En 2003, l'Organisation Mondiale de la Santé a déclaré la non-observance au traitement médical un problème de santé public majeur. Les impacts de la non-observance sont multiples touchant à la fois des facteurs économiques, humains et sociaux. La compréhension de la dynamique entourant la non-observance est un enjeu de taille, et ce, d'autant plus pour les patients qui ont subi une transplantation cardiaque. En effet, pour ces individus, la non-observance au traitement post-greffe menace directement leur survie et leur qualité de vie. Le concept de représentation de la maladie est l'un des facteurs s'étant montré en mesure de prédire de façon plus significative et constante l'observance au traitement. Malgré l'importance de l'observance au traitement pour les greffés cardiaques, et bien que les liens entre cette variable et la représentation de la maladie soient confirmés par la littérature, on ne retrouve aucune étude explorant en détails les représentations de la maladie des greffés cardiaques et ses liens possibles avec l'observance. De surcroît, cette relation n'a pas été explorée dans un contexte longitudinal où il serait pertinent d'évaluer si les fluctuations de la représentation de la maladie peuvent entraîner des impacts sur l'observance au traitement. Par ailleurs, le concept de représentation de la maladie est traditionnellement étudié par l'entremise d'outils quantitatifs. Pourtant, ce dernier fait référence à des croyances d'ordre idiosyncrasique, dynamique, qui peuvent être cohérentes, rationnelles ou non. L'ajout d'une évaluation qualitative pourrait permettre une meilleure compréhension de la représentation de la maladie et de ses liens avec l'observance au traitement. L'étude actuelle vise à explorer en détails les représentations de la maladie des greffés cardiaques à l'aide de deux méthodologies soit qualitative et quantitative. Les fluctuations de la représentation de la maladie à travers le temps, en plus d'être mesurées seront mises en relation avec l'observance au traitement dans un objectif de mieux cerner les liens entre ces deux variables. Une meilleure connaissance de ces deux concepts et de leur relation pourrait permettre le développement d'outils ou d'interventions visant à optimiser l'observance au traitement chez les greffés cardiaques. Le présent document présente un compte-rendu des travaux à ces effets. Le premier chapitre abordera la problématique, décrira les variables sous étude, et fera état de la littérature dans ce domaine. Le second chapitre présentera les résultats du premier volet de cette étude visant à explorer la représentation de la maladie des greffés cardiaques par des mesures quantitatives et qualitatives. Il sera démontré comment les mesures qualitatives permettent d'expliquer, de nuancer et d'approfondir les résultats quantitatifs. Des suggestions concrètes pour améliorer l'évaluation quantitative de la représentation de la maladie seront par le fait même proposées. Le troisième chapitre présentera les résultats du second volet de cette étude visant à analyser les fluctuations de la représentation de la maladie et ses liens potentiels avec l'observance au traitement. Il sera démontré que les représentations de la maladie des greffés cardiaques pourraient être stables et adéquates entre le 4e et le 10e mois suivant la transplantation cardiaque. De plus, la possibilité d'une relation entre les fluctuations de la représentation de la maladie et l'observance au traitement sera mise en lumière. Finalement, des profils d'observance seront présentés toujours dans une optique de mieux cerner les liens entre la représentation de la maladie et l'observance au traitement. Finalement, le quatrième chapitre fera une synthèse de l'ensemble de ces travaux en faisant un retour sur les objectifs de cette étude et les résultats encourus. De plus, les implications méthodologiques et cliniques seront survolées et des applications concrètes suggérées. Les limites et forces de l'étude seront aussi abordées pour ensuite terminer en extrapolant sur les recherches futures. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : représentation de la maladie, observance au traitement, greffés cardiaques, méthodologies qualitative et quantitative.

As Canada welcomes immigrants from around the world, planners increasingly strive for policies and initiatives that meet culturally diverse needs. In Greater Vancouver, British Columbia, park planners have directed more attention to wilderness use by ethnic minority groups, particularly the Chinese population. Nowhere in Canada are people of Chinese ancestry more prominent than in Greater Vancouver, where they comprise 47% of the visible minority population and 17% of the total population. However, the rate of Chinese participation in wilderness recreation is less than that of the general population. This exploratory study examines the cultural nuances and institutional barriers that impede Chinese participation in wilderness recreation activities. It is primarily based on 51 in-depth interviews with members of the Chinese community in Greater Vancouver during 2002. Recruitment was by a hybrid convenience-purposive-snowball sampling method, which resulted in a non-random sample. Interview questions addressed views about wilderness, outdoor recreation and wilderness experience, awareness of local recreation opportunities, means to retrieve park information, and preferences for park settings and facilities. The Vancouver Index of Acculturation was used to measure participants' levels of acculturation. Interviews were tape recorded and transcribed, and information from field notes and transcripts were organized into main themes and triangulated with secondary data sources for analysis. Results indicate that Chinese who are more acculturated to Canadian culture ('High Mainstream Chinese') visit a greater number of parks and are willing to travel a further distance to access them. They also tend to visit parks more often, stay longer, and tend to be attracted to more physically demanding or 'hard adventure' activities, whereas less acculturated individuals ('Low Mainstream Chinese') are inclined to more passive outdoor activities. The study points to reasons that explain why Low Mainstream Chinese ? particularly recent immigrants ? are participating less in wilderness recreation. Factors include fear of the wilderness environment, preference for more highly developed parks, a lack of awareness of wilderness opportunities, and inadequate access to park information. Subtle aspects of the Chinese subcultural identity, such as importance of cleanliness, emphasis on academics, priorities on work, and clannishness, also play a role in Chinese under-participation. Thus if park planners want to facilitate Chinese use of designated wilderness areas, they should address issues such as safety, level of park development, availability of information, and awareness of wilderness opportunities in a culturally sensitive way. Doing so would promote more equitable access to a public resource. Increased awareness and appreciation of wilderness by ethnic minority groups may also help garner political support for future conservation initiatives and build a stronger local economy.

It is now widely recognized that society’s over-reliance on the automobile contributes to environmental problems, especially in urban areas. Nevertheless, efforts to bring about modal shifts through transportation demand management strategies typically have had limited success. As a result, transportation research is increasingly focused on understanding the decision-making process of travel behaviour changes including mode choice and automobile ownership. The purpose of this study is to explore how individuals arrive at a decision to live either car-free or car-lite. Using a grounded-theory approach, this thesis explores the factors involved in a car-free/car-lite decision and the manner in which those factors work together to create the decision making process(es). Semi-structured interviews were conducted with 20 driving members of a car-sharing organization, each of whom made a decision to go car-lite (car-sharing is their additional vehicle) or car-free (car-sharing is their primary vehicle). Five main interconnected themes emerged from the analysis: finances, personal values and attitudes, personal history, perceived accessibility and situational life events. In particular, the participants’ experiences reinforce the importance of situation life events in the decision-making process, a factor not commonly identified in behaviour change theory. Additionally, the participants’ narratives illustrate that intention is created from an individual’s inclination and ability to make a travel behaviour change. However, translation from intention into action appears to be conditionally dependent on contextual and/or situational changes, most often in the form of situational life events, that provide a push into or out of the decision-making process. Findings underscore the importance of life events as catalysts for bringing travel behaviour in line with an individual’s sense of what is important and what is possible. This research illustrates the relevance of qualitative work in advancing transportation research – particularly in understanding human travel decisions. While the current transportation-planning paradigm is appropriate for making short-term forecasts, we must recognize that non-linear, non-utilitarian, long-term, often qualitative factors, such as those identified in this research, are not exogenous to travel decision making. Results also provide a basis for reflecting on the appropriateness of various metrics for evaluating the effectiveness of transportation demand management initiatives.

The population of medically fragile adolescents has grown in recent decades because of the sequelae of prematurity, injuries, and chronic or terminal illnesses. Medically fragile adolescents who require respiratory assistance are part of this unique population with challenges in their daily lives, yet as nurses, we know little about their experiences and the best approaches to use in caring for them. The purpose of this study was to explore the experiences of medically fragile adolescents who require respiratory assistance. Interpretive phenomenology was used to describe and interpret the experience of 11 medically fragile adolescents who required respiratory assistance. The adolescents ranged in age from 13 to 18 years of age and required respiratory assistances of tracheostomies, ventilator support, and Bi-level positive airway pressure (BiPap). Audiotaped semi-structured interviews were conducted with the adolescents. Data analysis was completed using the steps delineated by Diekelmann and Allen (1989). Six themes and one pattern were identified from the interviews with the adolescents. The major themes were “Get to know me”, “Allow me to be myself”, “Being there for me”, “No matter what, technology helps”, “I am an independent person”, and “The only one I know of”. This study explored medically fragile adolescents who required a specific technology, respiratory assistance, within a distinct developmental stage. These adolescents have a clear view of who they are as a person. They want nurses to view them as a person, not just a patient. The adolescents felt that friends were there for them when they needed support. This was in contrast to those that they did not consider friends who were judgmental. Technology had meanings that encompassed enhanced daily living and existing as a part of their day, not their whole day. The adolescents viewed themselves as an independent person and were actively engaging in activities and strategies to achieve their goals of independence. This study contributes to nursing knowledge by helping nurses to understand what these adolescents experience in their daily lives and aiding nurses in providing better care for these adolescents. Recommendations for nursing practice, education, and research were identified in this study.

Research continues to substantiate the influence of social, economic and family characteristics on students’ scholastic achievements. For example, children who are born in economically disadvantaged circumstances are more likely to score lower on tests that measure academic abilities than their same age economically advantaged peers (Brooks-Gunn and Markman, 2005; Rothstein, 2004). This dissertation examines the relationship between parenting interactions and young children's school readiness and initial academic success for a low-income, at-risk population in Georgia. The inter-disciplinary concept resiliency, defined as a process that encompasses positive adaptation within the context of significant adversity, frames the research (Arnold and Doctoroff, 2003; Henry et al 2005; Luthar, Cicchetti, and Becker (2000), p. 543). This dissertation utilized a subsample from a larger evaluation project, The Georgia Early Childhood Study, which looked at the effects of a state-funded universal Pre-K program. Participants in this study were at-risk children who attended either state lottery funded Georgia Pre-K or federally funded Head Start. Both qualitative and quantitative data were used. Quantitative data included norm-referenced test scores, teacher ratings, and parental surveys. Results show that at-risk children categorized as non-resilient scored lower on standardized assessments over a three-year period and were more likely to attend preschools of lower quality than their similarly economically advantaged counterparts. Qualitative data were used to gain an understanding of parental involvement that is not generally captured with traditional survey methods. The qualitative study encompassed in-depth interviews with parents of children classified as at-risk. The results show that parents report involvement in their child’s schooling, but that involvement among the non-resilient populations was more peripheral. Parents of children from the resilient group were more likely to use language that indicated involvement as a partner in their child’s education than parents from children in the non-resilient group. Parents from both groups, however, reported the difficulties they face in raising their children and were cognizant of the ways that being from a lower socio-economic group translates into parenting difficulties.

Sexual minority women have been repeatedly overlooked in violence against women research. As a result, we know little about the experiences and needs of non-heterosexual or gender non-conforming survivors. Given the paucity of information available on this topic, this study was exploratory in nature and used a phenomenological approach. Open-ended, unstructured interviews focused on the lived experience of surviving sexual violence and the impact that this experience has had on the survivors’ same-sex sexuality. While a number of reoccurring themes generated from this project are well represented within the broad and well-developed canon of sexual violence research, participants also introduced features unique to LBQ and same-sex attracted women. Results from this project are intended to begin a long overdue dialogue about the needs of this understudied community of survivors.

The purpose of this study is to examine how EU-migrants visiting the social project Crossroads experience their life situation in the Swedish society. Two questions were formulated: (1) How do the respondents describe their situation when it comes to work, housing and social network? (2) How do the interviewees describe and experience the social project Crossroads? The method used was qualitative interviews conducted with five EU-migrants who visited Crossroads. The theoretical framework is the concept of integration and Bauböcks (1996) theoretical model of the ideal society. The results show that none of the interviewees had their own accommodation. Most of theme were living under stress because of their job seeking situation. The results also show that the interviewees’ social networks consisted of small groups of individuals who speak the same language.  According to the interviewees. The results show that Crossroads provides a welcome but acute help to relive problems with everyday life. The interviewees perceived their situation as complex and frustrating, and it appeared as if their situation as regards work, accommodation, and social contacts was interrelated.  It is concluded that EU-migrants would benefit from structural changes that made it easier for theme to improve their life situation more lastingly.

The purpose of this study was to understand whether there is a difference in how the Swedish police work with Facebook in two municipalities with different criminal records. The methods used were qualitative interviews with the ones responsible for the Facebook-sites and quantitative content analysis of different Facebook-posts, both from members of the Facebook-site and from the police themselves. Among the theories used in this study were the ”four-step relations process” by Cutlip, Allen and Broom, theory around public relations and theory around the public sphere by Habermas. The results showed that there is a difference in how the police uses Facebook between the municipalities and one of the conclusions is that this is mainly because of the ways that the police choose to work with Facebook rather than the difference in criminal records. Another conclusion is that the police get positive feedback from the members on their Facebook-site, and that how much the police uses Facebook as a tool depends a lot on how much resources they have to spend since the ones writing on Facebook are policemen and policewomen, and that the police do not have someone who works with the Facebook-site as a primary task. Keywords: Facebook, police, social media, qualitative interviews, quantitative content analysis, authority, public relations.

Autoimmune diseases (ADs) are a classification of chronic of illnesses in which the immune system mistakes healthy cells for foreign invaders and attacks the body’s own tissues or organs. They are unique in that the diagnosis of one AD makes the individual more susceptible to developing other ADs, and the symptoms of one AD, influence the disease activity of the others. Disease activity may also be influenced by a mind-body connection due to the relationship between stress and the immune system. The purpose of this study was to provide empirical evidence to generate new knowledge and expand our understanding of how individuals diagnosed with multiple ADs are living well. The methodology of interpretive description guided analysis. Five women with their ages ranging from early twenties to late seventies who were diagnosed with two or more ADs participated. The participants’ experiences were illuminated through semi-structured interviews. Four major interconnected themes and 13 sub-themes emerged. They discussed their challenges and successes, their attitudes towards their illnesses, and how they managed living with multiple ADs. The knowledge of the importance of a holistic lens through which to view healthcare provides important insights for those working in physical or mental health settings.

Palestine has during the last two decades suffered from increasing water scarcity. This is particularlyvisible in the agricultural sector and in farming communities. These are heavily dependent on water as primaryirrigation source. Lack of water and investments has resulted in the destruction of the agricultural sector inPalestine. This thesis is focused as a case study in al-Auja, Jordan Valley that was once well-known for itsagricultural productivity and abundance of water resources. The aim of the thesis is to assess the socioeconomicand environmental impact of the water scarcity in Auja’s agriculture and livelihoods. The methods used arequalitative and the data was collected through field work in Auja in March – April, 2013. Results of the studyindicate that agricultural sector in Auja weakened due to lack of investments and technological innovation in achanging climate. The weakened agricultural sector was subjected to various shocks and stresses from late1980’s that ultimately led to an agricultural collapse, in 2003/4. Mass unemployment and food insecurityaffected the social sector; poorer nutritional intake, decreased school enrollment and the family composition.With little water, the environment changed from semi-arid to arid which eradicated various plant species andanimal habitat. Final results of the study indicate that the situation has gradually improved during the recentyears, much due to new investments in the area and higher education amongst Auja’s youth.