published_or_final_version / Speech and Hearing Sciences / Master / Master of Philosophy

Introduction Rheumatic disease is an autoimmune disorder with an unpredictable course of exacerbation and remission. There is no known cure for the disease at the moment. The patients’ conditions may progressively deteriorate despite intensive therapies, and runs an erratic course with the possibility of disfiguration and alteration in body image. Pain, disabilities and psychological distress are common. Rheumatic patients may respond differently to the same level of pain and physical symptoms. The understanding of the needs of rheumatic patients and how they successfully manage the disease and optimize psychological adjustment can help develop effective psychosocial interventions. Aims The aims of the study are (1) to identify the needs of rheumatic patients and perceptions of their disease, (2) to develop a conceptual framework for psychological adjustment, and (3) to identify factors associated with resilience in rheumatic patients. Methods The present study consisted of two phases. The first phase was a focus group interview, aiming to understand the patients’ feelings and to design a questionnaire. The second phase was a prospective questionnaire survey that includes a baseline study and a six-month follow-up study. Patients were recruited from support groups in Hong Kong. The baseline questionnaire was self-administrated, and the follow-up questionnaire was administrated by telephone interview. The self-regulation model was chosen as the basis for the conceptual framework for psychological adjustment. The questionnaire included demographics, illness representation, coping efforts, appraisal of coping efforts, sense of coherence, quality of care, functional disability, and health-related quality of life. The outcome measures were functional and psychological health, change in adjustment, and positive and negative resilience. Results Having a good and caring doctor, more information on the disease, and public understanding of the disease were the needs of rheumatic patients. The patients perceived that the disease was chronic, cyclical, and had poor consequences. They perceived that the disease caused great pain, stress, depression and anxiety, and affected their daily activities, appearance, and relationship with family and friends. Poor adjustment was associated with chronic and cyclical timeline, and poor perception of personal and treatment control. The analysis of resilience shows that positive perception of treatment control and disease consequence, correct understanding of disease causes, and high sense of own value and importance to the society, were protective. While those who lacked family support and blamed themselves or their families to be the cause of disease, were vulnerable. Discussion and conclusions The present study lends support to the validity of self-regulation model in psychological adjustment to disease, but coping efforts could only partially mediate the relationship of illness representation to appraisal of coping efforts, implying that the coping style might not sufficiently capture the underlying differences in individual coping styles. An effective psychosocial intervention can be developed based on the factors associated with better adjustment and resilience, and targeted at non-working older patients with rheumatoid arthritis. Last but not least, support from the community, and public understanding of the disease are important for rheumatic patients. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

No description available.

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Public Administration / Master / Master of Public Administration

No description available.

No description available.

No description available.

The purpose of this study was to better understand the self-care practices of female peer support specialists (PSS) with co-occurring mood and substance use disorders. The researcher took a qualitative grounded theory approach conducting in-depth semi-structured interviews with ten women employed at peer-run agencies in Maricopa County, Arizona. Data from these interviews were transcribed, then analyzed manually, as well as with NVivo 10.0 software, to identify the key terms, nodes, categories and emergent themes of the participants' experiences. Self-care practices of peer support specialists included accessing personal and professional support networks; maintaining a daily routine to balance the demands of recovery, parenting, and working; taking medications; sleeping; practicing spirituality; participating in service work; eating nutritiously; exercising, and building a sense of coherence. Although a variety of practices were being used and identified as helpful, spirituality was identified as the most important self-care practice to achieve overall wellness. Employment improved the ability for PSSs to practice self-care because they valued the support of their supervisors and coworkers, were reminded of the consequences of not practicing self-care by working with individuals who were unstable, gained knowledge from teaching others, found healing in telling their stories, and reported higher self-esteems from working and helping others. However, participants did identify ways that employment as a PSS could interfere with practicing self-care, such as staff turnover, limited access to supervisors, or being unprepared to work in the field. Several recommendations were suggested as a result of this study, such as the importance of understanding and using effective self-care practices, building personal and professional support networks, and establishing daily routines to balance recovery with personal and professional demands.

There are limited tools available for clinicians to affordably and objectively assess balance control to prescribe treatments and measure progress post-stroke. The objectives of this thesis were to: 1) develop a toolkit to quantitatively measure dynamic balance control and determine the repeatability of outcomes within and between-sessions in healthy adults; and 2) determine the repeatability of the tasks and the association between outcomes of an advanced clinical model of care in a post-stroke population. In study 1 a wireless balance assessment toolkit was developed using a grid of four Nintendo Wii Balance boards and custom software and repeatability of the outcomes were established in healthy adults. Study 2 revealed the measures to be repeatable in a sub-acute stroke population while further evidence is required to validate the toolkit, as it did not associate with outcomes from an advanced clinical model of care.