Pre-maps : An Educational Programme for Reading Tactile Maps

It is demanding for children with visual impairment to become aware of the world beyond their immediate experience. They need to learn to control spatial experiences as a whole and understand the relationships between objects, surfaces and themselves. Tactile maps can be an excellent source of information for depicting space and environment. By means of tactile maps children can develop their spatial understanding more efficiently than through direct travel experiences supplemented with verbal explanations. Tactile maps can help children when they are learning to understand environmental, spatial, and directional concepts. The ability to read tactile maps is not self-evident; it is a skill, which must be learned. The main research question was: can children who are visually impaired learn to read tactile maps at the preschool age if they receive structural teaching? The purpose of this study was to develop an educational program for preschool children with visual impairment, the aim of which was to teach them to read tactile maps in order to strengthen their orientation skills and to encourage them to explore the world beyond their immediate experience. The study is a multiple case study describing the development of the map program consisting of eight learning tasks. The program was developed with one preschooler who was blind, and subsequently the program was implemented with three other children. Two of the children were blind from birth, one child had lost her vision at the age of two, and one child had low vision. The program was implemented in a normal preschool. Another objective of the pre-map program was to teach the preschooler with visual impairment to understand the concept of a map. The teaching tools were simple, map-like representations called pre-maps. Before a child with visual impairment can read a comprehensive tactile map, it is important to learn to understand map symbols, and how a three-dimensional model changes to a two-dimensional tactile map. All teaching sessions were videotaped; the results are based on the analysis of the videotapes. Two of the children completed the program successfully, and learned to read a tactile map. The two other children felt happy during the sessions, but it was problematic for them to engage fully in the instruction. One of the two eventually completed the program, while the other developed predominantly emerging skills. The results of the children's performances and the positive feedback from the teachers, assistants and the parents proved that this pre-map program is appropriate teaching material for preschool children who are visually impaired. The program does not demand high-level expertise; also parents, preschool teachers, and school assistants can carry out the program.

Kinnasneulatekniikan verkko-oppimateriaalin kehittäminen ja neulalla neulomisen taidon kehittyminen

The purpose of the study was to develop a functional web-based learning material for the learning of the nålbinding technique. The study of the research topic was already begun in my pedagogical thesis in 2008 by considering the demands on pedagogic material for the teaching of the technique. This study falls into the field of qualitative design research which was carried out through three stages. In the study three methods of usability testing, i.e. expert analysis, the informants’ thinking aloud and interviews, were used as research methods. At the first stage of the study the first version of the learning material was created. This was done on the basis of theoretical knowledge, the demands set on learning materials as clarified in previous studies, on the basis of previously created learning materials for the learning of the nålbinding technique as well as with the help of two experts on the technique. At the second stage, the learning material was developed on the basis of expert analysis and another version of the material was created. At the third stage, usability testing was carried out on the material. At this stage two informants used the material, practiced stitching with the nålbinding needle and thought aloud while doing so. In the usability testing the Morae –programme was used to record the events on the screen, the actions of the informants and their spoken out thoughts. The Morae –programme was also used when analysing the recordings. After the testing, the informants practised stitching independently and in a few weeks time they were interviewed. The interviews were aimed at finding out the informants’ opinions on the future development of the material. On the basis of the informants’ independent attempts at using the nålbinding technique, the development of their skills after the testing was also discussed at the interviews. The development of the learning material will continue after this study on the basis of the usability testing and the interviews. The web-based learning material was created for the website Käspaikka in the address www.kaspaikka.fi/kinnasneula. By creating a multimodal learning material the dual-coding theory by Paivio was taken into consideration. According to the theory, several methods of presentation help a learner to restore information in his/her memory. The independent construction of the learner’s knowledge, i.e. learning according to the principles of the constructivist learning theory, was also supported by creating a logical navigation system, by linking interrelated topics to one another and by presenting the topics in several different forms. In the test situations the learning material was judged to work well when practising stitching with the nålbinding needle. Both informants learned the basics of the nålbinding technique even though their respective learning strategies were quite different. In the usability testing illogicalities and shortcomings were still noticed in the learning material which will still be further developed in the future.

Helicobacter pylori in Vammala, Finland: seroepidemiological studies and a population-based ‘screen-and-treat’ programme

Helicobacter pylorin (helikobakteeri) tartunta saadaan yleensä lapsena ja tauti jää tavallisesti pysyväksi ilman täsmähoitoa. Onnistunut hoito parantaa pysyvästi helikobakteerista aiheutuvan mahan haavataudin ja näyttää ehkäisevän mahalaukun pahanlaatuisten muutosten kehittymistä. Aloitimme Vammalassa terveyskeskuksessa toteutetun kansainvälisesti ainutlaatuisen väestöpohjaisen helikobakteeritulehduksen seulonta- ja hoito-ohjelman pilottitutkimuksella 1994. 1996 kaikki 15-40-vuotiaat ja 1997-2000 15- ja 45-vuotiaat vammalalaiset kutsuttiin verinäyteseulontaan. Yhteensä 4626 henkilöä (75% kutsutuista) osallistui seulontaan. Vasta-ainepositiivisille tarjottiin helikobakteeritulehduksen lopettava lääkekuuri. Toiminnan seurauksena helikobakteeritulehduksen esiintyvyyden laskettiin vähentyneen 12%:sta 4%:iin 15-40-vuotiaiden ikäryhmässä. Tutkimme myös helikobakteerivasta-ainepositiivisten ja -negatiivisten eroja sekä helikobakteeritulehduksen riskitekijöitä kyselytutkimuksella. Lapsuudenkodin asumisahtauden, äidin matalan koulutusasteen, tupakoinnin, alkoholinkäytön, huonojen asunto-olojen ja ylävatsavaivoista johtuvien sairauslomien todettiin liittyvän helikobakteeritulehdukseen monimuuttuja-analyysissa. Tutkimme seulontaohjelmassa käyttämiemme IgG- ja IgA-luokan helikobakteeri-vasta-ainetestien luotettavuutta eri ikäryhmissä ottaen huomioon atrofisen gastriitin esiintyvyyden. 561 kliinisin perustein gastroskopoidun potilaan aineistossa IgG-testi osoittautui erittäin herkäksi kaikissa ikäryhmissä (99%). Tarkkuus oli myös vanhemmissa ikäryhmissä hyvä (97-93%), kun atrofista gastriittia sairastavat suljettiin pois. IgA- ja CagA-helikobakteerivasta-aineiden on todettu liittyvän lisääntyneeseen mahahaava- ja mahasyöpäriskiin. Analysoimme 560 henkilön pariseeruminäytteet, jotka oli otettu kahden vuosikymmenen välein, ja totesimme, että IgA-vasta-aineiden esiintyvyyden lisääntyyminen iän myötä johtuu paitsi syntymäajankohdasta ja uusista infektioista myös IgA-vasta-ainetasojen kohoamisesta helikobakteeritulehduksen aikana. Selvitimme myös CagA-vasta-ainetasojen muuttumista analysoimalla seeruminäytteet, jotka oli otettu kahden vuosikymmenen välein. Totesimme, että samanaikaisesti kun helikobakteerin esiintyvyys väestössä on alentunut, erityisesti CagA-positiiviset infektiot ovat vähentyneet. Tutkimuksemme osoittaa, että Suomessa terveyskeskuksen yhteydessä voidaan toteuttaa näin laajamittainen seulonta- ja hoito-ohjelma, johon suomalaiset osallistuvat aktiivisesti. Nähtäväksi jää, kuinka paljon ohjelma kykeni vähentämään helikobakteeritulehdukseen liittyviä myöhäisseuraamuksia.

Randomised Evaluation of New Technologies within the Population‐Based Cervical Cancer Screening Programme in Finland: Cross‐Sectional Performance and Validity

A randomised and population-based screening design with new technologies has been applied to the organised cervical cancer screening programme in Finland. In this experiment the women invited to routine five-yearly screening are individually randomised to be screened with automation-assisted cytology, human papillomavirus (HPV) test or conventional cytology. By using the randomised design, the ultimate aim is to assess and compare the long-term outcomes of the different screening regimens. The primary aim of the current study was to evaluate, based on the material collected during the implementation phase of the Finnish randomised screening experiment, the cross-sectional performance and validity of automation-assisted cytology (Papnet system) and primary HPV DNA testing (Hybrid Capture II assay for 13 oncogenic HPV types) within service screening, in comparison to conventional cytology. The parameters of interest were test positivity rate, histological detection rate, relative sensitivity, relative specificity and positive predictive value. Also, the effect of variation in performance by screening laboratory on age-adjusted cervical cancer incidence was assessed. Based on the cross-sectional results, almost no differences were observed in the performance of conventional and automation-assisted screening. Instead, primary HPV screening found 58% (95% confidence interval 19-109%) more cervical lesions than conventional screening. However, this was mainly due to overrepresentation of mild- and moderate-grade lesions and, thus, is likely to result in overtreatment since a great deal of these lesions would never progress to invasive cancer. Primary screening with an HPV DNA test alone caused substantial loss in specificity in comparison to cytological screening. With the use of cytology triage test, the specificity of HPV screening improved close to the level of conventional cytology. The specificity of primary HPV screening was also increased by increasing the test positivity cutoff from the level recommended for clinical use, but the increase was more modest than the one gained with the use of cytology triage. The performance of the cervical cancer screening programme varied widely between the screening laboratories, but the variation in overall programme effectiveness between respective populations was more marginal from the very beginning of the organised screening activity. Thus, conclusive interpretations on the quality or success of screening should not be based on performance parameters only. In the evaluation of cervical cancer screening the outcome should be selected as closely as possible to the true measure of programme effectiveness, which is the number of invasive cervical cancers and subsequent deaths prevented in the target population. The evaluation of benefits and adverse effects of each new suggested screening technology should be performed before the technology becomes an accepted routine in the existing screening programme. At best, the evaluation is performed randomised, within the population and screening programme in question, which makes the results directly applicable to routine use.

The effect of exercise and light on mood

The aim of the study was to compare the effect physical exercise and bright light has on mood in healthy, working-age subjects with varying degrees of depressive symptoms. Previous research suggests that exercise may have beneficial effects on mood at least in subjects with depression. Bright light exposure is an effective treatment of winter depression, and possibly of non-seasonal depression as well. Limited data exist on the effect of exercise and bright light on mood in non-clinical populations, and no research has been done on the combination of these interventions. Working-age subjects were recruited through occupational health centres and 244 subjects were randomized into intervention groups: exercise, either in bright light or normal lighting, and relaxation / stretching sessions, either in bright light or normal gym lighting. During the eight-week intervention in midwinter, subjects rated their mood using a self-rating version of the Hamilton Depression Scale with additional questions for atypical depressive symptoms. The main finding of the study was that both exercise and bright-light exposure were effective in treating depressive symptoms. When the interventions were combined, the relative reduction in the Hamilton Depression Scale was 40 to 66%, and in atypical depressive symptoms even higher, 45 to 85%. Bright light exposure was more effective than exercise in treating atypical depressive symptoms. No single factor could be found that would predict a good response to these interventions. In conclusion, aerobic physical exercise twice a week during wintertime was effective in treating depressive symptoms. Adding bright light exposure to exercise increased the benefit, especially by reducing atypical depressive symptoms. Since this is so, this treatment could prevent subsequent major depressive episodes among the population generally.

Interculturality in Theory and Practice in the Master's Programme of Intercultural Bilingual Education in Bolivia

Tämän tutkielman aiheena on kulttuurienvälisyys kulttuurienvälisessä kaksikielisessä opetuksessa (Educación Intercultural Bilingüe, EIB) Boliviassa ja erityisesti kulttuurienvälisen kaksikielisen koulutuksen maisteriohjelmassa (Maestría en Educación Intercultural Bilingüe), jota koordinoi PROEIB Andes -järjestö yhteistyössä Cochabamban Universidad Mayor de San Simónin kanssa. Tutkielman tarkoituksena on selvittää, miten kulttuurienvälisyys määritellään ja mitä se käytännössä merkitsee opetuksen eri osa-alueilla: sisällöissä, opetusmetodeissa ja -materiaaleissa sekä arvioinnissa. Koska kulttuurienvälisen kaksikielisen opetuksen toteutus ja tutkiminen eri Latinalaisen Amerikan maissa on tähän asti painottunut lähes yksinomaan perusopetukseen, pyrin työssäni keskittymään kulttuurienvälisyyden ilmentymiin nimenomaan bolivialaisessa korkeakoulukontekstissa. Tutkielman aineistona on käytetty kahdeksaa EIB -asiantuntijoiden teemahaastattelua, jotka FM Eila Isotalus on tehnyt Boliviassa vuonna 2004. Haastatteluaineisto analysoitiin teoriasidonnaista eli abduktiivista sisällönanalyysiä käyttäen. Tutkielman teoriatausta koostuu yhtäältä kulttuurienvälisyyteen ja monikulttuurisuuteen liittyvien käsitteiden määrittelystä, ja toisaalta kulttuurienväliseen opetukseen liittyvien mallien esittelystä. Aineiston analyysissä avuksi on ollut etenkin James A. Banksin teoria monikulttuurisen opetuksen viidestä ulottuvuudesta, joiden kautta on voitu pohtia kulttuurienvälisyyden toteutumista opetuksen eri osa-alueilla ja nostaa esille bolivialaisen kulttuurienvälisen opetuksen erityispiirteitä. Aineiston analyysissä ilmenee, että kulttuurienvälisyyden käsitteen määrittely on vahvasti kontekstisidonnainen ja jatkuva prosessi, johon vaikuttavat eri toimijoiden näkemykset ja vaatimukset. EIB -asiantuntijoiden esittämät määrittelyt voidaan jakaa makro- ja mikrososiaaliseen kategoriaan sen mukaan, nähdäänkö kulttuurienvälisyys ensisijaisesti yhteiskunnallisena vai yksilötason käsitteenä. Aineistossa korostuu ajatus latinalaisamerikkalaisesta kulttuurienvälisyydestä poliittisena käsitteenä, jonka keskiössä on vaatimus yhteiskunnallisten valtasuhteiden muutoksesta. Yksi suurimmista haasteista kulttuurienvälisyyden toteuttamisessa bolivialaisessa korkeakouluopetuksessa ovat akateemiseen kulttuuriin liittyvät perinteet, jotka vaikeuttavat uusien toimintatapojen omaksumista. Kulttuurienvälisyys opetuksessa on toistaiseksi tarkoittanut etupäässä sisältöjen monipuolistamista lisäämällä opetusohjelmiin elementtejä paikallisista kulttuureista. Tärkeänä askeleena EIB:n kehityksessä voidaan pitää painopisteen siirtymistä sisältökysymyksistä kulttuurienvälisten opetusmetodien luomiseen. Näiden opetusmenetelmien tulisi pohjautua ymmärrykseen oppimisesta kokonaisvaltaisena, yhteisöllisenä prosessina ja siten kuroa umpeen kuilua koulun ja yhteisöjen arkielämän välillä. Opetusmenetelmien ja -materiaalien suhteen keskeinen kulttuurienvälisyyteen liittyvä kysymys on intiaanikansojen suullisen kulttuurin ja tiedon jakamisen perinteiden hyödyntäminen opetuksessa. Maisteriohjelman opiskelijoiden arvioinnissa pyritään huomioimaan yksilön kokonaisvaltainen kehitys pelkkien opintosuoritusten sijasta, mutta arvosanoihin pohjautuvasta arvostelukäytännöstä ei ole toistaiseksi voitu luopua yliopiston vaatimusten vuoksi. Kaiken kaikkiaan kulttuurienvälisyyden toteuttaminen EIB:ssä ja maisteriohjelmassa on pitkän tähtäimen prosessi, joka vaatii perinteisten opetuskäytäntöjen kyseenalaistamista ja korkeakouluopetuksessa myös akateemisen kulttuurin haastamista. On oleellisen tärkeää, että prosessiin osallistuvat asiantuntijoiden ohella myös esimerkiksi opiskelijat, intiaaniyhteisöt ja -järjestöaktiivit.

Psychosocial processes of health behaviour change in a lifestyle intervention : Influences of gender, socioeconomic status and personality

Background: The onset of many chronic diseases such as type 2 diabetes can be delayed or prevented by changes in diet, physical activity and obesity. Known predictors of successful behaviour change include psychosocial factors such as selfefficacy, action and coping planning, and social support. However, gender and socioeconomic differences in these psychosocial mechanisms underlying health behaviour change have not been examined, despite well-documented sociodemographic differences in lifestyle-related mortality and morbidity. Additionally, although stable personality traits (such as dispositional optimism or pessimism and gender-role orientation: agency and communion) are related to health and health behaviour, to date they have rarely been studied in the context of health behaviour interventions. These personality traits might contribute to health behaviour change independently of the more modifiable domain-specific psychosocial factors, or indirectly through them, or moderated by them. The aims were to examine in an intervention setting: (1) whether changes (during the three-month intervention) in psychological determinants (self-efficacy beliefs, action planning and coping planning) predict changes in exercise and diet behaviours over three months and 12 months, (2) the universality assumption of behaviour change theories, i.e. whether preintervention levels and changes in psychosocial determinants are similar among genders and socioeconomic groups, and whether they predict changes in behaviour in a similar way in these groups, (3) whether the personality traits optimism, pessimism, agency and communion predict changes in abdominal obesity, and the nature of their interplay with modifiable and domain-specific psychosocial factors (self-efficacy and social support). Methods: Finnish men and women (N = 385) aged 50 65 years who were at an increased risk for type 2 diabetes were recruited from health care centres to participate in the GOod Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial. The programme aimed to improve participants lifestyle (physical activity, eating) and decrease their overweight. The measurements of self-efficacy, planning, social support and dispositional optimism/pessimism were conducted pre-intervention at baseline (T1) and after the intensive phase of the intervention at three months (T2), and the measurements of exercise at T1, T2 and 12 months (T3) and healthy eating at T1 and T3. Waist circumference, an indicator of abdominal obesity, was measured at T1 and at oneyear (T3) and three-year (T4) follow-ups. Agency and communion were measured at T4 with the Personal Attributes Questionnaire (PAQ). Results: (1) Increases in self-efficacy and planning were associated with three-month increases in exercise (Study I). Moreover, both the post-intervention level and three-month increases (during the intervention) in self-efficacy in dealing with barriers predicted the 12-month increase in exercise, and a high postintervention level of coping plans predicted the 12-month decrease in dietary fat (Study II). One- and three-year waist circumference reductions were predicted by the initial three-month increase in self-efficacy (Studies III, IV). (2) Post-intervention at three months, women had formed more action plans for changing their exercise routines and received less social support for behaviour change than men had. The effects of adoption self-efficacy were similar but change in planning played a less significant role among men (Study I). Examining the effects of socioeconomic status (SES), psychosocial determinants at baseline and their changes during the intervention yielded largely similar results. Exercise barriers self-efficacy was enhanced slightly less among those with low SES. Psychosocial determinants predicted behaviour similarly across all SES groups (Study II). (3) Dispositional optimism and pessimism were unrelated to waist circumference change, directly or indirectly, and they did not influence changes in self-efficacy (Study III). Agency predicted 12-month waist circumference reduction among women. High communion coupled with high social support was associated with waist circumference reduction. However, the only significant predictor of three-year waist circumference reduction was an increase in health-related self-efficacy during the intervention (Study IV). Conclusions: Interventions should focus on improving participants self-efficacy early on in the intervention as well as prompting action and coping planning for health behaviour change. Such changes are likely to be similarly effective among intervention participants regardless of gender and educational level. Agentic orientation may operate via helping women to be less affected by the demands of the self-sacrificing female role and enabling them to assertively focus on their own goals. The earlier mixed results regarding the role of social support in behaviour change may be in part explained by personality traits such as communion.

Executive Stock Options: Exercise Policy and Market Reaction

In this paper I investigate the exercise policy, and the market reaction to that, of the executive stock option holders in Finland. The empirical tests are conducted with aggregated firm level data from 34 firms and 41 stock option programs. I find some evidence of an inverse relation between the exercise intensity of the options holders and the future abnormal return of the company share price. This finding is supported by the view that information about future company prospect seems to be the only theoretical attribute that could delay the exercise of the options. Moreover, a high concentration of exercises in the beginning of the exercise window is predicted and the market is expected to react to deviations from this. The empirical findings however show that the market does not react homogenously to the information revealed by the late exercises.

Governmental rationalities and the local dimension of European politics. A study of the Interreg IV programme "Alpenrhein-Bodensee-Hochrhein"

The thesis aims at investigating the local dimension of the EU cohesion policy through the utilization of an alternative approach, which aims at the analysis of discourse and structures of power. The concrete case under analysis is the Interreg IV programme “Alpenrhein-Bodensee-Hochrhein”, which is conducted in the border region between Germany, Switzerland, Austria and the principality of Liechtenstein. The main research question is stated as such: What governmental rationalities can be found at work in the field of EU cross-border cooperation programmes? How is directive action and cooperation envisioned? How coherent are the different rationalities, which are found at work? The theoretical framework is based on a Foucaultian understanding of power and discourse and utilizes the notion of governmentalities as a way to de-stabilize the understanding of directive action and in order to highlight the dispersed and heterogeneous nature of governmental activity. The approach is situated within the general field of research on the European Union connected to basic conceptualisations such as the nature of power, the role of discourse and modes of subjectification. An approach termed “analytics of government”, based on the work of researchers like Mitchell Dean is introduced as the basic framework for the analysis. Four dimensions (visiblities, subjectivities, techniques/practices, problematisations) are presented as a set of tools with which governmental regimes of practices can be analysed. The empirical part of the thesis starts out with a discussion of the general framework of the European Union's cohesion policy and places the Interreg IV Alpenrhein-Bodensee-Hochrhein programme in this general context. The main analysis is based on eleven interviews which were conducted with different individuals, participating in the programme on different levels. The selection of interview partners aimed at maximising heterogeneity through including individuals from all parts of the programme region, obtaining different functions within the programme. The analysis reveals interesting aspects pertaining to the implementation and routine aspects of work within initiatives conducted under the heading of the EU cohesion policy. The central aspects of an Interreg IV Alpenrhein-Bodensee-Hochrhein – governmentality are sketched out. This includes a positive perception of the work atmosphere, administrative/professional characterisation of the selves and a de-politicization of the programme. Characteristic is the experience of tensions by interview partners and the use of discoursive strategies to resolve them. Negative perceptions play an important role for the specific governmental rationality. The thesis contributes to a better understanding of the local dimension of the European Union cohesion policy and questions established ways of thinking about governmental activity. It provides an insight into the working of power mechanisms in the constitution of fields of discourse and points out matters of practical importance as well as subsequent research questions.

Whose ETSIP? National and local ownership of Namibia's education and training sector improvement programme

Tämä työ tarkastelee kansallista ja paikallista omistajuutta Namibian opetussektorin kehittämisohjelmassa. Opetussektorin kehittämisohjelma ETSIP on 15-vuotinen sektoriohjelma vuosille 2005-2015 ja sen tavoitteena on edesauttaa Namibian kehittymistä tietoyhteiskunnaksi. Tutkimuksen tarkoituksena on selvittää miten kansallinen ja paikallinen omistajuus on toteutunut ETSIP prosessin aikana. Erityisesti pyritään selvittämään paikallistason opetussektorin virkamiesten näkemyksiä ETSIP prosessista, heidän roolistaan siinä ja siitä millaisia vaikuttamisen ja hallinnan mahdollisuuksia heillä on ollut prosessin aikana. Tutkimuksen lähtökohta on laadullinen ja lähestymistapa konstruktionistinen: tutkimus tarkastelee todellisuutta ihmisten kokemusten, näkemysten ja toiminnan kautta. Tutkimusaineisto koostuu haastatteluista, epävirallisista keskusteluista, lehtiartikkeleista ja ETSIP dokumenteista. Tutkimus osoittaa että kansallinen omistajuus on epämääräinen käsite sillä kansallisia toimijoita ja näkemyksiä on useita. Tutkimus vahvistaa Castel-Brancon huomion siitä, että omistajuutta on tarkasteltava kontekstissaan: muuttuvana ja kilpailtuna. ETSIPin rinnalle ollaan valmistelemassa uutta strategista ohjelmaa opetusministeriölle mikä saattaa muuttaa omistajuutta ETSIPiin. ETSIP dokumenttien omistajuusretoriikka myötäilee kansainvälisiä sitoumuksia avun vaikuttavuuden parantamiseksi mutta niistä puuttuu syvällisempi analyysi siitä, miten kansallinen ja paikallinen omistajuus toteutuisi käytännössä. Avunantajien näkemys omistajuudesta on suppea: omistajuus nähdään lähinnä sitoutumisena ennalta määrättyyn politiikkaohjelmaan. Haastatteluaineistosta nousee esiin Whitfieldin ja Frazerin jaottelu suppeista ja laajoista omistajuuskäsityksistä. Sitoutumista ETSIP ohjelmaan pidetään tärkeänä mutta riittämättömänä määritteenä omistajuudelle. Paikallisella tasolla sitoutuminen ETSIP ohjelman periaatteisiin ja tavoitteisiin on toteutunut melko hyvin mutta jos omistajuutta tarkastellaan laajemmin vaikutusvallan ja hallinnan käsitteiden kautta voidaan todeta että omistajuus on ollut heikkoa. Paikallisella tasolla ei ole ollut juurikaan vaikutusvaltaa ETSIP ohjelman sisältöön eikä mahdollisuutta hallita ohjelman toteutusta ja päättää siitä mitä hankkeita ohjelman kautta rahoitetaan. Tujanin demokraattisen omistajuuden käsite kuvaa tarvetta muuttaa ja laajentaa omistajuusajattelua huomioiden paikallisen tason paremmin. Tämä tutkimus viittaa siihen että omistajuuden toteutuminen paikallisella tasolla edellyttäisi institutionaalisen kulttuurin muutosta ja institutionaalisen legitimiteetin vahvistamista. Omistajuuden mahdollistamiseksi paikallisella tasolla tarvittaisiin poliittista johtajuutta, luottamusta, vastuullisuuden kulttuurin kehittämistä, tehokkaampaa tiedonjakoa, laajaa osallistumista, vuoropuhelua ja yhteistyötä. Ennen kaikkea tarvittaisiin paikallisen tason vaikutusvaltaa päätöksenteossa ja kontrollia resurssien käytöstä. Tälle muutokselle on selvä tarve ja tilaus.