antenatal intervention to support women who fear childbirth; inform the study design for an RCT to assess the effectiveness of the intervention; and assess the most meaningful outcomes to include in future work. Methods: An explanatory mixed-methods study design was used. The first phase was a two-part online survey sent to Heads of Midwifery at 202 maternity units in the UK via Survey Monkey. Respondents were asked to give details of their unit in part 1 and service provision and evaluation for women with FOB in part 2. The second phase was a prospective cohort study of 148 women who had not experienced childbirth who were consecutively attending the Elisabeth Garrett Anderson and Obstetric Hospital, London or St Mary's Hospital, Manchester. Demographic data and details of sources of information on pregnancy were collected from participants in the first trimester along with their score on the tool chosen to measure FOB, the Fear Of Birth Scale (FOBS), and a saliva sample to measure cortisol level. In the third trimester, a second FOBS score and saliva sample were collected, and the Personal Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were administered to measure depression and anxiety respectively. Birth outcomes for the participants were collected from clinical records. In the third phase, 15 women participating in the second phase were purposively selected to reflect a range of FOBS scores and interviewed by telephone using a semi-structured interview to find out their experiences of pregnancy, being part of the study and service provision. Results: Response rates for the online survey were 63% for part 1 and 54% for part 2. Consultant obstetricians 25% had the most involvement in the care of women with FOB, followed by consultant midwives 21% and 30% had a designated midwife for dealing with FOB and only 32% provided specialist midwifery-led services for women with FOB, with 16% referring to a consultant obstetrician and 47% providing no specialist provision. No unit provided an evaluation of their services, although 19% had undertaken local audits. In the cohort study, using a cut-off of 54 for the FOBS, 30/148 (20%) had a FOB in the first trimester while 21/80 (26%) had a FOB in the third trimester. Compared with the first trimester, 51/80 women showed an increase in FOBS score, with 14 gaining and 7 losing a FOB. FOBS scores were not correlated with salivary cortisol in either trimester but they were correlated with PQH-9 and GAD-7 scores in the third trimester. They were also associated with a previous history of depression but only in the first trimester (p=0.011). FOBS scores showed considerable variability and a high measurement error, indicating a need for further refinement and psychometric testing. The qualitative interviews identified three themes underlying FOB: fearing the worst (pain, fear for the baby and fear of the unknown and complications), pathways to fear (friend-induced fear, mother-induced fear or reassurance and media-induced fear) and igniting or reducing fear (sources of information, support and communication). Conclusions: The FOBS is a potentially effective way of measuring FOB in clinical practice and research, but it requires enhancement informed by the themes identified by this study and psychometric testing in all three trimesters. An enhanced version of the FOBS could be used as the primary outcome to measure FOB during pregnancy in an RCT assessing the effectiveness of a suitable intervention, with the PHQ-9 and GAD-7 as secondary outcomes to measure depression and anxiety during pregnancy. An intervention to support primiparous women with FOB should be developed informed by the findings of this study, including components such as psychological education, relaxation, social support, reliable information sources and continuity of carer.

Background: Psychosocial loneliness is an unpleasant and distressing experience arising from subjective discrepancies between a person’s desired and actual social relationships. An increasingly common problem in UK society, loneliness is linked with serious adverse mental health outcomes and poses a significant risk to physical health, which several experts suggest is as great as smoking and obesity. In recent years leading cancer care organisations have raised awareness of the existence of loneliness and its potential importance in the context of cancer; however little attention has been paid in the literature or in clinical practice to understanding, identifying and alleviating loneliness. AimsThe project reported in this thesis aimed to: 1) clarify the conceptual and theoretical meaning of ‘loneliness’; 2) enhance understanding of loneliness in people living with and beyond cancer; and 3) develop an assessment tool for ‘cancer-related loneliness following treatment completion’. MethodsThe project began with a theoretical concept analysis of ‘loneliness’. This was followed by a systematic scoping review of loneliness and cancer. Gaps in the knowledge base were addressed by means of an exploratory mixed methods study. Phase 1 involved collection of quantitative data concerning loneliness from 107 individuals living with and beyond cancer. Descriptive and inferential statistical analysis of the data was conducted. Phase 2 involved the undertaking of semi-structured interviews with 12 individuals living with and beyond cancer who scored highly for loneliness in phase 1. Thematic Framework Analysis was employed to analyse the interview data. The findings of the qualitative phase, together with the initial conceptual work and the findings of the literature review were employed to develop the Cancer-related Loneliness Assessment Tool. Preliminary cognitive testing of this tool was conducted. FindingsLoneliness results from an interaction between personal and situational factors and is better viewed as an individual process rather than as a clinical condition for which specific diagnostic symptoms and cut-offs exist. The experience of loneliness appears to transcend the boundaries of cancer diagnosis, stage of disease, tumour site and treatment modality. The results of the quantitative phase indicated that participants in the study experienced, on average, ‘moderate’ levels of loneliness. In the study sample age was an independent predictor of cases of loneliness – the odds of individuals aged <30-59 being lonely were 23 times those of individuals aged 70+. Employment status was significantly associated with loneliness scores – non-employed individuals had higher loneliness scores than did employed individuals and retired individuals. The qualitative phase identified a contextual loneliness termed ‘cancer-related loneliness following treatment completion’. Such loneliness is a result of perceived social, emotional, cultural and healthcare-related relationship deficiencies stemming from or exacerbated by cancer-related sources. Loneliness emanating from deficiencies in relationships with healthcare professionals – termed healthcare-related loneliness – has not previously been referred to in the loneliness literature. The Cancer-related Loneliness Assessment Tool operationalised ‘cancer-related loneliness following treatment completion’ and preliminary cognitive testing indicated that the items generate the information intended and that individuals have little trouble completing the assessment tool. ConclusionsCancer-related loneliness following treatment completion should be addressed as part of comprehensive cancer care. Following further development, the Cancer-related Loneliness Assessment Tool could facilitate identification of loneliness in clinical practice. It could also aid with the development/adaptation and evaluation of interventions to address loneliness. Healthcare-related loneliness should be added to the existing tripartite (social, emotional and cultural) typology of loneliness, creating a quadripartite typology that encompasses all types of relationship deficits that can beget loneliness.

Thesis (M.A.)--University of the Witwatersrand, Faculty of Humanities, School of Human and Community Development (Psychology), 2013 / The prevalence, characteristics and causes of unemployment in the general population have been well researched in South Africa, however, the sub-population of unemployed graduates has been studied to a far lesser extent. In this mixed methods research, 2029 participants from the 23 public higher education institutions in South Africa were surveyed. The online survey was sent to approximately 20 000 participants via email, with an invitation to participate in the study and information on the study. The dependent variable was employment status; three categories described the employed and two categories described the unemployed. Survey results were analysed using frequency distributions, chi-squared analysis and binary logistic regression. Thereafter, ten Black, low socio-economic status, unemployed graduates were interviewed telephonically. The interview transcripts were analysed thematically looking for both variation and consistency. The results showed that unemployment in the sample was 5.1%. Black graduates, graduates of low socio-economic status and graduates with difficulty accessing resources showed the highest prevalence of unemployment. Having received career guidance was not associated with employment status. The perceived causes of unemployment were lack of resources available to look for a job, the lack of connections to the labour market and discriminatory recruitment practices.

The ubiquity of Web 2.0 technologies has led to a seismic shift in the way educational services are delivered. It comes as no surprise then that e-tutoring—otherwise known as electronic or online tutoring—is quickly supplanting face-to-face tuition for reasons of both cost and convenience. While e-tutoring is an effective form of academic support for many students, its efficacy remains tenuous for those confronted with a digital divide that figures predominantly around geographic barriers, socio-economic status, and educational levels. Premised on diffusion research, this master's dissertation explores the implementation of an e-tutoring service known as Homework Help that has effected relatively low adoption rates. It uses a concurrent mixed-methods approach—including surveys, interviews, and focus groups—to examine the factors that have led to this low adoption rate. The results are presented via two journal articles situated within a larger meta-talk: The first article contrasts the adoption patterns apparent between rural and urban students, while the second article looks at the utility of diffusion research in examining educational technologies, as it explores the use of e-tutoring for applied stream students. The findings of this study suggest that rural and urban, as well as applied and academic student subgroups, differ in terms of their perception and adoption of e-tutoring. Implications for educational policy, especially in regards to rural education, are discussed.

The purpose of this research is to explore the context of youth recreational soccer, and to examine how coaches volunteering in this context learn to coach soccer. Framed within Jarvis’ (2006, 2007, 2008, 2009) theory of lifelong learning and employing a mixed-methods approach, this dissertation research had two distinct phases. Phase One involved the collection of data via an on-line survey from 433 recreational youth soccer coaches from Eastern Ontario. The survey served to collect demographic information, as well as general information about their team, their role as a recreational coach, and their approach to learning. The data analysis for the on-line surveys was comprised of an analysis of descriptive statistics. Phase Two involved semi-structured interviews. Recruited through their participation in Phase One, 30 coaches were purposefully targeted and interviewed based on their varied biographies, experiences, and social contexts. Additionally, seven soccer administrators were interviewed. Interview data was analyzed according to the principles of thematic analysis (Braun & Clark, 2006). Findings examine the biographies of youth recreational coaches, their coaching context, how recreational coaches learn to coach, issues of shared responsibilities related to learning, as well as practical implications. It is suggested that recreational coaches differ from one-another on many factors, and that the context of recreational youth soccer is similarly diverse and presents unique challenges to coaches. Recreational youth coaches learn to coach through a variety of sources; mostly through informal learning situations. Responsibilities surrounding coach development fall on the shoulders of individual coaches and clubs, as well as regional, provincial, and national associations; and suggestions for increased engagement in this regard are provided.

Over the past few decades, research into public perceptions of crime has largely focused on how mass media consumption shapes beliefs about crime. Substantially less research has been dedicated to exploring the potential influence of alternative sources of information, and even less attention has been devoted to exploring the spatiotemporal aspect of perceptions of crime. This thesis combined Geographic Information Systems (GIS) and structured interviews in order to explore the narratives about crime constructed by three sources: (1) the Ottawa Police Service, (2) the Ottawa Citizen newspaper, and (3) residents of Ottawa. Eight participants were taken on a walking tour interview, and their responses were compared to two maps depicting the geographies of crime presented by the Ottawa Police Service and the Ottawa Citizen. It was found that the places participants believed to be criminal ones were poorly maintained and dirty, were populated by large numbers of homeless individuals, had little to no commercial space, were geographically close to other areas of the city believed to be criminal spaces, and were poorly lit. The three construction of the spatial distribution of crime in Ottawa shared many common features (such as a focus on the Byward Market area as highly criminal) while remaining distinct in their presentation of certain types of spaces (such as the newspaper’s presentation of homeless shelters as highly criminal spaces). Ultimately, this thesis explores three distinct narratives about the geography of crime in Ottawa through the use of a unique mixed methods design that provides an alternative way of interpreting data most commonly analyzed through deductive or quantitative means.

Problem: Financial strain has been reported by families of children with cancer. However, the specific costs and their impact on these families remain unknown. Objectives: (a) to identify the costs incurred by families of children newly diagnosed with cancer in Ontario, (b) to determine the variables that influence these costs, and (c) to explore the impact of these costs on families. Conceptual Framework: The conceptual framework incorporated the social, economic, disease, and treatment cost predictors with the direct and indirect cost of illness components. Setting: Two university-affiliated tertiary paediatric hospitals in Canada. Sample: English speaking parents of children newly diagnosed with cancer who were receiving treatment. Design: A prospective concurrent mixed method design. Instrumentation: The Ambulatory and Home Care Record © (AHCR) (Guerriere & Coyte, 1998) was used to record costs and an interview guide was developed to explore the impact of these costs on families. Procedure: Parents recorded the resources consumed and costs incurred during one week per month for three consecutive months beginning the 4th week following diagnosis and listed any additional costs incurred since diagnosis or between the face-to-face interviews. Parents also discussed the impact of these costs on their families in an audio taped interview. Data Analysis: Descriptive statistics and multiple regression modelling were used to describe families’ total costs (expressed in 2007 Canadian dollars) and to determine factors that influenced them. Descriptive qualitative content analytic methods were used to analyze the transcribed interview data. Results: In total, 99 parents including 28 fathers and 71 mothers completed three sets of cost diaries. The mean total three month expenditure was $28,475 (SD $12,670; range $2013 to $79,249) per family. There were no statistically significant factors that influenced families’ direct costs; however, 23% of the variance for indirect costs was explained by inpatient tertiary hospitalizations, language spoken at home, and distance to the hospital. Parents described the costs associated with their child’s illness and coping and management strategies used to lessen the financial impact including managing their expenses and seeking ways to increase their cash flow. Significance: Findings will inform health professionals and policy makers about families who are faced with potentially catastrophic costs following their child’s diagnosis with cancer.

Increased prevalence rates of overweight and obesity (OW/OB) have been reported among Aboriginal women and while the literature suggests that changes in lifestyle (i.e. physical activity and diet) account for this trend, few studies have explored how the physical and sociocultural environments and individual attitudes and beliefs regarding physical activity (PA) and healthy eating may contribute to the increase. The purposes of this project were to: 1) Determine the current prevalence of OW/OB in the community, 2) assess changes in OW/OB from 1991 to 2005, 3) assess current PA and dietary practices, and 4) explore the influence of the physical and sociocultural environments as well as individual attitudes and beliefs regarding PA and healthy eating among the females in the community.<p> The prevalence of OW/OB was 26% among youth and 68% among adults. Overall, no significant difference in rates of OW/OB among youth or adults occurred over time, however there was a significant decrease in rates of OW/OB for adult males and a tendency towards a greater increase in OW/OB among female youth. A pattern of abdominal obesity among all age groups of females was noted. There was a significant increase in body mass index (BMI) classification over time among individuals with serial data. Walking and housework were the most frequently reported activities. Although the PA data suggests levels associated with health benefits, these results must be interpreted cautiously given housework was performed at a low intensity. Personal, community-specific and environmental factors were highlighted as barriers to PA, whereas organized, age-specific, women-only programs were highlighted as potential enablers for PA. Low intakes of fruits and vegetables and milk products across all age groups, with high intakes of foods high in fat, oil, sugar, salt, particularly among those under 25 years were reported. Traditional food use increased with increasing age, however was low even among women aged 55+. While food preference was influenced primarily by taste, barriers to healthy eating were largely related to geographic location. Collectively, the results of this study emphasize the importance developing community-based health promotion programs that focus on reducing identified barriers to PA and healthy eating to promote healthy body weights in the community.

Background: An understanding of the meaning of health is an integral component in the development of effective health promotion programs aimed at promoting health or preventing diseases such as childhood obesity. One group of Canadian children known to be at higher risk for obesity is those living in rural settings. The purpose of this current research was to explore the meaning of health of preadolescent children living in rural Saskatchewan. The following four research questions were addressed: (a) What are the general health characteristics of the study sample?, (b) What is the rural context of children participating in this study?, (c) What is the meaning (i.e. values, norms, beliefs, behaviors) of health from the perspectives of a group of preadolescent children?, and (d) Is the meaning of health thematically congruent from the perspectives of healthy weight and unhealthy weight children?. Study Design: Mixed methods explanatory sequential design (Participant selection model) with qualitative emphasis. Methods: Participants were recruited through classroom presentations and invitational letters sent out to all children attending a rural elementary school in Saskatchewan. Ninety-nine children (51.0% response rate) participated in the quantitative component [measurement of height and weight for purposes of determining healthy weight and unhealthy weight (overweight or obese) status and completion of health questionnaire examining dietary and physical activity patterns]. Of the children who met the selection criteria for qualitative follow up (Grade 4, 5, & 6 children who agreed to be interviewed and had a parent who agreed to be interviewed), twenty children and their parents were randomly selected to be individually interviewed for a total of 71 interviews. An observational assessment of the community was conducted by the researcher for the purpose of gaining a greater understanding of the rural context in which the study participants construct their meaning of health. Results: Prevalence of unhealthy weights in these rural children was high (34%) with gender differences evident at a very young age. Regardless of weight or health status, children described their cultural meaning of health as an integration of Knowing Stuff, Having a Working Body, and Feeling Happy. Of these three themes Feeling Happy was recognized as the most meaningful and children described that receiving encouragement and support from valued relationships contributed to their happiness and overall meaning of health. The rural environment appeared to provide a sense of safety, security, and freedom in which children frequently engaged. Significance of Findings: The high prevalence of unhealthy weights in this sample of rural children has the potential to negatively influence the present and future health of these children. Developing an understanding of the cultural meaning of health and how this culture may influence patterns of healthy behaviors may be a foundation to the development of successful interventions aimed at promoting healthy weights in rural children.