The Impact Of The Diabetes Management Incentive On Diabetes-Related Services, Hospitalizations, And Mortality Risk In Ontario, Thaksha Thavam

Electronic Thesis and Dissertation Repository

Effective diabetes management provided in primary care has the potential to reduce hospitalizations and mortality. To improve diabetes management, a Diabetes Management Incentive (DMI) was introduced by the Ontario government for family physicians practicing in patient enrolment models. This thesis has three main objectives: 1) review the literature on the association between financial incentives for diabetes care and diabetes-related hospitalizations and mortality; 2) and 3) examine the impact of DMI on: diabetes-related services, diabetes-related hospitalizations, diabetes-related hospitalization costs, and mortality risk in Ontario. A review of the literature on the incentives revealed inconsistent findings. The impact of DMI was assessed …

Parents As Agents Of Change In The Treatment Of Childhood Obesity And The Promotion Of Children's Health Behaviours, Kristen C. Reilly

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The overarching purpose of this dissertation was to investigate the role of parents as agents of change in the treatment of childhood obesity and the promotion of children’s health behaviours. In order to achieve this purpose, four studies were conducted. The purpose of Study 1 was to explore parents’ perceptions of nutritional literacy, as well as their needs for nutritional literacy information, supports, and resources at familial and community levels. Next, Study 2 described the theoretical components and model used in the development and implementation of a parent-focused childhood overweight and obesity intervention (i.e., C.H.A.M.P. Families). The purpose of Study …

Normalizing Masculinity: Explaining Processes, Factors, And Contexts That Influence How Rural Male Farmers Seek Health Information In Southwest Ontario, Bradley C. Hiebert

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Disproportionately high mortality and morbidity rates experienced by rural men are often related to the high prevalence of rural male farmers (RMFs) who are consistently exposed to chemicals, animal waste, and dust, or injured or killed while working. This dissertation aimed to explain processes by which RMFs seek health information (HI), and how these processes are influenced by rural social, cultural, political, and geographical factors.

Three studies were conducted as part of this dissertation. The first study was a literature review that explored the relationship between rural men’s health, health information seeking (HIS) theory, and masculinity theory. The second study …

Promoting Healthy Beverage Consumption Habits Among Elementary School Children: Evaluating The Healthy Kids Community Challenge 'Water Does Wonders' Interventions In London, Ontario, Bridget R. Irwin

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Childhood obesity is a major public health concern and has been attributed to poor diet, among other factors. Sugar-sweetened beverage (SSB) consumption, in particular, has been linked to excess weight gain in childhood, while water consumption is a protective factor. Taking advantage of the Water Does Wonders theme of the Healthy Kids Community Challenge, an initiative by the provincial government to promote water consumption, this thesis uses pre-post surveys of children aged 8-14 years to examine (a) the association between knowledge and beverage consumption habits, and (b) the effectiveness of a school- based education and environment intervention to reduce SSB …

Examining The Relationship Between Body Mass Index And Health-Related Quality Of Life Perception Among People With Mental Illness, Fatima Bukair

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People suffering from mental illness are three times more likely to die prematurely from ‘natural’ causes than those without mental disorders as a result of their physical condition. Their life expectancy is reduced by 12-19 years. Obesity is commonly associated with mental illness and accounts for increased risk of cardiovascular disease, diabetes mellitus, stroke, heart disease, some cancers and osteoarthritis. This paper examined the relationship between body mass index (BMI) and health-related quality of life perception using the Short-Form Health Survey 36 among people living with mental illness. A Multivariate Multiple Regression model was employed to estimate the variables that …

Wait Times, Resource Use And Patient-Reported Outcomes For Patients Referred For Total Knee Replacement Surgery, Kate Lebedeva

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This prospective cohort study evaluated the usual care pathway for patients referred to total knee arthroplasty (TKA). We measured healthcare resource use, costs and health-related quality of life (HRQoL) over the continuum of care. We also determined the proportion of inappropriate referrals and estimated wait times for initial surgical consultation and TKA. We found that two in five patients referred to specialty care were deemed inappropriate surgical candidates. Prior to referral, few conservative treatment options were tried, and many imaging tests ordered by referring providers were unjustified. Overall, the greatest proportion of costs were borne by the patient or private …

Active And Safe Routes To School: Evaluating School Travel Planning To Support Children's Active Travel, Adrian Nicholas Buttazzoni

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Most Canadian children are not achieving their daily recommended physical activity (PA) levels despite the many emotional, psychological, and physical benefits of PA. Walking or wheeling to/from school, or active school travel (AST), is a viable method for improving children’s daily participation in PA. In Canada, the Active and Safe Routes to School initiative promotes AST through its comprehensive School Travel Planning (STP) program. Utilizing a mixed-methods approach, broadly, this thesis investigates the i) implementation and ii) effectiveness of a regional, two-year STP program supporting AST. This thesis includes a systematic review of AST intervention models implemented in North America, …

Examining Geographic Variation In Children's Perceived Barriers To Physical Activity And The Implications On Behaviour, Leah Gabrielle Taylor

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Low levels of physical activity among Canadian children has become a national public health issue. Recent research has suggested that children’s physical activity levels are associated with their perceptions of their everyday environments. A better understanding of the formation of these perceptions within different contexts is needed to explain the extent of the relationship. Using a multi-tool quantitative protocol, this thesis examines geographic variation in socio-ecological factors influencing children’s perceptions of barriers to PA, and the extent to which perceptions mediate the relationship of the environment and PA. Results indicate that perceptions form within contexts, and have an influence on …

Exploring The Influence Of Childcare Type On Physical Activity And Sedentary Time Of A Nationally Representative Sample Of Canadian Preschoolers, Julie Statler

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A large number of Canadian children are enrolled in childcare, and they spend substantial time there. Capturing a national picture of the relationship between childcare type and physical activity (PA; i.e., light, moderate- to-vigorous, and total) and sedentary time (ST) in young children is needed. Using a nationally representative sample of preschoolers (aged 3-5 years), this cross-sectional study used cycles 3 and 4 of the Canadian Health Measures Survey. Childcare type (e.g., centre-, home-based childcare, home with parent, kindergarten) was reported by parents. Preschoolers wore an accelerometer for 7 consecutive days. Device and population-specific cut-points were applied to delineate PA …

Exploring The Physical Activity And Screen Viewing-Related Knowledge, Training, And Self-Efficacy Of Early Childhood Education Candidates, Brianne Bruijns

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Early childhood educators (ECEs) greatly influence young children’s physical activity (PA) and screen viewing (SV) behaviours. This study explored the PA and SV-related knowledge (i.e., of important PA/SV concepts), training (i.e., PA/SV courses/content received), and self-efficacy (i.e., to facilitate PA and limit SV in childcare) of early childhood education students. A sample of 1,292 students from 61 Canadian colleges/universities completed the online survey. In general, students exhibited the least amount of knowledge regarding the link between SV and health. Further, 67.8% and 73.3% of students had not completed PA or SV courses during their post-secondary training, respectively, and students who …

Investigating The Health Meanings Of Young Saudi Women, Tagreed Alnajjar

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Women’s structural position within society and their family roles significantly influence their health. Previous studies have shown women hold lower health and socioeconomic status because of their gender within the Saudi culture. This study aimed to provide an understanding of how Saudi women value health and define being healthy within their social contexts. Adopting an ethnographic perspective, three focus groups (31 participants in total) were conducted with volunteer undergraduate Saudi female students on campus during a nine-week field trip to the participants’ university, King Abdulaziz University in Jeddah, Saudi Arabia. Three themes were generated from this study that characterize the …

Storied Bodies In Motion And Stillness: Shifting Meanings Of Physical Activity In Women's Life History Narratives, Shellie Mcparland

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Gender is a rarely studied social determinant of health. Qualitative methodologies, while underutilized in health promotion, may facilitate understanding of the gender and health relationship. The purpose of this work is to determine if narrative inquiry is a meaningful approach to study the relationship between femininity and physical activity and to examine this relationship within women’s life histories. Five women between 30 and 40 participated in two semi-structured interviews. Data were analyzed holistically, structurally, and categorically.

This dissertation is comprised of five integrated articles, in which I locate myself epistemologically as researcher through a discussion on the feminist underpinnings of …

The Development And Evaluation Of A Smartphone Nutrition Intervention For Adolescents, Sarah A. Cappuccitti

Electronic Thesis and Dissertation Repository

A diet high in fruit and vegetables is associated with the prevention of many chronic diseases; however, only one in ten Canadian students in grades 6 to 12 consume the recommended daily intake of fruits and vegetables. Using smartphones to deliver nutrition interventions is an emerging area of research, although to-date these interventions typically limit their focus to weight loss. The overarching purpose of this research is to redevelop and evaluate an existing smartphone application for an adolescent population. This thesis used a mixed-methods approach to gain adolescent perspectives on how to redevelop the app and to evaluate its use …

Exploring Physical Activity And Screen-Viewing Policies In Canadian Childcare Centres, Emily C. Ott

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This study aimed to explore the presence and characteristics of physical activity and screen-viewing regulations in Canadian childcare centres. Using a modified version of the Environment and Policy Assessment and Observation Self-Report tool (EPAO-SR), an online survey was distributed to childcare directors/administrators. A total of 1,290 childcare representatives accessed the survey, 514 provided complete data. Of these, 295 (44%) centres indicated having a written physical activity policy (with the majority regulated at the provincial-level). Characteristics of these policies included amount of time: spent outdoors (395; 63%); in teacher-led active play (101; 16%); and physical activity education for children (91; 16%). …

Promoting Benefits Of Physical Activity Through Persuasive Communication, Priynka Patil

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Inactivity early in life can lead to inactively later in life, which can result in negative outcomes. The primary purpose was to determine if gain- or loss-framed messages about physical activity would change the attitudes, intentions, and behaviours of students in the contemplation or preparation stage of the Transtheoretical model. The secondary purpose was to determine if framing the message in terms of the physical health benefits, appearance/social benefits, or mental health benefits (benefit condition) would change attitude, intention and behaviour. Undergraduate female students (N=60) between the ages of 18 and 36 were recruited from the university. The results found …

Understanding The Processes That Shape Cross Sector Service Provision In The Towards Flourishing Mental Health Promotion Strategy: A Secondary Analysis Utilizing Constructivist Grounded Theory Methodology, Shannon E. Winters

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In Canada, many national, provincial, and regional policies indicate that working together within and across sectors in health and social care is necessary and expected but evidence to support this call is lacking. This dissertation study explored the concept of cross sector service provision (CSSP), defined as: independent, yet interconnected sectors working together to better meet the needs of service users and improve the quality and effectiveness of service provision. The intent was to advance our understanding of processes involved in shaping service provision offered by two or more sectors. The thesis contains three studies. A Scoping Review that explored …

Assessing Physical Activity And Sedentary Time In The Early Years, Leigh M. Vanderloo

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The overall purpose of this dissertation was to explore young children’s (18 months to 5 years) physical activity and sedentary time. Study 1 assessed the physical activity and sedentary time among a sample of toddlers from London, Canada using two data processing approaches. Study 2 explored the impact of three different early learning environments, and their respective characteristics (e.g., staff behaviours, equipment, sedentary opportunities, etc.), on preschoolers’ activity levels. Study 3 examined differences in two popular accelerometers used to measure young children’s physical activity and sedentary time to better understand measurement discrepancies.

Study 1 revealed that toddlers engaged in 37.27 …

Understanding Views Of Evidence In Public Health Practice And Decision Making In Ontario, Sara Masood

Electronic Thesis and Dissertation Repository

Background: Perceptions of evidence by public health managers, practitioners and policy makers is one of the key determinants of evidence uptake. Therefore, understanding views of evidence in both practice and policy decision making is important to bridge the evidence-practice and policy gap in public health. Objectives & Methods: Two studies are presented in this thesis. The first is a systematic review synthesizing studies exploring the use of research evidence in public health decision making between 2010-2016. The second study is a qualitative descriptive study examining understandings about evidence in Ontario public health units by comparing perspectives from managers and frontline …

The Role Of Postural Stability And Other Factors In Distal Radius Fracture, Sheena Saju Philip

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The objective of the thesis was to describe the factors leading to falls in distal radius fracture (DRF) events, explore patient perceived risk of falls, and postural stability. A mixed method study described the type of fall in DRF patients (n= 1454) and patient perceived contributing factors (n=29). A prospective cohort study examined the postural stability and related fall risk of DRF participants (n=137) in Biodex Balance System (BBS) and compared to normative values. Environmental factors were a major contributor to DRF events. Older adults (44 to 65 years) had the highest rate of DRF (female: male ratio of 2:1). …

A Gender-Sensitized Weight Loss And Healthy Lifestyle Program For Overweight And Obese Male Hockey Fans: Effects On Dietary Behaviours, Ashleigh De Cruz

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BACKGROUND: Male dietary behaviours have often been associated with overweightness and obesity. Although little research exists to help prevent the problem, this can somewhat be explained by the lack of men engaging in healthy eating and lifestyle change. A gender-sensitized intervention study using hockey as a draw to participate may positively change dietary behaviours and associated health outcomes. METHODS: A 12 week, 12 session, weight loss and healthy lifestyle intervention program was conducted in which overweight and obese male fans of a local hockey team were coached to adopt healthy eating and lifestyle behaviour changes in collaboration with …

The Sixties Scoop Among Aboriginal Veterans: A Critical Narrative Study, Munira Abdulwasi

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This study explored the experience of Aboriginal Veterans adopted and/or fostered during the Sixties Scoop using critical narrative inquiry. The objectives were to: 1) understand the lived experience of Aboriginal veterans adopted and/or fostered during the Sixties Scoop, 2) explore any health needs expressed by Aboriginal veterans adopted and/or fostered during the Sixties Scoop, and 3) provide recommendations for the implementation of health services and programs to assist this group of Aboriginal veterans with their health needs. Eight individual interviews were conducted with participants in Kitchener-Waterloo, London, Ottawa, Winnipeg, and Vancouver. All interviews were audio-taped, transcribed verbatim, and analyzed using …

Exploring Mothers' Influence On Preschoolers' Physical Activity Levels And Sedentary Time, Alana M. Maltby

Electronic Thesis and Dissertation Repository

Physical activity (PA) patterns continue from childhood into adulthood; therefore, establishing healthy PA levels early is imperative. Mothers have been identified as influencing preschoolers’ activity behaviours; however, a holistic exploration of maternal influence is lacking. The purpose of this study was to explore maternal influence on preschoolers’ PA and sedentary time. Preschoolers (n = 30) and their mothers wore ActicalTM accelerometers, and mothers completed the adapted Environmental Determinants of Physical Activity in Preschool Children - Parent Survey. Direct entry regression analyses were conducted to explore maternal influence (e.g., support, enjoyment) on preschoolers’ activity levels. Maternal support was a significant predictor …

The Effect Of A Multiple Modality Mind-Motor Exercise Intervention On Single And Dual-Task Gait, Balance, And Executive Function, In Community Dwelling Older Adults With A Subjective Cognitive Complaint: A Randomized Controlled Trial., John P. Bocti

Electronic Thesis and Dissertation Repository

Cognitive decline disorders are becoming increasingly prevalent, with older adults at increased risk. Combined exercise has been recently explored as an intervention to help to prevent the decline, however cognitive activation in combination with physical activity has yet to be explored. Therefore, the purpose of the study is to determine the effects of multiple modality exercise programs in combination with a mind-motor task and their effects on mobility and cognitive variables. A total of (n=89) older adults (55+ yrs), with subjective cognitive complaints participated in a multiple modality exercise class, three days a week over six months, with the intervention …

The Experiences Of Criminalized Women When Accessing Health Care Services During Incarceration Within Provincial Jails: A Critical Narrative Study, Shamiram Zendo

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Abstract

There has been a noticeable increase in the imprisonment of women in Canada, within the last 20 years. The purpose of this critical inquiry was to capture and promote the voices and stories of criminalized women, in order to serve their interest. Five individual in-depth interviews were conducted with women, who were incarcerated in provincial jail. A critical paradigm was used to explore how socioeconomic and gender inequalities, embedded in the social, political, and historical contexts, influenced criminalized women’s experiences when accessing health care. The findings of this study described how criminalized women experience fragmentation in health care access, …

Evidence-Informed Advocacy: Non-Profit Organizations Use Of Evidence For Policy Influence In Public Health - A Case Study Of Wash Org Uganda, Carolyne Esther Nabalema

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Nonprofit organizations play a crucial role in lobbying governments for policy changes besides engaging in direct service delivery. Improved utilization of research and other evidence in health policy and practice will help save lives and improve quality of life. This case study of WashOrg International in East Africa was informed by two major questions 1) how is evidence on water, sanitation and hygiene being used by non-profit organizations to shape policy advocacy activities 2) what kinds of internal capacity exist in WashOrg International to use water, sanitation and hygiene evidence to inform policy advocacy? Data were collected through semi-structured interviews, …

Factors Associated With Success In Pare Testing Among Rcmp Officers, Robert Andre Seguin

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The purpose of this integrated article dissertation was to examine the predictive factors for success in the RCMP’s Physical Abilities Requirement Evaluation (PARE) in a retrospective observational study of 13, 709 unique records and a divisional subset of 620 for study two and three. Study one assessed the relative predictive power of the pursuit and body control times, while including covariates of height, weight, age. Significant (p< 0.05) and equally strong effects were for pursuit log odds (LO) of 2.95% CI [2.49, 3.11], and body control time LO of 2.80, 95% CI [2.51, 3.14] with a weak predictor , LO of 0.53, 95% CI [0.38, 0.72]. Not significant were height, weight, and sex with 99 % modeling accuracy.

Study two compared sex and performance factors on six repeated PARE pursuit circuit laps for pacing for both divisional data (535 men, 85 women) and 61 age and BMI matched male/female pairs. …

Motivational Interviewing Via Co-Active Life Coaching Intervention For Women Seeking A More Physically Active Lifestyle, Andrea M. Goddard

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The purpose of this 12-week pre-post design pilot study was to assess the impact of Motivational Interviewing via Co-Active Life Coaching (MI-via-CALC) on exercise-specific self-efficacy, barrier-specific self-efficacy, self-esteem, and 12-week study duration engagement in physical activity (PA) for 25 women between the ages of 30 and 55 years. Participants were assessed quantitatively using the previously validated McAuley Exercise-Specific Self-Efficacy Scale (EXSE), McAuley Barrier-Specific Self-Efficacy Scale (BARSE), Rosenberg Self-Esteem Scale (RSES), and International Physical Activity Questionnaire (IPAQ-SF) at pre-, mid-, and post-intervention. Four one-way repeated measures ANOVAs were completed for each scale, and statistically significant differences in barrier-specific self-efficacy were detected …

Rural Heterosexual Female Adolescents' Decision-Making About Sexual Intercourse And Pregnancy In Ontario, Paulina Ezer

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Rural areas in Ontario tend to have higher rates of adolescent pregnancy. A constructivist grounded theory methodology was used to gain an in-depth understanding of rural female adolescents’ decision-making process regarding sexual intercourse and their reproductive health, and how they view rural factors and circumstances influencing this process. The adolescent sexual decision-making process that emerged from the analysis involved prioritizing four influences that affect and are affected by the rural context: personal values and circumstances, family values and expectations, friends’ influences, and community influences. Findings will improve our understanding of how rural female adolescents make choices regarding their reproductive health. …

Navigating Life With Hiv: The Lived Experiences Of Youth Living With Hiv, Tamara M M Landry

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Youth and young adults living with HIV, between the ages of 15 and 29 represent one-quarter of the new infection rates in Canada, but little is known about the safer sex practices, HIV disclosure processes and coping mechanisms used by this important but often neglected group to manage the every day realities of living with HIV. The primary objectives of this study were to gather qualitative data about the lived experiences of Canadian youth who are living with HIV and enhance our understanding of their experiences of becoming HIV-positive, navigating issues related to safer sex and HIV disclosure, and managing …

Older Woman Workers: Met And Unmet Needs For Health And Wellbeing In The Workplace, Gillian Gorfine

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Older women workers report experiencing occupational injustices however the literature focuses on barriers faced rather than understanding the needs-based strategies empowering women as they age at work. This study engaged women aged 55 and older in a participatory action research project defining and examining strategies for older women workers’ health and wellbeing. In Phase 1, a key informant advisory group (N = 4) defined the problem and guided the design of an open answer survey conducted with 72 older women in work. Three categories emerged informing the fundamental, instrumental, and contextual needs of older women workers. Meeting fundamental needs may …