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OBJETIVO: Evaluar la salud percibida en fumadores de cigarrillos según las etapas del cambio. METODOLOGIA: Se estudiaron 253 personas mediante el cuestionario de salud SF-36 cada 6 meses durante dos años. RESULTADOS: Después del abandono del tabaco mejora la Evolución Declarada de la Salud y las percepciones de salud del componente físico y mental. Los fumadores que siguen fumando pero progresan en las etapas del cambio experimentan un descenso en Función Física, Salud General y en el Componente Sumario Físico. La recaída en el tabaquismo se asocia a peor Vitalidad y Salud Mental, y a considerar el consumo de tabaco como causa del deterioro actual de la salud. CONCLUSIONES: Se observa una peor percepción de salud física al plantearse el abandono del consumo de tabaco a medio plazo, una mejoría global de la salud percibida al dejar de fumar y una peor salud emocional en la recaída. / OBJECTIVES: To evaluate the health-related quality of life in smokers with different stages of change. METHODOLOGY: 250 subjects evaluating their perception of health every 6 months for two years through the SF-36 health questionnaire. RESULTS: After stopping smoking, the Self-evaluated Health Transition improves, and the perception of health improves both in physical and mental components. Smokers that do not stop smoking but progress in the stages of change experience a fall in Physical Functioning, General Health and in the Physical Component Summary. Relapse in the use of tobacco is associated with a worsening in the Vitality and Mental Health, considering smoking to be a cause of deterioration in the state of health. CONCLUSIONS: Worse perception of physical health is observed when stopping smoking is contemplated as a medium-term objective, an overall improvement in health is observed on stopping smoking, and worse emotional health is observed in the case of relapse.

The purpose of this study was to investigate the adequacy of the Stages of Change model in a group therapy treatment program for male batterers. The sample consisted of three groups with a total sample size of 22 participants. Data for this study were obtained by administering the Safe at Home Instrument and the Group Climate Questionnaire – Short Form. Results indicated the Safe at Home Instrument had limited clinical utility with involuntary male batterers. Independent of scoring method used, the majority of participants reached the action stage early in group treatment. Because the action stage is the highest stage attainable in this study, further growth was not measurable. The lack of variability in participants’ scores on the Safe at Home Instrument limits its clinical usefulness. Results from the Group Climate Questionnaire – Short Form indicate the groups did not progress according to a popular group development theory (MacKenzie & Livesley, 1983). The groups appear to enter the differentiation stage but do not successfully master the developmental issues needed to progress through the subsequent stages. The results from both instruments indicate that treatment groups with involuntary, male batterers did not progress as expected. Recommendations for future research and clinical practice are discussed.

Despite the facts that vehicle incidents continue to be the most common mechanism for Australian compensated fatalities and that employers have statutory obligations to provide safe workplaces, very few organisations are proactively and comprehensively managing their work-related road risks. Unfortunately, limited guidance is provided in the existing literature to assist practitioners in managing work-related road risks. The current research addresses this gap in the literature. To explore how work-related road safety can be enhanced, three studies were conducted. Study one explored the effectiveness of a range of risk management initiatives and whether comprehensive risk management practices were associated with safety outcomes. Study two explored barriers to, and facilitators for, accepting risk management initiatives. Study three explored the influence of organisational factors on road safety outcomes to identify optimal work environments for managing road risks. To maximise the research sample and increase generalisability, the studies were designed to allow data collection to be conducted simultaneously drawing upon the same sample obtained from four Australian organisations. Data was collected via four methods. A structured document review of published articles was conducted to identify what outcomes have been observed in previously investigated work-related road safety initiatives. The documents reviewed collectively assessed the effectiveness of 19 work-related road safety initiatives. Audits of organisational practices and process operating within the four researched organisations were conducted to identify whether organisations with comprehensive work-related road risk management practices and processes have better safety outcomes than organisations with limited risk management practices and processes. Interviews were conducted with a sample of 24 participants, comprising 16 employees and eight managers. The interviews were conducted to identify what barriers and facilitators within organisations are involved in implementing work-related road safety initiatives and whether differences in fleet safety climate, stage of change and safety ownership relate to work-related road safety outcomes. Finally, questionnaires were administered to a sample of 679 participants. The questionnaires were conducted to identify which initiatives are perceived by employees to be effective in managing work-related road risks and whether differences in fleet safety climate, stage of change and safety ownership relate to work-related road safety outcomes. Seven research questions were addressed in the current research project. The key findings with respect to each of the research questions are presented below. Research question one: What outcomes have been observed in previously investigated work-related road safety initiatives? The structured document review indicated that initiatives found to be positively associated with occupational road safety both during and after the intervention period included: a pay rise; driver training; group discussions; enlisting employees as community road safety change agents; safety reminders; and group and individual rewards. Research question two: Which initiatives are perceived by employees to be effective in managing work-related road risks? Questionnaire findings revealed that employees believed occupational road risks could best be managed through making vehicle safety features standard, providing practical driver skills training and through investigating serious vehicle incidents. In comparison, employees believed initiatives including signing a promise card commitment to drive safely, advertising the organisation’s phone number on vehicles and consideration of driving competency in staff selection process would have limited effectiveness in managing occupational road safety. Research question three: Do organisations with comprehensive work-related road risk management practices and processes have better safety outcomes than organisations with limited risk management practices and processes? The audit identified a difference among the organisations in their management of work-related road risks. Comprehensive risk management practices were associated with employees engaging in overall safer driving behaviours, committing less driving errors, and experiencing less fatigue and distraction issues when driving. Given that only four organisations participated in this research, these findings should only be considered as preliminary. Further research should be conducted to explore the relationship between comprehensiveness of risk management practices and road safety outcomes with a larger sample of organisations. Research question four: What barriers and facilitators within organisations are involved in implementing work-related road safety initiatives? The interviews identified that employees perceived six organisational characteristics as potential barriers to implementing work-related road safety initiatives. These included: prioritisation of production over safety; complacency towards work-related road risks; insufficient resources; diversity; limited employee input in safety decisions; and a perception that road safety initiatives were an unnecessary burden. In comparison, employees perceived three organisational characteristics as potential facilitators to implementing work-related road safety initiatives. These included: management commitment; the presence of existing systems that could support the implementation of initiatives; and supportive relationships. Research question five: Do differences in fleet safety climate relate to work-related road safety outcomes? The interviews and questionnaires identified that organisational climates with high management commitment, support for managing work demands, appropriate safety rules and safety communication were associated with employees who engaged in safer driving behaviours. Regression analyses indicated that as participants’ perceptions of safety climate increased, the corresponding likelihood of them engaging in safer driving behaviours increased. Fleet safety climate was perceived to influence road safety outcomes through several avenues. Some of these included: the allocation of sufficient resources to manage occupational road risks; fostering a supportive environment of mutual responsibility; resolving safety issues openly and fairly; clearly communicating to employees that safety is the top priority; and developing appropriate work-related road safety policies and procedures. Research question six: Do differences in stage of change relate to work-related road safety outcomes? The interviews and questionnaires identified that participants’ perceptions of initiative effectiveness were found to vary with respect to their individual stage of readiness, with stage-matched initiatives being perceived most effective. In regards to safety outcomes, regression analyses identified that as participants’ progress through the stages of change, the corresponding likelihood of them being involved in vehicle crashes decreases. Research question seven: Do differences in safety ownership relate to work-related road safety outcomes? The interviews and questionnaires revealed that management of road risks is often given less attention than other areas of health and safety management in organisations. In regards to safety outcomes, regression analyses identified that perceived authority and perceived shared ownership both emerged as significant independent predictors of self-reported driving behaviours pertaining to fatigue and distractions. The regression models indicated that as participants’ perceptions of the authority of the person managing road risks increases, and perceptions of shared ownership of safety tasks increases, the corresponding likelihood of them engaging in driving while fatigued or multitasking while driving decreases. Based on the findings from the current research, the author makes several recommendations to assist practitioners in developing proactive and comprehensive approaches to managing occupational road risks. The author also suggests several avenues for future research in the area of work-related road safety.

xvii, 169 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / The development, maintenance, and integration of multicultural competence into all aspects of psychologists' work is critical to ethical practice in an increasingly diverse society. Measurement of multicultural competency is critical to investigating the development of multicultural competence and the effectiveness of multicultural competency training. However, existing measures of multicultural competence are limited in scope and are not congruent with the conceptualization of multicultural competence as a lifelong process. The purpose of this dissertation study was to address the limitations of existing instrumentation through development and initial validation of the Multicultural Competence Change Scale (MCCS). The MCCS assesses the development of multicultural competence from a "stages of change" perspective. The stages of change model provides a framework for assessing subtle cognitive, emotional, and behavioral modifications indicative of change. Participants included 221 counseling, clinical, and school psychology graduate students. An exploratory factor analysis and the generalized graded unfolding model were used to establish the MCCS factor structure. The MCCS was found to have a five factor structure, with each factor representing one of the stages of change. Internal consistency reliabilities for the MCCS subscales ranged from .64 - .74. Estimates of validity were obtained by examining relationships between the MCCS and other measures, such as the Multicultural Awareness, Knowledge, and Skills Survey, Counselor Edition, Revised (MAKSS-CE-R). The MCCS Precontemplation, Contemplation, and Preparation subscales were significantly and negatively correlated with the MAKSS-CE-R, and the Action and Maintenance subscales were significantly and positively correlated with the MAKSS-CE-R. Examination of the sensitivity of the MCCS to respondent variability revealed that psychology trainees' who participated in a greater number of diversity-related trainings, who currently participate in diversity-related research, and who are members of underrepresented groups based on ethnicity, sexual orientation, and ability were more likely to be in either the action or maintenance stage of change. The MCCS provides a novel approach to multicultural competence assessment; however, it is still in the initial stages of development and additional items are needed to strengthen the factor structure and psychometric properties of the instrument. / Committee in charge: Ellen McWhirter, Chairperson, Counseling Psychology and Human Services; Paul Yovanoff, Member, Educational Methodology, Policy, and Leadership; Krista Chronister, Member, Counseling Psychology and Human Services; Michael Hames-Garcia, Outside Member, Ethnic Studies

The term ‘epidemic’ is often used to describe the obesity phenomenon and indicate that overweight or obesity is a worldwide phenomenon. While the prevalence of overweight and obesity has been increasing, reviews on overweight and obesity studies indicate a clear need for further effectiveness studies of innovative and cost-effective strategies to improve the long-term outcomes of weight loss and weight maintenance programmes in large populations. Current weight loss interventions, while successful in the short term, are often not cost effective enough to deliver on a large scale because they are labour and time intensive. Most importantly, they do not cover large populations. Despite some individual successful weight loss in these interventions programmes, individuals still need to self- manage their weight following intervention. It is unrealistic to expect health professionals and clinicians to provide timely and long-term ongoing support for 2.1 billions overweight and obesity populations around the world (OECD Health Statics, 2014).Therefore, the solutions for weight control may be more effective if grounded within the online community, that is, design long-term solutions that build and draw on social capital to support weight maintenance and are scaled to cope with large populations. Understanding the individual weight loss experiences through informal online social support and utilising the advantages of computer-mediated communication (CMC) can be a timely and cost-effective way to help people self-manage their weight. A three-month online longitudinal phenomenological interview of 17 informants recruited from an online community forum was applied to explore the weight loss experiences with assistance of informal online social support. Four weight loss threads selected by the informants during their weight loss process were also interpreted to map out the key roles of informal online social support and the interaction process that takes place in an online community forum. This research describes the lived experiences of individuals’ self-help weight loss process and maps out the critical moments and differential experiences involved in the Stages of Change (SoC) to explain the individual differences during different weight loss stages. This research also identifies the interrelationships of Processes of Change (PoC) for facilitating behaviour change. The findings of this research contribute to demonstrate the interaction process between community members and the process of providing and receiving social support at different individual members’ weight loss stages, which helped them to continue to lose weight or maintain their weight. The informal online social support could meet different self-help weight loss individual’s needs during different weight loss stages, which is difficult to be provided by the healthcare providers. The findings also contribute to social marketing as a way of offering a cost-effective and efficient way to assist the self-help individual to self- manage their weight in the long term. It may also be a viable way of addressing the issues of costs and labour intensity found in the current weight loss interventions that want to serve large populations.

Zielsetzung: Die Gültigkeit des Modells der Stadien der Veränderung von Prochaska und DiClemente für die stationäre Alkoholentwöhnungstherapie empirisch zu prüfen. Methoden: Reliabilität, Faktorstruktur und Konstruktvalidität der Veränderungsstadienskala (VSS) wurden an Alkoholpatienten querschnittlich (N = 265) und längsschnittlich (N = 108) untersucht. Ergebnisse: Die Reliabilität der VSS fiel befriedigend aus mit Ausnahme der Skala «Precontemplation», die sich auf nicht motivierte Patienten bezieht. Die faktorielle Validität war insbesondere für die Skalen «Contemplation» und «Maintenance» unzureichend. Clusteranalysen ergaben eine nicht modellkonforme Drei-Cluster-Lösung einschließlich «uninvolvierter » Patienten. VSS-Werte waren durchgängig mit der Therapiemotivation korreliert. Prädiktive Validität (Behandlungsdauer, Rückfallvorhersage) konnte nicht belegt werden. Schlussfolgerungen: Der Ansatz bestätigt seinen heuristischen Wert, kann aber noch nicht valide für praktische Entscheidungen in der Alkoholentwöhnungsbehandlung herangezogen werden. Spezifische Modelle für verschiedene Behandlungsgruppen und -settings scheinen Erfolg versprechender. / Aim: The validity of the ”Stages of Change” approach was tested in alcohol inpatient long-term treatment. Methods: Reliability, factor structure, and construct validity of the University of Rhode Island Change Assessment Scale (URICA, German version) was examined using cross-sectional (N = 265) and longitudinal data (N = 108). Results: Scale reliability proved to be satisfying, except for the precontemplation scale. Factorial validity was insufficient for the contemplation and the maintenance scale. Cluster analyses revealed a threecluster solution not in accordance with the model and included a cluster of ”uninvolved patients”. URICA-scores were correlated with therapy motivation, but predictive validity with respect to duration of treatment and prediction of relapse was not confirmed. Conclusions: The model proved to be of heuristic value but is not yet a valid basis for practical decisions. Models which are directed more specifically towards a particular treatment group or setting are expected to be more successful. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

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