<p>Många ungdomar med olika typer av problem kan i dagsläget inte bo kvar hemma. Anledningarna till det kan ligga hos ungdomen själv eller hos ungdomens familj och närsamhälle och kan då placeras på ett stödboende. Studiens syfte är att undersöka om ungdomar på stödboendet Kollektivboendet (Kollbo) i Örebro upplever sig vara delaktiga i den stödjande verksamheten och hur delaktigheten ser ut. Studien är en kvalitativ undersökning baserad på sex semistrukturerade intervjuer med ungdomar boende på Kollbo och i deras slusslägenheter. De sex pojkarna är slumpmässigt utvalda utifrån ett antal sammanställda kriterier. Resultatet av studien framställs under olika teman som vi har identifierat under intervjuerna. Resultatet visade på att majoriteten av ungdomarna till stor del upplever sig delaktiga i den stödjande processen på Kollbo. Det framkommer även att ungdomarna är positiva till personalen och Kollbo, men att det finns vissa aspekter där pojkarna upplever att delaktigheten brister.</p> / <p>Many young people with different types of problems can at present not live at home. The reasons to it can lie at the youth alone or at the youth’s family and near society and can then be placed on a supportive residential home. The study's purpose is to examine whether young people on Kollektivboendet (Kollbo) in Örebro are to be involved in supporting activities and how the participation looks. The study is a qualitative survey, based on six semi structured interviews with young people living at the supportive residential home Kollbo and in their sluice-gate apartments. The six boys are randomly selected from a number of consolidated criteria. The results of the study are produced under different themes that we have identified during the interviews. The results showed that the majority of young people largely feel involved in the supporting process around themselves at Kollbo. It is found that young people feel positive towards the staff and Kollbo, but that there are certain aspects where the boys experiences that the participation deficiencies.</p>

Significant research has investigated Jack Gibb’s model of defensive and supportive communication, but little has explored the influence of the type of talk -- defensive or supportive -- on perceptions of communication climate and the role that verbal aggressiveness may play in influencing both the types of talk and these perceptions. This thesis explored the relationship between defensive and supportive talk, verbal aggressiveness and communication climate using a mixed-method approach. Specifically, the Verbal Aggressiveness Scale was used to group participants for a dyadic problem solving exercise which generated conversational data that was analyzed qualitatively. Then, the Communication Climate Inventory was used to measure participants’ perceptions of the communication climate that emerged in their problem-solving dyad. The findings highlight factors that may influence the perception of communication climate. Examples of supportive talk that builds positive communication climates and limits the effects of verbal aggressiveness and examples of defensive talk that leads to negative communication climates are provided. This research demonstrates that language has an influence on communication climate through the words that shape the complex ways people perceive and understand each other and, interestingly, that the negative impact of defensive communication overrides the positive impact of supportive communication on the emergent communication climate.

The effective use of formative assessment practices has resulted in some of the largest gains in student learning ever documented (Meisels, 2006; Davies 2007; Black & Wiliam 2006, 1998; Marzano 2006). Given this support in the literature for the connection between improving classroom assessment and increasing student learning, the critical question among school leaders no longer seems to be, "what classroom practices best improve student learning?" Instead, leaders interested in student learning through classroom assessment are increasingly driven to inquire into the conditions that will best foster effective assessment practices in the classroom.<p> The purpose of this study was to take cases of schools where changes in classroom assessment practices had increased student learning, and to examine both the practices of leadership that supported the assessment initiatives, and the ways in which these leaders were connected. In recent studies of school improvement efforts focused on classroom assessment, Wiliam (2004, 2007) and Reeves (2007) concluded that teachers required support across the entire school system in order to embed effective formative assessment practices into their instructional repertoire. Hargreaves (1999) and Fullan (2005) defined this type of systemic support as lateral and overall capacity. While Goleman (2006) and Barabasi (2009) pointed to the influence of the social network of learners surrounding an initiative, Fullan (2005) warned that learning networks also require quality and implementation controls in order to sustain changes. Wiliam (2007) defined this tension between educators learning from one another and being openly responsible for sharing new practices as supportive accountability (p. 199).<p> This study sought to inquire into leadership networks and leadership practices that supported schools in which an assessment initiative had resulted in improved student learning. Two elementary schools were selected for study following a nomination process by central-office staff. A chain-sampling methodology was used to identify individuals who were seen to play an important leadership role in initiating and sustaining assessment efforts in each school. In all, qualitative data were generated from interviews with ten participants, eight from within the selected schools, and two central-office support staff.<p> This study revealed several major themes in the leadership practices of leaders inside the schools: engagement in a range of formal and informal professional learning experiences by teachers and school administrators; application of assessment for learning principles to the overall work of the initiative; engagement in a multi-level learning community; and the integration of school and system-level plans. Additionally, participants described a cross-role network of leadership supports that seemed to infuse teachers and staff with the positive energy required to maintain a high level of commitment to the initiative. While all participants described feelings of frustration and discomfort with the elements of accountability to their peers, they also described valuing the high levels of active support they received from other teachers, school administrators, and central-office staff. Leadership practices within the context of a network or pattern of leadership relationships aimed at fostering effective levels of supportive accountability seem to be most effective.

Primary care clinics play a vital role in the US healthcare system, providing preventative and cost-effective care. New trends in healthcare such as the development of the medical home model for care, the application of electronic medical records (EMRs), the effort to increase access to care, and the need to adhere to the Health Insurance Portability and Accountability Act (HIPAA) will have direct impacts on the work flow and spatial delineation of primary care clinics. To ensure the success of primary care practices, the architectural design of primary care clinics needs to address these changes to satisfy both patients and staff, and to improve efficiency and outcomes of care. There is limited literature on the design usability (efficiency, effectiveness, and user satisfaction) of primary care clinics. This study developed a set of building usability evaluation tools to collect, analyze and interpret the “usability” of a primary care facility. The study used previous literature as well as a case study primary care clinic in Maryland as a basis to develop these tools. In the clinic, data were collected through an initial interview with the head nurse, a forty-hour behavioral observation, and a staff survey. A behavioral observation tool and a survey questionnaire were developed for the data collection. For data analysis, JMP Pro 9 software was used to analyze the data collected through behavioral observation and the staff survey. The literature review developed a “Building Usability Framework” specifically for healthcare design. A data analysis tool, the “Usability Matrix” was created to integrate and understand the analyzed data within the Building Usability Framework. Integrating the analyzed data from the case study within the Usability Matrix, a primary care clinic usability evaluation survey was developed at the end of the study. This survey along with the behavioral observation tool and design analysis tools were compiled together to produce the “Building Usability Evaluation Tool-Kit for Primary Care Clinics.” This tool-kit can be used by architects and researchers interested in designing and analyzing “usable” primary care clinics.

This dissertation uses a multi-method approach to examine the role of online communities as a source of peer-to-peer supportive care for breast cancer survivors. A collection of four studies is presented. Study 1) A systematic search of the Internet identified 111 active online communities for breast cancer survivors with extensive archives of personal health experiences (one third had over 100,000 posts each as of 2010-10-26). More than one-third (36.0%) were initiated by breast cancer survivors or loved ones, and more than two-thirds (69.5%) were maintained with little or no professional input. Study 2) An analysis of Facebook (www.Facebook.com) identified 620 public breast cancer groups containing a total of 1,090,397 members as of 2008-11-23. The majority of groups were created for fundraising and awareness purposes (92.6%), rather than supportive care (7.4%). Study 3) One hundred breast cancer survivors, known to provide peer support were surveyed on their supportive care needs and use of online communities. Two-thirds (68.6%) of the 73 respondents reported at least one unmet need, most frequently (30 to 40%) concerning sexual problems, stress, survivor identity, fear of recurrence, and ongoing symptoms or side effects. About one-third (31.5%) used online communities predominantly during and while recovering from treatment. Reasons for non-use included lack of need, self-efficacy, trust and awareness. Study 4) Twelve breast cancer survivors who participated in the previous study were interviewed on how and why they used online communities. Unmet needs drove use, particularly during periods of stress, uncertainty or insufficient local support. Online communities served as a unique supportive care resource due to their quality of information, reassurance from similar others, availability, anonymity, and limited commitment. Social support, technology adoption and health behaviour theories help to explain use. Online communities have the potential to fill gaps in health care services by addressing the supportive care needs of breast cancer survivors in a way that may not be available elsewhere, and survivors may play an increasingly important role as care providers. Future research must focus on overcoming barriers to use, and identifying factors that enhance their effectiveness among diverse groups.

This dissertation uses a multi-method approach to examine the role of online communities as a source of peer-to-peer supportive care for breast cancer survivors. A collection of four studies is presented. Study 1) A systematic search of the Internet identified 111 active online communities for breast cancer survivors with extensive archives of personal health experiences (one third had over 100,000 posts each as of 2010-10-26). More than one-third (36.0%) were initiated by breast cancer survivors or loved ones, and more than two-thirds (69.5%) were maintained with little or no professional input. Study 2) An analysis of Facebook (www.Facebook.com) identified 620 public breast cancer groups containing a total of 1,090,397 members as of 2008-11-23. The majority of groups were created for fundraising and awareness purposes (92.6%), rather than supportive care (7.4%). Study 3) One hundred breast cancer survivors, known to provide peer support were surveyed on their supportive care needs and use of online communities. Two-thirds (68.6%) of the 73 respondents reported at least one unmet need, most frequently (30 to 40%) concerning sexual problems, stress, survivor identity, fear of recurrence, and ongoing symptoms or side effects. About one-third (31.5%) used online communities predominantly during and while recovering from treatment. Reasons for non-use included lack of need, self-efficacy, trust and awareness. Study 4) Twelve breast cancer survivors who participated in the previous study were interviewed on how and why they used online communities. Unmet needs drove use, particularly during periods of stress, uncertainty or insufficient local support. Online communities served as a unique supportive care resource due to their quality of information, reassurance from similar others, availability, anonymity, and limited commitment. Social support, technology adoption and health behaviour theories help to explain use. Online communities have the potential to fill gaps in health care services by addressing the supportive care needs of breast cancer survivors in a way that may not be available elsewhere, and survivors may play an increasingly important role as care providers. Future research must focus on overcoming barriers to use, and identifying factors that enhance their effectiveness among diverse groups.

Significant research has investigated Jack Gibb’s model of defensive and supportive communication, but little has explored the influence of the type of talk -- defensive or supportive -- on perceptions of communication climate and the role that verbal aggressiveness may play in influencing both the types of talk and these perceptions. This thesis explored the relationship between defensive and supportive talk, verbal aggressiveness and communication climate using a mixed-method approach. Specifically, the Verbal Aggressiveness Scale was used to group participants for a dyadic problem solving exercise which generated conversational data that was analyzed qualitatively. Then, the Communication Climate Inventory was used to measure participants’ perceptions of the communication climate that emerged in their problem-solving dyad. The findings highlight factors that may influence the perception of communication climate. Examples of supportive talk that builds positive communication climates and limits the effects of verbal aggressiveness and examples of defensive talk that leads to negative communication climates are provided. This research demonstrates that language has an influence on communication climate through the words that shape the complex ways people perceive and understand each other and, interestingly, that the negative impact of defensive communication overrides the positive impact of supportive communication on the emergent communication climate.

Sleep problems affect a considerable number (49-86%) of patients undergoing peritoneal dialysis (PD) treatment. Insomnia i.e. difficulties to initiate and/or maintain sleep or too early wakening, combined with daytime symptoms, seems to be the dominating problem. Despite these facts there is a lack of research in PD-patients, especially studies with objective data on the sleep-wake cycle and evaluation of sleep promoting non-pharmacological  interventions. The overall aim of this thesis was to describe sleep problems from different perspectives, and how these problems affect daily life and health in patients treated with PD at home. The aim was also to evaluate an individualised non-pharmacological intervention for improvement of sleep quality outcomes. Four studies were conducted during eight years, starting in 2002. Patients from six hospitals in the south-east of Sweden were invited to participate. In addition, data from a reference group with Coronary Artery Disease and a population group were used for comparisons with PD-patients in one of the studies. Data was collected by self-reported questionnaires, actigraphy registrations and interviews. Sleep was evaluated in a 17-week single-case study with an intervention focusing on sleep hygiene advice. Data from a total of 700 sleep-wake cycles was collected in the patients’ homes. The main findings clearly demonstrated that PD-patients have seriously fragmented sleep compared to the CAD- and population group, and that the PD-patients have a high prevalence of insomnia. The sleep was mainly disturbed by pruritus and Restless Legs Syndrome (RLS). Daytime impairments and a frequent napping behaviour were detected. The prevalence of fatigue was also reported to be extremely high. The patients described that an ever-present tiredness and poor sleep had consequences in their everyday life both physically, mentally, socially and existentially. The nurse-led intervention demonstrated that individual, non-pharmacological sleep interventions can improve sleep and daytime activities in PD-patients. This thesis elucidates that deteriorated sleep with serious fragmentation leads to a variety of daytime impairments and fatigue. By adopting “renal supportive care” in clinical work a more elaborate assessment and individualised non-pharmacological treatment of sleep problems may improve sleep quality and activity in frail patients undergoing peritoneal dialysis at home.

BACKGROUND: Cancer is primarily a disease of older adults with sixty percent of all incidences occurring in individuals 65 years and over. Coping with cancer may entail additional challenges for older adults due to co-morbidities, declining mobility, reduced social networks and ageism. To date, the majority of research examining supportive care needs has focused on younger women with breast cancer. Little attention has been paid to older adults’ experience with cancer, particularly with respect to psychosocial support. PURPOSE: The aims of the present studies were twofold: (1) to learn more about peer support services in Ontario, specifically: the type and location of available programs; extent of utilization by older adults; and factors that might facilitate or inhibit use by older adults; and (2) to gain a better understanding of the experiences and challenges facing older adults living with cancer, strategies and resources used to meet these challenges, unmet support related needs, as well as awareness of support services, principally peer support. METHODS: First, peer support services in Ontario were identified through an environmental scan. Subsequently, interviews were conducted with 24 key contacts from a purposeful sample (based on type and geographic location) of 30 of these groups. Next, surveys were administered to participants (n=220) and facilitators (n=39) from these groups to establish a profile of current peer support users and deliverers, and examine the extent to which older adults (age ≥ 65) utilized these services. Finally, a preliminary, in-depth, qualitative exploration from the perspective of older adults living with cancer was conducted through a focus group (n=6) and interviews with 20 older adults. RESULTS: The environmental scan yielded a total of 177 peer support cancer programs across Ontario; predominately group-based (93%). Most were located in urban centers. Few programs targeted colon cancer. In the 30 groups examined, breast and prostate cancer were the most common focus (60%). Group facilitators were primarily female (75%) and most had personally experienced cancer (77%). The male facilitators were older (p <.05) and most likely to lead the prostate groups. None of the programs systematically collected client information. Clients ranged in age from 25 to 91 years (mean = 64 ± 10.7). Many were long-term cancer survivors (average five years post diagnosis). Overall, less than half the clients were aged 65 or older. Clients over age 65 were predominately men (86%; p <.001) with prostate cancer. Almost 70% of program directors and over 90% of facilitators were unaware most individuals with cancer are over the age of 65. Interview participants were recruited primarily through the Canadian Cancer Society (CCS). Not surprisingly, 46% had participated in peer support. Older adults identified several challenges with respect to physical functioning, sexuality, emotional distress, and obtaining information. Participants utilized a variety of resources to meet informational and emotional challenges including, the Internet and the support of family and friends. Accessing routine follow-up care after the transition from ‘patient’ to ‘survivor’ was a significant unmet need. CONCLUSIONS: The findings support the premise that cancer peer support services may be under-utilized by older adults, particularly older women. The reasons for these findings remain unclear although ageism may be a factor. Due to the reliance on a convenience sample, qualitative findings that older adults were generally able to meet their supportive care needs cannot be generalized to all older adults living with cancer. Large organizations such as the CCS need to begin systematically collecting demographic and other information on clientele to enhance program planning and delivery. Further research studies on older adults living with cancer are needed to examine their supportive care needs.

Adolescents raised in impoverished environments are at substantial risk of making poor life decisions because they are often exposed to high levels of neighborhood violence and substance use, and attend under-resourced schools. Despite facing these risks, many youth experience adaptive developmental outcomes in the face of these challenges. Resilience literature identifies the presence of a supportive adult relationship and a positive future orientation (i.e., an optimistic conceptualization of the future) as factors related to decreases in negative outcomes and increases in positive outcomes among youth exposed to conditions of risk This study examined both mediation and moderation as possible mechanisms explaining the interplay of future orientation and supportive adult relationships as contributors to resilient outcomes in African-American youth raised in areas of risk. Specifically, this study assessed (1) whether youth develop a positive future orientation through their contact with supportive adults which results in decreased engagement in problem behaviors and increased grades (i.e., a mediated effect), and (2) whether the associations of supportive adult relationships with problem behavior and academic achievement differ as a function of variation in future orientation (i.e., a moderated effect). Data from an evaluation conducted in a low-income, high risk area in Atlanta were used to tests these mechanisms. This study found that these processes are complex and depend on the outcome variable being assessed. Specifically, future orientation mediated the association between supportive adult relationships and problem behaviors, but moderated the association between supportive adult relationships and academic achievement. In the mediation model, supportive adult relationships were associated with decreases in problem behaviors through its association with future orientation. In the moderation model, among youth with a low future orientation, supportive adult relationships were associated with increases in school grades. This study also found that future orientation interacted with gender associations, such that among youth with high future orientation, girls had higher school grades and among youth with low future orientation, girls engaged in more problem behaviors. This study has implications for future research on future orientation, youth development prevention and intervention programming, and policy around low-income youth.