Exploring The Experience Of Sexuality And Gender During The Healthcare Transition Of The Youth With Cerebral Palsy, Umma Salma

Electronic Thesis and Dissertation Repository

Background: Transition from the pediatric to adult health care system is an important phase of healthcare for youth with cerebral palsy (CP). Sexuality and gender are two very important components of health that are mostly ignored in the healthcare transition process. It is possible that health care providers only see a client’s disability, and therefore, key aspects of sexuality and gender diversity may be ignored, or deemed irrelevant as a result of their disability status. Therefore, the purpose of our study is to explore how gender and sexuality may influence the experience of health care transition for youth with cerebral …

(In)Dependence, Socio-Sexual Relationships, And Sexual Health Among Adults With Mild Intellectual Disability (Mid): A Critical, Qualitative Exploration, Vanessa L.E. Cox Ms

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The purpose of this critical, qualitative study was to explore how adults with mild intellectual disability navigate independent socio-sexual relationships in settings where they are highly dependent upon caregivers and family members who exert significant control over most aspects of their lives. Data were gathered during one-on-one interviews conducted with adults with MID (n=15), and parental caregivers (n=6). Theoretical insights from critical disability studies and sexual citizenship were used to analyze the findings, which are presented thematically by study population. Participants with MID faced challenges to establishing and maintaining meaningful relationships, including a lack of choice about where and how …

Exploring The Experience Of Disclosing In The Workplace, Jillian Auger

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An alarming rate of workplace violence/harassment is observed each year, with negative outcomes that affect the organization (i.e., financial loss) and those directly involved (i.e., job loss, financial strain, fear of being blamed, being labeled a ‘troublemaker’). The literature indicates that, for many victim-survivors, there is little hope for positive outcomes following a disclosure of workplace violence/harassment. In fact, some studies show that negative reactions to disclosure can compound and intensify the impact of violence/harassment on psychological functioning. However, minimal research has been devoted to the experiences of victim-survivors regarding the outcomes of a disclosure. Utilizing virtual semi-structured interviews, the …

How We Debrief: An Interpretive Description Of Social Service Community Workers' Experiences, Andrea C. Krywucky

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The aim of this research was to understand current practices of debriefing being used or not used in community social service organizations and the presumed frameworks or evidence justifying these practices in London, Ontario. The geographical area under concern has seen an increasing poverty gap, lack of affordable housing, toxic drug crisis, with mental health issues being exasperated by the pandemic. Social service agencies are overwhelmed with caseloads, creating an increase in need of care for frontline workers, as they are the first point of contact for many. This research utilized an interpretive description methodology to explore workers’ experiences and …

Examining The Socio-Economic And Gendered Structure Of Canada's Live-In Caregiver Program: A Qualitative Study Of Filipina Women's Health Experiences, Andrea Bobadilla

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The primary aim of this critical ethnographic study was to examine how Filipina women in the Canadian live-in caregiver program (LCP) negotiate their own physical and mental well-being while managing the complex health needs of their clients. Using global care chain and postcolonial theoretical frameworks, I also sought to identify how multi-scalar forces including caregiving and migrant policies in Canada and South East Asia exacerbate pre-existing gendered and labour inequities faced by these women. The distressing impact of this precarious form of employment on family dynamics and relationships among family members in the Philippines was also explored. Data collection took …

The Coping Strategies Of Older Adults With Age Related Vision Loss (Arvl) – A Narrative Account, Zakara J. Stampp

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The goal of this study was to share the stories of older adults with age-related vision loss (ARVL) and how they have coped to maintain meaningful occupational engagement. Grounded in a constructivist paradigm, data collection and analysis were guided by the narrative inquiry methodology. The participants consisted of six older adults aged 60 or older, diagnosed with one of the following ARVL conditions: macular degeneration, diabetic retinopathy, and/or glaucoma. Participants were recruited from vision loss non-profit organizations such as the Canadian National Institute for the Blind (CNIB) and the Alliance for Equity of Blind Canadians (AEBC). One older adult was …

Cost-Effectiveness Analysis Of Tpmt Genotype-Guided Azathioprine Treatment Compared To Standard Treatment For Patients With Moderate/Severe Ulcerative Colitis, Ali Unsal

Electronic Thesis and Dissertation Repository

This study assessed cost-effectiveness of pharmacogenomics (PGx)-based azathioprine (AZA) compared to standard AZA therapy for ulcerative colitis (UC) patients in Canada. A patient-level Microsimulation model was developed to compare the lifetime costs and quality-adjusted life years (QALYs) gained by a hypothetical cohort of UC patients with age and sex characteristics. The parameters used in the model were derived from the published literature and costs from the Ontario Schedules of Payments and published sources. The results were summarized in terms of the incremental cost-effectiveness ratio (ICER). Compared to standard AZA, PGx-based AZA care was the dominant strategy with 0.17 incremental QALYs …

Examining The Impact Of Financial Incentive Removal On Physical Activity: A Quasi-Experimental Study Of 584,760 Mobile Health Application Users, Sean Kevin Spilsbury

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BACKGROUND: Government interest in using financial incentives (FIs) to stimulate physical activity (PA) is increasing. The cost of longer-term incentive interventions may be prohibitive, however. PURPOSE: To examine the impact of FI withdrawal on PA. METHODS: A 25-week retrospective pre-post quasi-experimental study was conducted with users of a FI-based mHealth app. Users from three Canadian provinces were included. Daily FI were removed in Ontario (ON; intervention) but not British Columbia (BC) and Newfoundland and Labrador (NL; control). Simple linear regression models were used to examine weekly mean daily step count after FI withdrawal. RESULTS: The total sample included 584,760 users …

Implementing Health Impact Assessment As A Required Component Of Government Policymaking: A Multi-Level Exploration Of The Determinants Of Healthy Public Policy, Stephanie A. Simpson

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It is widely understood that the public policies of ‘non-health’ government sectors have greater impacts on population health than those of the traditional healthcare realm. Health Impact Assessment (HIA) is a decision support tool that identifies and promotes the health benefits of policies while also mitigating their unintended negative consequences. Despite numerous calls to do so, the Ontario government has yet to implement HIA as a required component of policy development. This dissertation therefore sought to identify the contexts and factors that may both enable and impede HIA use at the sub-national (i.e., provincial, territorial, or state) government level.

The …

Improving Developing Countries’ Health Information Systems Capacity For Infectious Disease Pandemic Responses: A Case Study Of The Ebola Virus Disease And The Coronavirus Disease Pandemics, Uche Ikenyei

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There is increasing evidence to demonstrate that current information system theoretical models meant to assess the success of the health information systems (HIS) lack the applicable theoretical underpinning suitable for developing countries. This stems partly from a theory-evidence gap where theoretical models developed in the West are applied in developing country contexts but lack tailoring to localized, contextual realities. Therefore, this study addresses this gap by enhancing the DeLeon and McLean's information system success model with six contextual factors peculiar to the infectious disease HISs in a developing country context.

This study took place in two developing countries, Liberia and …

The Development, Short-Term Efficacy, And Pilot Implementation Of An E-Learning Course In Physical Activity And Sedentary Behaviour For Pre-Service Early Childhood Educators, Brianne Bruijns

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The overarching purpose of this dissertation was to develop an e-Learning course in physical activity and sedentary behaviour and test its short-term efficacy and implementation among pre- and in-service early childhood educators (ECEs). The Delphi approach was adopted for Study 1, wherein a panel of international experts in physical activity and sedentary behaviour suggested topics for the course and, together with a panel of ECE experts, rated their importance. Study 2 employed a pre-post design to explore the changes in pre- and in-service ECEs’ physical activity and sedentary behaviour-related knowledge, self-efficacy, behavioural intention, and perceived behavioural control following course completion. …

Examining Public Health Risk Communication Via Social Media By Provincial And Local Health Authorities In Ontario During The Covid-19 Pandemic, Marc Resendes

Electronic Thesis and Dissertation Repository

Risk communication campaigns are essential during public health crises to inform the public about ways to mitigate, alleviate and manage potential risks. The purpose of this study was to describe risk communication on social media by Ontarian health authorities amid COVID-19, in addition to examining the strategies that guided their social media use. This was completed through (a) a narrative review of risk communication literature; (b) a qualitative content analysis of select health authority Twitter messaging following three major COVID-19 milestones; and (c) key informant interviews with those coordinating social media responses to COVID-19. Information giving and news updates were …

The Role And Importance Of Social Support During Recovery Following Distal Radius Fracture, Ogheneruona Mi Idoghor Ikpen

Electronic Thesis and Dissertation Repository

This thesis explored how social support changes with time and differs across genders within 1-year post distal radius fracture (DRF). It also examines the effect of social support on the patient-rated wrist evaluation (PRWE) score and health-related quality of life (HRQoL) of DRF patients at 3 months post-fracture. In this cohort study, patient-reported social support (emotional/informational, tangible, affectionate and positive social interaction) was measured using the Medical Outcomes Study (MOS) social support survey, and HRQoL was measured using the 36-Item Short-Form Survey (SF-36). Social support significantly decreased at 3 months in comparison to baseline, 6 months and 1 year (with …

An Epidemic Amidst A Pandemic: A Critical Policy Analysis Of Supervised Consumption Sites, Vanisa Ezukuse

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This study's primary purpose is to critically appraise current federal and provincial policies regarding supervised consumption sites (SCS), noting intended and unintended consequences; and how these policies could impact SCS users. This study's secondary goal is to compare current policies related to SCS in Alberta, British Columbia, Ontario, and Quebec to provide critical insight and suggestions for ongoing policy development. Carol Bacchi’s (2009) “What is the Problem Represented to Be?” framework was applied to the Canadian policy document with a focus on SCS. Four themes are proposed: Public Health versus Criminality, Presumptions versus Assumptions, Policy Unaccountability, and Policy Duality. It …

Impacts Of Covid-19 Related Changes In Income On Women Experiencing Intimate Partner Violence At Home, Cara Davidson

Electronic Thesis and Dissertation Repository

Introduction: Intimate partner violence (IPV) has increased in Canada due to COVID-19 and associated public health measures. Economic status may be responsible, but this must be validated during COVID-19.

Methods: An online survey was administered to 23 Canadian women to measure their income pre and during COVID-19 and their experiences of IPV in the past 12 months. Factorial ANOVAs and MANOVAs were used to explore the relationship between income and IPV.

Results: Of women responding to both timepoints, 56.5% (n=13) indicated an increase in IPV. Analyses did not suggest that income was significantly related to IPV, apart from the effect …

"Man Up": Male Survivors Of Intimate Partner Violence Through The Eyes Of Their Providers, Xavier S. Borsato

Electronic Thesis and Dissertation Repository

Intimate partner violence (IPV) is a complex phenomenon that is often understood with women as the primary recipients of violence and men as the primary perpetrators. However, emerging literature on heterosexual relationships suggests that men also experience interpersonal violence, most often from their female partners. Drawing on research data gathered through semi-structured interviews with service providers (n = 4), this qualitative inquiry explores how gender, power, and the stigma associated with interpersonal violence impact men who have experienced abuse through the perspectives of the service providers who work with them. The findings from this study highlight how traditional constructions …

Analysis Of Health Care Costs Over A One-Year Period Following Anticoagulant Therapy Among Ontario Patients Diagnosed With Atrial Fibrillation, Michael Situ

Electronic Thesis and Dissertation Repository

Atrial fibrillation patients are at high risk of ischemic strokes, which can be drastically reduced using oral anticoagulants (OACs). Warfarin has been the standard OAC for this population but its effectiveness rests on consistent monitoring with the potential for severe bleeding events. Newer OACs, like rivaroxaban and apixaban, address these drawbacks but have a comparatively higher upfront cost. Uncertainty remains over which OAC is cost-saving from a health care system perspective. Using a retrospective cohort study design and inverse probability weighting regression adjustment estimators, one-year health care costs among patients treated with warfarin, rivaroxaban, and apixaban were compared. Compared to …

The Experiences Of Iraqi Refugees In Canada: A Life History Study Of War And Resilience In The Aftermath Of Migration, Nada Nessan

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This thesis reports on a life history narrative on the experiences of Iraqi refugees who resettled in Canada after living through war. The aim of this study is to help change the narrow perspectives on the mental health of war affected populations to a broader perception shaped by cultural and social aspects and to inform the development of meaningful and cultural relevant programs and policies with a particular attention to the concept of resilience.

The first part of the study presents the chronological narratives, or profiles. of eight participants. The second part of the study is a thematic discussion of …

A Novel Spatio-Temporal Examination Of Children's Accessibility, Exposure, And Engagement To Parks And Recreation Spaces In Middlesex-London, Ontario, Malcolm K. Little

Electronic Thesis and Dissertation Repository

Children are spending more free time engaged in activities indoors, rather than in outdoor environments such as parks and recreation spaces. Parks and recreation spaces provide amenities that promote physical, cognitive, and social health among children. As it relates to the complexities of children’s living situations, properly measuring children’s levels of interactions with these spaces is poorly understood in geography research.

By examining various attributes of children, this thesis improves on the measurement of children’s levels of interactions with parks and recreation spaces. Research herein utilized household survey data, a high-resolution GIS dataset of environmental factors, and GPS logs from …

Understanding The Determinants Of The Cost Of Coronary Artery Bypass Graft Surgery, Hun Lee

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Introduction: The relationship between patient demographics, clinical factors, and cost of coronary artery bypass graft (CABG) is complex. Investigation of these relationships is important to aid clinical practice and inform reimbursement models. This thesis analyzes multiple different domains in order to understand the significant factors that impact the cost of CABG at the London Health Sciences Centre (LHSC).

Methods: Model selection, construction of nested descriptive models, exploration of mediation analysis of the impact of peri-operative factors and cost through length of stay, and construction of estimative models were performed.

Results: Several baseline characteristics, socio-demographics, peri-operative variables, and post-operative variables were …

Investigating Children's Experiences And Participation In A Free Community-Based Physical Activity Program: The Grade 5 Act-I-Pass, Emma E. Ostermeier

Electronic Thesis and Dissertation Repository

Physical activity is an important component of children’s health and development; however, a majority of Canadian children are not meeting the physical activity recommendations. This thesis aimed to identify the factors that influenced children’s enrollment and participation in a free community-based physical activity program, the Grade 5 ACT-i-Pass (G5AP). This thesis consisted of two individual, but interrelated studies. First, focus groups with G5AP participants were used to explore the factors that influenced children’s perceived physical activity levels and participation in the program. Second, a spatially-targeted promotional campaign was developed and implemented to help evaluate the impact of promotions on program …

Pregnancy In Peril: The Impact Of Conflict On Antenatal Care And Skilled Birth Attendant Utilization In The Democratic Republic Of The Congo And Burundi, Bianca R. Ziegler

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As of 2019, over two billion people globally reside in conflict-affected areas, and as a result, face negative health implications. Burundi and the Democratic Republic of the Congo are among those countries classified as fragile and conflict-affected situations, resulting in disproportionally high maternal mortality rates. Grounded in Andersen’s Model of Healthcare Utilization, this thesis employed multivariate binary logistic regressions to examine factors which influence antenatal care and skilled birth attendant usage in these two countries. Findings indicate that women living in high conflict regions were significantly less likely than those in low conflict regions to have their first antenatal care …

Investigating Elementary School Food Programs: Impacts On Child Knowledge And Dietary Behaviours, Paige Colley

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Good nutrition is an important part of maintaining a healthy lifestyle. A balanced diet can promote positive health outcomes, protecting against health problems caused by nutritional deficiencies. Canada has reported poor diet quality and high rates of overweight and obesity among children. Obesity has been linked to several non-communicable diseases including type 2 diabetes, heart disease, and some forms of cancer. Efforts to improve lifelong, healthy eating behaviours must be implemented.

This dissertation investigated the impacts of school food programming on child nutrition. A Centrally Procured School Food Program (CPSFP) was implemented at 30 elementary schools in Southwestern Ontario, Canada. …

Implementation Adherence And Perspectives Of The Physical Activity (Play) Policy Study: A Process Evaluation, Monika B. Szpunar

Electronic Thesis and Dissertation Repository

This study entailed a process evaluation of the Childcare PhysicaL ActivitY (PLAY) Policy. Early childhood educators (ECEs) in childcare centres (n = 5) delivered the policy (which included 8 recommendations) and documented adherence (i.e., dose) in daily implementation logs. Program evaluation surveys (n = 21) and interviews (n = 10) were completed post-intervention to assess barriers/facilitators, feasibility, enjoyment, and likelihood of future implementation. Descriptive statistics and thematic analysis were conducted. Adherence was highest for delivery of child-directed play (85.9%) and lowest for delivery of frequent outdoor periods (16.5%). Participants reported they were likely to continue policy implementation, …

Development And Application Of A Teen-Informed Tool For Measuring The Power Of Food-Related Advertisements In Canadian Environments, Drew Bowman

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Food environments are influential in shaping dietary behaviours of adolescents. Exposure to food and beverage marketing is known to impact food knowledge, behaviours, and health outcomes, yet food environment research largely overlooks advertisements. Given that marketers tend to advertise less healthy foods to teens and teens predominantly purchase low-nutrient foods, it is crucial to study the information environment in the context of secondary school environments. This thesis uses a sequential mixed-methods approach, including environmental audits and teen consultations, to develop and apply a teen-informed tool to measure the power of advertisements surrounding secondary schools. Results indicate that exposure to and …

Timely Access To Maternal, Neonatal And Child Healthcare For Rural Communities In Rwanda: The Role Of Community Health Workers, Jean Bosco Bigirimana

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Abstract

Introduction: In Rwanda, although there has been some progress in health care delivery as expressed in the reduction in maternal and child mortality, rates are still high and geographically variable. Improving equitable access to quality healthcare services for maternal, neonatal and child healthcare (MNCH), community-based maternal, neonatal and child healthcare (CBMNCH) depends upon using “community health workers” (CHWs). Yet CHWs program faces difficulties that upset delivery of the quality of the comprehensive package of services. Unfortunately, little is known about CHWs` performance and job satisfaction in the provision of CBMNCH.

Goal: The study aimed to provide insight into …

Using The Health Action Process Approach (Hapa) To Understand And Change Sedentary Behaviour In Office Workers: Effects On Motivation, Behaviour, And Health Outcomes, Andrew Scott Rollo

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Sedentary behaviour (SB) is positively associated with all-cause mortality, as well as numerous chronic diseases, including fatal and non-fatal cardiovascular disease, type 2 diabetes, certain types of cancer, and metabolic syndrome. Interventions targeting reductions in sedentary time among office workers who are an at-risk population for high levels of SB are needed. The main objective of this dissertation was to contribute to the body of knowledge surrounding theory-based behavioural interventions targeting SB among office working adults. First, a systematic review of the literature (study 1, chapter 2) was conducted that highlighted important cognitive and motivational factors associated with SB, which …

Resedent Study- Reducing Sedentary Behaviour May Slow Cognitive Decline In Older Adults With Mild Cognitive Impairment: A Pilot Study, Kirsten B. Dillon

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Physical activity (PA) has been shown to slow down dementia. Unfortunately, older adults spend most of their day in sedentary behaviours (SB). Breaking up prolonged bouts of sitting with intermittent bouts of light intensity PA may reduce glycemic variability in the brain; potentially mitigating cognitive decline. This study investigated how interrupting SB with 10 min bouts of light intensity PA 3x a day would affect mild to moderate cognitive impairment progression (primary outcome) in older adults residing in an assisted living facility. Participants (n=25) were assigned in clusters into a two arm 10-week single site pilot randomized controlled trial. Secondary …

Health Policy And Social Change: Women’S Advocacy Groups And Narrative Mobilization, Jill Moffatt

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The goal of this study is to systematically investigate the mobilization of co-created (storyteller and story-gatherer) narratives for policy and social change. A case study format investigated the mobilization of narratives by a women’s health organization in London, Ontario. Semi-structured interviews resulted in transcripts from key actors. These transcripts were thematically coded and analyzed. All interview participants emphasized that from their perspective the organization did influence health policy or social change through their narrative use. Specific policy change examples were provided by participants, and social change was subjectively recognized as realized through the creation of awareness and affirmed through audience …

Examining Climate Change-Health Nexus In Ghana, Lucia Kafui Hussey

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Climate change is one of today’s most pressing global issues with its physical, biological and social impacts widely recognized. One area of concern is its potential health consequences. The postulated health effects from climate change are far-reaching that climate change induced health risks are signaled as the most pressing problems to public health in the 21^st century. Although developing countries such as Ghana had been suggested as a vulnerable hotspot for the health consequences of climate change, there is a paucity of empirical research on climate change and its health linkages in the country.

The purpose of this dissertation …