Time use, daily activities, and health-related quality of life of school-going late adolescents in Cork city and county: A cross-sectional study

Aim: This thesis examines a question posed by founding occupational scientist Dr. Elizabeth Yerxa (1993) – “what is the relationship between human engagement in a daily round of activity (such as work, play, rest and sleep) and the quality of life people experience including their healthfulness” (p. 3). Specifically, I consider Yerxa’s question in relation to the quotidian activities and health-related quality of life (HRQoL) of late adolescents (aged 15 - 19 years) in Ireland. This research enquiry was informed by an occupational perspective of health and by population health, ecological, and positive youth development perspectives. Methods: This thesis is comprised of five studies. Two scoping literature reviews informed the direction of three empirical studies. In the latter, cross-sectional time use and HRQoL data were collected from a representative sample of 731 school-going late adolescents (response rate 52%) across 28 schools across Cork city and county (response rate 76%). In addition to socio-demographic data, time use data were collected using a standard time diary instrument while a nationally and internationally validated instrument, the KIDSCREEN-52, was used to measure HRQoL. Variable-centred and person-centred analyses were used. Results: The scoping reviews identified the lack of research on well populations or an adolescent age range within occupational therapy and occupational science; limited research testing the popular assumption that time use is related to overall well-being and quality of life; and the absence of studies that examined adolescent 24-hour time use and quality of life. Established international trends were mirrored in the findings of the examination of weekday and weekend time use. Aggregate-level, variable-centred analyses yielded some significant associations between HRQoL and individual activities, independent of school year, school location, family context, social class, nationality or diary day. The person-centred analysis of overall time use identified three male profiles (productive, high leisure and all-rounder) and two female profiles (higher study/lower leisure and moderate study/higher leisure). There was tentative support for the association between higher HRQoL and more balanced time use profiles. Conclusion: The findings of this thesis highlight the gendered nature of adolescent time use and HRQoL. Participation in daily activities, singly and in combination, appears to be associated with HRQoL. However, the nature of this relationship is complex. Individually and collectively, adolescents need to be educated and supported to create health through their everyday patterns of doing.

Workers’ compensation and mental health : examining the mental health impacts of involvement in the Victorian Work Cover system from the perspective of long-­term injured workers

The project aimed to explore long--term injured workers’ experiences and perceptions of their mental health as they progressed through the Victorian WorkCover process. The purpose of the project was to assist in understanding these factors in order to identify how workers might be better supported, and to identify changes that compensation authorities, employers and unions can make to reduce mental distress amongst injured workers. As a project based on workers’ accounts of their experiences, it aimed to provide a narrative basis for the development of supportive policy and practice to reduce mental distress amongst people who are clients of the WorkCover system. The project was a qualitative study based on fifteen in--depth interviews with people who had been injured at work and who had been off work for at least six months. The workers who took part in the study were recruited with the assistance of their trade unions, using an advertisement that was distributed via the unions’ regular communication channels. Workers were asked to tell their story of injury and recovery with a particular focus on how they felt and the factors that affected them, both positively and negatively. They were also asked what could or should be changed to support workers’ recovery and improve their experience of the WorkCover system. The workers who took part in the study came from a variety of industry sectors (education, textile and clothing manufacturing and meat industries) and different occupational categories (professional, trade/technical and manual). They included people whose primary injury was physical and those whose primary injury was psychosocial.

Family Health Support Centers: challenges and opportunities from the perspective of primary care professionals in the city of Sao Paulo, Brazil

Family Health Support Centers (NASF) were created in Brazil to increase the case-resolution capacity of primary healthcare. Prior to their implementation in the West Side of the city of Sao Paulo, Brazil, a series of workshops were held for primary healthcare professionals to prepare a proposal for such centers. Hermeneutic analysis was used to study the transcribed material. The thematic categories were: role, constitution, and functioning of the NASF, relationship with family health teams, and interdisciplinarity. The participants' expected the NASF to be an empowering device for comprehensiveness of care, intervening in an existing culture of unnecessary referrals while fostering linkage with other levels of care. The participants also expected the NASF to contribute to the discussion on health professionals' training and stimulating reflection with policy-makers on health indicators based exclusively on the number of consultations. These indicators fail to reflect the impact on the services' activities and the quality of care offered to the population in the coverage area.

An Asian perspective of occupational stress coping model : a case study of Sri Lankan employees

Sri Lanka has one of the highest rates of natural disasters and violent conflicts in the world. Yet there is a lack of research on its unique socio-cultural characteristics that determine an individual's cognitive and behavioural responses to distressing encounters. This study extends Goh, Sawang and Oei's (2010) revised transactional model to examine the cognitive and behavioural processes of occupational stress experience in the collectivistic society of Sri Lanka. A time series survey was used to measure the participant's stress-coping process. Using the revised transactional model and path analysis, a unique Sri Lankan model is identified that provides theoretical insights on the revised transactional model, and sheds light on socio-cultural dimensions of occupational stress and coping, thus equipping practitioners with a sound theoretical basis for the development of stress management programs in the workplace.

Caught in a 'spiral': barriers to healthy eating and dietary health promotion needs from the perspective of unemployed young people and their service providers

The number of young people in Europe who are not in education, employment or training (NEET) is increasing. Given that young people from disadvantaged backgrounds tend to have diets of poor nutritional quality, this exploratory study sought to understand barriers and facilitators to healthy eating and dietary health promotion needs of unemployed young people aged 16-20 years. Three focus group discussions were held with young people (n=14). Six individual interviews and one paired interview with service providers (n=7). Data were recorded, transcribed verbatim and thematically content analysed. Themes were then fitted to social cognitive theory (SCT). Despite understanding of the principles of healthy eating, a ‘spiral’ of interrelated social, economic and associated psychological problems was perceived to render food and health of little value and low priority for the young people. The story related by the young people and corroborated by the service providers was of a lack of personal and vicarious experience with food. External, environmental factors such as the proliferation and proximity of fast food outlets and the high perceived cost of ‘healthy’ compared to ‘junk’ food rendered the young people low in self-efficacy and perceived control to make healthier food choices. Agency was instead expressed through consumption of junk food and substance abuse. Both the young people and service providers agreed that for dietary health promotion efforts to succeed, social problems needed addressed and agency encouraged through (individual and collective) active engagement of the young people themselves.

A patient perspective of pharmacist prescribing: 'crossing the specialisms-crossing the illnesses'

Background: The drive for non-medical prescribing has progressed quickly since the late 1990s and involves a range of healthcare professionals including pharmacists. As part of a commissioned research project, this qualitative element of a larger case study focused on the views of patients of pharmacist prescribers. 

Objective: The aim of this study was to explore patients' perspectives of pharmacists as prescribers. 

Methods: Three pharmacists working as independent prescribers in the clinical areas of (i) hypertension, (ii) cardiovascular/diabetes management, (iii) anticoagulation were recruited to three case studies of pharmacist prescribing in Northern Ireland. One hundred and five patients were invited to participate in focus groups after they had been prescribed for by the pharmacist. Focus groups took place between November 2010 and March 2011 (ethical/governance approvals granted) were audio taped, transcribed verbatim, read independently by two authors and analysed using constant comparative analysis. 

Results: Thirty-four patients agreed to participate across seven focus groups. Analysis revealed the emergence of one overarching theme: team approach to patient care. A number of subthemes related to the role of the pharmacist, the role of the doctor and patient benefits. There was an overwhelming lack of awareness of pharmacist prescribing. Patients discussed the importance of a multidisciplinary approach to their care and recognized limitations of the current model of prescribing. 

Conclusion: Patients were positive about pharmacist prescribing and felt that a team approach to their care was the ideal model especially when treating those with more complex conditions. Despite positive attitudes, there was a general lack of awareness of this new mode of practice.

A Multinational Health Professional Perspective of the Prevalence of Mood Disorders in Patients with Acute and Chronic Wounds.

Recent research has started to identify mood disorders and problems associated with acute and chronic wounds, which have been shown to contribute to delayed healing, poor patient well-being and a reduced quality of life. Furthermore, mood disorders have been shown to have a negative impact on financial costs for service providers and the wider society in terms of treatment and sickness absence. This study aimed to survey a multinational sample of health professionals to explore their perspective and awareness of mood disorders amongst acute and chronic wound patients. Responses were received from n = 908 health professionals working in Asia, Africa, Australia, Europe, North America and South America. A strong awareness of the prevalence of mood disorders appeared to be widespread among the health professionals across the world, in addition to a view on the potential factors contributing to these problems with mood. Despite this, it was thought that few patients were actually receiving treatment for their mood disorders. Implications for clinical practice include the need for health professionals to actively engage with their patients to enable them to learn from their experiences. Studies that explore the benefits of treatments and techniques appropriate for minimising mood disorders in patients with wounds would provide empirical evidence for health professionals to make recommendations for patients with acute and chronic wounds.

Health literacy [Document électronique] : an economic perspective and data for Switzerland. Part 2, A review of health literacy measures and a cost assessment of limited health literacy

Summary : 1. Measuring health literacy in Switzerland: a review of six surveys: 1.1 Comparison of questionnaires - 1.2 Measures of health literacy in Switzerland - 1.3 Discussion of Swiss data on HL - 1.4 Description of the six surveys: 1.4.1 Current health trends and health literacy in the Swiss population (gfs-UNIVOX), 1.4.2 Nutrition, physical exercise and body weight : opinions and perceptions of the Swiss population (USI), 1.4.3 Health Literacy in Switzerland (ISPMZ), 1.4.4 Swiss Health Survey (SHS), 1.4.5 Survey of Health, Ageing and Retirement in Europe (SHARE), 1.4.6 Adult literacy and life skills survey (ALL). - 2 . Economic costs of low health literacy in Switzerland: a rough calculation. Appendix: Screenshots cost model

The Legal Framing of Computerized Processing of Health Data : A European and Canadian Perspective

The use of information and communication technologies in the health and social service sectors, and the development of multi-centred and international research networks present many benefits for society: for example, better follow-up on an individual’s states of health, better quality of care, better control of expenses, and better communication between healthcare professionals. However, this approach raises issues relative to the protection of privacy: more specifically, to the processing of individual health information.

Street-level labour inspection in China and the implementation of ILO Convention No.155 concerning occupational safety and health

Les relations de travail et d'emploi sont devenues des enjeux importants en Chine. La Chine a ratifié 25 conventions internationales du travail et a travaillé en étroite collaboration avec l'OIT pour améliorer la sécurité et la santé au travail. Malgré ces efforts, la Chine est souvent critiquée pour des violations du travail. Face à ces problèmes, un système législatif d'administration de travail a été développé au niveau national. Mais l’application de ces règlements demeure problématique.. En particulier, les difficultés rencontrées par les inspecteurs du travail dans l'application de ces lois constituent un élément clé du problème. Notre mémoire s'intéresse essentiellement au rôle de l'inspecteur du travail dans l'administration publique de la sécurité du travail en Chine. Ces fonctionnaires jouent un rôle important et peuvent parfois exercer leur discrétion en tant qu'acteurs de première ligne, faisant d'eux de vrais décideurs politiques. Par conséquent, la compréhension de leur rôle et de leur discrétion dans l'application des normes du travail en Chine est cruciale. Notre mémoire est centré sur une étude de cas qualitative d'un bureau d'inspection du travail dans la région de Beijing. Dans le cadre de notre recherche nous avons examiné le rôle des inspecteurs du travail au moyen d’entretiens semi-structurés, d’une recherche documentaire ainsi qu’à l’occasion d’une brève observation des inspecteurs sur lors de la visite d’un lieu de travail. Les résultats démontrent que la définition du pouvoir discrétionnaire des inspecteurs du travail de première ligne en Chine est un enjeu très complexe. L’étude de cas permet cependant d’élaborer un cadre permettant l’identification des facteurs critiques déterminants pour l'évaluation et la compréhension de la nature du pouvoir discrétionnaire de l'inspecteur du travail en application de la loi.

Service provision factors that affect the health and wellbeing of people living in a lower SES environment: the perspective of service providers

Inequalities in health and wellbeing within low socioeconomic (SES)  environments are well documented. Factors inherent to the health care system itself, such as inaccessible, inflexible or inappropriate seroiceprovision, contribute to the poorer health status ofresidents oflow SES areas. This paper explores the issues ofseroice provision in low SES areas, documenting the perceptions of seroice providers about the seroice needs of residents, in order to understand the systemic factors that negatively impact on health and wellbeing. A total of54 health and welfare seroice providers from two adjacent low SES suburbs within regional Victoria were interoiewed using qualitative research methods. Keyfindings indicate that successful navigation of health care seroices by residents within these low SES environments is being impeded by issues ofaccess, a lack ofappropriate early interoention options or measures, and general resident disempowerment. Central to the improvement of seroice provision is the need for seroices to become economically, geographically and culturally accessible. In particular, the importance of community involvement in health planning and health promoting seroices must be reflected in the ethos ofseroice provision.