Alcohol misuse and related harm costs money, drains resource and takes lives. Alcohol brief interventional advice forms an important method to moderate alcohol consumption at both individual and population level. Alcohol exerts a significant negative influence on the oral cavity and is implicated in the development of oro-mucosal and dental disease. Alcohol and tobacco smoking are recognised a key aetiological agents in the development of oral cancer which is the 14th most common cancer, accounting for approximately 2% of new cases, killing over 2300 people in the UK every year. A crucial weapon to tackle the disease is prevention through management of those modifiable lifestyle factors. The role of the general dental practitioner (GDP) in providing alcohol advice has received sparse attention, however evidence suggests that GDPs do not routinely engage in this activity. The aim of this research was to identify factors preventing or facilitating GDP engagement and develop strategies to support them to deliver alcohol advice. GDPs salient beliefs were applied, using behaviour change theories (the Theory of Planned Behaviour and Social Cognitive Theory), to formulate a theory based questionnaire. A postal survey (n=300, RR 60%) identified that few (17%) GDPs routinely provide advice to patients exposing potential for improvement. Subsequent exploratory multiple regression analysis identified 5 key items which might act as targets. The resultant five-item model accounted for 41% of the variance in intention [Adjusted R2 for this model is .41; F = 15.34 (.001)].A theoretically informed intervention was administered as a multi-centre, parallel group, three-arm randomized controlled pilot study. The aims were to test the feasibility and acceptability of implementing an alcohol advice intervention in dental primary care. The intervention was not entirely acceptable to patients or dentists. Qualitative analysis revealed factors (not limited) to remuneration, perceived relevance, confidence, embarrassment and fear of consequences mar progress. Modifications to study processes and methods would seem a sensible prior to further study.

Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.

The older adult population and the number of older adults who rely primarily on driving as their means of transportation in later life are increasing. Older adults experience changes due to aging and age-related diseases that may put them at increased risk of crashes and other unsafe driving behaviours. Considerable evidence has demonstrated that some older adults compensate for their declining abilities by voluntarily restricting their own driving to limit exposure to risky driving situations or by stopping driving altogether. Since mobility is critical for maintaining the independence and quality of life of the older adult, it is important to examine factors that influence driving behaviours of older adults and to promote their safe driving for as long as possible. It has been suggested that driving cessation might occur in discrete stages of driving restriction culminating in driving cessation. Yet, the application of TM to older driver behaviour has not been explored in detail. Thus, the purpose of this research was to explore older adults’ perceptions and experiences of the process of older driver behaviour change within the TM framework. Drivers and former drivers (both men and women) aged 71-94 years of age completed a health and demographic questionnaire and participated in either a digitally recorded semi-structured individual interview or a group discussion. Participants were asked a series of pre-determined questions and probes tailored for either current or former drivers to examine this process. The recordings were transcribed and reviewed for themes related to driving behaviour change. The participants exhibited a wide variety of perceptions and experiences related to the process of driving behaviour change in aging. Their driving behaviour in aging could be divided into 2 general classes: those who changed their driving with age and those who did not. The spectrum of experiences ranged from those who gradually imposed restrictions on their driving with age (“the gradual restrictors”) or made plans for stopping (“the preparers”) to those who always employed driving restrictions throughout their driving history (“the consistent”) or those who made no or only minor changes to their driving behaviour with age (“the non-changers”). Some preliminary support for TM within the driving context was found and recommendations for extensions to the TM model were suggested. Further exploration of driving behaviour change within the TM framework is warranted. The findings from this study may be appropriate for use in designing educational strategies and interventions aimed at helping older adults remain on the road safely longer or stop driving, if needed.

La présente thèse s’inscrit dans la problématique de la mise en acte de l’intention. Elle traite des variables influençant la résistance à l’usage du préservatif, en s’inspirant de la théorie du comportement planifié d’Ajzen (1991). Cette théorie postule qu’un comportement planifié est précédé d’une intention d’action et l’intention est le prédicteur décisif du comportement. Cependant, les résultats obtenus de l’enquête menée auprès des adolescents-élèves sexuellement actifs des classes terminales de la ville de Yaoundé (Cameroun) montrent que la relation intention-comportement n’est pas évidente. En effet, 38% des participants manifestant par ailleurs une bonne intention de porter le préservatif pour se protéger du VIH/Sida ont malheureusement eu des rapports sexuels non protégés (sans préservatif). L’analyse des résultats montre que cette asymétrie est due à l’influence exercée par des variables statistiquement inventoriées comme intermédiaires à l’intention d’agir et à l’action. C’est ainsi que la conclusion suivante a été retenue : il existe entre l’intention d’agir et l’action des variables qui conduisent à la réalisation d’un comportement « anti-intentionnel ». Autrement dit, l’intention perd parfois l’autonomie sur le comportement. / The present thesis facts within the problematic framework of putting into action an intention. It deals with variables influencing resistance in the use of preservatives with inspiration from the theory of planned behaviour by Ajzen (1991). This theory states that a planned behaviour is preceded by an intentional action and the intention is a decisive predictor of behaviour. However, the results obtained from fieldwork involving sexually active adolescents-students in the upper sixth form in the city of Yaounde (Cameroon) show that the relationship between intention and behaviour is not evident. In reality, 38% of participants manifesting a good intention of using preservatives (condoms) for protection against Hiv/Aids have unfortunately had improtected sexual intercourse (ie without preservatives). The analysis of results show that this asymetry is due to the influence exercised by the inventorised statistical variables as intermediaries in the intention to act and action. Thus the following conclusion is retained: there exists between the intention to act and action variables which lead to the realisation of a behaviour “anti-intentional”. Put in another sense, the intention loses sometimes its autonomy on the behaviour.

Most gamblers never experience addiction and the majority of those who do eventually recover. This thesis investigates how most maintain control over their gambling and how the majority of those who do experience gambling addiction regain control. Findings are based on 25 qualitative semi-structured interviews with participants who fit one of three ideal-type groups: (i) gamblers who have never experienced addiction; (ii) gamblers who have regained control after experience of gambling addiction; and (iii) gamblers experiencing addiction at time of interview. Participants were recruited who had never engaged in formal treatment because existing research suggests most who experience gambling addiction and/or recovery never to do so. This study is underpinned by a synthesis of Bourdieusian theory and Foucauldian-inspired governmentality literature which was used to guide the thesis and help explain gambling behaviour. Taking a Foucauldian genealogical approach, the dominant theory of addiction as a biomedical disorder is critiqued and revealed to be myth. Instead, (gambling) addiction is demonstrated to be a social construction which becomes embodied within individuals and thereby influences gambling behaviour. Consequentially, it is shown that research concerning substance use is applicable to the investigation of gambling behaviours. Given paucity of gambling research, substance-related literature is drawn upon throughout the thesis. Attention is given to research demonstrating regulation over drug use to be influenced by the social settings in which consumption takes place as well as the wider social and cultural milieus in which the lives of actors are embedded. Moreover, particular appreciation is given to literature indicating recovery from addiction to be supported by shifts in socio-cultural milieu. In contrast to most existing addictions/gambling research, the agential capacities of gamblers to shape their own behaviours, albeit in ways heavily constrained by context (or ‘structure’) are emphasised throughout the thesis. Data revealed various gambling-related strategies to help constrain gambling and minimise harm. These are examined and it is recommended that this knowledge could be used to aid development of more effective ‘harm-reduction’ style interventions and policies in ways which support less harmful patterns of gambling behaviour. However, although valuable, those with greater control tended to rely little on such strategies to manage their gambling. Instead, greater control over gambling and recovery from gambling addiction was found to have less to do with how participants gamble (e.g. whether or not they followed harm-reduction strategies) and far more to do with the wider, non-gambling-related, aspects of their lives and the nature of their subjectivities/dispositions. Principally influential were found to be the qualities of interviewees’ socio-cultural milieus. Alongside gambling, those with greater control tended to participate in non-gambling-related communities with attendant ways of thinking and cultural expectations (values/norms) that marginalise (heavier) gambling. Drawing on Bourdieusian and Foucauldian governmentality theory, it is argued that, because of their day-to-day participation in such communities/milieus, those with greater control embody mentalities and expectations which discourage riskier gambling behaviour. This, in turn, results in more ‘prudential’ subjectivities which discourage problematic gambling behaviour. Participants who had experienced recovery and many of those who had never experienced addiction revealed long-term reductions in gambling behaviour. Findings suggested these reductions (as well as recovery) to be supported by social and cultural processes, occurring over the life-course, which encourage increased participation in more ‘conventional’ life/milieus and thereby promote alterations in subjectivities in ways more conducive to control. A dual approach to discouraging problematic gambling behaviour is recommended. Although it is important to promote ‘safer’ ways of gambling (e.g. through promotion of harm-reduction style interventions and by designing gambling environments in ways to support greater constraint), it is also imperative to support the development of lives/milieus and subjectivities more conducive to control (e.g. participation in ‘conventional’ life and access to resources required to do so).

As waste is separated at the source, the success of the Swedish recycling system largely depends on an active participation of households. However, especially young people were found to not consistently follow their local recycling schemes. A recent and promising approach to tackle such suboptimal household recycling behaviour (HRB) is the use of persuasive technology. To understand and further its context-specific potential, this research aims to explore the key elements of persuasive technology which aspires to promote sustainable household recycling behaviour among adults in Sweden. The chosen methodology is research through design. Based on the results of a literature review and online survey among target users (N=50), a mobile phone application was designed in an iterative manner. Through these activities, the following key elements were established: (1) easy access to information about optimal household recycling behaviour, (2) employment of several motivational strategies, (3) recognition of differences between local recycling schemes, (4) regard of users as equals and (5) use of a readily accessible technology channel. The impact of these elements depends on the users’ ability to carry out the target behaviour and therefore on a well-functioning recycling system. The technological format of persuasive technology interventions was found to spark the target users’ curiosity. Using this as a ‘carrot’, a well-designed content is argued to encourage repeated use and a reflection process to help break unsustainable household recycling habits. / Eftersom avfall separeras vid dess källa, beror Sveriges återvinningssystems framgång i stor utsträckning på aktivt deltagande hushåll. Studier har visat att särskilt unga inte följer lokala återvinningsrutiner på ett konsekvent sätt. Ett nytt och lovande tillvägagångssätt för att hantera detta suboptimala hushållsåtervinningsbeteende (English: household recycling behaviour (HRB)) är användningen av övertygande teknik. Syftet med denna studie är att utforska de viktigaste delarna av övertygande teknik som strävar till att främja ett hållbart hushållsåtervinningsbeteende hos vuxna i Sverige. Den valda metodiken är forskningsdriven design. Baserat på resultat från en litteraturstudie samt en online enkätundersökning fokuserad på målgruppen unga (N=50), designades en mobilapplikation genom ett iterativt tillvägagångssätt. Studien identifierade följande nyckelelement för en övertygande design i domänen: (1) Lättillgänglig information angående optimalt hushållsåtervinningsbeteende, (2) Användning av flera motivationsstrategier, (3) Identifiering av skillnader mellan lokala återvinningsrutiner, (4) Betrakta användare som jämställda och (5) Användning av lättillgänglig teknikkanal. Effekterna av dessa element är beroende av att användarna även har möjlighet att utföra den önskade sopsorteringen, och därför på ett välfungerande återvinningssystem. Designlösningen att använda sig av övertygande teknik i form av en app visade sig väcka målanvändarnas nyfikenhet. Studien visar att en väldesignad app kan fungera som en 'morot' för att uppmuntra användning över en längre tid, och skapa en reflektionsprocess som kan bryta ohållbara återvinningsvanor.

O objetivo deste trabalho foi investigar barreiras, motivações e estratégias que apresentam potencial para promover a mobilidade sustentável de alunos de graduação, pós-graduação, servidores técnico- administrativos e servidores docentes no campus da Universidade de São Paulo em São Carlos. O método utilizado para atingir o objetivo foi dividido em três etapas: i. desenvolvimento de ferramenta para coleta de dados; ii. análise dos dados por meio do modelo transteórico de mudança comportamental; iii. análise de estratégias visando a mobilidade sustentável. O questionário on-line desenvolvido e aplicado para o estudo forneceu uma taxa de resposta robusta e bem distribuída dos principais usuários do campus (25,5% da população do campus total). Percentagens consideráveis de usuários em todos os grupos investigados manifestaram a intenção de mudar para outro modo de transporte. Entre aqueles que mudariam para modos de transporte sustentáveis, 27,1% mudariam para o modo a pé, enquanto que 46,2% mudariam para o modo bicicleta. No entanto, 13,6% dos entrevistados declararam que mudariam para o automóvel, o que representa uma demanda adicional de cerca de 300 lugares de estacionamento no campus. Em relação às barreiras para a adoção de modos de transporte sustentáveis, a posse de um veículo motorizado foi o principal obstáculo identificado (independentemente do modo a ser adotado como uma alternativa). Duas alternativas foram classificadas como as melhores estratégias para promoção da mobilidade sustentável no contexto estudado: a construção de ciclovias que ligam o campus com a rede viária urbana e estacionamento para bicicletas dentro do campus. Uma avaliação adicional da primeira alternativa demonstrou significativo potencial para servir a usuários de vários modos de transporte, com grande impacto positivo sobre o modo a pé. Outra estratégia também testada foi a abertura de novos pontos de acesso para pedestres no campus. Estimou-se que sua implantação resultaria em uma redução de 20% nas distâncias de viagem a pé dos alunos. / The objective of this study was to investigate barriers, motivators and strategies with potential to promote sustainable mobility for graduate and undergraduate students, staff and faculty at the campus of the University of São Paulo at São Carlos. The method used to reach the objective had three steps: i. development of a data collection tool; ii. analysis of the data with the transtheoretical model of behavior change; iii. analysis of strategies aiming at sustainable mobility. The online questionnaire developed and applied for the study provided a robust and well-distributed response rate of the main users (25.5% of the total campus population). Considerable percentages of users in all groups investigated have declared that would eventually change to another travel mode. Among those who would change to sustainable modes, 27.1% would change to the walking mode, whereas 46.2% would change to the cycling mode. However, 13.6% of the respondents declared they would change to the automobile, what represents an additional demand of approximately 300 parking spaces in the campus. Regarding the barriers to the adoption of sustainable modes, owning a motorized vehicle was identified as the main obstacle (regardless of the mode to be adopted as an alternative). Two alternatives have been rated as the best strategies for promoting sustainable mobility in the studied context: the construction of cycling paths connecting the campus with the urban street network and parking facilities for bicycles within the campus. An additional evaluation of the first alternative has shown a significant potential to serve users of several transport modes, with a large positive impact on pedestrians. Another strategy also tested was the opening of new access points to pedestrians in the campus. This strategy could reduce the total walking distance travelled by the students in 20%.

This research project is designed to enhance the planning process that can aid authorities moving towards sustainable and economically feasible local and regional mobility systems. The improvements that have been made to transit so far have not been successful in breaking the trend of increasing car traffic and decreasing transit trip making. This means that sustainable mobility is a complex system which also encompasses changing attitudes and behaviours, integrating spatial and energy planning into it, and looking upstream to affect the causes of the problem instead of downstream to just fix its consequences. Environmental impacts (noise, pollution, health problems), accidents and congestion are all by-products of transport activities – they are the so-called external costs – and must be made part of the equation. European guidelines were analysed, as well as the results of many of the European Union‘s mobility research programs. The core of the research analyses how to move Karlskrona municipality‘s mobility system towards its vision of success in the future through the Framework for Strategic Sustainable Development – Sustainable Mobility (FSSD-SM). Backcasting from a sustainable vision in the long-term future is central to this process. The Municipality of Karlskrona, in Sweden, is the case study. A sustainability analysis of Personal Rapid Transit (PRT) systems was undertaken to determine the feasability of integrating this modal system into the mobility solution for Karlskrona municipality.

The older adult population and the number of older adults who rely primarily on driving as their means of transportation in later life are increasing. Older adults experience changes due to aging and age-related diseases that may put them at increased risk of crashes and other unsafe driving behaviours. Considerable evidence has demonstrated that some older adults compensate for their declining abilities by voluntarily restricting their own driving to limit exposure to risky driving situations or by stopping driving altogether. Since mobility is critical for maintaining the independence and quality of life of the older adult, it is important to examine factors that influence driving behaviours of older adults and to promote their safe driving for as long as possible. It has been suggested that driving cessation might occur in discrete stages of driving restriction culminating in driving cessation. Yet, the application of TM to older driver behaviour has not been explored in detail. Thus, the purpose of this research was to explore older adults’ perceptions and experiences of the process of older driver behaviour change within the TM framework. Drivers and former drivers (both men and women) aged 71-94 years of age completed a health and demographic questionnaire and participated in either a digitally recorded semi-structured individual interview or a group discussion. Participants were asked a series of pre-determined questions and probes tailored for either current or former drivers to examine this process. The recordings were transcribed and reviewed for themes related to driving behaviour change. The participants exhibited a wide variety of perceptions and experiences related to the process of driving behaviour change in aging. Their driving behaviour in aging could be divided into 2 general classes: those who changed their driving with age and those who did not. The spectrum of experiences ranged from those who gradually imposed restrictions on their driving with age (“the gradual restrictors”) or made plans for stopping (“the preparers”) to those who always employed driving restrictions throughout their driving history (“the consistent”) or those who made no or only minor changes to their driving behaviour with age (“the non-changers”). Some preliminary support for TM within the driving context was found and recommendations for extensions to the TM model were suggested. Further exploration of driving behaviour change within the TM framework is warranted. The findings from this study may be appropriate for use in designing educational strategies and interventions aimed at helping older adults remain on the road safely longer or stop driving, if needed.

Magister Public Health - MPH / The aim of this study was to conduct an evaluation of the campaign implementation between 2009 and 2012, taking account of its implementation plan. This qualitative evaluation study employed a descriptive study design focusing on whether the programme components were being implemented as planned and whether any issues that have arisen, require attention. Key Informant Interviews were conducted with a purposive sample of 12 respondents drawn from the study population of people who were directly involved with the campaign, and a documents review was also conducted.