School of Rehabilitation Therapy Graduate Theses
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Item Community Schools in India: Design Considerations to Improve Participation and Inclusion for Children with Physical DisabilitiesGaurav, Navjit; Rehabilitation Science; Aldersey, Heather M; Batorowicz, BeataBackground: More than 1.7 million primary school-age children do not attend school; among them, children with physical disabilities (hereinafter referred to as "children”) in grades 3-8 face significant barriers to education due to limited built environment support in Mumbai. Despite local government efforts to reduce physical barriers, inclusive education remains challenging, particularly in Dharavi, an informal settlement in Mumbai. Furthermore, there is a lack of insight into how Indian architects perceive physical disability and design needs and how this translates into designing community schools. Exploring school environments, children's experiences, and architects' perspectives is crucial to enhancing children’s inclusion. Purpose: The research was guided by three specific questions: (1a) How do Indian architects conceptualize physical disability and disability-related design needs? (1b) How is this conceptualization reflected in their community school design in Dharavi, Mumbai? (2) How does community schools’ built environment impact children's meaningful participation and social interaction in Dharavi, Mumbai? (3) What modifications could be made to the built environment to facilitate children's meaningful participation and social interaction at school? Method: I conducted two studies: a) an exploratory qualitative descriptive study involving architects' interviews to gain insight into their conceptualization of physical disability and how it influenced their school design decisions; b) an embedded instrumental case study involving multiple data sources (interviews, photograph, mental maps) with five children and ten people from their educational circle (i.e., a teacher and a family member for each child) in one community school focused on children’s participation and social interaction experiences inside the school. Findings: The architects had difficulties conceptualizing physical disabilities, leading to well-intentioned but misguided design choices that did not align with the needs of children and their educational community. Children and their education circle emphasized the importance of accessible, safe spaces with adequate physical support and informal areas for socialization, fostering friendships, and enhancing participation in academic and non-academic activities. Conclusion: Access to education is a human right, and children have the right to be actively involved in decisions about their school spaces. Architects must collaborate with children to create safe, accessible, inclusive, and conducive environments for all.Item The Well-being of Older Immigrants and Refugees in Canada: Examining the Role of Entry Characteristics on Later-Life SatisfactionMorassaei, Sara; Aging and Health; Ghahari, SetarehDespite the proportionally large older immigrant and refugee population in Canada, relatively few studies focus on the well-being of older immigrants and refugees in Canada. Existing studies often consider immigrants as a single group and this aggregation leads to a weaker ability to detect important differences within this population. Admission classes through which individuals are granted entry to Canada, namely, economic class, family sponsorship, and refugee class may represent a divergence in the trajectories of newcomers with later-life implications for well-being. This thesis aimed to understand how entry characteristics are associated with the later-life satisfaction of older immigrants and refugees in Canada. A thesis with three studies included a scoping review which identified the role of admission classes on the health of immigrants and refugees, a second study which compared later-life satisfaction between Canadian-born older adults and older immigrants and refugees by admission class, and a third study which examined whether human capital characteristics at arrival were associated with the later-life satisfaction of older immigrants and refugees in Canada. Data from individuals over 55 from the Canadian Community Health Survey (2009-2014) was linked to official landing records within the Longitudinal Immigration Database. Ordinary least squared regression models examined the association between entry characteristics on later-life satisfaction, adjusting for covariates and residency time in Canada. The review confirmed that certain classes of immigrants have worse health outcomes, particularly refugees, family class and dependent applicants. The review also confirmed that there are no existing studies on the well-being of older immigrants in Canada by admission class. The second study found that after accounting for a range of correlates, economic class principal applicants and refugees had significantly lower later-life satisfaction than Canadian-born older adults. The negative association with life satisfaction among economic class principal applicants persisted after accounting for residency time in Canada. The third study found that having no official language proficiency at arrival was significantly associated with lower later-life satisfaction. These findings shed light on important heterogeneity that exists within immigrants and help identify vulnerable immigrants and refugees in Canada at risk of lower later-life satisfaction.Item The Relationship Between Military Sexual Assault, Post-Traumatic Stress Disorder and Participation Among Women Veterans of the Canadian Armed ForcesDoak, Daphne; Rehabilitation Science; McColl, Mary AnnExposure to military sexual assault within the Canadian Armed Forces (CAF) has deleterious outcomes for women veterans. A mixed methods retrospective cohort study (n=70) was undertaken to examine the relationship between military sexual assault and post-traumatic stress disorder (PTSD) and their association with participation. In addition, the mitigating role of self-efficacy and social support on participation was also explored. Quantitative and qualitative studies were conducted to investigate these associations wherein the quantitative study developed and tested a model using multivariate regression analysis. The quantitative results indicated that military sexual assault, self-efficacy and social support, had a significant association with participation. The qualitative study (n=12) included a sample of women veterans who were interviewed to explore these relationships about how military sexual assault and PTSD affected participation and how social support mitigated these effects. Findings of this study identified four unique contributions to military, trauma, and rehabilitation research. First, participation scores for women in the study were moderate and comparable with other studies of veterans. Second, women veterans who experienced sexual assault had significantly lower participation scores than women who did not. Third, women veterans attributed their participation difficulties to PTSD symptoms. Fourth, self-efficacy and social support were found to be related to participation and had the potential to be mitigating factors in the relationship between military sexual assault, PTSD and participation. In particular, belonging support among peer veterans was particularly important to the women as it had a restorative function in relationships and often led to opportunities to access other types of support. Further research is warranted to build on these findings, including a population level analysis to understand the effects of military sexual assault on participation among other CAF groups. Implementation of an intervention study which bolsters social support may be of benefit to women veterans. Sharing these findings with the CAF and civilian healthcare providers will provide meaningful guidance to address military sexual assault in rehabilitation practice.Item Postoperative Transitions in Care for Older Adults With Frailty and Their Informal CaregiversHladkowicz, Emily; Aging and Health; Miller, JordanAdults over the age of 65 are undergoing elective inpatient surgery more often than any other age group. Approximately 40% of older adults having surgery also live with frailty. Preoperative frailty is associated with many poor patient- and system-level outcomes after surgery. The postoperative transition in care is a vulnerable time for older adults with frailty and their informal caregivers. When patients transition out of hospital after surgery they can experience uncertainty around medications, lack of follow-up, ineffective communication between care providers and the patient, which can result in adverse health outcomes. Further, patients and their caregivers are often unprepared to navigate the postoperative transition in care which can lead to stress and poor experience. Hospital standards have been developed to improve the care of geriatric surgical patients, with specific goals for optimizing transitions in care to improve outcomes. However, many of these standards have not been systematically implemented and are not specific to older adults with frailty. While knowledge synthesis studies have identified transitional care interventions for older adults, there remains a gap in postoperative transitions in care for older adults with frailty. The overarching aim of this dissertation was to develop foundational, patient-centered knowledge on postoperative transitions in care for older adults with frailty and their informal caregivers. This work encompasses four separate but related studies. The first study is a scoping review where the objective was to synthesize what processes and outcomes are being used to evaluate postoperative transitions in care for older adults in the literature. The second and third studies are both qualitative studies in the interpretive description tradition where the objectives were to explore what is important during a postoperative transition in care from the perspectives of older adults with frailty and their informal caregivers. The fourth study is a secondary analysis of a multi-center cohort study where the objective was to evaluate the association of non-home discharge with decisional regret trajectories in the year after elective inpatient surgery among older adults. The results of these studies demonstrate that there is a need to develop and evaluate postoperative transitional care programs that prioritize the unique needs of older adults with frailty and their informal caregivers.Item The Effect of a Story-Telling Attention-Refocusing Intervention on Parental Stress in Parents with Infants in the Neonatal Intensive Care UnitWong, Anisia; Rehabilitation Science; Fucile, SandraBackground/Rationale: Newborn admission to the neonatal intensive care unit (NICU) is a stressful situation for parents. Prevalence of some acute stress symptoms is nearly universal after NICU admission, with physical separation due to infection control or minimal handling measures to be a major contributor to parental stress. A contact-free intervention to lower parental stress in the NICU could improve health outcomes for parents and in turn lead to improved developmental outcomes for infants. Objective: The objective of this study is to assess the effect of a Story-Telling Attention-Refocusing (STAR) intervention on parental stress in parents with infants in the NICU. Methods: A randomized trial was conducted in a level II/III NICU at Kingston Health Sciences Centre. Parents were randomized to either the intervention or standard care control group. The intervention involved parents using story prompts to share stories related to themselves or their families and friends with their infants over a ten-minute period, three times over a seven-day period. The intervention started at ten days of life. Outcomes measured included parental stress via the Parental Stressor Scale (PSS:NICU) and anxiety using the State Trait Anxiety Inventory (STAI). Results: Twenty-one parents completed the study. Mean overall PSS:NICU scores lowered significantly in the intervention group than the control group (p = 0.04) post-intervention, and parents who completed the intervention felt that the intervention helped them feel less stressed in the hospital and more connected to their infants. The intervention had no effect on STAI anxiety scores. Conclusion: The findings suggest that the STAR program may help reduce parental stress in the NICU. An effective intervention to lower stress in the NICU could reduce the incidence of chronic stress-related disorders in this high-risk population, improve parent-infant interactions and infant developmental outcomes.