Essays on auditor independence

Auditor independence is a cornerstone of the auditing profession and the basic principle that underpins the reputation of the auditing profession in the public eye. Indeed, it is the attribute most demanded from auditors by the public. Therefore, the sustainability of the auditing profession depends on how auditors can protect this principle. This dissertation consists of four interrelated essays concerned with auditor independence. Specifically, it examines situations that can threaten and impair auditor independence. In addition, this dissertation also examines several variables that may enhance and protect auditor independence. The first essay aims to examine the impact of social pressures occurring within audit firms on auditors’ judgment in the setting of a society with “high power distance” and “low individualism” cultural dimensions. The social pressures consisted of obedience pressure exerted by an auditor’s superior and conformity pressure exerted by an auditor’s colleague. Moreover, two moderating variables—a multi-dimensional professional commitment and locus of control—were included as moderator variables in the relationship between the social pressures faced by auditors and their judgment. The findings show that obedience and conformity pressures influence auditor judgment. Auditors who face the social pressures will make a judgment that may be even diametrically opposite to the independence principle. The findings also indicate that a multi-dimensional professional commitment and locus of control may potentially influence auditor judgment in a situation with social pressures. The second essay aims to investigate the association of advocacy and familiarity threats caused by auditor fee dependence and auditor tenure on auditor independence based on Finnish data, law, and auditing environment. This essay was motivated by the Green Paper on Audit Policy, published by the European Commission in 2010 that questions whether the maximum fee collected from a client should be regulated and whether consecutive assignments should be limited, among others. Contrary to popular belief, this essay does not find evidence that audit fees and long auditor tenure will jeopardise auditor independence. Therefore, the findings do not support policies to regulate auditor fees or limit auditor tenure in Finland. The third essay aims to examine the effect of client intimidation on auditor independence in an audit-client conflict situation. Intimidation threat is one of five independence threats that are explicitly referenced in the IFAC’s independence framework. Client intimidation was manifested in the client threatening to replace the auditor if the auditor did not adopt the client’s position. In addition, this essay examines the role of auditor’s perceived pressure and multi-dimensions of professional commitment as moderator variables. The findings suggest that auditors who experience client intimidation in an audit conflict situation are more likely to have their independence impaired than those who are in a similar situation but without client intimidation. Moreover, auditors who experience client intimidation perceive higher pressure than those who do not experience intimidation. Finally, auditors’ affective and continuance professional commitment dimensions moderate the relationship between auditors’ perceived pressures and auditor independence. The aim of the fourth essay is twofold. First, it aims to develop a scale for measuring auditors’ reputation awareness. Second, it aims to examine the correlation between the levels of auditor reputation awareness and auditor independence. A seven-item scale was developed as the reputation awareness scale. The findings indicate that the scale consists of one dimension. It also has a level of satisfactory reliability and a high level of validity. The findings show that there is a positive correlation between the level of auditors’ reputation awareness and auditor independence.

Impact of reliability of supply on long-term development approaches to electricity distribution networks

The Finnish electricity distribution sector, rural areas in particular, is facing major challenges because of the economic regulation, tightening supply security requirements and the ageing network asset. Therefore, the target in the distribution network planning and asset management is to develop and renovate the networks to meet these challenges in compliance with the regulations in an economically feasible way. Concerning supply security, the new Finnish Electricity Market Act limits the maximum duration of electricity supply interruptions to six hours in urban areas and 36 hours in rural areas. This has a significant impact on distribution network planning, especially in rural areas where the distribution networks typically require extensive modifications and renovations to meet the supply security requirements. This doctoral thesis introduces a methodology to analyse electricity distribution system development. The methodology is based on and combines elements of reliability analysis, asset management and economic regulation. The analysis results can be applied, for instance, to evaluate the development of distribution reliability and to consider actions to meet the tightening regulatory requirements. Thus, the methodology produces information for strategic decision-making so that DSOs can respond to challenges arising in the electricity distribution sector. The key contributions of the thesis are a network renovation concept for rural areas, an analysis to assess supply security, and an evaluation of the effects of economic regulation on the strategic network planning. In addition, the thesis demonstrates how the reliability aspect affects the placement of automation devices and how the reserve power can be arranged in a rural area network.

Long-term nutrient load management and lake restoration: Case of Säkylän Pyhäjärvi (SW Finland)

Eutrophication caused by anthropogenic nutrient pollution has become one of the most severe threats to water bodies. Nutrients enter water bodies from atmospheric precipitation, industrial and domestic wastewaters and surface runoff from agricultural and forest areas. As point pollution has been significantly reduced in developed countries in recent decades, agricultural non-point sources have been increasingly identified as the largest source of nutrient loading in water bodies. In this study, Lake Säkylän Pyhäjärvi and its catchment are studied as an example of a long-term, voluntary-based, co-operative model of lake and catchment management. Lake Pyhäjärvi is located in the centre of an intensive agricultural area in southwestern Finland. More than 20 professional fishermen operate in the lake area, and the lake is used as a drinking water source and for various recreational activities. Lake Pyhäjärvi is a good example of a large and shallow lake that suffers from eutrophication and is subject to measures to improve this undesired state under changing conditions. Climate change is one of the most important challenges faced by Lake Pyhäjärvi and other water bodies. The results show that climatic variation affects the amounts of runoff and nutrient loading and their timing during the year. The findings from the study area concerning warm winters and their influences on nutrient loading are in accordance with the IPCC scenarios of future climate change. In addition to nutrient reduction measures, the restoration of food chains (biomanipulation) is a key method in water quality management. The food-web structure in Lake Pyhäjärvi has, however, become disturbed due to mild winters, short ice cover and low fish catch. Ice cover that enables winter seining is extremely important to the water quality and ecosystem of Lake Pyhäjärvi, as the vendace stock is one of the key factors affecting the food web and the state of the lake. New methods for the reduction of nutrient loading and the treatment of runoff waters from agriculture, such as sand filters, were tested in field conditions. The results confirm that the filter technique is an applicable method for nutrient reduction, but further development is needed. The ability of sand filters to absorb nutrients can be improved with nutrient binding compounds, such as lime. Long-term hydrological, chemical and biological research and monitoring data on Lake Pyhäjärvi and its catchment provide a basis for water protection measures and improve our understanding of the complicated physical, chemical and biological interactions between the terrestrial and aquatic realms. In addition to measurements carried out in field conditions, Lake Pyhäjärvi and its catchment were studied using various modelling methods. In the calibration and validation of models, long-term and wide-ranging time series data proved to be valuable. Collaboration between researchers, modellers and local water managers further improves the reliability and usefulness of models. Lake Pyhäjärvi and its catchment can also be regarded as a good research laboratory from the point of view of the Baltic Sea. The main problem in both of them is eutrophication caused by excess nutrients, and nutrient loading has to be reduced – especially from agriculture. Mitigation measures are also similar in both cases.

Brand Identity and Image in B2B Factory Automation Context

The goal of this thesis is to study how a solution-oriented business-to-business company can utilize its brand as a strategic asset by using the concepts of brand identity and brand image. The study analyses the intended brand message (identity) contrasting it with the customer perceptions (image) to reveal points of parity and congruence. The study uses a case company as an example and discusses the benefits of brand management as well. Internally, brands can be studied by performing a set of interviews amongst top and middle management. The interviews need to consider the various elements of branding from associations to differentiation and value creation. Customers’ perceptions can be reliably studied via online survey designed to compare the intended brand message with customers’ experiences. From the perspective of industrial management the incentive for brand development lies in both monetary and managerial benefits. In literature the four essential benefits of B2B branding are risk dilution, efficiency of communications, strategic direction and price premiums. As a result, suggestive models for brand identity and image were devised and compared. The Case Company perceives itself as a technically oriented open-integrator, with a strong focus on reliability and customer service. Customers agree with the picture in general, but there are some points of parity as well: they are quite satisfied with the company and perceive it as reliable and providing the promised value. The problematic areas revolve around customer interaction and maintaining the leadership position. The results confirm previous findings in B2B branding theory, where the reliability and credibility of the supplier are in major role. The results also suggest a holistic, corporate approach on branding.

In search of information systems value : a case study of the EHR benefits realisation efforts of three Swedish hospitals.

The Swedish public health care organisation could very well be undergoing its most significant change since its specialisation during the late 19th and early 20th century. At the heart of this change is a move from using manual patient journals to electronic health records (EHR). EHR are complex integrated organisational wide information systems (IS) that promise great benefits and value as well as presenting great challenges to the organisation. The Swedish public health care is not the first organisation to implement integrated IS, and by no means alone in their quest for realising the potential benefits and value that it has to offer. As organisations invest in IS they embark on a journey of value-creation and capture. A journey where a costbased approach towards their IS-investments is replaced with a value-centric focus, and where the main challenges lie in the practical day-to-day task of finding ways to intertwine technology, people and business processes. This has however proven to be a problematic task. The problematic situation arises from a shift of perspective regarding how to manage IS in order to gain value. This is a shift from technology delivery to benefits delivery; from an ISimplementation plan to a change management plan. The shift gives rise to challenges related to the inability of IS and the elusiveness of value. As a response to these challenges the field of IS-benefits management has emerged offering a framework and a process in order to better understand and formalise benefits realisation activities. In this thesis the benefits realisation efforts of three Swedish hospitals within the same county council are studied. The thesis focuses on the participants of benefits analysis projects; their perceptions, judgments, negotiations and descriptions of potential benefits. The purpose is to address the process where organisations seek to identify which potential IS-benefits to pursue and realise, this in order to better understand what affects the process, so that realisation actions of potential IS-benefits could be supported. A qualitative case study research design is adopted and provides a framework for sample selection, data collection, and data analysis. It also provides a framework for discussions of validity, reliability and generalizability. Findings displayed a benefits fluctuation, which showed that participants’ perception of what constituted potential benefits and value changed throughout the formal benefits management process. Issues like structure, knowledge, expectation and experience affected perception differently, and this in the end changed the amount and composition of potential benefits and value. Five dimensions of benefits judgment were identified and used by participants when finding accommodations of potential benefits and value to pursue. Identified dimensions affected participants’ perceptions, which in turn affected the amount and composition of potential benefits. During the formal benefits management process participants shifted between judgment dimensions. These movements emerged through debates and interactions between participants. Judgments based on what was perceived as expected due to one’s role and perceived best for the organisation as a whole were the two dominant benefits judgment dimensions. A benefits negotiation was identified. Negotiations were divided into two main categories, rational and irrational, depending on participants’ drive when initiating and participating in negotiations. In each category three different types of negotiations were identified having different characteristics and generating different outcomes. There was also a benefits negotiation process identified that displayed management challenges corresponding to its five phases. A discrepancy was also found between how IS-benefits are spoken of and how actions of IS benefits realisation are understood. This was a discrepancy between an evaluation and a realisation focus towards IS value creation. An evaluation focus described IS-benefits as well-defined and measurable effects and a realisation focus spoke of establishing and managing an on-going place of value creation. The notion of valuescape was introduced in order to describe and support the understanding of IS value creation. Valuescape corresponded to a realisation focus and outlined a value configuration consisting of activities, logic, structure, drivers and role of IS.

B2SHARE – Storing and Sharing Research Data

Poster at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Validation of the Beck Depression Inventory for a Portuguese-speaking Chinese community in Brazil

The objective of the present study was to investigate the psychometric properties and cross-cultural validity of the Beck Depression Inventory (BDI) among ethnic Chinese living in the city of São Paulo, Brazil. The study was conducted on 208 community individuals. Reliability and discriminant analysis were used to test the psychometric properties and validity of the BDI. Principal component analysis was performed to assess the BDI's factor structure for the total sample and by gender. The mean BDI score was lower (6.74, SD = 5.98) than observed in Western counterparts and showed no gender difference, good internal consistency (Cronbach's alpha 0.82), and high discrimination of depressive symptoms (75-100%). Factor analysis extracted two factors for the total sample and each gender: cognitive-affective dimension and somatic dimension. We conclude that depressive symptoms can be reliably assessed by the BDI in the Brazilian Chinese population, with a validity comparable to that for international studies. Indeed, cultural and measurement biases might have influenced the response of Chinese subjects.

Moderate-term reproducibility of heart rate variability during rest and light to moderate exercise in children

Previous studies have demonstrated the high reproducibility of heart rate variability (HRV) measures in adults while little information exists concerning HRV reproducibility in children. Subsequently, the aim of the current study was to examine the moderate-term reproducibility of heart rate and frequency domain measures of HRV during rest and light to moderate exercise in children. Ten healthy children (6 males, 4 females) aged between 7 and 12 years of age volunteered for this study with HRV recordings obtained during supine rest and three treadmill walking exercise work rates (≤60% maximum heart rate), initially and then 8 weeks later. Differences (P < 0.05) between variables were examined using paired t-tests or Wilcoxon signed rank tests while reliability and reproducibility were examined by intraclass correlation coefficients (ICC), coefficients of variation (CV), and mean bias ratio and ratio limits of agreement (LOA). Heart rate and all measures of HRV at rest and exercise were unchanged after 8 weeks. Significant ICC were documented primarily during rest (0.72-0.85) while weaker relationships (-0.02-0.87) were evident during exercise. A large range of CV was identified during rest (6-33%) and exercise (3-128%) while the ratio LOA were variable and substantial (1.04-2.73). Despite similar HRV over an 8-week period, variable ICC and sizable CV and ratio LOA indicate moderate to poor reproducibility of HRV in children, particularly during light to moderate exercise. Studies examining HRV in children should include age- or maturation stage-matched control participants to address the age-related change in HRV and inadequate HRV reliability.

Value perceptions of measurement and monitoring system customers

The value that the customer perceives from a supplier’s offering, impacts customer’s decision making and willingness to pay at the time of the purchase, and the overall satisfaction. Thus, for a business supplier, it is critical to understand their customers’ value perceptions. The objective of this thesis is to understand what measurement and monitoring system customers value, by examining their key purchasing criteria and perceived benefits. Theoretical part of this study consists on reviewing relevant literature on organizational buying behavior and customer perceived value. This study employs a qualitative interview research method. The empirical part of this research consisted of conducting 20 in-depth interviews with life science customers in USA and in Europe. Quality and technical features are the most important purchasing criteria, while product-related benefits seem to be the most important perceived benefits. At the marketing of the system, the emphasis should be at which regulations the system complies with, references of supplier’s prior experience, the reliability and usability of the system, and total costs. The benefits that should be emphasized are the better control of customer’s process, and the proof of customer’s product quality

Finnish doctoral dissertations of nursing education research

Nursing education research has confirmed its place in the discipline of nursing and caring sciences being one of the most central research areas. However, extensive and systematic analysis of nursing education research has been lacking both nationally and internationally. The aim of this study was to describe the focus of nursing education research in Finnish doctoral dissertations in the field of nursing and caring sciences between the years 1990–2014. In addition, the characteristics (i.e. methods, study informants and reporting of validity, reliability, and research ethics) of the dissertations were described. Also, international reviews (N=39) focusing on nursing education research were analysed for a background literature. A literature review was carried out. Altogether 51 (=N) Finnish doctoral dissertations of nursing and caring sciences in the field of nursing education research were included in the final analysis. The data for this research was collected from the open publication lists of each university offering education in nursing and caring sciences in Finland. The dissertations were published in 1990–2014. The data were analysed by content analysis both deductively and inductively. This study consists of a scientific article manuscript and a background literature review. Nursing education research has focused both nationally and internationally on four main areas: structural factors in nursing education, nurse teacherhood, teaching activities, and learning and learning outcomes in nursing education. In Finland, the most central focus area was learning (84.3 %) whereas nurse teacherhood and structural factors in nursing education were studied the least. Students were the predominant study informant group while nurse staff including nurse mentors were next and nurse educators only the third. Surveys and interviews were the most common data collection methods. In the findings there were a lot of similarities with international reviews of nursing education research. Finnish nursing education research has been very student-centred yet studies focusing on the education of other nursing based professions or different levels of education are rare. Future research about nurse teacherhood, curricula and structural factors in nursing education is recommended. There is also a need for experimental designs. In addition, nursing education research should focus on the central phenomena of nursing education and working life. All in all, more nursing education research is needed. Nursing education dissertations cover only 12.3 % of all the dissertations of nursing and caring sciences in Finland.

Does altering brachial artery tone with lower-body negative pressure and flow-mediated dilation affect arterial stiffness?

Although medium sized, muscular vessels normally respond to sympathetic stimulation by reducing compliance, it is unclear whether the large brachial artery is similarly affected by sympathetic stimulation induced via lower-body negative pressure (LBNP). Similarly, the impact of flow-mediated dilation (FMD) on brachial artery compliance and distensibility remains unresolved, hi addition, before such measures can be used as prognostic tools, it is important to investigate the reliability and repeatability of both techniques. Using a randomized order design, the effects of LBNP and FMD on the mechanical properties of the brachial artery were examined in nine healthy male subjects (mean age 24y). Non-invasive Doppler ultrasound and a Finometer were used to measure simultaneously the variation in systolic and diastolic diameter, and brachial blood pressure, respectively. These values were used to calculate compliance and distensibility values at baseline, and during both LBNP and FMD. The within-day and between-day repeatability of arterial diameter, compliance, distensibility, and FMD measures were assessed using the error coefficient and intra-class correlation coefficient (ICC). While heart rate (P<0.01) and peripheral resistance increased during LBNP (P<0.05), forearm blood flow and pulse pressure decreased (P<0.01). hi terms of mechanical properties, vessel diameters decreased (P<0.05), but both compliance and distensibility were not changed. On the other hand, FMD resulted in a significant increase in diameter (P<0.001), with no change in compliance or distensibility. hi summary, LBNP and FMD do not appear to alter brachial artery compliance or distensibility in young, healthy males. Whereas measures ofFMD were not found to be repeatable between days, the ICC indicated that compliance and distensibility were repeatable only within-day.

The examination of predictors of success in two programmes requiring self-direction /

The new Physiotherapy and Occupational Therapy programmes, based in the Faculty of Health Sciences, McMaster University (Hamilton, Ontario) are unique. The teaching and learning philosophies utilized are based on learner-centred and selfdirected learning theories. The 1991 admissions process of these programmes attempted to select individuals who would make highly qualified professionals and who would have the necessary skills to complete such unique programmes. In order to: 1 . learn more about the concept of self-directed learning and its related characteristics in health care professionals; 2. examine the relationship between various student characteristics - personal, learner and those assessed during the admissions process - and final course grades, and 3. determine which, if any, smdent characteristics could be considered predictors for success in learner-centred programmes requiring self-directed learning skills, a correlational research design was developed and carried out. Thirty Occupational Therapy and thirty Physiotherapy smdents were asked to complete 2 instruments - a questionnaire developed by the author and the Oddi Continuing Learning Inventory (Oddi, 1986). Course grades and ratings of students during the admissions process were also obtained. Both questionnaires were examined for reliability, and factor analyses were conducted to determine construct validity. Data obtained from the questionnaires, course grades and student ratings (from the admissions process) were analyzed and compared using the Contingency Co-efficient, the Pearson's product-moment correlation co-efficient, and the multiple regression analysis model. The research findings demonstrated a positive relationship (as identified by Contingency Coefficient or Pearson r values) between various course grades and the following personal and learner characteristics: field of smdy of highest level of education achieved, level of education achieved, sex, marital stams, motivation for completing the programmes, reasons for eru-oling in the programmes, decision to enrol in the programmes, employment history, preferred learning style, strong selfconcept and the identification of various components of the concept of self-directed learning. In most cases, the relationships were significant to the 0.01 or 0.(X)1 levels. Results of the multiple regression analyses demonstrated that several learner and admissions characteristic variables had R^ values that accounted for the largest proportion of the variance in several dependent variables. Thus, these variables could be considered predictors for success. The learner characteristics included: level of education and strong self-concept. The admissions characteristics included: ability to evaluate strengths, ability to give feedback, curiosity and creativity, and communication skills. It is recommended that research continue to be conducted to substantiate the relationships found between course grades and characteristic variables in more diverse populations. "Success in self-directed programmes" from the learner's perspective should also be investigated. The Oddi Continuing Learning Inventory should continue to be researched. Further research may lead to refinement or further development of the instrument, and may provide further insight into self-directed learner attributes. The concept of self-directed learning continues to be incorporated into educational programmes, and thus should continue to be explored.

Reliability of a new measure of motoneuron excitability

Objectlve:--This study examined the intraclass reliability· of different measures of the excitability of the Hoffmann reflex, derived from stimulus-response curves. The slope of the regression line of the H-reflex stimulus-response curve advocated by Funase et al. (1994) was also compared to the peak of the first derivative of the H-reflex stimulus-response curve (dHIdVmax), a new measure introduced in this investigation. A secondary purpose was to explore the possibility of mood as a covariate when measuring excitability of the H-reflex arc. Methods: The H-reflex amplitude at a stimulus intensity corresponding to 5% of the maximum M-wave (Mmax) is an established measure that was used as an additional basis of comparison. The H-reflex was elicited in the soleus for 24 subjects (12 males and 12 females) on five separate days. Vibration was applied to the Achilles tendon prior to stimulation to test the sensitivity of the measures on test day four. The means of five evoked potentials at each gradually increasing intensity, from below H-reflex threshold to above Mmax, were used to create both the H-reflex and M-wave stimulus response curves for each subject across test days. The mood of the subjects was assessed using the Subjective Exercise Experience Scale (SEES) prior to the stimulation protocol each day. Results: There was a modest decrease in all H-reflex measures from the first to third test day, but it was non-significant (P's>0.05). All measures of the H-reflex exhibited a profound reduction following vibration on test day four, and then returned to baseline levels on test day five (P's<0.05). The intraclass correlation coefficient (ICC) for H-reflex amplitude at 5% of Mmax was 0.85. The ICC for the slope of the regression line was 0.79 while it was 0.89 for dH/dVmax. Maximum M-wave amplitude had an ICC of 0.96 attesting to careful methodological controls. The SEES subscales of fatigue and psychological well-being remained unchanged IV across the five days. The psychological distress subscale (Pand psychological distress (P>O.05). Conclusions: The peak of the first derivative of the H-reflex stimulus-response curve (dH/dVmax) was shown to have comparable reliability and sensitivity to other more established measures of excitability. Psychological distress and the amplitude of the H-reflex at 5% Mmax follow similar trends across days, however there was no significant correlation between the two measures. Significance: The proposed method appears to be a more robust measure ofH-reflex excitability than the other methods tested. As such it would be an advantageous method to apply in clinical and investigative settings. Additionally, the results suggest that the relationship between psychological distress and H-reflex amplitude should be investigated further.

Identification précoce des nouveau-nés qui auront des problèmes de développement à deux ans: utilité de l'Évaluation neurologique d'Amiel-Tison

Malgré les avancées médicales, la prédiction précoce du devenir développemental des enfants nés prématurément demeure un défi. Ces enfants sont à risque de séquelles plus ou moins sévères telles l'infirmité motrice d'origine cérébrale, les déficiences intellectuelles et sensorielles ainsi que les difficultés d'apprentissage. Afin de diminuer l’impact fonctionnel de ces séquelles, l’identification de marqueurs précoces devient un enjeu important. Dans le contexte actuel de ressources financières et humaines limitées, seuls les enfants nés avant 29 semaines de gestation ou avec un poids de naissance (PN) <1250g sont systématiquement suivis, laissant pour compte 95% des enfants prématurés. L’identification de marqueurs précoces permettrait de cibler les enfants nés après 28 semaines de gestation porteurs de séquelles. Le principal objectif des présents travaux visait à évaluer l’utilité de l’Évaluation neurologique d’Amiel-Tison (ENAT) dans l’identification et le suivi des enfants nés entre 29 et 37 semaines de gestation et qui présenteront des problèmes neurodéveloppementaux à l’âge corrigé (AC) de 24 mois. Plus précisément, la fidélité inter-examinateurs, la stabilité ainsi que la validité prédictive de l’ENAT ont été évaluées. La cohorte était composée initialement de 173 enfants nés entre 290/7 et 370/7 semaines de gestation, avec un PN<2500g et ayant passé au moins 24 heures à l’unité de soins néonatals du CHU Sainte-Justine. Les enfants étaient évalués avec l’ENAT à terme et aux AC de 4, 8, 12 et 24 mois. À l’AC de 24 mois, leur développement était évalué à l’aide du Bayley Scales of Infant Development–II. Les principaux résultats révèlent une excellente fidélité inter-examinateurs ainsi qu’une bonne stabilité au cours des deux premières années de vie du statut et des signes neurologiques. Des différences significatives à l’AC de deux ans ont été relevées aux performances développementales en fonction du statut neurologique à terme, qui constitue l’un des meilleurs facteurs prédictifs de ces performances. Les résultats encouragent l’intégration du statut neurologique tel que mesuré par l’ENAT comme marqueur précoce dans le cours d’une surveillance neurodéveloppementale des enfants les plus à risque.

Le rôle du sentiment d’efficacité personnelle, de l’insatisfaction corporelle et de l’alexithymie dans l’étiologie et le maintien des troubles des conduites alimentaires

La forte prévalence des troubles des conduites alimentaires (TCA) chez les jeunes femmes et les faibles taux de rémission suite à un traitement ont encouragé les chercheurs à mieux comprendre les facteurs impliqués dans ce trouble mental. L’un des premiers modèles à mettre l’emphase sur des traits de personnalité associés au développement d’un TCA a été proposé par Hilde Bruch (1962, 1973, 1978) et a toujours une grande influence dans la recherche actuelle. Le modèle de Bruch inclue trois facteurs, soit l’insatisfaction corporelle, l’inefficacité et la conscience intéroceptive. Le but de cette thèse est d’apporter un support empirique au modèle de Bruch. En se basant sur une revue extensive des écrits scientifiques, cette thèse vise aussi à déterminer si deux facteurs reliés, soit l’alexithymie et le sentiment d’efficacité personnelle face à l’adoption de conduites alimentaires saines, améliorent la précision du modèle dans la prédiction de symptômes de TCA. Pour répondre empiriquement à cette question, il était d’abord nécessaire de disposer d’un questionnaire évaluant le sentiment d’efficacité personnelle en lien avec les conduites alimentaires qui peut être utilisé dans tout le spectre de présentation des TCA. Ainsi, le Eating Disorder Self-Efficacy Questionnaire (EDRSQ) a été adapté en français et ses propriétés psychométriques ont été évaluées. Une analyse factorielle confirmatoire a révélé une structure bi-factorielle, soit le sentiment d’efficacité personnelle en lien avec l’insatisfaction corporelle et avec l’adoption d’une alimentation normative. Chaque échelle a démontré une bonne fiabilité ainsi qu’une validité de construit cohérente avec la théorie. Par la suite, la capacité des facteurs proposés par Bruch à prédire les symptômes de TCA a été évaluée et comparée à des adaptations du modèle découlant des écrits. Au total, 203 étudiantes de premier cycle universitaire ont complété les versions validées en français du Eating Disorder Inventory 2, du Eating Attitudes Test, et du Toronto Alexithymia Scale en plus du EDRSQ. Les résultats montrent que le modèle de Bruch explique 46% de la variance des symptômes de TCA. Alors que l’insatisfaction corporelle et la conscience intéroceptive démontrent chacun une contribution importante dans la prédiction des symptômes de TCA, il a été démontré que l’inefficacité présente seulement une contribution spécifique négligeable. Le modèle de Bruch est amélioré par la substitution de l’inefficacité par le sentiment d’efficacité personnelle tel que mesuré par le EDRSQ; le modèle explique alors 64% de la variance des symptômes de TCA. Finalement, cette étude démontre que l’alexithymie n’a pas de contribution spécifique dans la prédiction des symptômes de TCA. Ainsi, la combinaison d’une faible conscience intéroceptive, de l’insatisfaction corporelle et d’un faible sentiment d’efficacité personnelle en lien avec les conduites alimentaires est fortement associée aux symptômes de TCA dans un échantillon non-clinique de jeunes femmes. Finalement, les implications conceptuelles et cliniques de ces résultats sont discutées.