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This descriptive phenomenology had two purposes: first, to explore the experience of making decisions for women with advanced cancer; and second, to explore the experience for significant others and health care team members as women made their decisions. A plethora of research exists on making decisions during the cancer experience, including research regarding: 1) decision-making styles; 2) factors or determinants which play a role in decision making; 3) information: needs, seeking behaviours, and utilization; and 4) decision support technologies. However, a gap exists in the literature regarding the experience of making decisions. Conversational interviews were conducted with five women and three relevant others for each woman: her primary nurse, her oncologist, and one significant other. Women were also provided with the opportunity to journal in a diary or email their memories of decisions and the surrounding experience. Van Manens (1990) phenomenology guided the analysis of data. For the women, analysis centered on the four existentials of lived time, lived other, lived space, and lived body, revealing four themes of the lived experience of making decisions: 1) control, 2) influence, 3) normalcy, and 4) vulnerability. Phenomenological analysis on data from the significant others revealed three themes: 1) what used to be, 2) power shift, and 3) life on hold. Themes for the health care teams experience as women made decisions were: 1) emotional detachment, 2) discomfort, and 3) acquiescing. Understanding the perspectives from these lived experiences will assist the health care team to support women, and their significant others, through the experience of making decisions.

This descriptive phenomenology had two purposes: first, to explore the experience of making decisions for women with advanced cancer; and second, to explore the experience for significant others and health care team members as women made their decisions. A plethora of research exists on making decisions during the cancer experience, including research regarding: 1) decision-making styles; 2) factors or determinants which play a role in decision making; 3) information: needs, seeking behaviours, and utilization; and 4) decision support technologies. However, a gap exists in the literature regarding the experience of making decisions. Conversational interviews were conducted with five women and three relevant others for each woman: her primary nurse, her oncologist, and one significant other. Women were also provided with the opportunity to journal in a diary or email their memories of decisions and the surrounding experience. Van Manens (1990) phenomenology guided the analysis of data. For the women, analysis centered on the four existentials of lived time, lived other, lived space, and lived body, revealing four themes of the lived experience of making decisions: 1) control, 2) influence, 3) normalcy, and 4) vulnerability. Phenomenological analysis on data from the significant others revealed three themes: 1) what used to be, 2) power shift, and 3) life on hold. Themes for the health care teams experience as women made decisions were: 1) emotional detachment, 2) discomfort, and 3) acquiescing. Understanding the perspectives from these lived experiences will assist the health care team to support women, and their significant others, through the experience of making decisions.

Aim: To evaluate an audiologic rehabilitation program previously piloted in the U.S. (Kelly-Campbell, in review) for unaided hearing-impaired working adults that was also modified to include their significant others. <p> <p> Method: In this quasi-randomised repeated measures waitlist design, forty-eight participants (24 hearing-impaired adults and their 24 normal hearing significant others) aged 50-64 years were randomised into either a non-waitlist group (immediate treatment), or a waitlist group (treatment after 12-weeks). In these groups, participant couples attended three weekly 2-hour group sessions and completed health-related quality of life (HRQOL) assessments. Treatment outcomes for hearing-impaired adults (HIAs) were measured from self and significant other (SO) proxy reports of the Communication Profile for the Hearing Impaired (CPHI; Demorest & Erdman, 1986; 1987). Treatment outcomes for SOs were measured from self-reports of the Significant Other Scale for Hearing Disability (SOS-HEAR; Scarinci, Worrall & Hickson, 2009b). An investigation of the effect of treatment on the congruence of SO-proxy versus HIA HRQOL measures was also undertaken. <p> Results: A series of analyses of variance and repeated-measures t-tests examined HRQOL outcomes for HIAs and their SOs between pre-treatment, post-treatment, and at 12-weeks follow-up. Results suggest a significant effect of time for all HRQOL assessments, with gender effects found for CPHI measures, but not for SOS-HEAR measures. Medium to large effect sizes were revealed for both HIAs and their SOs. <p> Conclusions: Group AR appears to be a beneficial treatment approach for reducing the consequences of hearing impairment for HIAs and for their normal hearing SOs.

Brain injury affects nearly 1.5 million people in the United States every year and estimated that 124,000 of those affected will have some form of long-term disability. Impaired Self Awareness (ISA) has been identified as one of the largest obstacles to successful brain injury rehabilitation and adaption to living with a brain injury. Research on the relationship between the awareness of individuals with acquired brain injury (IwABI) and their significant others has been inconsistent. This study examined the role IwABI and their significant others perception concordance&mdashagreement concerning functioning&mdashhas on maintenance of rehabilitation gains at a follow-up date after completion of adolescent brain injury rehabilitation services. Contrary to the hypotheses, the data showed a strong correlation (.872, p&le.01) and significant relationship (t=35, p&le.001) between IwABI and their significant others Functional Area Outcomes Menu (FAOM) scores at follow-up. There was no relationship between functioning at discharge and perception concordance at follow-up or time post-discharge and perception concordance at follow-up. Several explanations for the findings are provided along with suggestions for future investigation of the research subject.

Background: Traditional psychosocial treatments have been adapted for use with individuals with bipolar affective disorders due to the limited prophylactic nature of pharmacotherapy and the recognition of the role of psychosocial factors in the course of this disorder. Psychosocial interventions that include a prodromal monitoring and management component have been empirically shown to be an effective adjunct to medication for the treatment of bipolar disorder. Aims: There is a deficit of quantitative research that examines the impact of individualrelated (e.g. age, self-efficacy), disorder-related (e.g. time since diagnosis, experience of prodromal symptoms) and treatment-related (e.g. level of psychosocial input) factors on individuals’ ability to manage this disorder via the use of prodromal monitoring. The current research aimed to investigate factors that are associated with the identification and management of prodromal symptoms. Method: Participants completed five self-report measures in order to provide information on their experience of prodromal symptoms, current mood state, general self-efficacy, view of social support from significant others, and demographic and clinical-related variables. The data were collected from 101 participants, 58 of whom were female. The sample consisted of individuals with a diagnosis of bipolar disorder type I and II. Results: Univariate and bivariate analyses were used to explore the relationship between individual, disorder, and treatment-related variables associated with participants’ experience of bipolar disorder. Variables that were significantly associated with participants’ perception of their ability to identify and manage prodromes were further investigated using ordinal logistic regression analyses. The results indicated that general self-efficacy and prodromal-specific help from significant others were associated with an increase in participants’ perception of their ability to identify manic and depressive prodromal symptoms. General self-efficacy was also associated with participants’ view of their ability to manage cognitive and behavioural prodromes. Experience of prodromal symptoms (e.g. consistency of symptoms experienced, type of prodrome experienced) was associated the participants’ perception of their ability to identify and manage prodromes. In general, disorder-related variables (e.g. time since diagnosis, mood state, diagnosis type, and number of episodes experienced) were not significantly associated with the participants’ view of their ability to identify and manage prodromal symptoms. Individual-related variables such as gender and age, however, were associated with prodromal identification. Conclusion: The results indicated the need to consider constructs such as general selfefficacy and experience of prodromal symptoms (e.g. consistency of symptoms, types of prodromes experienced, and ability to recognise prodromes when they first present) when helping patients to learn how to identify and manage prodromal symptoms. In addition gender differences and the role of help from significant others were highlighted as variables that should be considered when using prodromal monitoring approaches with patients with bipolar disorder. Limitations of the research are reviewed in relation to the methodology used. Clinical implications and directions for future research are considered.

The personality characteristic locus of control internality is widely-accepted as a trait possessed by women entrepreneurs. Recent research also suggests the presence of a coexisting attribute of similar strength, characterized as influence of a significant other. The presence of one personality characteristic implying perception of self-directed capability, together with indication of need for external assistance, poses a theoretical paradox. The study's purpose was to determine the nature and extent of direct and interactive effects which these and related variables had on entrepreneur return on investment. It was hypothesized that dimensions of significant other, as operationalized for this research, would support internality of locus of control and also modify constraining effects of educational and experiential disadvantage which the literature cites as pertinent to women entrepreneurs. This was nonexperimental, exploratory research of correlational cross-sectional design which examined hypothesized variable linkages. A convenience sample from a women's entrepreneur networking group was surveyed. Significant other elements were derived from factor analysis, resulting in four common dimensions. These factors, together with Rotter's Locus of Control instrument scores, reports on levels of education and experience, and hypothesized interactions, were independent variables. Hierarchial multiple regression was used to test a proposed path model. Two interpretable four-factor solutions derived from significant other variables were tested in two models. Although neither model attained overall significance, individual variables were directionally as hypothesized, and locus of control and certain factoral dimensions attained bivariate significance. Significant other factors appear to influence locus of control through statistical suppression as they interact with other variables. Results point toward a possibility that significant others who most affect female entrepreneur performance are those who give specific advice and aid, rather than moral support. Further research to explore what seems a strong relationship between return on investment and locus of control internality is recommended.

It is widely recognised that parents play an important role in children’s emotional and intellectual development, including their success at school. Recently, there has been a growing awareness of the potential of parents to support and enhance children’s English foreign language learning, especially since English learning resources are easily accessible through electronic media. In appreciation of this, there has been an increased interest in recent years in finding ways to harness parental potential through the creation of home-school partnerships in many parts of the world, including in the field of teaching English as an additional language. An important point of departure for developing effective home-school dialogues is an informed understanding of what parents are already doing to support their children’s learning, as an awareness of this can help schools and governments provide parents with targeted input to assist and improve their efforts. However, to date, this remains under researched. Of the limited research that has been undertaken, very little has examined parental efforts to support their children’s learning at home in non-western settings, and research into parental support for children’s foreign language learning is virtually non-existent. In order to address this research gap, the study reported in this thesis examines parental support for young children’s foreign language learning in Saudi Arabia with respect to English T.V. viewing. Drawing upon Vygotsky’s concepts of mediation and the ZPD, it aims to examine the extent and the ways in which parents currently mediate their children’s viewing of English T.V. programmes in Saudi Arabia, the factors which impact on their mediation practices, and how this is seen to contribute to their children’s experience of English language learning. The study is comprised two stages. The first stage entails the distribution of a questionnaire to 500 parents of children aged 6-8, who are currently learning English in a number of private schools in Jeddah, in Saudi Arabia in order to gain a global overview of parental perspectives on mediation. This is followed by stage 2, which aims to examine the features and quality of parent-child mediational dialogues. This is achieved by collecting recordings of the dialogues of two parent-child dyads watching DVDs of English T.V. programmes over a four-week period as well as interviewing parents and their children on the experience. The results of the study show that parents believe in the importance and value of supporting their children’s learning (both in general and with regard to their EFL learning). Moreover, they show that they are actively engaged in trying to do so. However, they also highlight a number of ways in which their mediational practices could be improved so that these are less directive and more responsive to their children’s learning needs and growing ability to self-regulate. More broadly, they highlight the need to engage with the complexity of parental mediation as an activity system in discussions of the quality of mediational practice. That is, to understand that parental efforts to mediate need to be considered alongside task, sociocultural setting and, most importantly, the child’s engagement with parental efforts. A number of implications are drawn from the results of the study. Chief among these is that research into parental mediation should look at the inter-relationship between the different elements of the parental mediational system identified and that this provides richer in-depth understandings of parental efforts to support their children than are currently available from those who seek to understand this merely as parental scaffolding. In addition, it is argued that the picture this in-depth analysis revealed provides valuable information which can be used to inform the need for home-school partnerships and the support parents need to make sure they engage in these effectively in settings such as Saudi Arabia where there is currently little appreciation of the importance of parental involvement and the concept of home school partnerships remains in its infancy. In line with the emphasis on the complex multidimensional understanding of mediation as activity as illustrated by the results of the study, it is argued that efforts to promote parental involvement should primarily focus on how parents can help promote quality learning experiences for their children.

Hearing impairment is the most common communication disability in older people. The wide-ranging impact of hearing impairment on communication means that not only does the person with hearing impairment experience the consequences but also his or her frequent communication partners. This thesis investigates the impact of hearing impairment on spouses and uses the World Health Organization’s term “third-party disability.” Third-party disability is defined as the impairments, activity limitations, and participation restrictions experienced by the family due to the health condition of their significant other, and was identified by the World Health Organization as an area for future development and application of the International Classification of Functioning, Disability and Health (ICF). Despite a number of studies previously published on the effect of hearing impairment on family members, including younger couples and carers, there remain substantial gaps in knowledge and understanding of the difficulties specifically relating to older people and factors associated with third-party hearing disability. This thesis focuses on the third-party disability experienced by normally hearing spouses (termed the “spouses” in this thesis) of older people with hearing impairment (termed the “partners” in this thesis). To add empirical data to the body of research, this series of studies first explored the lived experience of spouses of older people with hearing impairment in a qualitative study, then identified the ICF domains and categories that described third-party hearing disability, described the extent of third-party hearing disability in this population, modelled the contribution of factors to third-party hearing disability, and developed and psychometrically tested a scale to measure the third-party disability of spouses of older people with hearing impairment. Studies conducted within this thesis were therefore completed in two phases. Ten spouses of older people with hearing impairment participated in the first qualitative phase, consisting of semi-structured in-depth interviews. Results of this study showed that spouses experience a number of effects as a result of their partners’ hearing impairment including: (1) the broad ranging effects of the hearing impairment on the spouses’ everyday lives; (2) the spouses’ need to constantly adapt to their partners’ hearing impairment; (3) the effect of acceptance of the hearing impairment on the spouse; and (4) the impact of ageing and retirement. Findings were then linked to the ICF to identify the most typical and relevant domains and categories of the ICF for spouses of older people with hearing impairment. The majority of themes were able to be linked to the ICF, with most linking to codes in the activities and participation component. A number of contextual factors were also identified that influenced the spouses’ third-party disability. In the second phase, a further 100 older couples affected by hearing impairment participated in a quantitative face-to-face survey to describe the nature and degree of third-party disability in spouses, and to examine factors associated with third-party hearing disability. Concepts identified in the first qualitative study were used to formulate a 36-item tool for measuring spouses’ third-party hearing disability, namely the Significant Other Scale for Hearing Disability (SOS-HEAR). The majority of spouses in this study (98%) reported some degree of third-party hearing disability on at least one item of the SOS-HEAR. Communication difficulties between the couple were the central source of stress reported by spouses, followed by emotional problems in the spouse. Three factors were found to be significantly associated with greater third-party hearing disability: (1) lower relationship satisfaction as described by spouses; (2) a larger spouse-partner age difference; and (3) greater hearing disability in the hearing impaired partner as perceived by the spouse. The scaling properties of the SOS-HEAR were then examined, with a revised 27-item questionnaire found to be a reliable means of measuring older spouses’ third-party hearing disability. Use of the SOS-HEAR is proposed as a means of identifying spouses of older people with hearing impairment in need of intervention. If spouses are identified as experiencing third-party hearing disability, health professionals are then in a position to facilitate discussions with the couple about the impact of the hearing loss on their daily functioning. The inclusion of spouses in rehabilitation takes into account the needs of both members of the couple such that they become partners in rehabilitation. In summary, this research has shown that hearing impairment in older people has an effect on the spouse, as they too experience situations of communication activity limitations and participation restrictions. It is clear that the lives of participants in this study were considerably affected as a result of their partners’ hearing impairment, with spouses reporting a wide variety of stresses involving lifestyle changes, communication difficulties, and emotional consequences. This series of studies has highlighted the potentially important role of family-centred intervention in rehabilitation for older adults with hearing impairment, and strongly suggests the need for increased inclusion of spouses and significant others in the rehabilitation process.