Doctor of Philosophy in Curriculum Studies (PhD)
No child left inside: loose parts, risky play, and teachers' perceptions of risk associated with playful learning outside the classroom
My research focuses on understanding injuries in children and youth, and measuring the physical, psychosocial and financial impacts of injuries on children, their families and the health care system. I also investigate the importance of outdoor risky play for children’s healthy development, and how built outdoor environment impacts children’s play.
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This dissertation explores whether Lakatos’ methodology of scientific research programs and Elster’s notion of causal explanations can be used to drive innovation in injury prevention research. For illustration purposes, the problem of low rates of booster seat use is applied to a case study. Contrary to popular belief, the purpose seat belts is not solely to prevent people from being ejected out of the car, but to redirect crash forces to stronger parts of the body: hips and chest. Children between the ages of 4 and 8 years are usually too small to wear the seat belt across the hips and chest, and may end up with the straps on their bellies and neck. If a child wears it in this way, the seat belt directs crash forces to the child’s internal organs or spine, potentially causing fatal injuries. For this reason, children of these ages require a booster seat; a device that raises the child and ensures the seat belt is placed correctly across the hips and chest. Unfortunately, in Canada, 50% of children aged 4 to 8 years ride in cars strapped in seat belts, but without booster seats. To address this problem, I formulate a hypothesis that explains why booster seat use is infrequent: parents are prone to see injuries to vehicle occupants as resulting from ejection. This fixation on ejection makes them more concerned about the child being thrown through the windshield, and less worried about the dangers of early use of seat belts. I term this proposition the ejection stereotype hypothesis. This dissertation spans over philosophy of science, psychology, decision science, visual arts, and injury prevention. After summarizing different views of scientific progress and discussing the philosophy of booster seat research, fuzzy-trace theory and the ejection stereotype are described. Next, a psychological study that reports a falsification test of the ejection stereotype is reported. Following, a visual arts project is described in terms of how Tufte’s principles of information design were used to develop an infographic to correct the ejection stereotype. Finally, a proof-of-concept pilot study to test the efficacy of the infographic is reported.
In Canada, unintentional injuries are a leading cause of hospitalization for children aged 5-19 years old. The need for longitudinal studies examining the impact of non-fatal childhood injuries across age groups and injury types has been identified internationally. Health related quality of life (HRQoL) measures assess functional limitations in multiple health domains making HRQoL an interesting and appropriate outcome to measure the impact of injury. The overarching goal of this dissertation was to advance the understanding of HRQoL among children following injury and the appropriate analysis of longitudinal HRQoL data. A systematic review was performed to summarize the findings of research on HRQoL following pediatric injury, and to examine the methods used to measure and analyze HRQoL data in the childhood injury context. In addition, primary research was conducted with 365 children 0-16 years old and their parents who presented with an injury at a tertiary care pediatric hospital in Vancouver, British Columbia. Children aged between 5-16 years old and all parents completed questionnaire measures at the time of presentation for the injury and again at one-, four- and 12-months post-injury. How childhood injury and the process of recovery impacts children’s HRQoL from both the child’s and parent’s perspective was investigated. Four different longitudinal models were explored to determine the model that best fit the data.Analyses revealed that injuries among older children, children requiring hospitalization and children with lower extremity fractures had more significant impact on HRQoL at one-month post-injury. By four-months post-injury differences in HRQoL were minimal. On average, parents rated their children’s HRQoL lower at one-month post-injury relative to the children’s self-perceived HRQoL. Most injured children regained HRQoL baseline status by four-months post-injury. Non-linear quantile regression provided the best fitting model as it is robust to skewness and outliers and free from any assumptions regarding the distribution of errors. Older children, those hospitalized, and children with lower extremity fractures were at higher risk of having lower HRQoL in the early part of recovery relative to younger children, those seen in the ED and children with other types of injuries.
Traumatic knee injuries are among the most common sport-related injuries sustained by youth and are associated with significant personal and societal burden, including increased risk of post-traumatic osteoarthritis (PTOA). Despite the key role of physical activity (PA) in prevention of disease, disability, and death, there is a paucity of knowledge surrounding PA participation, and other health-related outcomes for these individuals. The overarching aim of this dissertation was to understand the attitudes and beliefs, health-related outcomes, and PA participation of youth and young adults after recovery from acute knee injury, yet before onset of symptomatic joint disease. This dissertation is comprised of four studies. First, qualitative interviews were conducted with youth and young adults 3-10 years following intra-articular knee injury examining the influence of their injury on attitudes and beliefs about PA and PTOA. Four main themes were: acceptance of the injury impact; high determination and resiliency; lack of knee confidence; and evolving sense of athletic identity.Second, knee confidence was quantitatively examined in youth and young adults 3-10 years after intra-articular knee injury and age-and sport-matched uninjured controls. Individuals with a previous knee injury had over seven times greater odds of being troubled by knee confidence than controls. Third, the Swedish Knee Self-Efficacy scale (K-SES) was translated and cross-culturally adapted into English for individuals with an intra-articular knee injury in the previous five years. Measurement properties were evaluated and revealed high internal consistency, acceptable validity, and very good reliability. Fourth, objectively measured PA and other health-related outcomes were examined in female youth and young adults, 1-2 years after anterior cruciate ligament reconstruction (ACLR), as well as in age-and-sport-matched uninjured female controls. Participants with previous ACLR had less vigorous PA; increased knee pain and symptoms; reduced function in sports; lower quality of life; as well as poorer neuromuscular control than controls. Taken together, these studies highlight specific longer-term physical and psychological health-related outcomes that should be addressed in youth and young adults with previous knee injury. They support that these individuals deserve intervention beyond the traditional injury recovery period with the ultimate goal of preventing PTOA.
Children’s independent mobility (IM), their freedom to move about their neighbourhood without supervision by adults, has been in steady decline in recent decades. Previous research has linked perceptions of the environment with various measures of IM, but recently concerns have been raised regarding inconsistency in measuring IM. This study used various measures of IM and aimed to address how parental perceptions of the neighbourhood environment are associated with children’s territorial range – their actual spatial mobility – as well as how this relationship is mediated by IM parenting practices. Territorial range was derived from GPS, accelerometer, and activity diary data and IM parenting practices measured by license for independent mobility (LIM), roaming allowance, and parental boundaries. Path analysis was used to investigate the direct and indirect effects of these relationships. Some parental perceptions of the neighbourhood environment were significantly associated with IM parenting practices (LIM and roaming allowance). IM parenting practices were significantly associated with children’s territorial range. Direct effects of parental perceptions of the neighbourhood environment on children’s territorial range were variable, and only roaming allowance was found to mediate this relationship. Results indicate that IM parenting practices directly affect children’s territorial range to varying degrees. Parental perceptions of the neighbourhood environment have mixed effects on IM parenting practices and children’s territorial range. These findings suggest that future interventions to increase children’s IM should focus primarily on behavior change among parents since they are setting restrictions or allowances for children’s IM.
Unintentional injuries are the leading cause of death for Canadian children aged 1 to14 years and an important public health concern. Given that parental behaviour is a key determinant of these incidents, this study examines parents’ perception of injury risk and their decision to take preventive action after medically attended injuries (MAIs) to their children. The present study examined parents’ perceived risk of injury and their likelihood of engaging in safety behaviour, approximately the day of the injury, as well as one month, four months, and 12 months later. Longitudinal analysis with mixed models was performed to examine changes in parents’ judgments of injury risk and likelihood to search injury prevention information. A sample of 39 fathers and 132 mothers (total 171) were included in the study. Parents of children who had a history of MAIs before enrolling in the study reported a higher perceived risk of the same and of any injury. Further, the perceived risk of any injury for parents of children without a history of injuries decreased over time, indicating that the first MAI to a child has a transient effect on perception of injury. There was insufficient statistical power to examine if parents were more likely to engage in safety behaviour after their child sustained a MAI. Findings are discussed in light of previous research, and implications for prevention of injury recurrence are described.