Theses (Public Health and Social Policy)

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    Enhancing the well-being of racialized international graduate students at a Canadian post-secondary institution
    (2024) Kanabar, Sahana Jaya; Cloutier-Fisher, Denise S.; Madan, Athena
    Racialized international graduate students, a rapidly growing population within Canadian post-secondary institutions, face systemic institutional barriers to their well-being. Despite the significant role that post-secondary institutions can play in promoting international student well-being, the Canadian educational context lacks standardized best practices that direct the quality of care provided to international students. Through a qualitative case study research approach situated within critical race and decolonial paradigms, this study sought to understand how racialized international graduate students understand well-being, and how their well-being is promoted or hindered within the academic and socio-political conditions of the university. Semi-structured interviews were conducted with a diverse sample of 22 racialized international graduate students from 16 countries and five continents, studying in 17 programs at the University of Victoria. From a thematic analysis of the interviews, four major themes emerged that reflect different aspects of well-being: Political-Economic Determinants; Academic Institutional Conditions; Socio-Cultural Influences; and Personal Wellness. This research scrutinizes various institutional policies, practices, and actors that play a role in shaping racialized international student well-being, which led to the development of recommendations for institutional-level modifications to enhance the well-being of racialized international graduate students, targeting four key areas: Affordability and Access to Education; Improving Academic and Work Dynamics; Meaningful Inclusion in the Campus Community; and Enhancing Student Services Provision. The findings also uncovered the formal and informal strategies that participants practice to enhance their well-being. While the participants faced challenges in their journey as an international graduate student, they generally felt positively about their experience as it strengthened them and allowed for transformational personal and professional growth.
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    Understandings of health equity and organizational constraints on health equity work among frontline public health practitioners in British Columbia
    (2024) Jamal, Aliya; Worthington, Catherine; Pauly, Bernadette M.
    Health equity occupies a central place in the field of public health. However, significant challenges exist to public health practitioners promoting health equity, many of which are produced by the organizational contexts in which they work. This study explored how frontline public health staff engaged with health equity during a time when the organization they worked for had declared health equity an organizational priority. The project involved secondary analysis of focus groups and interviews conducted in 2014-2015 with frontline practitioners in a health authority in British Columbia, Canada. Using a critical discursive organizational approach, I identified a number of ideas at work in frontline staff’s construction of health equity. Frontline staff prioritized health equity in their work, even if they did not always use the term ‘health equity’. They most often articulated health equity as downstream access to services and less often as an upstream structural phenomenon. Some articulated concerning individualist ideas about health equity that pushed back against systemic approaches. Frontline staff described an organizational environment that mostly impeded their ability to promote health equity through inadequate resources, bureaucratization, an overemphasis on targeted programs, and limited professional scope. They posited that the organization’s lack of prioritization of health equity and the hierarchical distance between senior leaders and the frontline produced an organizational environment that was unsympathetic to and unsupportive of health equity. This research highlighted some of the relations of power that impacted frontline public health staff’s ideas and action on health equity, concluding that the conditions and dynamics of the organizational environment are critical factors in organization-wide health equity initiatives. It also raised concerns about how the concept of health equity plays out in real world public health contexts, questioning whether the concept is politically generative at the level of frontline practice.
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    The lived experience of North Park neighbourhood residents as it relates to community planning, social inclusion, and well-being
    (2024) McAllister, Kate; Lachowsky, Nathan; Card, Kiffer
    This research aims to gather input into the health, wellness, social inclusion and dynamics within Victoria’s North Park, a mixed-used mixed income neighbourhood. Employing a community-based participatory approach in collaboration with the North Park Neighbourhood Association, 19 participants were interviewed. Analysis revealed diverse perceptions of the neighbourhood emphasising the community in a period of transition, competing interpersonal relationships and the impact of policy and bylaws on daily life. Residents expressed frustration with political decision-making processes and tensions between housed and unhoused neighbours and territorial stigma was pervasive. Despite advocacy for inclusivity, exclusionary attitudes persisted. Placemaking was identified as both a barrier and facilitator to community connection and well-being, alongside concerns about ongoing development and gentrification. This research underscores the importance of accessible public spaces and community programming as vital resources for fostering well-being and inclusion through centering community voices in neighbourhood planning. While territorial stigma persists, opportunities for meaningful community engagement offer hope for resilience and connection. Achieving this outcome requires buy-in from both community and local government, and equitable decision-making processes to promote community well-being in dynamic urban environments.
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    The Medicine Bundle Pilot: An Indigenous Two-Spirit Approach to HIV and STBBI Health in British Columbia
    (2024-01-29) Ronayne, Emma; Lachowsky, Nathan
    The social determinants of health and the determinants of Indigenous health, including the historical and ongoing effects of settler-colonialism across Turtle Island, contribute to increased rates of HIV and sexually transmitted and blood-borne infections (STBBI) facing Indigenous people in Canada. Two-Spirit and queer Indigenous folks face further systemic barriers to accessing sexual health resources. The Medicine Bundle Pilot project takes a strengths-based approach to addressing health inequities in HIV and STBBI awareness and prevention. The Medicine Bundle Pilot was developed by the Community-Based Research Centre’s Two-Spirit Program to address barriers and increase culturally safe access to sexual health resources for Indigenous people in British Columbia. The Medicine Bundle is an Indigenous-developed approach to the HIV self-test kit and dried-blood spot test, combining traditional Indigenous medicines with Western sexual health resources. Medicine Bundles were distributed to Indigenous communities and community members across British Columbia, fostering safer pathways to care. My thesis aimed to (1) understand participants’ experience with the Medicine Bundle Pilot, and (2) determine barriers and access limitations to sexual health resources for Indigenous people in British Columbia. Existing barriers include limited access to sexual health resources within communities and being wrongfully denied access to services. Results demonstrate that the Medicine Bundle is a very effective sexual health resource for Indigenous people, and participants reported improved experiences with testing through the Medicine Bundle.
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    “They couldn’t talk to anybody because there’s so much stigma”: A qualitative study exploring Indigenous Peoples’ experience of abortion-related stigma in Canada
    (2023-12-20) Ross, Arie; Monchalin, Renée; Frandsen, Natalie
    Although there are no laws restricting abortion access in Canada, stigmatizing views of abortion still exist. Abortion-related stigma contributes to feelings of isolation and shame among those who have abortions, often leading to secrecy and hesitancy to seek support. However, experiences of abortion-related stigma among Indigenous Peoples in Canada have not been explored. This thesis research was nested within the exploratory study Global Goal, Local Impact: Access to Abortion Services for Indigenous Peoples in Canada (GGLI). Interview data were collected using a conversational method and analyzed following the DEPICT model. An intersectional feminist approach woven with a Two-Eyed Seeing methodology guided this work. Abortion-related stigma was experienced by all participants (N=15) and included internalized, service provider, social, and community stigma. Commonly, multiple aspects of stigma were experienced, revealing the interwoven and layered nature of abortion-related stigma. Abortion-related stigma was heightened further in the presence of intersecting identity factors, geographic barriers, lack of support, stereotypes, and perceived lack of credible information. Service provider stigma was most prevalent and manifested as poor communication, coercion, poor treatment, and potentially health care avoidance. Family and community, particularly those influenced by faith-based values and beliefs, impacted the experience of stigma and influenced feelings of shame, abortion access decisions, and contributed to a perceived lack of choice among some participants. Participants embodied resilience in the face of systemic barriers and proposed multiple solutions to reduce abortion-related stigma, including sharing stories as a means of resilience, reclamation, and support.
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    Accessing and Implementing Community Drug Checking in Smaller Urban Vancouver Island: Contextual Factors to Consider
    (2023-09-18) Hutchison, Abby; Wallace, Bruce; Urbanoski, Karen
    The criminalized drug supply in British Columbia and, on a larger scale, in North America is unregulated and leaves those who access the supply to navigate consumption of substances that may be of unknown composition. Drug checking has increasingly been used as a harm reduction measure that provides individuals with greater information about the substances they consume, share, manufacture, and distribute. There is a growing body of evidence related to the acceptability, implementation, service delivery models, and impacts of drug checking. However, much of this research is centered in large urban regions. This follows a trend of inequitable access to harm reduction services within smaller urban centers with a concentration of harm reduction resources and research in large urban regions. This research focuses on the experience of those who will be accessing and implementing drug checking, with specific focus on the context of smaller urban geographic location informs these activities. Data collection tools were informed by the outer context domain of the Consolidated Framework for Implementation Research, to capture experiences related to service implementation and accessibility of drug checking within a smaller urban setting and 39 in-depth interviews were conducted. We identified six core factors related to smaller urban context: community and political climate; lack of anonymity and experiences of stigma; social groups and personal relationships; resource availability; geographic profile; and criminalization. Consideration of these factors in drug checking program development and implementation can support equity-oriented services within smaller urban settings.
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    “We need all the help we can get”: A Qualitative Examination of Service Provider Perspectives on the Barriers and Facilitators to the Implementation of The Emergency Risk Mitigation Guidelines
    (2023-04-28) Kalicum, Jeremy; Urbanoski, Karen; Pauly, Bernie
    The Risk Mitigation Guidance (RMG) was an interim clinical guidance implemented to respond to both the public health emergency on COVID-19 and the overdose crisis through the provision of pharmaceutical alternatives to the illicit drug supply to facilitate isolation, social distancing, and reduce overdose risk. This study analysed the perspectives from a broad range of service providers, whose work was impacted or related to the RMG, to elucidate a nuanced narrative regarding the perceived facilitators and barriers to RMG implementation. In this study, 24 qualitative interviews were conducted with service providers with the RMG from across British Columbia. Service Providers viewed RMG as a tangible item they could refer to when providing RMG medications to people who clearly fit in the intended target populations. Implementation challenges included, lack of comprehensive guidance and support, inconsistent application of RMG, historical prescribing contexts, the potential risk of destabilizing people on alternative treatments, and diversion. Future research is needed in determining the qualitative and quantitative impacts of pharmaceutical alternative initiatives, particularly in relation to diversion and the initiation of substance use; the relative impact of increased planning in the context of public health emergencies; and deeper analysis into the perspectives of other stakeholders, such as PWUD or pain patients, on the implementation of pharmaceutical alternatives.
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    Siem Qulmuhw Mustimuxw Tze Tzu Wut Tu Mamu’na’tzt: Honoured Indigenous People Helping Our Children: The co-creation of a culturally grounded family wellness curriculum with Tillicum Lelum Aboriginal Friendship Centre and urban-Indigenous families
    (2023-01-05) Simpson, Ashley; Monchalin, Renee; Carriere, Jeannine
    Urban Indigenous families draw on wholistic understandings of what it means to be well that are deeply rooted in culture, ceremony, extended family support, and intergenerational connection. Despite calls from Indigenous families, communities, scholars, and organizations to develop culturally-based and context-specific maternal, child, and family health programs that are rooted in these perspectives (Clifford et al., 2015; Mushquash et al., 2021), there is limited research that includes the needs and experiences of Indigenous families within urban contexts. Through the lens of an Indigenist and relational research paradigm, this study aimed to address a community-identified priority to develop culturally-based family wellness programming and resources to support urban Indigenous families during the perinatal period and early parenting years. A Medicine Bundle Methodology was utilized to gather sacred items– knowledges, stories, teachings, and experiences –from urban Indigenous families who access programs at Tillicum Lelum Aboriginal Friendship Centre, and from the Elders and Knowledge Keepers who support them. Three talking circles were held to better understand the cultural wellness needs and priorities of urban Indigenous families, followed by one-on-one conversations with four Elders. Overarching themes from these conversations included Prenatal Wellness, Postpartum Wellness, Parenting Young Children, Intergenerational Family Wellness, and Honouring Diversity of Cultures and Teachings in Urban Spaces. Results from this research demonstrate the need for urban Indigenous organizations to be self-determining in the development and delivery of health services; for family wellness programming and resources to be rooted in culture and ceremony; and for the use of a family-centered and intergenerational approach in the development and implementation of family wellness programs. Co-creation of this research bundle contributes to expanding the knowledge base on the wellness needs and experiences of urban Indigenous families, and the community-led development of responsive, culturally-relevant, and effective family wellness programming within urban Indigenous communities.
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    A syndemic in nonurban gay and bisexual men in British Columbia and within Island Health
    (2021-04-30) Hickman, Caitlin; Lachowsky, Nathan
    Inequitable HIV acquisition persists among gay and bisexual men (GBM). In 2017, GBM represented 69.8% of new HIV diagnoses in British Columbia (BC) and 80.5% of new HIV diagnoses within Island Health (BCCDC, 2019). I used syndemic theory to examine the relationship between nonurban living environment, syndemic factors, and health outcomes among GBM within Island Health and in BC. I conducted a secondary analysis of the Community Based Research Centre’s Sex Now 2015, a national cross-sectional survey of approximately 8000 Canadian GBM. I conducted chi-square tests to compare levels of stigma stratified by urban or nonurban, Cramer’s V to examine the association between syndemic factors, and Poisson regression to determine which demographics and health outcomes were associated with more syndemic outcomes. I found prevalent stigma that negatively impacts urban and nonurban GBM. Urban GBM experience more stigma (e.g., called names or slurs) and worse outcomes (e.g., considered suicide) than nonurban GBM in Island Health and BC. Among nonurban GBM within Island Health, Cramer’s V may demonstrate a syndemic (e.g., strong associations between several measures of stigma such as verbal violence and discrimination at work and health outcomes such as depression, suicide, partner violence, and alcohol use). Among nonurban GBM within Island Health, Poisson regression revealed that more syndemic factors were associated with negative health outcomes and risk factors, such as attempting suicide, condomless sex, having sexual partners of unknown HIV status, and living with HIV. These findings suggest that a syndemic can occur among nonurban GBM without migration to a large urban centre. Key implications include a need for structural change to destigmatize sexual diversity. Results illustrate a need to normalize conversations about mental health among GBM who would benefit from co-located services that address stigma, mental health, substance use, and sexual health.
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    Evaluating a Métis community pilot of dried blood spot testing within a Métis-specific cultural response for those lIving with/affected by HIV and other STBBI
    (2020-06-04) Atkinson, Danielle N.; Worthington, Cathy
    There is a shortage of literature on culturally grounded Métis approaches to addressing human immunodeficiency virus (HIV) and sexually transmitted and blood-borne infections (STBBI). The goals of this research were two-fold: to document and explore the development of an emerging Métis model of health and wellness for people living with or impacted by HIV and STBBI, and to conduct an evaluation of a dried blood spot testing (DBST) pilot for HIV and STBBI in Alberta drawing strongly on perspectives of Métis community members. This study utilized community-based and Indigenous research approaches in partnership with Shining Mountains Living Community Services (Shining Mountains) to address these goals. The first research goal (documenting and exploring a Métis model of health and wellness for people living with/impacted by HIV/STBBI) involved three gathering circles comprised of eight diverse Métis community members and stakeholders, which was supplemented by a community mapping exercise, and resulted in the development of the Red River Cart Model. The second research goal (evaluating a pilot of DBST for HIV/STBBI) involved the analysis of 26 survey responses and four gathering circles comprised of 19 participants who were self-identifying Métis individuals who received DBST at one of two events in the Métis community; semi-structured interviews with three DBST providers; and the document analysis of minutes from meetings with stakeholders held throughout the planning process of the DBST pilot. Results include the Red River Cart Model (a service tool and multi-level conceptual model describing a Métis understanding of health within an HIV/STBBI context) and suggest that DBST is an acceptable community-led testing intervention for Métis people. This research builds on limited existing literature by articulating a Métis model to health and wellness which can be used by service providers, policy makers, and Métis communities, and provides evidence in support of a testing intervention implemented by Métis Peoples for Métis Peoples.
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    A place “I feel is home”: the meaning of home and implications for health among people living with HIV/AIDS in Greater Vancouver
    (2018-05-30) Deyman, Megan; Worthington, Cathy; Picotte, Heather
    Background: Housing continues to be one of the most significant unmet needs for many people living with HIV/AIDS in British Columbia. While there has been a focus on documenting the material aspects of housing and housing extremes (i.e., homelessness), there are important gaps in our understanding of the complex relationship between housing and health for people living with HIV/AIDS. The aim of this research was to identify what “home” meant for people living with HIV/AIDS across a continuum of housing/living situations, the ways in which people living with HIV/AIDS construct meanings of home, and how these factors interact with their (physical, mental, and emotional) health and wellbeing. Methods: This thesis reports on a secondary analysis of individual interviews from the Positive Living, Positive Homes (PLPH) community-based research study. For the PLPH study, community-based research approaches were used to explore a variety of lived experiences across a continuum of housing situations, while promoting collaborative inquiry among community and academic research team members. For this analysis, a purposively selected sample of 10 transcripts was drawn from 53 semi-structured qualitative interviews with people living with HIV/AIDS in Greater Vancouver (GV). Transcripts were analyzed using a thematic analysis approach, adopting constant comparative and other coding techniques from a grounded theory approach to explore how people constructed the meaning of home, and how people living with HIV/AIDS perceived the various elements of their home environment to interact with their health and wellbeing. Descriptive thematic coding was augmented with higher-level conceptual coding to further develop over-arching conceptual themes. Some participatory analysis elements, including involvement of a community advisory committee (CAC), were included in the analysis process to allow for collaborative inquiry, and to augment and confirm results. Results: The participants (5 Caucasians, 3 Indigenous persons, 1 Chinese-Canadian and 1 African refugee; 5 females, 1 trans-female, and 4 males) lived in a range of housing situations (market rental, subsidized, supportive, and precarious housing). Results from a thematic analysis showed that even when people had access to four-walled housing structures, they didn’t necessarily feel that their living environment was safe, secure, or conducive to having their health and social needs met. Emerging themes highlighted how people define home and their conditions for this designation revealed the ways in which people manage their living spaces to foster feelings of autonomy, security, constancy, and opportunities to strengthen their identity. Discussion: Understanding the distinction between housing and home, and the meaningful dimensions of peoples’ living environments, can help improve options for appropriate housing by moving away from a ‘one-size-fits-all’ approach. Furthermore, collaborative inquiry may help address the action-oriented needs of the research findings through community-academic partnerships, knowledge sharing, and knowledge translation activities.
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    Exploring healthy vending contracts as a localized policy approach to improve the nutrition environment in publicly funded recreation facilities
    (2018-04-19) Lane, Cassandra; Worthington, Catherine
    Objective: Many Canadian publicly funded recreation facilities have an obesogenic environment. Researchers recommend food and beverage policies to change these environments, however further research is needed to distinguish effective policy approaches. A promising, localized policy approach not yet well evidenced is the use of vending machine contracts with health stipulations to improve nutrition environments. The primary objective of this study was to determine whether a sample of Canadian publicly funded recreation facilities with healthy vending contracts had healthier vending machine nutrition profiles than those facilities with conventional contracts. A secondary research objective was to explore the additional influence of policy quality on the health profile of vending machines. Methods: This quantitative study used results from the baseline assessment done of the broader Eat, Play, Live (EPL) initiative. Vending machine audits and questionnaires were completed in participating publicly funded recreation facilities with vending machines (N=46). Vending product profiles were assessed using the Brand Name Food List which categorizes packaged foods according to the BC Guidelines for Vending in Public Buildings. Mann-Whitney U tests were used to determine if there were significant differences in the health profile of vending products between facilities with healthy vending contracts and those without. Results: Facilities with healthy vending contracts had significantly healthier vending product profiles compared to facilities with conventional contracts. On average, significantly less availability of unhealthy (DNS) products represented these healthier profiles. Vending profiles did not significantly differ based on higher quality contract health stipulations although sample size limited conclusions about this. Conclusion: Facilities with health stipulated in their contract differed from those without health stipulations. This suggests that healthy vending contracts (even with relatively generic stipulations) may be supportive of improved nutrition environments.
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    Clearing the air: the stories of municipal smoking-control bylaws in British Columbia
    (2018-03-28) Brigden, Linda Waverley; Prince, Michael J.
    The development and implementation of municipal smoking-control bylaws in British Columbia during the 1990s was characterized by polarity and confrontation. Health sector professionals, members of the hospitality industry, community activists, and municipal politicians disagreed over the need for bylaws, types of establishments that should be regulated, and the degree of restriction. This research used narrative policy analysis to understand the factors that influenced the development of these bylaws in order to delineate a less confrontational process and ensure a more stable resolution. Narratives were collected from representatives of the main policy sectors in four communities throughout British Columbia. Victoria and Vancouver represented urban communities that were updating existing bylaws. Professional staff headed their top-down bylaw processes. In the rural communities of Squamish and Kimberley community volunteers attempted to introduce new bylaws through a bottom-up process. The narratives proved to be a rich source of information that would have been difficult to capture in any other manner. They offer a novel and fruitful means of engaging in policy analysis. The provincial government's tobacco-control strategy served as a backdrop for all policy processes, although it was experienced unequally in the four communities. Urban centres were more aware of provincial tobacco-control initiatives and accessed provincial resources to a greater extent than did Kimberley and Squamish. Each policy sector was led by champions, but the nature of these groups and individuals greatly influenced their success. Those who were credible, persistent, and had access to decision makers were most likely to influence the policy-making process. The antagonism that distinguished the bylaw process was itself a determinant. In all communities, the discord reached a level where it precluded a fair and inclusive process. The bylaw debate was framed and reframed by different sectors. The ability of champions to reach policy makers and frame the debate in a way that was compelling played a significant role in the outcome. Finally, the narratives indicate that each community's “readiness” for policy change is a factor that must be considered. Community readiness was seen to comprise seven main components: (1) each policy sector's belief that a policy is worth adopting and their ability to successfully influence the public and policy makers; (2) the nature of a community—its size, demographics, and social norms; (3) the politicians involved and the ability of champions to understand the political process and reach policy makers; (4) the type of policy under consideration and its relationship to both previous statutes and social norms; (5) the ability of media to reflect sectoral interests and influence public knowledge and attitudes; (6) the temporal context in which the policy change was considered; and (7) a process that fits the needs and resources of the community.
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    Indigenous health equity as a priority in British Columbia's public health system: a pilot case study
    (2017-08-30) Kent, Alexandra; Reading, Charlotte Loppie; Pauly, Bernadette M.
    For her MPH thesis research, Alex Kent conducted secondary analysis of data from the Equity Lens in Public Health (ELPH) research program to explore whether and how Indigenous health equity is prioritized within one regional health authority [HA100] in British Columbia’s public health system. Her thesis addresses the question: How has Indigenous health equity been identified and prioritized within HA100 as reflected in core documents and plans as well as interviews with key decision makers in the health authority? Using the Xpey’ Relational Environments Framework, a theoretical framework designed by Drs. Charlotte Loppie and Jeannine Carriere, Alex identifies and discusses the physical and theoretical settings where Indigenous health equity is and is not manifested in the public health system. Her findings highlight a number of examples of how HA100 has implemented successful strategies aimed at enhancing Indigenous health equity as well as several areas for improvement across the relational environments. Alex concludes that improving Indigenous health equity through human, non-human and symbolic interactions in institution, system and community settings appears to be a current priority for HA100; whereas reconciling historical relationships and creating equitable social, cultural and political conditions that promote optimal health and wellbeing for Indigenous peoples is positioned as a long-term and indirect goal.
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    Two practices and one Act: Mangling tecnologically mediated transparency.
    (2013-12-05) Brown, Pamela Anne; Moss, Pamela
    During a municipal election in 2010, Canadian citizens used a blog to enact an ad hoc campaign funding disclosure request of all candidates. After the election, the municipality implemented formal legislation requiring campaign funding disclosure on their own website. This thesis is a case study that explores how two technologically mediated transparency practices were constituted within and outside the scope of legislation. I draw on Andrew Pickering's (1995) notion of the mangle of practice and Karen Barad's (2003) concept of intra-action to conceptualize these transparency practices as a mangle of entwining intra-connected phenomena. In my exploration of policy in practice I deconstruct transparency practice through a discussion of how transparency mechanisms and social media characteristics intra-act and transform each other into a practice that supersedes the original intent of the ad hoc request and formal legislation. This research queries assumptions about transparency practices and contributes to establishing an interdisciplinary methodology for policy evaluation in technologically mediated environments.
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    Empowering Exclusivity
    (2013-05-24) Munk, Julia; Prince, Michael J.
    The segregation of disabled people is often perceived of as a form of oppression that acts as a means of exclusion from mainstream society. Disability rights activists and theorists have worked to end segregation as a form of oppression using the social model of disability and drawing on feminist theory. Feminist use of disengagement as a tool for empowerment is one component of feminist theory that has been left unexplored as it relates to disability. This work explores the role of segregation within the disability rights movement and within the development of the activist identity for disabled people. Based on the individual and collective experiences of six participants, all of whom are activists who attended segregated summer camps, I use a thematic analysis to reframe segregation as Empowering Exclusivity. This reframing has the potential to shift the strategic goals of the disability rights movement away from binary understandings of integration and segregation and towards a critical analysis of full inclusion and empowerment.