Health sciences

A consistent provincial approach to capacity planning for rehabilitative care had been

identified as a critical gap in the field of health care in Ontario (Rehabilitative Care

Alliance, 2015a). In response, the rehabilitative care alliance (RCA) developed a needs

based hip fracture capacity planning canvas together with persons and families. This

research utilized computer assisted participation (CAP) to gather additional perspectives

from Virtual Voices via an on-line survey. The results of the Virtual Voices survey were

compared to Ontario's RCA hip fracture patient focus group findings. CAP facilitated

more voices and more ideas through virtual engagement. The survey method required

97% (10.6 hours) less time than the focus group. The Virtual Voices respondents

provided validation of the focus groups' confirmation of the rehabilitative care needs,

locations and most core team members as well as identified new ideas. The results

support the implementation of a needs-based capacity plan that enables individualized

care planning. This research provides a blueprint for the ongoing engagement of

persons and families in the co-creation of a sustainable rehabilitative care system. A

dashboard and e-health app would enable ongoing co-design, monitoring and

evaluation.

Author Keywords: Computer Assisted Participation (CAP), Computer Assisted Survey, Hip Fracture, Rehabilitative Care Needs, Virtual Collaboration, Virtual Engagement

Eating Disorders (ED) are notoriously difficult to treat due, in part, to commonly observed inefficiencies in cognitive flexibility and central coherence, which are believed to maintain disordered cognitions and behaviours and negatively impact prognosis. Cognitive remediation therapy (CRT) has recently been used effectively with adults with ED; however, evidence among adolescents is limited. The present study explored change in flexibility and central coherence in a group of 23 adolescent ED inpatients (M = 16 years, SD = 0.95). All participants received a comparable dose of ED treatment. Participants were split into two groups for comparison: the CRT group (n = 15) received CRT in addition to TAU; and a TAU group for control (TAU; n = 8). Improvements in flexibility and central coherence were superior in the CRT group, suggesting that CRT is a potentially useful treatment for adolescents with AN as part of an overall psychosocial rehabilitation program.

Author Keywords: anorexia nervosa, central coherence, cognitive flexibility, cognitive remediation, eating disorders, set shifting

Cardiovascular disease (CVD) prevention, treatment and outcomes in women remain largely inequitable globally. Unique sex-specific stages of life, including pregnancy conditions, and their influence on cardiac risk is a growing area of research (Norris et al., 2020). For example, preeclampsia is strongly associated with CVD risk. This connection has led to prevention interventions such as postpartum risk clinics. Research to date on pregnancy and chronic disease is rooted in the medical paradigm of risk and lacks women's lived experience. The present study qualitatively explored illness and risk perceptions of women with risky pregnancy conditions. Some participants felt self-blame for their conditions. Consequences and severity were focused on "baby first", while maternal risk was viewed in the distant future. Aspects of the pregnancy experience, including prompt access to mental health support, was viewed as a "blessing in disguise". Risks, such as lack of agency, and benefits of healthcare risk communication and intervention and implications for practice were also explored.

Author Keywords: communication, critical, health care, phenomenology, pregnancy, risk

The strong relationship between poverty and poor health has been well-established for millennia; however, the mechanisms through which this relationship manifests are only recently becoming understood. Perceptions of relative wealth and status, chronic stress, and immunodeficiencies are implicated in recent research studying the social determinants of health. The purpose of the current study is to access the detailed and contextualized perceptions of these relationships and contribute evidence-based policy suggestions to improve the health of the Canadian population. A qualitative approach was employed to provide a unique perspective in addressing the concerns identified within the literature, and fifteen semi-structured interviews with relevant experts were conducted and evaluated using a Content Analysis. The results of the current study suggested a consensus among the participants with regards to the income-related social factors which determine poor health outcomes. A basic income was also perceived to moderate these mechanisms to a certain degree, but was not considered the most effective policy solution. Emulating the progressive tax policies of more economically equal countries was the preferred approach to addressing the issues of poverty and poor health in Canada (though a basic income was not excluded as a potential subsection of these policies). A lack of political will was perceived to be one of the primary obstacles preventing such policies from coming into practice, and it was the conclusion of this paper that virtuous and knowledgeable political leaders are a necessity in the successful pursuit of improving the health of the Canadian people.

The present thesis entails a qualitative investigation of the unique notion to transition media change from the current paper-based system to the potential use of information technology innovation for communication between health care providers and employers during return to work. Stakeholder perspectives on relevant communication phenomena were gathered from workers, employers, and health care providers with experience in return to work. Methods for analysis involved critical realist grounded theory, as well as the use of a prototype innovation, named the Return to Work Expert App, as a platform for participant evaluation and discourse. The study's findings provided comprehensive and in-depth understanding of return to work communication, beyond its empirical regularities. The generative mechanisms of common communication problems that were discovered included situated reasoning, media as information ("the medium is the message"), epistemological disjuncture, egoism-altruism-collectivism quandary, and perspective taking. A novel theoretical framework based on ecological psychology was also advanced to offer a coherent and systematic understanding of the situated nature of health care providers' reasoning and information development. Media change via the Return to Work Expert App was argued to be limited in handling and resolving many of the communication problems that can occur. However, the app had perceptible value and benefits to prospective users that suggested a distinct advantage over current paper-based practices. Opportunities for further development and research exist to address relevant challenges, most notable of all being the need to address the app's burden of proof. For the interested reader, this thesis advances research and knowledge of provider-employer communication to a state that is truly fitting of the importance acknowledged of it in the field of return to work.

Author Keywords: critical realism, ecological psychology, media change, return to work, stakeholder communication, technological acceptance

It is universally accepted that human motor performance is variable in both its timing and spatial qualities. However, it is unclear to what extent motor variability impedes performance when learning a new skill and to what extent it enables our ability to learn. The first experiment examined whether performance during a test task depended on whether participants practiced to constrain or vary the task-relevant parameter. Participants used their right hand to make simple point-to-point movements. Results demonstrated the importance of paying attention to test task demands to evaluate which form of practice is most beneficial. The second experiment examined whether levels of variability could be manipulated using a reward-based paradigm to enhance learning when adapting to a perturbation of a simple visually-guided reaching movement. A reward-based feedback task was designed to encourage exploration along the task-relevant dimension, specifically movement direction variability. Overall, I did not find any significant results.

Author Keywords: Adaptation, Motor Control, Motor Learning, Reaching

Young children learn their emotion regulation skills by modeling and internalizing their caregivers' emotional competencies. Inadequate or problematic emotional competencies in parents can result in insufficient development of these competencies in children, which can

have severe consequences on multiple domains of their lives, including physical wellbeing. This study examined the relationship between emotional competencies, health care usage rates, somatization and health anxiety in the context of a family with young children. Participants were mothers of children 4-11 years old recruited in the community. The results revealed a relationship between mother's emotional competencies and mother and child's health care usage rates. Mother's health care usage rates were also linked to mother's health anxiety and child's somatic symptoms. These findings add to our understanding of the relationship between emotional competencies of parents and children, and the effects it can have on both mother's and child's physical wellbeing. Implications and avenues for future research are discussed.

Author Keywords: emotional competencies, health care usage, mother and child, somatization