Intimate partner violence is a prevalent problem throughout the world and is associated with significant physical as well as psychological impairment for women. Few studies are available to fully illuminate which interventions are most beneficial in healing and empowering women after their experience of violence in an intimate relationship. Although many traditional as well as creative approaches (Cognitive Behaviour Therapy, Person-Centred Therapy or Creative Arts Therapies) are used in practice, much of the work with survivors is not grounded in empirical research. In the present study the effects of Art Therapy in comparison with Person-Centred Therapy and routine intervention without additional therapy have been measured by quantitative as well as qualitative means. Measures of self-efficacy, self-esteem, depression, symptoms of PTSD and general psychological well-being were administered to a sample of survivors of intimate partner violence at baseline, end-oftreatment and follow-up. Therapy experience has been the focus of one-on-one interviews with participants. In general, all intervention groups improved on most outcome measures at follow-up. Participation in either of both therapeutic interventions in addition to routine care, however, contributed to improvements in difficulties related to phobic anxiety and impaired self-reference. Art Therapy was particularly effective in improving general psychological wellbeing and in particular self-efficacy, self-esteem, depression, somatic problems and several debilitating symptoms of PTSD.

Purpose: A majority of childhood and adolescent cancer survivors face life-long cancer- and treatment-related sequelae. Long-term follow-up is necessary to facilitate timely diagnosis and management of these health conditions. As part of strategic long-term follow-up, provider continuity of care (PCOC) may improve outcomes through appropriate use of surveillance, screening, and coordination of services. The purpose of this thesis was to assess physician services utilization and PCOC among survivors of childhood cancer compared with general population subjects, and to examine factors associated with survivors' use of physician services and PCOC scores. Methods: Physician services utilization and PCOC were assessed in a population-based cohort of 1322 five-year cancer survivors diagnosed between 1981 and 1995 under age 20 in British Columbia, and a group of 13,220 age- and gender-frequency matched, randomly selected population-based subjects, whose records were linked to individual-level administrative healthcare datasets. Effects of clinical and sociodemographic modifiers on utilization and PCOC were examined using generalized linear modeling. Changes in utilization and PCOC by age were estimated using a longitudinal, repeated measures modeling approach. Results: Survivors incurred an average of 8.94 medical visits per year: 4.82 to primary care physicians, 2.69 to specialists, and 1.43 to non-physician providers. Survivors had more visits than comparators in all visit categories (p<0.0001 for all). As they age, survivors' use of primary care services increases significantly, while their use of specialist services declines, trends that are not mirrored by the comparison population. The average PCOC score for survivors was 0.54 ± 0.22, indicating survivors saw the same primary care provider for only 50% of their primary care visits. Mean score did not differ between survivors and comparators; however, in the population sample scores improved with age (p=0.02), while among survivors, scores worsened (p=0.05). Conclusions: The dramatic age-related increase in primary care visits observed in the survivor group suggests that primary care physicians play a key role in ensuring quality long-term follow-up care. Survivors are at heightened risk for poor PCOC as they age and transition into adult-oriented community care, raising concerns about whether they are receiving the appropriate follow-up care encompassing screening, surveillance and psychosocial support. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第22839号 / 人健博第81号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 恒藤 暁, 教授 田村 恵子, 教授 戸井 雅和 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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Previous studies of resistance in the field of sociology have focused on many types of resistance but have not examined poor women’s resistance in the aftermath of trauma. Psychologists have examined trauma recovery and resilience, but have not examined these topics from an integrated, sociological perspective. In this work, I synthesize current scholarship on resistance from sociology with resilience in psychology and address these existing gaps. Through open-ended, semi-structured interviews with twenty-three women who suffered traumatic life events, I answer the following questions: How do women narrate their rebound from trauma and how do they define those experiences? What are the commonalities in women's narratives of overcoming? How do race, class, sexuality, and poverty intersect to affect resistance and resilience for these women? What themes emerge in women’s discussions of overcoming trauma? What aspects of their trauma recovery involve resistance and resilience? My findings show that women trauma survivors are resilient and resistant in a number of ways: through understood therapeutic means including self-help, support groups, therapy, reading about and watching programs regarding the subject, discussing trauma and recovery with family and friends, using mentors, engaging in positive spirituality, and through creative expression. I found women were resistant in less traditionally understood ways. These include choosing to get help with coping from therapy or support groups against the wishes of loved ones or others due to stigma. Other methods included renaming themselves “survivor”, “thriver”, or reject labels entirely, and creating new, resilient selves. Finally, I found that survivors of traumatic life events often rejected community norms regarding how gender is “done,” by rejecting femininity, eschewing marriage, living as out lesbians, or choosing not to have children. Two unique findings emerged through the data collection. The first was that women from lower socioeconomic backgrounds frequently rejected the idea of victimhood, identified as survivors, or chose no label at all. They narrated their transition from victim to survivor as a sudden choice as opposed to, as the literature suggests, a process. Second, I find that there is a very particular script for coping in women from lower classes which frames traumatic life experiences as, “just part of being a woman.” I find that these frequently women employed a “tough guise” identity to reclaim respect in their low-income communities. I further find that women recreate new, socially valorized identities free from stigma by engaging in prosocial coping.

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Research on the effects of downsizing has focused on several levels including the global, organization, and the individual. However, this research, at the individual level, focused specifically on the effects of downsizing on the survivors of the organization. Downsizing refers to activities undertaken by management to improve the efficiency, productivity, and competitiveness of the organization by reducing the workforce size. Many researchers explain the types of response we can expect from survivors of a corporate downsizing. The possible attitudes and behaviors due to downsizing are of particular interest to managers, because managers will inevitably face a workforce at least partially staffed with survivors of downsizing activities. The purpose of this research is to give a better understanding of the effects of downsizing on survivors. This is accomplished by systematically analyzing and combining the findings of independent studies through meta-analysis. This research investigates the variables and variable relationships which represent effects of downsizing on the survivors. The individual downsizing studies are the sources of the variables used to measure behaviors and attitudes prevalent among downsizing survivors. The results of this research give a summary of the cumulated correlations for sixteen(16) variable relationships specifying the strength, direction, and the range of the correlations. These findings enable the manager to preview, in a combined sense, a certain set of downsizing survivor responses. These results support the findings reported in the independent studies and by other downsizing researchers. The studies that did not qualify for use in the meta-analysis cumulation procedures are analyzed, through the meta-analysis vote count method, and show that the majority of the survivors had experienced negative downsizing effects. Included also is an analysis of the small sample of studies done in the public versus those done in the non-public sectors that shows no real differences, due possibly to the small sample size. This research, through the use of meta-analysis, confirms the findings of the independent studies and gives more statistical reliability and confidence to the findings. / Ph. D.

Thesis advisor: Shanta Pandey / Thesis advisor: Jessica Shaw / Sexual violence remains one of the most pervasive and underreported crimes in modern society. Sexual violence largely impacts women and people with other marginalized identities and has historical origins as a tool for domination and control. Although, sexual assault and rape are common occurrences, survivors of sexual assault and rape do not report their crime, and many choose not to seek help. One reason offered in sexual violence literature as an explanation for low rates of reporting and resource-seeking is attributed to the “hidden rape” victim phenomenon. More than half of survivors do not acknowledge or label their experience as a sexual assault or rape, even though their experience meets the legal definition of rape. While many reasons may influence survivors to call their experience a rape or sexual assault, such as their relationship to the person who sexually assaulted them, substance use, or prior sexual encounters with the person who sexually assaulted them, there remains much to be explored about how survivors come to understand and label their assault. Especially, as research demonstrates that unacknowledged rape is directly correlated with non-reporting and resource-seeking decisions. This study examined the influences of internalized oppression and conscientization on how survivors label and understand their experience with sexual violence, and how those influences may affect post-assault resource-seeking decisions. This study is a secondary qualitative analysis of 22 semi-structured interviews collected between the years of 2018-2019 in a Northeast region of the U.S that focused on the experience of adolescent sexual assault. I examined the process of labeling a sexual assault among survivors and how their interactions with others in the social world informs that labeling process. Boejie’s constant comparative analytical method (CCM) for analyzing qualitative interviews, was used for code and category generation with the intent of theme identification. Findings from this study outlined types of oppressive and anti-oppressive messages that informs manifestations of internalized oppression and the conscientization process that attenuates it among sexual assault survivors. Additionally, as internalized oppression and conscientization are psychological states that necessitate cultivation this study highlights the reinforcing and disruptive experiences that allowed for its continued indoctrination. Finally, this study uplifts the multiplicative experiences among sexual assault survivors with marginalized identities. Insights from this study provide new understandings of how internalized oppression and conscientization manifest among sexual assault survivors. Furthermore, the study highlights the impact these intrapsychic phenomena have on post-assault processing and decision-making. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Stroke survivors in low-resource settings like Rwanda often face high levels of disability, and access to rehabilitation care is limited. To effectively allocate resources, it is crucial to understand and address the most significant concerns of stroke survivors and explore contextually appropriate approaches to post-stroke care. We conducted a needs assessment survey of 337 patients from six hospitals in Rwanda, collecting data at discharge and three months post-stroke. Rwandan stroke survivors have similar unmet functional needs as those in high-resource settings. However, over half of the participants still reported moderate to severe mobility, usual activities, and social/recreational activities needs at three months post-discharge. Stroke survivors indicate that limited access to services was a significant barrier to addressing these needs. Community-based interventions may be an important method for addressing these needs; however, rehabilitation services are limited, warranting the need to consider alternative strategies to address these needs. The thesis explores the potential of involving community health workers (CHWs) in providing rehabilitation interventions for stroke survivors in community settings. Although the effectiveness of CHWs in providing physical rehabilitation interventions in low-resource settings remains uncertain and sustainability of these interventions outside the studied context is also unclear. Subsequent the use of CHWs for post-stroke rehabilitation is a worthwhile endeavor. To facilitate the implementation of CHW-delivered interventions, two crucial steps were considered: the development of an intervention and establishing an operational team that will ensure implementation success. A multi-phased process was used to design a new evidence-informed post-stroke community-level mobility intervention suitable for low-resource settings. The Rehabilitation Treatment Specification System enabled the intervention design and description toward facilitating its accurate replication. The next step is to test the intervention’s feasibility, effectiveness, and implementation in low-resources settings. / Thesis / Doctor of Philosophy (PhD) / The issue of post-stroke disability is significant in Rwanda due to limited resources for stroke survivors. To improve the resources available for stroke survivors in such settings, it is important to understand their specific needs and explore alternative approaches to provision of interventions. We surveyed 337 patients from six hospitals in Rwanda to describe their functional unmet needs after stroke and at three months. Within 90 days of stroke, Rwandan stroke survivors have more moderate to severe functional needs in almost all usual activities, which is twice compared to post-stroke unmet needs for stroke survivors living in areas with post-stroke resources. Three months after leaving the hospital, over half of the participants still have moderate to severe functional needs in mobility and other usual activities, working, and social/recreational activities. Rwandan stroke survivors identified that not being able to use therapy services made it difficult to address these needs. These data indicate it is crucial to focus on community-based interventions to address the needs of stroke survivors. In my research, I investigated whether Community Health Workers (CHWs) could administer rehabilitation treatment in resource-limited areas. Although the effectiveness of physical rehabilitation by CHWs is uncertain, there is potential for CHWs to participate in delivering rehabilitation. It is worth considering the use of CHWs for post-stroke rehabilitation. In order to successfully implement CHW-delivered interventions, two important steps were considered. First, an intervention was developed. Second, an operational team is being established to ensure the intervention’s success. The process of designing a new evidence-informed post-stroke community-level mobility intervention suitable for resource-limited areas, consisted of multiple phases. The Rehabilitation Treatment Specification System was used to design and describe the intervention accurately so that it could be replicated easily. The next phase involves examining if the intervention is practical, efficient, and can be successfully implemented in areas with limited resources.