Thesis (MA)--University of Stellenbosch, 2000. / ENGLISH ABSTRACT: AIDS is a killer disease which is spreading like wildfire in all sectors of the population of Southern Africa, in spite of AIDS prevention programmes that are implemented in these communities. Why does this state of affairs exist? Conflicting views exist about the origin of AIDS and about the knowledge of different racial groups with regard to the disease. A number of researchers have argued that knowledge or information dissemination is not a necessary condition for behavioural change, as is evident from historical efforts to combat sexually transmitted disease. However, this thesis shows that knowledge is a variable or component that has frequently been used in almost all studies done on AIDS in Southern Africa. The present author thus searches for the rationale for the phenomenon that knowledge of AIDS does not necessarily result in preventative behavioural change. In this regard the importance of effective communication strategies and cognisance of the nature of target groups are highlighted, because negligence regarding these factors can serve as an impediment to behavioural change. The whole social fabric of the target community and basic individual needs are important elements that should also be major considerations before preventative programmes are implemented. / AFRIKAANSE OPSOMMING: VIGS is 'n dodelike siekte wat snel versprei in aile sektore van die bevolking van Suider- Afrika, ten spyte van VIGS-verkomingsprogramme wat in hierdie gemeenskappe qermplementeer word, Waarom gebeur dit? Botsende menings bestaan oor die oorsprong van VIGS en oor die kennis van die verkillende rassegroepe ten opsigte van die siekte. 'n Aantal navorsers is van mening dat kennis of informasieverspreiding nie 'n noodsaaklike vereiste is om gedrag te verander nie, soos blyk uit die geskiedenis van vorige pogings om seksueel oordraagbare siektes te beveg, In hierdie tesis word egter ge'illustreer dat kennis 'n veranderlike of komponent is wat dikwels gebruik is in byna aile vorige studies oor VIGS in Suider-Afrika. Die huidige skrywer ondersoek dus die rasionaal vir die verskynsel dat kennis van VIGS nie noodwendig tot voorkomende gedragsverandering lei nie. In hierdie verband word die belangrikheid van effektiewe kommunikasiestrategiee en kennis van die aard van die teikengroep beklemtoon, aangesien verwaarlosing van hierdie faktore as struikelblok in gedragsverandering kan dien Die totale sosiale struktuur van die teikengemeenskap en basiese individuele behoeftes is belangrike elemente wat ook in ag geneem moet word voordat voorkomingsprogramme ge'implemeteer word,

published_or_final_version / Anatomy / Doctoral / Doctor of Philosophy

The Purpose of this research was to describe relationships between Murdaugh and Verran's (1987) Preventive Behavior Model Concepts in military-affiliated individuals at risk for coronary artery disease. One hundred forty-three subjects were recruited by their primary care physician and were requested to voluntarily complete questionnaires measuring health beliefs, health locus of control, value orientations, and health care activities. Laboratory values and blood pressure were also evaluated. There were significant positive correlations between health beliefs, health locus of control, and value orientations. However, these PBM concepts explained only 13% of the variance in dietary habits, 9% of smoking behaviors, 16% of habitual physical activity, 4% of cholesterol levels, 2% of diastolic blood pressure, 7% of body mass index, and 21 percent of glucose levels. PBM concepts explained a relatively small amount of the variance in the dependent variables within this sample and the results were not clinically significant.

M.Cur

O controle da transmissão da doença de Chagas no Estado de São Paulo, delineado\" no presente estudo, foi equacionado e solucionado e não constitui, nos dias atuais, problema de saúde pública. O risco de ocorrência de casos agudos fica restrito a eventos isolados. Este quadro, portanto, autoriza otimismo, podendo-se supor que a atual incidência da doença no Estado seja próxima de zero e esperar que a incidência futura se mantenha nesse nível. Sob a ótica da transmissão vetorial, as ações de vigilância sobre as espécies peridomiciliares presentes atualmente no Estado têm respondido de maneira eficaz à possibilidade de infecção por Trypanosoma cruzi a partir do contato homem-vetor. A casa rural paulista não constitui hoje ecótopo adequado para a domiciliação de tais espécies de triatomíneos. O comportamento invasor, característico principalmente dos indivíduos adultos fêmeas, não tem passado despercebido à população que prontamente coleta e encaminha o inseto para análise utilizando-se, na maioria das vezes, do Centro de Saude local, numa integração da vigilância vetorial à rede de atenção à saude. O pronto atendimento a cada notificação serve de estímulo à participação. Em síntese, a vigilância vetorial está consolidada junto à comunidade e à rede de saúde local. A transmissão transfusional constitui fenômeno raro dadas as condições com que se pratica a hemoterapia no Estado de São Paulo. As ações de controle do sangue foram implementadas pela Secretaria de Saúde a partir de 1988, com índices de cobertura de seleção de doadores próximos de 100 por cento já em 1990. Mais recentemente, com a instalação da Hemo-rede estadual e a ampliação da cobertura dos Hemocentros incluindo os pequenos municípios, pode-se observar uma melhora da qualidade da hemoterapia. O descarte do candidato à doação quando procedente de área endêmica de doença de Chagas, tem contribuído para a obtenção de baixos percentuais de prevalência na triagem sorológica, situados próximos a 1 por cento . A transmissão congênita, entendida como mecanismo residual de perpetuação da infecção, ocorre em níveis discretos e pode ser perfeitamente controlada desde que se realizem provas sorológicas para doença de Chagas em gestantes com epidemiologia compatível e se pesquise a infecção na criança ao nascer e seguimento até os 6 meses. A persistência da positividade sorológica deve orientar para tratamento específico. Outros mecanismos de transmissão não apresentam qualquer importância no contexto da endemia. Resta ao sistema de saúde, portanto, olhar de frente os indivíduos infectados que merecerão atenção médica e previdenciária e cujo direito à saúde está garantido pela carta constitucional. / The present study about the contrai of Chagas\' disease transmission in the State of Sao Paulo has pointed out that nowadays the disease is no more a public health problem. The risk of occuring acute cases is restricted to isolate events. Therefore it is possible to suppose that the disease incidence is near to zero. Conceming to the vectorial transmission the surveillance of the peridomestic bugs did not detect actual Trypanosoma cruzi transmission. The rural houses nowadays do not offer conditions to triatomine bugs colonization. The presence of female adult insects indoors is noted by the population. They collect and send the bugs to the local Health Services. Each bug notification is promptly answered in order to induce local communities to participate effectively in the vector surveillance. This surveillance is now consolidated among the communities and the Local Health Services. Transfusional transmission constitutes, as far is known, a rare event because hemotheraphy in the State of Sao Paulo is sufficiently adequated. Blood control practices were improved by Govemment since 1988. Actually almost 100 per cent of blood donors are covered with serological tests. Recently a net of State Blood Services was installed witch improved the quality of hemotherapic practices. The donors coming from Chagas\' disease endemic areas are deleted. The serological prevalence is near by 1 per cent . Congenital transmission occurs in low leveis and can be controlled. Serological tests for Chagas\' disease in pregnants with compatible epidemiology and in new-bom followed up to 6 months of age children is recommended. Children with serological positivity must be treated. Other transmission routes have no importance in the disease context. So, the task of assuring medical health care to the infected people as law order is left for the health system.

O controle da transmissão da doença de Chagas no Estado de São Paulo, delineado\" no presente estudo, foi equacionado e solucionado e não constitui, nos dias atuais, problema de saúde pública. O risco de ocorrência de casos agudos fica restrito a eventos isolados. Este quadro, portanto, autoriza otimismo, podendo-se supor que a atual incidência da doença no Estado seja próxima de zero e esperar que a incidência futura se mantenha nesse nível. Sob a ótica da transmissão vetorial, as ações de vigilância sobre as espécies peridomiciliares presentes atualmente no Estado têm respondido de maneira eficaz à possibilidade de infecção por Trypanosoma cruzi a partir do contato homem-vetor. A casa rural paulista não constitui hoje ecótopo adequado para a domiciliação de tais espécies de triatomíneos. O comportamento invasor, característico principalmente dos indivíduos adultos fêmeas, não tem passado despercebido à população que prontamente coleta e encaminha o inseto para análise utilizando-se, na maioria das vezes, do Centro de Saude local, numa integração da vigilância vetorial à rede de atenção à saude. O pronto atendimento a cada notificação serve de estímulo à participação. Em síntese, a vigilância vetorial está consolidada junto à comunidade e à rede de saúde local. A transmissão transfusional constitui fenômeno raro dadas as condições com que se pratica a hemoterapia no Estado de São Paulo. As ações de controle do sangue foram implementadas pela Secretaria de Saúde a partir de 1988, com índices de cobertura de seleção de doadores próximos de 100 por cento já em 1990. Mais recentemente, com a instalação da Hemo-rede estadual e a ampliação da cobertura dos Hemocentros incluindo os pequenos municípios, pode-se observar uma melhora da qualidade da hemoterapia. O descarte do candidato à doação quando procedente de área endêmica de doença de Chagas, tem contribuído para a obtenção de baixos percentuais de prevalência na triagem sorológica, situados próximos a 1 por cento . A transmissão congênita, entendida como mecanismo residual de perpetuação da infecção, ocorre em níveis discretos e pode ser perfeitamente controlada desde que se realizem provas sorológicas para doença de Chagas em gestantes com epidemiologia compatível e se pesquise a infecção na criança ao nascer e seguimento até os 6 meses. A persistência da positividade sorológica deve orientar para tratamento específico. Outros mecanismos de transmissão não apresentam qualquer importância no contexto da endemia. Resta ao sistema de saúde, portanto, olhar de frente os indivíduos infectados que merecerão atenção médica e previdenciária e cujo direito à saúde está garantido pela carta constitucional. / The present study about the contrai of Chagas\' disease transmission in the State of Sao Paulo has pointed out that nowadays the disease is no more a public health problem. The risk of occuring acute cases is restricted to isolate events. Therefore it is possible to suppose that the disease incidence is near to zero. Conceming to the vectorial transmission the surveillance of the peridomestic bugs did not detect actual Trypanosoma cruzi transmission. The rural houses nowadays do not offer conditions to triatomine bugs colonization. The presence of female adult insects indoors is noted by the population. They collect and send the bugs to the local Health Services. Each bug notification is promptly answered in order to induce local communities to participate effectively in the vector surveillance. This surveillance is now consolidated among the communities and the Local Health Services. Transfusional transmission constitutes, as far is known, a rare event because hemotheraphy in the State of Sao Paulo is sufficiently adequated. Blood control practices were improved by Govemment since 1988. Actually almost 100 per cent of blood donors are covered with serological tests. Recently a net of State Blood Services was installed witch improved the quality of hemotherapic practices. The donors coming from Chagas\' disease endemic areas are deleted. The serological prevalence is near by 1 per cent . Congenital transmission occurs in low leveis and can be controlled. Serological tests for Chagas\' disease in pregnants with compatible epidemiology and in new-bom followed up to 6 months of age children is recommended. Children with serological positivity must be treated. Other transmission routes have no importance in the disease context. So, the task of assuring medical health care to the infected people as law order is left for the health system.

1,708 members of the Australian Infection Control Association were surveyed to describe the practices of Australian infection control practitioners. The study details the methods infection control practitioners use to co-ordinate and measure nosocomial infections as clinical outcomes of Australian infection surveillance and control programs. Administrators' and clinicians' perceptions of the elements and infrastructure of infection surveillance and control programs and the role of the infection control were measured in 316 hospitals in New South Wales, Australia. A literature review found that the development of Australian infection surveillance and control programs is behind that of U.S.A and the United Kingdom. The survey of the infection control practitioners identified that their role and duties varied between facilities as did the time allocated to infection control tasks. The survey of infection control practitioners demonstrated variation in their levels of skill, education and experience. Infection control practitioners' use and application of evidence and associated skills was examined and found to be limited in relation to clinical decision making and policy development. The survey also examined the methods infection control practitioners use to undertake surveillance of nosocomial infections. The methods reported indicated non-standard approaches to surveillance activity. A survey of administrators and clinicians in NSW hospitals was undertaken to identify variation in administrator and clinician perceptions and to describe their level of support for recommended essential infrastructure and criteria for infection surveillance and control programs and the role of the infection control practitioner in accordance with Scheckler's model. The survey indicated divergent views regarding the role of the infection control practitioner and the essential elements of infection surveillance and control programs. The study identified that education of infection control practitioners is necessary to facilitate standard approaches to co-ordinating infection surveillance and control activity. The development of Australian infection surveillance and control programs require a strategic alliance between stakeholders. to define essential elements of infection surveillance and control programs. In addition, the role of the infection control practitioner must be defined before key stakeholders can agree on the minimum skills, qualifications and experience required by an infection control practitioner.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Consumer behavior has long suggested the importance of prior knowledge in understanding behavior. In spite of the vast amount of research in this area, there is a vacuum regarding to what extent an individual applies his/her knowledge in decision-making situations (a concept from economic psychology). An individual may have the knowledge but might not use it or apply it when making decisions. This is of great importance, especially within a health context where decisions may result in life or death situations. In addition, operationalizations of dimensions of prior knowledge within the consumer behavior field have been inconsistent. To eliminate these gaps in prior research and extend the consumer behavior literature this dissertation draws upon the consumer behavior and economic-psychology literatures to investigate the impact of six dimensions of prior knowledge on health information-seeking and disease prevention behaviors. The case of HPV is used here to examine the theoretical relationships. This dissertation is also of particular interest to better understanding direct-to-consumer (DTC) advertising. DTC advertising usually provides information to consumers through the listing of sources consumers can go to, other than providing disease prevention information within the message itself. Hence, examining how prior knowledge impacts information-seeking and prevention behaviors can help guide the development of more effective DTC messages. Results show that information-seeking intentions are predicted by how much consumers think they know and how much of their knowledge they apply in decision-making situations. Also, consumers who have high confidence in using their knowledge are more likely to use external (as opposed to internal) sources of information. In addition, prevention behaviors are predicted by how much consumers know about the disease, how much they think they know and their experience with the disease. This investigation helps guide the development of future DTC campaigns, in terms of motivating consumers to seek additional information, and take the recommended preventative actions; based on consumers’ prior knowledge set. In conclusion, this dissertation extends the literature on the role of prior knowledge in consumer decision-making on multiple levels and provides interesting findings for future research. / text

This thesis reports on a formative evaluation study conducted, firstly, to inform an adaptation of the Collaborative HIV Prevention and Adolescent Mental Health Program (CHAMP) so as to strengthen the adult protective shield in order to prevent high risk behaviour and HIV among children in the targeted community in Embo, Kwadedangendlale, KwaZulu-Natal (Study 1); and secondly, after a pilot intervention, to evaluate the adapted programme in order to understand the processes involved in strengthening the adult protective shield (Study 2). The research design for both Study 1 and Study 2 was qualitative in nature. More specifically, the two studies used a focused ethnographic case study approach. Thematic content analysis was used to analyse the data from both studies and three theoretical approaches facilitated the understanding of the data: Joffe’s psychoanalytic extension of social representation theory, Carpiano’s integrative theory of social capital, and Campbell and Murray’s critical approach to community health psychology. The participants in the first study were a volunteer convenience sample of parents of children aged 9-12 years from a school in the targeted community. Focus groups and in depth follow up interviews were conducted with the parents. Interviews were also conducted with key members of the community. At the community level, lack of containment emerged as an overarching theme, with splitting and lack of trust as subthemes interpreted as emerging to deal with anxiety. Anxiety was also linked to stigmatization of people suspected of being HIV positive or having AIDS. Coping mechanisms used to deal with stigmatization were silence and denial. Linked to the issue of stigmatization was that of death and bereavement. At the family level, disempowerment of caregivers emerged as an overarching theme creating anxiety for parents, one of the sources of which was the generational knowledge gap, with parents being generally less educated than their children. This was linked to two issues: that of children’s rights; and parents’ attempts to resort to severe forms of authoritarian parenting. In the second study, in-depth semi-structured interviews, based on the themes that had emerged from the pre-intervention focused ethnographic study, were conducted with a volunteer convenience sample of nine mothers who had been part of the CHAMPSA intervention. Two broad themes emerged: Individual empowerment, including the subthemes parental empowerment, women empowerment, and social support and social leverage; and collective empowerment, including the subthemes informal social control and community organisation, and HIV/AIDS stigma. The findings of the second study contributed to the development of a model showing how improved parent child communication and parental HIV knowledge at the individual level as well as renegotiated, empowered parental identities facilitated through the group process restored parental authority at the individual level as well as collectively, strengthening social capital and restoring the adult and community protective shields. / Theses (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.