The purpose of this study is to qualitatively explore how physical activity engagement is initiated and maintained in adult patients with congenital heart disease (ACHD). The rising number of aging ACHD patients means they could need more healthcare resources for lifelong treatments to maintain their health. One cost-efficient and natural way to maintain the health of ACHD patients is through physical activity participation. Unfortunately, though, ACHD patients tend to be sedentary, and research has yet to adequately explore the factors influencing physical activity behaviour within this population. To gain a better understanding on this topic, this study combines the transtheoretical model and social ecological model to uncover factors influencing physical activity behaviour in ACHD patients who are at different levels of motivation. This study utilizes a qualitative research design: over six months, 27 participants took part in three individual semi-structured interviews for a total of 78 interviews (three participants did not complete all three interviews). The study revealed that several factors influenced physical activity behaviour in ACHD patients at different stages of motivation. In addition, findings on the characteristics of participants in each stage, meanings of physical activity and strategies for promoting physical activity for ACHD patients are also presented, as well as practical findings (i.e., physical activity program for ACHD patients). This thesis is important for healthcare professionals as it could facilitate the development of stage-specific interventions designed to increase physical activity behaviour in ACHD patients.

A thesis submitted to the Faculty of Education in fulfilment of the requirements for the Degree of Doctor of Education in the Department of Educational Psychology and Special Education at the University of Zululand, 2018 / This study investigated the resilience among Orphans and Vulnerable Children (OVC) in KwaZulu-Natal schools. It identified OVC challenges and developed a psychosocial model of intervention. The Social Ecological Model was adopted as a framework for the study. The study adopted the mixed method research design. The population for the study was the OVC, caregivers and teachers from Kwazulu-Natal schools, specifically Amajuba and Zululand Districts. Random selection was done for OVC from mainstream schools. Purposive sampling method was used to select OVC from special schools, schools near the orphanage, home of safety and a Full Service school. The sample which participated during quantitative data collection consisted of 303 OVC from 12 to 20 years old who were selected from 7 school in Amajuba and Zululand Districts.The sample which participated in qualitative data collection consisted of 4 focus groups and those were 6 caregivers, 6 teachers and 12 OVC. OVC were selected from 303 OVC who filled the questionnaires and CYRM-28. This made a total of 24 participants for focus groups. The total of participants for the whole study was 315. Three instruments were used to collect data for this study, namely; the Child and Youth Resilience Scale-28 (CYRM-28), the self-constructed psychosocial questionnaire and the interview schedule. The CYRM-28 was used to measure the extent of OVC resilience with the self-constructed questionnaire. Both descriptive and inferential statistics were used to analyse data. Frequencies were created for descriptive data and the Chi-Square statistical technique was used to test the null hypothesis. Then the thematic content analysis was used to identify themes from the focus group interviews. The results of descriptive statistics indicated that 79% of all participants reported high availability of resources that enabled resilience. Fewer resources were reported for children who had experienced abuse, followed by those with disabilities and more resources were reported for orphans. The main challenges of OVC identified were lack of support from teachers and neighbours/ communities. Other challenges included maltreatment by caregiver, OVC behavioural problems, unavailability of documents for social grant applications. Child Headed Household was identified as lacking all resources. The findings of inferential statistics indicated that there is a significant relationship between the age, gender and custody of OVC and their availability of resources. OVC and caregivers encountered various problems which were risk factors for the resilience of OVC. Availability of resources to a majority of OVC who participated in the study was a protective factor. Participants recommended that more resources which promote resilience of OVC be made available to communities, for examples, old age homes, and entrepreneurship skills, continuous counselling services for caregivers and OVC and recreational facilities for communities. Lastly, the psychosocial model of intervention was developed based on the literature and findings of the study. / Natonal Research Foundation National Institute for Humanities and Social Sciences (NIHSS)

Health-related quality of life (HRQOL) is a comprehensive construct including physical and psychosocial health functioning. Despite significant health benefits of regular physical activity (PA), over 40% of female college students do not meet recommended PA guidelines to improve their health. This study investigated the influences of individual, social, and physical environmental factors on students’ PA and HRQOL. Participants were 235 female university students who completed validated surveys assessing their perceptions of PA, HRQOL, and social ecological factors. Three hierarchical regressions revealed individual and physical environmental factors as predictors of PA and HRQOL. These findings indicated health professionals need to consider students’ individual factors and physical environmental factors to promote female students’ PA and HRQOL.

Sports-related concussions are a growing public health concern affecting numerous varsity football student-athletes. This study used the social ecological model to identify intrapersonal, interpersonal, and environmental factors. The purpose of this study is to identify constraints and facilitators in academic and athletic settings for varsity football student-athletes with a sport-related concussion. Twelve current varsity football student-athletes from one institution who suffered a sport-related concussion took part in semi-structured interviews. Data were thematically analyzed. Results indicate that varsity football student-athletes with a sport-related concussion perceived numerous constraining and facilitating social ecological factors in the academic and athletic settings. Intrapersonal constraints revolved around loss of motivation, loss of social identification, stress, anxiety and depression, injury-specific issues (i.e. difficulty thinking clearly, remembering, drowsiness), internal pressure to return, while intrapersonal facilitators included prior experiences of enjoyment in academic and athletic activities, seeing improvements in the recovery process, and not giving up. Interpersonal constraints related to insufficient social support, lack of awareness and guidance on concussion knowledge, external pressure to return, and lack of academic support post-concussion, while interpersonal facilitators included passionate therapy staff, and sport psychologist. Environmental constraints pertained to return-to-play and return-to-learn protocols, while environmental facilitators included having access to concussion-based resources. Findings suggest that there remains a need to address constraining and facilitating factors in the academic and athletic settings for varsity football student-athletes with a sport-related concussion

Social ecological models are recognized for allowing researchers to examine the influence of multiple factors on behaviour, yet to date relatively little research has simultaneously examined the role of personal, social, and environmental factors on youths’ physical activity, while giving consideration to the role of different types of neighbourhoods. The current study examined the physical activity of 804 youth aged 10 to 16 years residing in urban high density, suburban, or suburban low density neighbourhoods, by exploring relationships between several personal, social, and environmental factors. Findings revealed that all three factors were significant in explaining youths’ physical activity. Differences in participation were found based on gender and neighbourhood; males and youth from suburban low density neighbourhoods were significantly more physically active. Moreover, several variables were found to be important for understanding youth physical activity: sex, age, self-efficacy, encouragement, neighbourhood safety, and the use of a number of neighbourhood facilities.

Social ecological models are recognized for allowing researchers to examine the influence of multiple factors on behaviour, yet to date relatively little research has simultaneously examined the role of personal, social, and environmental factors on youths’ physical activity, while giving consideration to the role of different types of neighbourhoods. The current study examined the physical activity of 804 youth aged 10 to 16 years residing in urban high density, suburban, or suburban low density neighbourhoods, by exploring relationships between several personal, social, and environmental factors. Findings revealed that all three factors were significant in explaining youths’ physical activity. Differences in participation were found based on gender and neighbourhood; males and youth from suburban low density neighbourhoods were significantly more physically active. Moreover, several variables were found to be important for understanding youth physical activity: sex, age, self-efficacy, encouragement, neighbourhood safety, and the use of a number of neighbourhood facilities.

The focus of this research relates to physical activity (PA) among populations at risk for inactivity. Two studies were completed. Study 1 was an exploratory study examining the relationship between health literacy (HL) and PA as they relate to the Theory of Planned Behaviour (TPB) constructs. Study 2 was an action research-based project in partnership with the staff and students of an alternative school. In Study 1 participants (N=65) completed measurements including the REALM to assess HL, and accelerometers to establish PA levels. The results of this study showed that even after controlling for covariates HL and PA are significantly linked (r = 0.37, p < 0.01), however, the TPB constructs were not found to mediate this relationship. However, Perceived Behavioural Control (r = 0.29, p < 0.05) and Intention to Exercise (r = 0.29, p < 0.05) were significantly linked to HL. Of particular interest, Difficulty Reading was cited as a significant barrier to PA for those with lower levels of HL (r = 0.37, p < 0.01). Finally, HL was found to be a significant moderator of the Education-PA relationship. Study 2 contained two components. First, focus groups with community partner organization (CPO) members to establish issues of relevance to them related to PA, to gather suggestions for incorporating PA into CPO programs, to gain an understanding of the barriers experienced by the community members, and to receive input regarding their current feelings and knowledge surrounding PA. Second, a process evaluation was conducted with administration to gauge how the CPO had progressed over the first academic year, using the TRACE process evaluation tool. The findings from the focus groups were organized by socio ecological level into PA facilitators and inhibitors, and were used to plan a new PA program for the school year. A repeated measures survey and process evaluation tool were used to assess these program objectives for the initial year. Perceived HL scores increased from baseline (M = 20.71,SD = 4.29) to follow-up (M = 22.58, SD = 5.15 ); t(-2.44), p < 0.05, as did perceived understanding of the importance of PA from September (M = 4.46 , SD = 1.60) to June (M = 5.54 , SD = 1.67); t(-3.06), p < 0.01. There was an increase in total minutes of MVPA among students as well, although this trend merely approached significance, from September (M = 526.60, SD = 557.63) to June (M=817.0, SD = 674.69), t(-1.97), p = 0.06. The evaluation tool revealed that the community was “Half Way There”, and identified areas where improvements could be made. These findings are relevant to creating equitable and comprehensive promotion and education of physical activity in the future and to understanding the mechanisms involved in PA disparities. These findings also support the need for health promoters and researchers to work with communities known to be at risk for low HL, and using action research methods to create locally relevant program development and research. / Graduate

Breastfeeding offers numerous health benefits to both the mother and infant, yet it is not routinely practiced due to a number of internal and external factors that influence the mother's decision. Guided by the social ecological model, the purpose of this study was to examine the effect of required reporting to The Joint Commission on perinatal measures, a proxy measure for maternity care practices, and those professional effects on breastfeeding initiation and exclusivity for first-time mothers. The hypotheses were that the mandatory reporting, and thus an increase in maternity care practices, would increase the initiation of breastfeeding and exclusive breastfeeding on discharge in first-time mothers. This study was a quantitative retrospective study design that included data collected from the medical records of 1,000 mothers from Southeast Alabama Medical Center who gave birth between 2013 and 2014. The multiple logistic regression analysis indicated that the odds ratio for initiation of breastfeeding was greater among first-time mothers after implementation of mandatory reporting measures (OR = 2.07; p = 0.0007); however, the odds for exclusive breastfeeding on discharge did not show a statistically significant change (OR = 0.94; p = 0.7507). These findings may inform the work of healthcare providers at hospitals, community centers, and public health workers, guiding their maternity care practices to increase the number of first-time mothers who will breastfeed for longer periods of time and improving children's health outcomes.

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Community violence can have lasting impacts on populations that experience it, including but not limited to, financial damages, property damage, and psychological trauma. Therefore, exploring mechanisms of violence prevention is increasingly important, especially within the context of multicultural societies. This research does just that by approaching community violence prevention from an interdisciplinary perspective, including aspects of public health, political science, criminology, and sociology. This dissertation explores the interfaith organization InterFaith Leadership Council of Metro Detroit and those in the organization's network. It considers how interfaith leaders, through activism and dialogue, can contribute to community violence prevention. By applying the social ecological model and social disorganization theory, this research considers how to prevent community violence through building social capital, collective efficacy, and community capacity. This inquiry also utilized the social determinants of health to describe how violence and violence prevention is linked to community health. This dissertation uses qualitative data, including interviews, document analysis, and field notes to explore the mechanisms by which interfaith leadership can prevent community violence, specifically gang violence and violent extremism. / Doctor of Philosophy / Community violence can have lasting impacts on populations that experience it, including but not limited to, financial damages, property damage, and psychological trauma. Therefore, exploring methods of violence prevention is increasingly important. This dissertation uses qualitative data to explore community violence prevention in Metro Detroit as carried out by the InterFaith Leadership Council and its broader network. Included in this dissertation are insights from interviews, document analysis, and field notes. All this data informs the research and attempts to address how the question of how the interfaith community in Metro Detroit is working to prevent community violence. This research utilizes the social ecological model and social disorganization theory as its overarching framework for analysis. The analysis examines interfaith relationships, collective efficacy, and community capacity. This research also frames violence and violence prevention within the context of the social determinants of health in an attempt to identify the factors that affect violence and violence prevention.