Health policy making is fraught with difficult decisions that result from conflicts between people’s values. Citizens are important stakeholders in this process, and it is through methods of public engagement that they can be involved in developing health policy. Deliberative forms, in particular, have the ability to improve decision quality and promote greater acceptance of decisions. This study used the Toronto Health Policy Citizens Council to examine citizens’ values on 7 specific health policy questions asked over a two-year period. A thematic analysis was performed on the transcript content derived from the audiotaped deliberations from Council meetings. Nineteen values were identified. The results suggest that it may be a combination of factors of the health policy topic discussed that shapes the values elicitation seen in this kind of public engagement. In conclusion, citizens councils appear effective at eliciting citizens’ values, and are a good way to actively educate participants about health care.

Background: Tuberculosis (TB) and human-immunodeficiency virus (HIV) infections are intertwined through complex biological and social pathways that affect over one million people worldwide. Mitigation of the co-epidemic is undermined by a failure to integrate TB and HIV healthcare services as a result of critical clinical, operational and social challenges. The social challenges of TB/HIV coinfection and integrated care are least understood. Objectives: This research examines the social contexts of TB/HIV illness and related healthcare from the perspective of patients coinfected with TB and HIV. Methods: The study was set within a constructivist-interpretivist theoretical framework. Non-participant field observations and semi-structured in-depth interviews were held with 40 coinfected adults (24 women, 16 men) and 8 healthcare workers at 3 ambulatory clinics in KwaZulu-Natal, South Africa, providing varying models of TB and HIV care. Subjective meanings of illness and healthcare were analyzed in relation to patients’ social contexts. Findings and Interpretations: Coinfection exposes patients to a double and unequal form of social stigma around TB and HIV. Affected individuals construct dual identities and negotiate selective disclosure of TB over HIV in order to manage this double stigma. Their experiences with stigma are bound by social, structural and gendered inequalities, and mediate their decisions to disclose, access and adhere to medical care. Coinfection also exposes patients to pluralistic, disparate and fragmented forms of healthcare delivery. Experiences with stigma and with distinct cultures of TB and HIV care affect their decisions for integrated healthcare. While integration may allow for some technical and clinical efficiency, it may also heighten some patients’ social burden of illness as a result of HIV disclosure and stigmatization. Conclusion: Integration efforts should consider the social contexts of TB/HIV coinfection, social consequences of patients’ health decisions, and paradigms within which such efforts are set in the design and execution of successful interventions.

Background: Tuberculosis (TB) and human-immunodeficiency virus (HIV) infections are intertwined through complex biological and social pathways that affect over one million people worldwide. Mitigation of the co-epidemic is undermined by a failure to integrate TB and HIV healthcare services as a result of critical clinical, operational and social challenges. The social challenges of TB/HIV coinfection and integrated care are least understood. Objectives: This research examines the social contexts of TB/HIV illness and related healthcare from the perspective of patients coinfected with TB and HIV. Methods: The study was set within a constructivist-interpretivist theoretical framework. Non-participant field observations and semi-structured in-depth interviews were held with 40 coinfected adults (24 women, 16 men) and 8 healthcare workers at 3 ambulatory clinics in KwaZulu-Natal, South Africa, providing varying models of TB and HIV care. Subjective meanings of illness and healthcare were analyzed in relation to patients’ social contexts. Findings and Interpretations: Coinfection exposes patients to a double and unequal form of social stigma around TB and HIV. Affected individuals construct dual identities and negotiate selective disclosure of TB over HIV in order to manage this double stigma. Their experiences with stigma are bound by social, structural and gendered inequalities, and mediate their decisions to disclose, access and adhere to medical care. Coinfection also exposes patients to pluralistic, disparate and fragmented forms of healthcare delivery. Experiences with stigma and with distinct cultures of TB and HIV care affect their decisions for integrated healthcare. While integration may allow for some technical and clinical efficiency, it may also heighten some patients’ social burden of illness as a result of HIV disclosure and stigmatization. Conclusion: Integration efforts should consider the social contexts of TB/HIV coinfection, social consequences of patients’ health decisions, and paradigms within which such efforts are set in the design and execution of successful interventions.

This dissertation presents three separate studies investigating elementary school personnel's perceptions of and recommendations for managing child obesity. First, a systematic literature review will be presented with an assessment of the very limited current body of literature related to elementary school personnel's perceptions of child obesity to determine the direction of the second and third studies. The systematic review presents personnel's perspectives of (1) the extent of child obesity, (2) contributing factors of child obesity, (3) solutions for child obesity, and (4) barriers to overcoming child obesity. Second, drawing upon the systematic review, a qualitative investigation of elementary school personnel's perceptions of and recommendations for managing child obesity will be presented. Utilizing an emergent design, data collection comprised one-on-one interviews with 31 elementary school personnel. A thematic analysis was employed on raw data and a socioecological model was utilized to explain emergent themes. Participating school personnel identified the home environment and parental factors as the leading factors contributing to child obesity. Personnel also emphasized child control of dietary and physical activity choices, most notably within the home environment. Third, a qualitative case study examining an elementary physical education (P.E.) teacher's perspectives of the impact of obesity on her obese students' experiences in her classroom will be presented. A narrative framework was employed, utilizing both thematic and structural analyses to examine the narratives elicited during the interview. The thematic analysis illuminated a participation refusal pattern of obese students within this P.E. teacher's classroom. The structural analysis highlighted the participating P.E. teacher's customized intervention for her obese students' participation refusals. The combination of thematic and structural methodologies resulted in a preliminary model of the behavioral impact of obesity in this P.E. classroom, which provided a more holistic view than either method alone. Prior to this study, just seven studies had investigated elementary school personnel's perceptions of and recommendations for managing child obesity; only three of which were published in the past decade. Thus, this study is both timely and desperately needed. The valuable insights gained from participating elementary school personnel in this study provide a justification for their inclusion in future studies addressing child obesity.

Despite widespread health promotion and nutrition education efforts, gaps between official healthy eating messages and people’s actual eating practices persist. There is increasing recognition that emphasizing individual responsibility for eating may have limited applicability in improving people’s health. Many experts advocate that future research on healthy eating should involve exploration of how food practices are shaped by social structures (or determinants) and individual agency. The purpose of this study was to explore the ways in which people engage with food structures to construct everyday notions of healthy eating. ‘Food structures’ draws on the concept of ‘structure,’ described by the social theorist Anthony Giddens, to refer to the range of food rules and resources people draw on. The research was conducted as part of a qualitative study on family food decision-making that included 144 participants from 13 African Nova Scotian, 10 European Nova Scotian, 12 Punjabi British Columbian and 11 European British Columbian families. These groups were chosen for their potential differences in perspectives based on place, ethnocultural background and histories of immigration to Canada. Data collection consisted of individual interviews with three or more family members aged 13 and older, and, with each family, observation of a grocery shopping trip and a family meal. Analysis followed common qualitative procedures including coding, memoing and thematic analysis. Together, the analyses support views that the gaps between official healthy eating messages and people’s eating practices may not be closed by further education about how to eat. Drawing on the theoretical concepts of Anthony Giddens and Michael Foucault, the findings suggest that one way to understand why people eat the way they do and how changes in eating habits occur is to think about the constant exposure to change through everyday, taken-for-granted practices. The findings also suggest that further healthy eating discourses may require more reflection with respect to the roles of nutrition educators and the social roles/autonomy of people in goals for health and well-being. Dietary goals for the population cannot be considered as isolated scientific objectives without taking into consideration how healthy eating discourses provide social standards beyond messages about healthy eating.

No description available.

The discovery that it is possible to identify an individual before the onset of first episode psychosis and that treatment may prevent or delay onset have led to a proliferation of early intervention clinics designed to intervene before symptoms of psychosis have fully appeared. Early intervention has generated considerable debate, given the risks associated with intervening and that the majority of those identified will never develop full-blown psychosis. Despite potential stigmatizing effects, little is known about young people’s views regarding the favourable and/or adverse consequences of early intervention. This research examines the experiences and meaning of illness in young people identified as being at ultra high risk for psychosis and participating in a psychological intervention program. Specifically, the study uses photo elicitation to explore how participants construct and interpret their experiences, and the impact an at risk label has on their sense of self, identity, and social relationships. Five young people were invited to photograph their daily experiences at home, at school, and in the community. The participants and I then analyzed the photographs together in a photo elicitation interview. I further analyzed the visual and textual data from an interactionist perspective, exploring the concept of stigma and its relationship to young people’s experiences. Visual and narrative data revealed that young people reject their at risk status and redefine their experiences to fit with more acceptable and familiar notions of health. Participants are conscious of the stigma associated with psychosis and actively undertake strategies of resistance to avoid stigmatization and uphold a normal self conception and social impression. Photo elicitation provided insight and understanding into the experiences of young people at risk for psychosis that were not available through more traditional methods. The results from this study support the call for a reconsideration of the psychosis risk paradigm. There is a need to increase awareness about the power of diagnostic information and the labeling process. Non-specialized settings such as schools and community health centres may offer more appropriate environments for mental health monitoring and intervention.

The discovery that it is possible to identify an individual before the onset of first episode psychosis and that treatment may prevent or delay onset have led to a proliferation of early intervention clinics designed to intervene before symptoms of psychosis have fully appeared. Early intervention has generated considerable debate, given the risks associated with intervening and that the majority of those identified will never develop full-blown psychosis. Despite potential stigmatizing effects, little is known about young people’s views regarding the favourable and/or adverse consequences of early intervention. This research examines the experiences and meaning of illness in young people identified as being at ultra high risk for psychosis and participating in a psychological intervention program. Specifically, the study uses photo elicitation to explore how participants construct and interpret their experiences, and the impact an at risk label has on their sense of self, identity, and social relationships. Five young people were invited to photograph their daily experiences at home, at school, and in the community. The participants and I then analyzed the photographs together in a photo elicitation interview. I further analyzed the visual and textual data from an interactionist perspective, exploring the concept of stigma and its relationship to young people’s experiences. Visual and narrative data revealed that young people reject their at risk status and redefine their experiences to fit with more acceptable and familiar notions of health. Participants are conscious of the stigma associated with psychosis and actively undertake strategies of resistance to avoid stigmatization and uphold a normal self conception and social impression. Photo elicitation provided insight and understanding into the experiences of young people at risk for psychosis that were not available through more traditional methods. The results from this study support the call for a reconsideration of the psychosis risk paradigm. There is a need to increase awareness about the power of diagnostic information and the labeling process. Non-specialized settings such as schools and community health centres may offer more appropriate environments for mental health monitoring and intervention.

This dissertation examines the origins, applications, and functions of visual effects in the historical documentary film. This research study investigates how aesthetic and editorial practices and tools are used for different image forms and as part of the visual presentation. A research design that implements qualitative interviews, visual analysis, and focus groups was incorporated to examine visual effects and images at three specific sites. The pan-and-zoom effect and its variants as well as select titles from the filmography of Ken Burns were used as case studies for this dissertation. The findings from the analyses suggest that visual effects for still image forms and the repetition of these applications and strategies are significant to the content depicted in images, the scope of the visual presentation, and the capacity for audiences to connect to historical information in the film.

This autoethnographic study focuses on changing identity after experiencing a rare disease. The purpose of this study was to examine the ways in which identity shifts during an after a rare illness. Three research questions guided this study: How and in what ways has my identity as a teacher shifted as a result of my experience with major illness? How and in what ways have other aspects of my identity shifted as a result of my illness? How can the writing of my autoethnography influence the healing process and my understanding of identity? The participant/researcher of this study was hospitalized with anti-NMDA receptor encephalitis, and subsequently lost her position as a high school teacher and was forced to find a position at a new school. Using Gee’s (2000/2001) concept of identity as an analytic lens, the researcher developed a narrative of her journey from illness back into the classroom. After analysis, she identified a transition from a traditional, knowledge-giver teacher role to the role of teacher as a facilitator. Another finding was the role confidence played in the recovery process. The researcher then offers suggestions for further research regarding teachers who return to the classroom after illness.