In Ontario, the organs of deceased donors are usually allocated to those recipients who are ranked highest on the province’s waiting list for transplant surgery. However, on rare occasion, a donor, or the donor’s family, will request that an organ be given to a designated recipient or designated group of recipients. The ethical acceptability of these so-called “directed donations” of organs from deceased donors is debated in the transplant literature. The purpose of this study was to elicit the views of a group of transplant professionals in Ontario on the question, “Under what circumstances, if any, should a donor or the donor’s family be allowed to choose the recipient of the organ?” Qualitative in-depth interviews were conducted with 14 Ontario transplant professionals from a range of clinical disciplines. An analysis of these interviews revealed several practical and ethical considerations that the transplant professionals believed to be important in assessing the acceptability of directed donations.

While smoking prevalence among the general Canadian population has declined to 17%, declining rates have not been achieved equitably across all sub-populations (Statistics Canada, 2011). Smoking prevalence is particularly high among blue-collar workers, and individuals employed in the construction industry have the highest smoking prevalence (34%, Conference Board of Canada, 2013). Though studies have attempted to understand these disparities and how to combat them, research is necessary to understand the social contexts in which construction workers smoke. This study sought to understand these contexts by exploring experiences and meaning of smoking. Semi-structured, in-depth interviews were conducted with 14 construction workers living and working in Southern Ontario. Qualitative inductive analysis was conducted in three phases: (1) simultaneous data gathering and generating nodes, (2) coding and subgroup analysis, and (3) limited theory development. Grounded theory approach to analysis identified six main categories encompassing various subthemes. These included: day-to-day workplace experiences, experience of smoking, reasons for smoking, sociability of smoking, mechanisms associated with continued smoking, and experiences with quitting or cutting back. Sub-group analyses identified differences between participants depending on age, skill level (unskilled worker versus skilled tradesperson), and job sector (residential versus commercial/industrial). Social theories and concepts identified in the literature review were referred to, including the Social Contextual model by Sorensen and colleagues (2004). A potential set of contextual factors and modifying mechanisms that may be impacting construction worker’s tobacco use on or off jobsites are presented. The findings indicate that smoking is a complex issue among construction workers. For many, smoking goes hand-in-hand with working. Smoking is a social experience, and common on worksites. Workers experience various smoking policies on different jobsites. Policies may or may not be followed or enforced. Smoking has different meanings for different workers. However, factors external to the workplace must also be considered (e.g. partner smoking status). Supports that could be offered in workplace contexts include incentives, coverage of quitting aids, and limiting smoking (e.g. smoke-free policy). These findings have implications for policy and practice. Further research, including collaborative intervention development, is necessary to address high and persistent rates of tobacco use among construction workers.

Friendship matters. Practical support, caring, moral guidance, enjoyment, improved health and greater life expectancy are but a few of its benefits. Despite living in a stigmatizing social environment where isolation is common among disabled youth, some disabled teens establish strong friendships. A nuanced understanding of these meaningful friendships from the perspective of disabled teens was constructed through this qualitative study. Teens aged 15 to 20 who self-identified as experiencing stigma due to disability were recruited from urban, suburban and rural areas of Nova Scotia, Canada. Each teen was involved in a friendship of at least six months’ duration and had a close friend (with or without a disability) who was also willing to participate. Seven boys and seven girls, all but one of whom were disabled teens, took part in the study. These seven sets of friends engaged in research interviews and participant observation sessions. Nine adults who witnessed the friendships develop over time were also interviewed. Preliminary coding was completed using Atlas.ti. This was followed by a deeper, critical approach to analysis which generated three inter-connected themes. The first theme outlines how stigma disrupts the friendships of disabled youth though a range of processes (labeling, stereotyping, status loss, separation) that arise from and contribute to ableism – discrimination against disabled people. The second theme, finding a balance between adult support and surveillance, emphasizes the crucial role adults play in facilitating the friendships of disabled youth. The final theme, disrupting oppression to create enduring friendship, highlights the strategies used by these disabled teens to make and keep friends in a stigmatizing society. Strategies most often used that appeared to be effective for participants were disrupting norms about friendship, coming out as disabled, connecting through stigma, and choosing self-exclusion. Two strategies – horizontal hostility and passing as nondisabled – were potentially harmful to disabled youth and in some ways limited friendship opportunities. Ideas to counter the harmful effects of ableism while creating lasting friendships are addressed to disabled teens, to their families, to allies in the education system, and to the broader community.

This thesis investigates how capacity development techniques, including training and group formation, can be leveraged to aid in new livelihood development for women living in rural areas who lack the resources necessary for agricultural livelihoods: lack arable land, labour, and capital. This study is situated as a case in an agroforestry development project. The study used multiple qualitative methods to identify how these micro-livestock rearing activities contributed to women’s practical and strategic needs. Key informant interviews (n=5); in-depth interviews, including ranking and scoring exercises, with beneficiaries (n=16); and participant observation all contributed to an in-depth understanding of the relevant phenomena. Interviews were coded and analyzed for key themes that emerged. The study focuses on how micro-livestock as a development intervention may contribute to increased capacities of women in the communities. The conclusions emphasize the importance of fostering knowledge exchange amongst beneficiaries for the maximization of tangible and intangible benefits.

The present study assessed participants’ motivations for misusing insulin using phenomenological analysis and risk theory. Eleven women with type 1 diabetes were interviewed and asked to discuss body image, their experiences with adjusting to type 1 diabetes, and their particular insulin misuse behaviour. Nine women misused insulin for body image and weight concerns, as a result of diabetes burnout, or a combination of these factors. The majority of participants had poor body image at the time of insulin misuse, and reported feeling more confident following weight loss related to misusing insulin. The opinions of family, friends, and health care providers were, generally, not influential on the women’s self-care behaviour. The perceived benefits of insulin misuse (i.e. weight loss and improved body image) were deemed more important than both short-term and long-term health. Participants in this study did not consider themselves to be at risk of developing diabetes-related complications in the short-term, and this belief appeared to foster their continued insulin misuse. There is a need for health care providers to recognize the signs of insulin misuse behaviour and offer resources where available. / Ministry of Health and Long-Term Care as supporter of the Ontario Women's Health Scholar Award

Emerging conversations within oncology have drawn more attention to cancer among young adults (ages 18-45). Recent research has illuminated many of the psychosocial difficulties young adults face as they go through the many trials and tribulations of chronic illness. However, a subject still understudied, much is unclear about the personal as well as the cultural implications of being diagnosed during this period of time. In a book of cancer stories, performer and young adult cancer patient Kairol Rosenthal (2009) expressed her frustration with what she saw as “stereotypes” promulgated by the limited public discourses that exist on the subject (p. 7). She sought to counterbalance these representations with stories capturing the “complexities of our real daily lives” (p. 7). Indeed, in oncological discourses young adults tend to be cast in oversimplified terms, based upon cultural expectations about what young adulthood should be and pressures to conform to those standards. Intersecting with dominant discourses within narrative identity development, two imperatives are placed upon young adults’ stories: integration of different life experiences and selves into a coherent narrative and developing a sense of self-authorship in the direction of one’s life. What seems to be lost in these imperatives within the existing research is what is at stake for individual lives (a phenomenological perspective) and how those stakes are negotiated or contested with hegemonic trajectories of life (a critical perspective). Receptive to Rosenthal’s critique of dominant discourses around cancer and young adulthood, the purpose of this thesis was to explore the complexity and diversity of young adults living with cancer. More specifically, I intended to interrogate some of their existential and biographical challenges as expressed in their narratives of cancer, as well as their engagements with ideological constructions of young adulthood, namely, the expectations of narrative coherence and self-authorship. This research marked a departure from most studies on the subject in its qualitative methodology (i.e., narrative analysis) and in its explicit evaluation of the effects of cultural discourses on young adults’ attempts to make meaning. More generally, this research shows the importance of language—in discourses, narratives, and metaphors—in constructing and communicating illness experiences. For this project, I gathered a mix of written and oral narratives (through semi-structured interviews) from 21 participants from across Canada. The foci of analyses were on what could be called narrative ‘moments of meaning’ and ‘moments of being,’ that is, situated expressions of how they made sense of their worlds and themselves. Many of these were critical moments in the sense of questioning and resisting dominant discourses of cancer and young adulthood. Their moments of meaning often expressed negotiation of personal desires and innovative intentions with familiar cultural narratives or “prototypical plots” (Good, 1994)—including stories of battling cancer, embarking on a life journey, nearing recovery, encountering unpredictability and mystery, and living with chaos. These moments of meaning served an array of purposes well beyond the expected function of constructing a coherent narrative. When telling of identity disruptions and the liminality of cancer, participants produced both more orderly moments of being (e.g., survivor, patient, or warrior identities) and more liminal moments of non-being (e.g., victim, phoenix, or trickster identities). Self-authorship seemed to be present among the former, while the latter expressed less control and certainty of being—which was not always seen as a problem. These moments of being and non-being were collaborated and contested within the intersubjective spaces of their clinical relationships, local worlds, and cancer patient communities. More specific to their age group, their moments of being and non-being often related to what may be understood as developmental identities, including the ‘traditional milestones’ such as individual autonomy, family (i.e., marriage and parenthood), and vocation (i.e., getting an education and building a career). In their struggles they sometimes reaffirmed these cultural ideals toward identity integration and other times resisted them as “normalizing ideologies” (Becker, 1997) of young adulthood. As part of these larger negotiations of meaning and being, the participants expressed struggles to understand the moral significance of their illnesses. Confronted with what may be called “causal ontologies” of suffering (Shweder, 1997), they spoke of different etiological models of cancer’s origins as well as reconciliatory models for living with cancer in the future. Their narratives sometimes led toward “remoralization” (Kleinman, 1988)—couching experiences of suffering in terms of a moral order (narrative coherence) and personal responsibility (self-authorship)—and sometimes led away from it, depending on whether they believed their illnesses originated from events in their personal and social lives. Overall, the participants in this study communicated complex and potentially chronic existential challenges. In many ways their narratives resisted dominant representations of young adults with cancer—and of cancer patients in general—suggesting that such representations need to be rethought. Their critical moments of meaning and being may serve as counternarratives to the stereotypes of concern to Rosenthal and many other cancer patients. Specifically, their narratives revealed the merits and limits of the ideological construction of young adulthood as a time of narrative coherence and self-authorship. This study has important implications for future health research and psychosocial support in the field of oncology; building upon a “narrative medicine” (Charon, 2006), sensitivity to how language is used among young adult cancer patients may lead toward more inclusive clinical practices.

Abstract Background. Physical therapists report inconsistent use of valid and reliable measures of walking post-stroke. Objective. To describe the methods physical therapists use to evaluate walking, reasons for selecting these methods, and the use of the evaluation results in clinical practice along the continuum of an organized system of stroke care. Methods. A qualitative descriptive study involving semi-structured telephone interviews of physical therapists in Ontario was conducted. A thematic analysis was performed. Results. Participants (n=28) used both standardized and non-standardized methods to assess walking. A hierarchy of factors influencing use of both methods was observed. Assessment results were commonly used for communication with other healthcare professionals or education of the patient. Conclusions. A variety of factors influence physical therapists to use standardized assessment tools. Future knowledge translation interventions should focus on these factors to improve the standardized assessment of walking post-stroke.

As a contraceptive technology, women’s sterilization is a medical event that is uniquely situated in relation to the dominant discursive link between women and reproduction. Intended as a contraceptive option that permanently ends a woman’s potential ability to sexually reproduce, women’s sterilization presents a significant point for exploring the discursive formation of femininity, and how the concepts thereof relate to broader questions of access, control, and regulation of sterilization and the female sterilization patient. This study uses a Foucauldian feminist theory of discourse to explore such questions in a qualitative discourse analysis of women’s sterilization, from both a historical perspective and from within contemporary medical texts. Sterilization has had a particularly tumultuous history in the provision of reproductive healthcare for women; situated within public health and welfare discourse that differentiates the “unfit” from the “fit” reproducers, women have been forcibly sterilized under classist and racist eugenic programs, while subtle yet coercive forms of sterilization abuse continue to occur as inequality of reproductive healthcare access is an ongoing issue for immigrant women, poor women, and women of colour. In light of this historical analysis, as well as the impact of feminist and bioethics discourse upon contemporary medical practice, an analysis of medical texts further explores the association of women with reproduction in the discursive form of the sterilization patient. This study argues that the sterilization patient is situated within a discourse of ideal femininity, associated with normalized forms of mothering, sexuality, and family structure. Given the historical link between the discursive “fit” reproducer, these concepts have continued implications for women’s experience of accessing sterilization as a contraceptive option. / Thesis (Master, Sociology) -- Queen's University, 2007-07-17 17:09:15.595

Purpose: This thesis focuses on the development of occupational therapy competencies to enable executive occupational performance with school-aged children and youth. Methods: Three studies were structured according to the knowledge inquiry, synthesis, and product stages of the Knowledge To Action cycle (Graham et al., 2006). A scoping review in Phase One explored how executive functioning is described in the occupational therapy literature. In Phase Two, a qualitative study was conducted to determine how occupational therapists who have worked with children and youth perceive executive functioning to be understood and addressed. Phase Three used established competency development processes to produce an occupational therapy competency model and framework for enabling executive occupational performance. Results: Although there is little consensus on how executive functioning is understood, literature reviewed in Phase One demonstrated its pervasive effect on performance of complex, novel, and goal-directed occupations. Emerging themes suggest that assessment requires occupational, dynamic, and performance-based approaches, with interventions rooted in metacognitive frameworks. The Phase Two qualitative study suggested that, although there are challenges to being able to “see” executive functioning, it is necessary to explicitly and systematically consider executive functioning during clinical reasoning. Learning to “see” through the executive functioning lens is a complex process. The competency framework development process utilized in Phase Three yielded the Competencies in Context Model. Responding to series of contextual challenges related to system, client, and occupational therapist factors, professional assessment, intervention, iii knowledge acquisition, and knowledge translation competencies are used to organize 16 specific occupational therapy practice competencies. Conclusion: Points of tension within the literature and the field have implications for occupational therapy curricula, research, practice, and professional development. Executive functioning issues have wide reaching effects on occupational performance of children and youth that have not been adequately recognized or explored in the occupational therapy literature. The competency model and framework developed through this research make a substantive contribution to the field in beginning to redress the dearth of occupational therapy-specific models, resources, and tools designed to support occupational therapists’ acquisition or implementation of the executive functioning perspective. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2012-08-26 22:27:09.05

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