The purpose of this study was to explore the aspects of therapy as proposed by "common factors" literature (e.g., extratherapeutic change, hope and expectancy, therapy technique, and therapeutic relationship) by surveying the clients of a university based family therapy clinic. Data were used to provide information about what factors are therapeutically helpful according to the client's perspective. Surveys provided a quantitative and qualitative description of the client's therapeutic experience and were compared with those aspects of therapy found in the research. Quantitative results indicate that therapeutic relationship, client motivation, factors outside of therapy, and hope and expectancy accounted for around 49% of the variance of clients' perception of change and about 73% of the variance of clients' perceptions of therapy helpfulness. Findings further suggest that the clients' level of hopefulness and expectancy for positive change is the most significant predictor for both client change and therapy helpfulness. Qualitative results indicate that the therapeutic relationship is considered by clients to be the most helpful aspect of their therapeutic experience. / Master of Science

Advanced maternal age (AMA) is linked to several adverse pregnancy outcomes, hence these pregnancies are considered to be "high risk." Risk perception impacts pregnant women’s health care use, health behaviors, and adherence to medical recommendations. Yet, a gap remains in the understanding of perception of pregnancy risk and its contributing factors. This mixed methods research study was developed to address this gap, using a conceptual framework based on a literature review and the Psychometric Model of risk perception. The specific objectives of this study were to compare risk perception in nulliparous women of AMA with younger women, determine the factors influencing perception of pregnancy risk, and gain an understanding of women’s perspectives of risks associated with AMA. Between December 2009 and January 2011, a sample of 159 participants (105 women aged 20-29 years and 54 women aged 35 years or older) was recruited from a variety of settings in Winnipeg, Manitoba. Several questionnaires were completed by participants. Descriptive statistics, chi square, t tests, Pearson's r correlations, and stepwise multivariate linear regressions were used to analyze data. Fifteen women of AMA were chosen purposefully to participate in individual and semi-structured interviews. Interviews were audio-taped and transcribed verbatim, and content analysis was used to identify themes. Results revealed that pregnancy-related anxiety, maternal age, medical risk, perceived control (internal), and gestational age were significant predictors of perception of pregnancy risk accounting for 47-49% of the variance in risk perception. Maternal age interacted in a synergistic manner with pregnancy-related anxiety to increase perception of pregnancy risk levels. In the qualitative component, four main themes emerged from the data: definition of pregnancy risk, factors influencing risk perception, risk alleviation strategies, and risk communication with health professionals. Women of AMA perceived higher pregnancy risk for both themselves and their fetuses than younger women. However, they were not a homogenous group in their pregnancy risk appraisal. This study contributed to the field by proposing pregnancy-related anxiety as a pregnancy dread factor in risk perception theories. Risk communication is an important element of developing care plans for women of AMA and should be integrated into prenatal care visits.

Advanced maternal age (AMA) is linked to several adverse pregnancy outcomes, hence these pregnancies are considered to be "high risk." Risk perception impacts pregnant women’s health care use, health behaviors, and adherence to medical recommendations. Yet, a gap remains in the understanding of perception of pregnancy risk and its contributing factors. This mixed methods research study was developed to address this gap, using a conceptual framework based on a literature review and the Psychometric Model of risk perception. The specific objectives of this study were to compare risk perception in nulliparous women of AMA with younger women, determine the factors influencing perception of pregnancy risk, and gain an understanding of women’s perspectives of risks associated with AMA. Between December 2009 and January 2011, a sample of 159 participants (105 women aged 20-29 years and 54 women aged 35 years or older) was recruited from a variety of settings in Winnipeg, Manitoba. Several questionnaires were completed by participants. Descriptive statistics, chi square, t tests, Pearson's r correlations, and stepwise multivariate linear regressions were used to analyze data. Fifteen women of AMA were chosen purposefully to participate in individual and semi-structured interviews. Interviews were audio-taped and transcribed verbatim, and content analysis was used to identify themes. Results revealed that pregnancy-related anxiety, maternal age, medical risk, perceived control (internal), and gestational age were significant predictors of perception of pregnancy risk accounting for 47-49% of the variance in risk perception. Maternal age interacted in a synergistic manner with pregnancy-related anxiety to increase perception of pregnancy risk levels. In the qualitative component, four main themes emerged from the data: definition of pregnancy risk, factors influencing risk perception, risk alleviation strategies, and risk communication with health professionals. Women of AMA perceived higher pregnancy risk for both themselves and their fetuses than younger women. However, they were not a homogenous group in their pregnancy risk appraisal. This study contributed to the field by proposing pregnancy-related anxiety as a pregnancy dread factor in risk perception theories. Risk communication is an important element of developing care plans for women of AMA and should be integrated into prenatal care visits.

The importance of curriculum in education is uncontested. Nevertheless, this has not translated into a thorough examination of what constitutes a ‘quality’ curriculum. Extant educational quality models mostly investigated ‘quality’ from students’ perspective and were predominantly conducted in the business and engineering fields. Some of these models encompass curriculum quality dimensions, nonetheless, given their focus on student perspectives, emerging curriculum themes were limited to issues of interest to students only, such as the number of courses, and the courses enhancing students’ job perspectives. To date, only a few studies pertaining to quality and service quality have been conducted in the field of Teaching English to Speakers of Other Languages. Thus, this exploratory sequential mixed-methods case study was conducted in an English for Academic Purposes programme in the State of Qatar to uncover teachers’ perceptions of curriculum quality and its attributes. Additionally, this study seeks to discover whether teachers’ perceptions of ‘quality’ affected their curriculum implementation. Qualitative data indicates that participants understood a quality curriculum as one that meets stakeholders’ needs in addition to meeting twenty-five attributes pertaining to curriculum design, course content, and resources. The findings reveal that curriculum design is the most important aspect of quality followed by course content and resources. Qualitative data also revealed that the exclusion of teachers from curriculum decision-making, students’ admission criteria, and lack of trust were detrimental to the quality of curriculum design. Curriculum relevance to students is of concern to some participants, since students and the wider community do not perceive the English for Academic Purposes courses as relevant. Although the participants’ do not deem quality of resources as an essential attribute of curriculum quality, it affects their curriculum implementation. Overall, the quantitative data supports the qualitative findings with respect to the importance of the curriculum quality attributes. Two curriculum quality attributes emerge from two participants’ comments related to curriculum design section in the questionnaire. Based on the study findings, it is recommended that the needs and situation analyses be modified at the study site to address concerns raised by the participants. It is also suggested that the university explores different options of English for Academic Purpose programmes to enhance students’ perceptions of the relevance of the English for Academic Purposes courses.

<p>This dissertation investigated an affective curriculum intervention’s effectiveness in resolving</p><p>underachievement. The intervention was first implemented at a summer program with 20 students</p><p>and four camp counselors. Inductive analysis of qualitative data indicated that most participants</p><p>had positive perceptions of the model. Descriptive analyses indicated the intervention had small,</p><p>positive effects on students’ academic self-perceptions (MD = 0.122, SD = 0.621, d = 0.196) and</p><p>attitudes toward teachers (MD = 0.139, SD = 0.848, d = 0.164) were found. There was no change</p><p>in attitudes toward school (MD = 0.080, SD = 1.327, d = 0.060) and goal valuation (MD = 0, SD =</p><p>0.721, d = 0) and a moderate, negative effect on self-regulation (MD = -0.620, SD = 1.346, d = -</p><p>0.460). The intervention was then implemented in a middle school with one 12-year old girl who</p><p>was gifted and underachieving. An explanatory mixed methods design, combining a single-case</p><p>A-B design, an interrupted time series simulation, and inductive analysis, was used. The model</p><p>was perceived as useful, mainly in increasing self-perceptions. Results showed a significant</p><p>increase in behavioral engagement (d = 1.224, p <.001) and improved achievement (SMD = 1.28).</p><p>Academic self-perception (MD = 0.57) and attitudes toward school (MD = 1.00) improved,</p><p>attitudes toward teachers showed no change, and goal valuation (MD = -0.67) and self-regulation</p><p>(MD = -0.40) decreased. These two studies provide preliminary evidence for the effectiveness of</p><p>the intervention.</p>

Background: The trajectory of recovery after sepsis varies. Survivors may have considerable ongoing limitations, requiring a caregiver for a prolonged period. Objectives: To learn about experiences, quality of life, coping, resilience, and social support of caregiver caring for survivors of sepsis. Methods: We conducted a convergent mixed-methods study, recruiting informal caregivers of patients who had survived sepsis in the past year and were readmitted to the intensive care unit with sepsis. Individual face-to-face, semistructured interviews and validated surveys on quality of life, coping, caregiver burden, resilience, and social support were administered to caregivers. Interview transcripts were analyzed using content analysis. Surveys were scored and summarized using descriptive statistics. Results: Caregivers were primarily middle-aged, White, and female. Half were spouses of their care recipient. Caregivers reported some deficits in mobility, pain, and anxiety/depression. Coping styles varied, with engaged coping being more prevalent. Most caregivers reported mild to moderate burden, all reported either normal or high resilience levels, and types of social support were similar. However, interviews and survey findings were not always consistent. Major themes that emerged from the analysis included (1) advocating for and protecting their loved one, (2) coping with caregiving, (3) uncertain future, (4) rewards of caregiving, and (5) need to optimize communication with family. Discussion: Caregivers of sepsis survivors are protective of their care recipient and use a variety of strategies to advocate for their loved one and to cope with the uncertainty involved in a new intensive care unit admission. More advocacy and support are needed for this population.

Class size has long been recognized as a factor affecting achievement in face-to-face contexts. However, few studies have examined the effects of class size in online courses, or the effects of dividing an online class into smaller discussion groups. The current study examined the relationship between class size and the use of grouping strategies on note reading, note writing, and collaborative discussions in online graduate-level courses. This mixed-methods study analyzed tracking logs from 25 graduate-level online courses using Web Knowledge Forum (25 instructors and 341 students) and interviews from 10 instructors and 12 graduate students with diverse backgrounds. The quantitative and qualitative data analyses were designed to complement each other. Findings suggested 13 to 15 as an optimal class size and four to five as an ideal subgroup size. Not surprisingly, the results revealed that, as class size increased, the total notes that participants read increased significantly. However, as class size increased, the percentage of course notes that students read decreased significantly (i.e., students were reading a smaller proportion of the course notes). In larger classes, participants were more likely to experience information overload and students were more selective in the notes that they read. A significant positive correlation was found between class size and total notes written. Students’ note size and grade-level score were negatively correlated with class size. The data also suggest that the overload effects of large classes can be minimized by dividing students into small groups for discussion purposes. Interviewees felt that the use of small groups in large classes benefited their collaborative discussions. The preceding results underscore the importance of using small discussion groups when class sizes are large. The research concludes with a list of pedagogical recommendations and suggests new software features that may help enhance learning in online courses.

Class size has long been recognized as a factor affecting achievement in face-to-face contexts. However, few studies have examined the effects of class size in online courses, or the effects of dividing an online class into smaller discussion groups. The current study examined the relationship between class size and the use of grouping strategies on note reading, note writing, and collaborative discussions in online graduate-level courses. This mixed-methods study analyzed tracking logs from 25 graduate-level online courses using Web Knowledge Forum (25 instructors and 341 students) and interviews from 10 instructors and 12 graduate students with diverse backgrounds. The quantitative and qualitative data analyses were designed to complement each other. Findings suggested 13 to 15 as an optimal class size and four to five as an ideal subgroup size. Not surprisingly, the results revealed that, as class size increased, the total notes that participants read increased significantly. However, as class size increased, the percentage of course notes that students read decreased significantly (i.e., students were reading a smaller proportion of the course notes). In larger classes, participants were more likely to experience information overload and students were more selective in the notes that they read. A significant positive correlation was found between class size and total notes written. Students’ note size and grade-level score were negatively correlated with class size. The data also suggest that the overload effects of large classes can be minimized by dividing students into small groups for discussion purposes. Interviewees felt that the use of small groups in large classes benefited their collaborative discussions. The preceding results underscore the importance of using small discussion groups when class sizes are large. The research concludes with a list of pedagogical recommendations and suggests new software features that may help enhance learning in online courses.

Within the construction industry, proximity of actual to scheduled completion time is a primary performance measure, and deviations from planned schedules remain a popular concern in the field of construction management. Prevailing research assumes that delays arise either from flawed execution of the plan or from failure to plan effectively. Thus, solutions suggested include improving execution and developing ever more sophisticated planning techniques. In spite of these efforts, accuracy in scheduling construction projects has shown little or no improvement, and clients continue to incur the significant costs associated with the failure to more accurately plan. Eschewing this traditional techno-rational view, the current research turned to critical management studies for solutions and investigated planning intentionality, the intentional and unintentional roles planners play in project delays. Thus, it sought to explore the following with respect to the project planner role: optimism bias, where a planner unintentionally mitigates negative information in decision-making; strategic misrepresentation, where a planner intentionally mitigates negative information; and group dynamics in time estimation. The latter is relevant because a team rather than an individual typically embodies the planner function within a construction project. To perform this research, two mixed-methods studies, preceded by a pilot study, and seven interviews with project planners were conducted. The first mixed-methods study investigated how intended and unintended actions of participants affected underestimation of time during task performance; and the second investigated the creation of collective intentionality, the transmutation of individual preferences into a group consensus in time estimation. Results of the first mixed-methods study identified the key situational variables differentiating intended and unintended actions of planners and indicated how these can influence the quality of time estimation. Results of the second study showed that group performance in time estimation was inferior to that of individuals and that group member interaction appeared detrimental to good decision-making. Reasons found were sense of power, commitment, confidence level, cultural diversity, conflicts, and groupthink. The findings were compared and contrasted with those obtained from interviews with project planners to enhance the scope of the study.

Introduction: In a mixed-methods study I assessed the role of social networks as predictors and outcomes of the implementation of an intervention to promote evidence-informed decision-making (EIDM) in three public health departments in Ontario, Canada. The quantitative strand included the analysis of the role of staff’s position in networks on the adoption of EIDM, the longitudinal evolution of networks, and the association between the name generators’ position in surveys and respondents’ motivation to answer survey questions. The qualitative strand aimed to explain and contextualize the quantitative findings. Methods: A tailored intervention was implemented in the public health departments, including the mentoring of staff through the EIDM process by a knowledge broker. The staff participated in three online surveys before and after the 22-month intervention, providing the names of peers to whom they turned to seek information, whom they considered as experts, and their friends. I assessed the dynamic evolution of social networks, and the role of local opinion leaders (OL) in promoting the adoption of EIDM. I interviewed key network actors about their interpretation and experience regarding the quantitative findings. Results: Overall, there was no statistically significant impact on EIDM behavior and skill in health departments. However, the analysis of the role of OLs in behaviour change showed that non-engaged staff who were connected to highly engaged OLs, and those OLs who communicated with each other improved their EIDM behavior. Social networks became more centralized around already popular staff due to selective training of recognized experts. Highly engaged staff tended to connect to each other, and to limit their connections within organizational divisions over time. In the department where multiple activities were being implemented to support EIDM, the highly engaged staff became more popular due to department-wise presentations and informal information spread. I also found that when name generator questions are asked later in surveys then respondents are more likely to refuse, indicate they do not know anyone, or provide fewer names than when these questions are asked earlier Conclusion: Social network analysis showed the structure of information-seeking relations, the impact of opinion leaders on the EIDM behavior of their peers, and underlying social changes through implementing an EIDM intervention. These findings can inform the design and tailoring of EIDM interventions in public health organizations. / Thesis / Doctor of Philosophy (PhD) / In three public health departments in Ontario, where we offered an intervention to a group of staff on how to use more research evidence in practice, I studied how the pattern of communication among staff influenced their use of evidence, how those communications changed over time, and how the staff themselves viewed those changes. In the department that largely promoted staff engagement in the intervention, the staff who were engaged became more popular over time. In all departments, already popular staff became more popular. The staff who sought information from popular people engaged in the intervention, and those popular people who communicated with each other used more research evidence over time. Network analysis helped reveal the social structure and identify popular staff and could be used to inform similar interventions. It also showed how selecting and training a group of staff can change the way people communicate in health departments.