This study explores the meaning of informal caregiving for individuals living with HIV disease. As the number of individuals living with HIV disease continues to increase, there is a need for research on both the structure of caregiving networks and the meaning these networks have for individuals living with chronic illness. This study is continuous with prior research on social support and the illness experience, but departs from past work by addressing both the objective features of social support relationships and the way that they are subjectively interpreted by people living with HIV disease. Fifty-four (n = 54) individuals living with HIV disease participated in in-depth, qualitative interviews (31 women, 23 men). Participants were recruited from local AIDS service organizations and healthcare facilities in Western New England. Interview data were analyzed using cluster analysis and content analysis techniques. Respondents' informal caregiving networks are summarized using five categories developed using cluster analysis. Content analysis of interview transcriptions illustrate the diverse way respondents interpreted the care they received from network members and the way in which their illness experience was shaped by the different contexts in which they received care. The way in which caregiving networks and respondents interpretations of them varied by gender, race and ethnicity, sexual identity and other self-identifications is discussed. This research furthers the literature on social support and chronic illness. As an exploratory project, the aim of the research was to describe how individuals living with HIV disease make sense of the care they do and do not receive from family members, friends and other informal caregivers. This study contributes to the literature on social support and HIV disease by focusing on low-income individuals, living in small towns and cities and two urban areas that have not been the focus of a great deal of HIV/AIDS research. The results of this study can be used to better understand and strengthen existing relationships within social support networks. This research also has direct implications for both formal and informal caregivers and programs and activities to support them.

Oklahoma is home to over fifty tribes or sovereign nations relocated during the era of U.S. Government removal. The tribes display their own unique cultural heritage, which combine elements of traditional culture with the frontier heritage of the American West. The health care context of these Native communities is pluralistic including elements of traditional health practices, intertribal health perspectives, and medical care delivery by the Indian Health Service and community health services. This case study is a biocultural evaluation of the health of the Caddo tribe utilizing historical reconstruction, ethnographic methods, qualitative, and quantitative methods of health characterization of the contemporary population. The orientation is integrative to understand what I term the "health matrix" of this population. The health matrix is the biocultural interface where the interaction of social processes and biopsychological relations is monitored through an understanding of how cultural and biological variables intersect and overlap. The purpose is to understand social and behavioral processes, specifically social relations and cultural support mechanisms, on biological health. The main goal of the dissertation was to track Caddo health through time and to develop a tribe-specific morbidity and mortality profile to understand contemporary health patterns and issues facing the tribe. Defining the limits of the Caddo sample population and distinguishing them from other Native Americans in the area was a catalyst for developing an Indian Health Service grant to assess the health needs of the local population and work toward community program development. Political economic factors influencing the tribe were instrumental in the execution and delivery of the research and served to highlight areas of tribal dynamics and contradictions. This case study allows for a consideration of cultural and personal context in health behavior and profiles. A broad range of methodological techniques were combined to understand the complexity of the health matrix within this community. Although specifically focused on one tribe, the dissertation has theoretical implications for communities grappling with implementing community health care programs. This work presents sociopolitical and personal issues that impact individual health, as well as community programs, and incorporates Native Americans and anthropologists, or other consultants who work within these communities.

In this theoretically focused thesis I make use of the example of vaccination against infectious diseases to show how expert institutions define value of its products through constructing a continuity of its rational and moral dimensions. This continuity allows rational and moral arguments to naturally complement themselves in a coherent discoursive and procedural frame which I call an institutional regime of the value of vaccination. Regarding general public, its crucial products are sanctions in the form of imputing decisional competence to those who vaccinate and decisional incompetence to those who do not. This competence is understood as both sign of optimal rationality and morally responsible behaviour which takes into account the common good. But besides external imputation, a decisional competence is also acquired through individual activity, which takes on a special importance for those who reject vaccination. They manage the imputations of incompetence through constituting alternative definitions of the value of health care in which they stress the importance of natural treatment and individual responsibility. These definitions of value manifest both on the level of narrowly focused rational discussion of expert recommendations and the level of more general ideas about legitimate ways to...

<p dir="ltr">Background—Adverse Childhood Experiences (ACEs) are events that occur before age 18, such as abuse and neglect, which are potentially traumatic. ACEs can lead to profound negative impacts on physical and psychological health and social relationships. Despite this, positive social connections can mitigate these effects. However, individuals with ACEs may struggle to form healthy relationships because of mistrust, leading to continued exposure to detrimental social environments. Additionally, ACE-exposed adults often internalize stigma.</p><p dir="ltr">Methods—Utilizing data spanning from 1995 to 2014, Chapter 2 examines 629 adults from the MIDUS II: Biomarker study. Employing counterfactual modeling, the study estimates the treatment effect of ACE exposure on well-being and employs weighted multilevel mixed models to analyze life course changes. Chapter 3 uses 1,243 respondents from the MIDUS II: Biomarker study, employing latent class analysis to identify social relationship patterns and assess their mediation between ACEs and the pursuit/enjoyment of new relationships. Chapter 4 uses experimental data from 493 respondents, employing vignette experiments to gauge perceptions of warmth and competence, with gender and happiness examined as moderators, and threat, status, four stigmatizing descriptions as mediators.</p><p dir="ltr">Results—ACE exposure is associated with increased chronic conditions, lower self-rated health, diminished psychological and social well-being. However, the strength of the treatment effects differs based on the type and number of ACE exposures. Latent Class Analysis of social relationships indicates four classes: healthy, ambivalent, kin-focused, and difficult, with higher ACEs linked to a decreased probability of being in the “healthy” class. ACEs also predict reduced enjoyment of interactions with new people, mediated 41% by the current social relationship class. ACE vignettes are perceived as less warm and competent, with happiness moderating some ACE-related perceptions. Status, “mentally ill”, and “damaged” emerged as strong mediators.</p><p dir="ltr">Conclusion—While ACE exposure is related to lower well-being, the rate of decline does not differ from non-ACE-exposed individuals across time. Those in strained relationships are less likely to enjoy new social interactions, potentially perpetuating ACE-related health consequences. Addressing interpersonal trust issues in ACE-exposed adults through social interventions may mitigate these effects. Additionally, there is stigma against each of the ten ACEs, and the medicalization of ACEs contributes to stigma.</p>

This thesis is a subset of a larger “parent” project under the direction of my supervisor, Dr. Cecilia Benoit. The purpose of the larger project is to seize an unique research opportunity that has emerged with the development and implementation of the HerWay Home (HWH) program, a community-based initiative for pregnant and early parenting women who face substance use and other challenges in the Greater Victoria Area. My research has capitalized on the pre-implementation phase of the HWH program between 2010-2011. Thirteen in-person semi-structured interviews were conducted with women who would likely be clients for the HWH program, based on their pregnancy experiences, substance use concerns and other life challenges. The goal of this research has been to explore these women’s pregnancy and postpartum narratives and investigate what, in their view, should be crucial components of the HWH intervention in the short and longterm. My findings indicate that, consistent with the literature on pregnant and early parenting women facing substance use and other life challenges, a range of complex, intertwined disadvantages exist in their lives that translate into multiple barriers to accessing continuous health and social care during their pregnancy and after the birth of their child. An adapted model of the Health Lifestyle Theory is used to frame the analysis of the data collected from this research. The results from this research support the argument that the life choices of the participants are constrained by structural life chances and socially determined inequities that systematically disadvantage and disempower them. The findings also reveal an implicit sense of agency in the women’s narratives, as well as key specifics about what they view as the main gaps in care and their desired program services. The findings will be relayed to HWH organizers, and used to inform the development and implementation of the program’s services. / Graduate

La recherche porte sur l’analyse des relations entre l’hôpital et la ville dans la prise en charge des malades atteints de cancer et sur les enjeux d’une formalisation de la coordination des interventions au sein de réseaux de santé. Il s’agit d’élucider le processus de formalisation de la coordination dans le système de prise en charge des patients atteints de cancer, à travers l’identification des objectifs des acteurs et des facteurs de convergence de leurs discours. Pour cela, on retrace dans un premier temps la problématisation de la coordination dans la politique de lutte contre le cancer : depuis la définition d’un « problème » de coordination dans le champ de la lutte contre le cancer, sa mise sur agenda, jusqu’à l’ « instrumentation » de l’action publique. Dans un second temps, une méthodologie qualitative et quantitative permet de cerner le jeu des acteurs autour de cet enjeu de coordination. On décrit les pratiques et les représentations des malades, des médecins généralistes et des professionnels et les conditions de leur adhésion à une formalisation de la coordination au sein de réseaux de santé. Il apparaît finalement que leur adhésion repose sur des variables symboliques et stratégiques. / This work deals with the relationships between hospital and general practice, while caring for people suffering from cancer. It focuses on what is at stake in the coordination of these healthcare network actors. In order to clarify the process of formalization of coordination in cancer’s care system, we identified actor’s goals and causes of the convergence of their concerns. Firstly, we described the process of definition of coordination as a problem in the policy of fight against cancer and the selection of an instrument to solve this problem. Secondly, thanks to a qualitative and quantitative methodology, we understood the way “social actors” play with the coordination issue. We described perceptions and practices of patients, General Practitioners and Hospital Doctors and the conditions of subscription to formal health networks. The study showed that their subscription depends on symbolic and strategic variables.

Nas últimas décadas, assistimos ao aumento da preocupação com a saúde e à consolidação da concepção de que ser saudável depende tão somente da sistematização dos hábitos cotidianos e de comportamentos considerados corretos para manter a longevidade. A adoção de um estilo de vida saudável padronizado por critérios científicos vem se tornando, aparentemente, uma obrigação que independe da escolha voluntária, tamanha é a pressão social que demanda do indivíduo autocuidado. A propalada concepção de saúde enquanto amplo bem-estar inclui a adoção de hábitos preventivos que mantenham a saúde física e mental pelo máximo número de anos, de preferência conservando a beleza, o bom humor e a disposição produtiva da juventude. Ao mesmo tempo evidencia-se uma nova moralidade pautada nos riscos de saúde, na qual a responsabilidade sobre o próprio adoecimento condena os não saudáveis à condição de irresponsáveis e desviantes. O objetivo desta tese é problematizar a retórica acerca da vida saudável, a partir do noticiário semanal veiculado em revistas brasileiras de variedades, procurando identificar o que poderia ter contribuído para a sobrevalorização da saúde como norteadora dos comportamentos. Do ponto de vista da discussão efetuada, o atual ideário de saúde e bemestar é resultado de um processo abrangente, de âmbito mundial, que envolve tanto aspectos macroeconômicos como modificações nos valores culturais que confluíram para a legitimação da responsabilidade individual por todas as condições de existência, inclusive por aquelas advindas das circunstâncias sociais. O autocuidado em matéria de saúde seria parte de uma conduta racional de gestão de si, como se o indivíduo fosse uma empresa, legitimada como ideal de bem-viver, que pressupõe a autodisciplina corporal e emocional para maximização da vitalidade ou do capital humano. O indivíduo passa a ser, ele próprio, objeto de trabalho para alcançar uma vida melhor e mais longa, que, de acordo com o noticiário, estaria apenas nas mãos de cada um / In recent decades we have witnessed the increasing concern about health and the consolidation of the view that being healthy depends solely on the systematization of daily habits and supposedly correct behaviors to maintain longevity. The adoption of a healthy lifestyle based on scientific criteria has become, apparently, an obligation that is independent of voluntary choice, such is the social pressure imposed to the individual by the self-care demand. The broad conception of health as wellness includes taking preventive habits to keep physical and mental health for as long as possible, preferably by retaining beauty, good mood and the productive energy of the youth. At the same time there is evidence of a new morality based on health risks, in which taking the responsibility for ones own illnesses condemns the unhealthy ones to be considered irresponsible and devious. The objective of this thesis is to problematize the rhetoric about healthy living, based on empirical research on the weekly news of Brazilian varieties magazines. We try in this work to identify the factors that might have contributed to the overvaluation of health in its role of determining behaviors. From the point of view of the discussion made, the current ideals of health and wellness are the result of a worldwide comprehensive process, involving both macroeconomic issues and changes in cultural values that led to the legitimization of individual responsibility for all his conditions, even those stemming from social circumstances. Self-care in health would be part of a rational conduct of self-management that extends the enterprise logic to the individual behavior and is legitimized as an ideal of good living, which presupposes the body and the emotional self-discipline to maximize vitality or human capital. The individual works on himself to achieve a better and longer life, which, according to the news, would be each ones responsibility

Nas últimas décadas, assistimos ao aumento da preocupação com a saúde e à consolidação da concepção de que ser saudável depende tão somente da sistematização dos hábitos cotidianos e de comportamentos considerados corretos para manter a longevidade. A adoção de um estilo de vida saudável padronizado por critérios científicos vem se tornando, aparentemente, uma obrigação que independe da escolha voluntária, tamanha é a pressão social que demanda do indivíduo autocuidado. A propalada concepção de saúde enquanto amplo bem-estar inclui a adoção de hábitos preventivos que mantenham a saúde física e mental pelo máximo número de anos, de preferência conservando a beleza, o bom humor e a disposição produtiva da juventude. Ao mesmo tempo evidencia-se uma nova moralidade pautada nos riscos de saúde, na qual a responsabilidade sobre o próprio adoecimento condena os não saudáveis à condição de irresponsáveis e desviantes. O objetivo desta tese é problematizar a retórica acerca da vida saudável, a partir do noticiário semanal veiculado em revistas brasileiras de variedades, procurando identificar o que poderia ter contribuído para a sobrevalorização da saúde como norteadora dos comportamentos. Do ponto de vista da discussão efetuada, o atual ideário de saúde e bemestar é resultado de um processo abrangente, de âmbito mundial, que envolve tanto aspectos macroeconômicos como modificações nos valores culturais que confluíram para a legitimação da responsabilidade individual por todas as condições de existência, inclusive por aquelas advindas das circunstâncias sociais. O autocuidado em matéria de saúde seria parte de uma conduta racional de gestão de si, como se o indivíduo fosse uma empresa, legitimada como ideal de bem-viver, que pressupõe a autodisciplina corporal e emocional para maximização da vitalidade ou do capital humano. O indivíduo passa a ser, ele próprio, objeto de trabalho para alcançar uma vida melhor e mais longa, que, de acordo com o noticiário, estaria apenas nas mãos de cada um / In recent decades we have witnessed the increasing concern about health and the consolidation of the view that being healthy depends solely on the systematization of daily habits and supposedly correct behaviors to maintain longevity. The adoption of a healthy lifestyle based on scientific criteria has become, apparently, an obligation that is independent of voluntary choice, such is the social pressure imposed to the individual by the self-care demand. The broad conception of health as wellness includes taking preventive habits to keep physical and mental health for as long as possible, preferably by retaining beauty, good mood and the productive energy of the youth. At the same time there is evidence of a new morality based on health risks, in which taking the responsibility for ones own illnesses condemns the unhealthy ones to be considered irresponsible and devious. The objective of this thesis is to problematize the rhetoric about healthy living, based on empirical research on the weekly news of Brazilian varieties magazines. We try in this work to identify the factors that might have contributed to the overvaluation of health in its role of determining behaviors. From the point of view of the discussion made, the current ideals of health and wellness are the result of a worldwide comprehensive process, involving both macroeconomic issues and changes in cultural values that led to the legitimization of individual responsibility for all his conditions, even those stemming from social circumstances. Self-care in health would be part of a rational conduct of self-management that extends the enterprise logic to the individual behavior and is legitimized as an ideal of good living, which presupposes the body and the emotional self-discipline to maximize vitality or human capital. The individual works on himself to achieve a better and longer life, which, according to the news, would be each ones responsibility

This thesis is a subset of a larger “parent” project under the direction of my supervisor, Dr. Cecilia Benoit. The purpose of the larger project is to seize an unique research opportunity that has emerged with the development and implementation of the HerWay Home (HWH) program, a community-based initiative for pregnant and early parenting women who face substance use and other challenges in the Greater Victoria Area. My research has capitalized on the pre-implementation phase of the HWH program between 2010-2011. Thirteen in-person semi-structured interviews were conducted with women who would likely be clients for the HWH program, based on their pregnancy experiences, substance use concerns and other life challenges. The goal of this research has been to explore these women’s pregnancy and postpartum narratives and investigate what, in their view, should be crucial components of the HWH intervention in the short and longterm. My findings indicate that, consistent with the literature on pregnant and early parenting women facing substance use and other life challenges, a range of complex, intertwined disadvantages exist in their lives that translate into multiple barriers to accessing continuous health and social care during their pregnancy and after the birth of their child. An adapted model of the Health Lifestyle Theory is used to frame the analysis of the data collected from this research. The results from this research support the argument that the life choices of the participants are constrained by structural life chances and socially determined inequities that systematically disadvantage and disempower them. The findings also reveal an implicit sense of agency in the women’s narratives, as well as key specifics about what they view as the main gaps in care and their desired program services. The findings will be relayed to HWH organizers, and used to inform the development and implementation of the program’s services. / Graduate

Thesis (Ph.D.) - Carleton University, 2005. / Includes bibliographical references (p. 301-313). Also available in electronic format on the Internet.