Background: Myocardial infarction is one of the biggest health issues in Sweden. Over 25000 swedes get affected every year. There is strong evidence to show physical exercise can reduce heart related diseases and death. Only about 50 % of the patients participate in physical exercise after myocardial infarction. More knowledge about which biopsychosocial barriers and facilitators that can influence initiation to physical exercise in myocardial patients is therefore demanded. Purpose: The aim of this study was to investigate experienced barriers and facilitators to initiate physical exercise after a myocardial infarction. Method: A qualitative design with semi-structured interviews was used in this study. Five informants which experienced a myocardial infarction in the last 24 months. For the process and analysis of data a qualitative content analysis was used. Results: Other priorities, fatigue, fears and lack of self awareness to exercise activity-level was found as barriers for initiating physical exercise after myocardial infarction.Social support, importance of exercise, goals and individualised activity was found to be facilitators for initiating physical exercise after myocardial infarction. Conclusion: A good relationship, trust and information about the effects of physical exercise together with individualised exercise recommendations is important for facilitating initiationof physical exercise in myocardial patients.

Boas estratégias não garantem o sucesso do negócio, a menos que sejam implementadas com sucesso (Ho et al., 2014). Entretanto, a literatura contemporânea de administração sugere que há uma lacuna entre a formulação e a execução das estratégias. Após dedicarem-se ao planejamento da estratégia, os executivos mantêm apenas razoável compreensão das ações necessárias para alcançá-la (Leonardi, 2015; Mintzberg, 1994), os fatores influentes mais relevantes, bem como os principais entraves encontrados pelas empresas e como superá-los (Li et al., 2008), resultando numa taxa de 50-90% de planos implementados de forma ineficiente (Cândido & Santos, 2015). A partir de um referencial teórico composto por questões referentes ao planejamento estratégico, à administração estratégica, à implementação estratégica, bem como relativas aos fatores influentes, entraves e facilitadores encontrados na fase de execução das estratégias planejadas, o objetivo principal dessa pesquisa é, então, mapear e identificar os principais entraves e facilitadores encontrados pelos administradores em cada fator influente na fase de implementação das estratégias de negócios planejadas, em empresas brasileiras. Para alcançar o objetivo proposto, delineou-se uma pesquisa quantitativa e descritiva (Cervo et al., 2007), junto a gestores de diversos níveis hierárquicos em grandes empresas privadas, sediadas na Brasil. Propõe-se para tanto, a utilização do método survey, através da aplicação de um questionário online. A análise de dados prevê a utilização de estatísticas descritivas e testes de hipótese. Os resultados apontam que os principais entraves relacionam-se à comunicação, à formulação e ao relacionamento entre unidades de negócios, sendo que as dificuldades referentes a sistemas administrativos parecem superadas. Constatou-se ainda facilitadores com baixa penetração nas empresas, como a existência de um sistema de alertas antecipados sobre mudanças no ambiente competitivo e um clima aberto e encorajador para a comunicação multidirecional, indicando uma via para desenvolvimento e melhoria do processo de implementação estratégica das organizações brasileiras / Good strategies do not guarantee business success, unless they are successfully implemented (Ho et al., 2014). However, contemporary administration literature suggests that there is a gap between the formulation and implementation of strategies. After devoting themselves to the planning part of strategy, executives maintain only reasonable understanding of the actions necessary to achieve it (Leonardi, 2015; Mintzberg, 1994), the most relevant influential factors, as well as the main obstacles encountered by companies and how to overcome them (Li et al., 2008), resulting in a 50-90% rate of plans implemented inefficiently (Cândido & Santos, 2015). From a theoretical framework consisting of matters relating to strategic planning, strategic management, the strategic implementation as well as on the influential factors, barriers and facilitators encountered in the implementation phase of the planned strategies, the main objective of this research is to map and identify key barriers and facilitators encountered by administrators at each influential factor in the implementation phase of planned business strategies in brazilian companies. To achieve the proposed goal, a quantitative and descriptive research (Cervo et al., 2007) was designed, with managers of different hierarchical levels in large private companies headquartered in Brazil. To collect the data, it is proposed the use of a survey, through the application of an online questionnaire. Data analysis includes the use of descriptive statistics and hypothesis testing. The results show that the main obstacles are related to communication, strategy formulation and the relationship between business units, and that the difficulties related to administrative systems seem to be overcome. It was found facilitators with low penetration in companies still, such as the existence of an early warning system for changes in the competitive environment and an open and supportive climate for multidirectional communication, indicating a path to development and improvement of the strategic implementation process in brazilian organizations

Context. Decision-making is a significant step in development process of software engineering. Evidence-based Software Engineering has been one of the strategies attempting to facilitate decision-making process. It follows process of gathering suitable evidence in the aim of making a viable use the evidence. Objectives. In this study, evidence use in practice was mainly focused as a part of which barriers and facilitators concerning it were aspired to be obtained from the practitioners. Concerning existing evidence, it was also aimed in finding out and gathering the existing evidence in software engineering, as a contribution to the evidence use in practice. Methods. To obtain the outcomes for the specified objectives, an extensive tertiary study and 18 interviews were conducted. The tertiary study was replication of study by Kitchenham et al. [1]. It was also an updated version for the years of 2010 to 2016. The interviews were conducted among the software practitioners from several types of industries and regions. Results. 67 SLRs were analysed and extracted to gather and obtain existing evidence. 18 interviews were conducted among software practitioners to assess barriers and facilitators to evidence use in making decisions. Conclusions. We conclude from results of tertiary study that the research studies in every sub-domain are available under software engineering and are even increasing year by year. From the analysed results of the semi-structured interviews, it was clear that the implementation of research results in practice is inter-dependant on many major as well as trivial factors concerning the practitioners. Reference [1] B. Kitchenham et al., “Systematic literature reviews in software engineering – A tertiary study,” Inf. Softw. Technol., vol. 52, no. 8, pp. 792–805, Aug. 2010.

Syfte: Att undersöka vilka faktorer personer med cervikal dystoni (CD) anser underlättar respektive hindrar deras möjlighet till fysisk aktivitet.  Design och metod: Explorativ och deskriptiv design. Kvalitativ innehållsanalys och kvantitativ frekvensberäkning av svar på två öppna frågor i en enkät (n=144). Utifrån graden av upplevt aktivitetshinder på grund av CD gjordes även uppdelning i subgrupper. Resultat: Sju kategorier (och 28 subkategorier) underlättande faktorer framkom.  De tre största var ”Rörlig i vardagen”, ”Psykiska faktorer” och ”Nytta av hjälpmedel”. Vid större grad av aktivitetshinder angavs ”Nytta av hjälpmedel” oftare än ”Psykiska faktorer”. Vid mindre grad av aktivitetshinder utgjorde istället ”Psykiska faktorer” största kategorin följt av ”Rörlig i vardagen” och ”Träningsrelaterade faktorer”. Åtta kategorier (och 24 subkategorier) hindrande faktorer framkom. De tre största var ”Nackrelaterade besvär”, ”Psykiska begränsningar” och ”Andra fysiska besvär”. Vid större grad av aktivitetshinder angavs ”Nackrelaterade besvär” mest frekvent, följt av ”Andra fysiska besvär” och ”Begränsningar i vardaglig fysisk aktivitet”. Vid mindre grad av aktivitetshinder angavs istället oftast ”Psykiska begränsningar” följt av ”Nackrelaterade besvär” och ”Andra fysiska besvär”. Konklusion: För att optimera möjligheten till fysisk aktivitet hos personer med CD bör fysioterapiinsatser förutom fokus på reducering av sjukdomsrelaterade besvär även inkludera ett evidensbaserat beteendemedicinskt förhållningssätt. Insatserna bör påbörjas i ett tidigt skede av sjukdomen. / Purpose: To investigate the self-perceived facilitators and barriers to physical activity among people with cervical dystonia (CD). Design and method: Explorative and descriptive design. Qualitative content analysis and quantitative frequency analysis of two open-ended questions in a survey (n= 144). Subgroups based on self-perceived CD-related limitations in activity were also formed. Result: Seven categories (and 28 subcategories) facilitators emerged. The three most commonly reported were “Motion in everyday life”, “Psychological factors” and “Supportive aid”. Patients with major activity limitation mentioned more frequent “Supportive aid” than” Psychological factors”. Among patients with minor activity limitation “Psychological factors” was the largest category followed by “Motion in everyday live” and “Exercise-related factors”. Eight categories (and 24 subcategories) barriers emerged. The three most commonly reported were “Neck-related problems”, “Psychological limitations” and “Other physical disabilities”. People with major activity limitation most frequent experienced “Neck-related problems” followed by “Other physical disabilities” and “Limitations in everyday physical activities”, while “Psychological limitations” was most frequent mentioned by patients with minor activity limitation, followed by “Neck-related problems” and “Other physical disabilities”. Conclusion: To optimize the possibility for people with CD to be physical active, physical therapy interventions should not only focus on reducing disease-related complications but also incorporate an evidence-based behavioral medicine approach. Interventions should begin at an early stage of the disease.

Magister Public Health - MPH / Background Nigeria accounted for 2.95 million of the 22 million people globally living with HIV in 2008. In 2010, the HIV prevalence increased to 3.1 million, with 1.5 million people requiring anti-retroviral treatment (ART). ART is effective if patients adhere to treatment (taking 95% or more of drugs as prescribed) over a sustained period. Taking less than 95% of the medication can lead to drug resistance and treatment failure, which have dire individual and public health consequences. This study described adherence to ART and the factors that constrain and motivate adherence among patients on ART at the University of Abuja Teaching Hospital in the Federal Capital Territory (FCT), Nigeria. Methodology An observational, descriptive and analytical, cross-sectional survey of adherence among 502 adult ART patients (254 women and 248 men) from the University of Abuja Teaching Hospital was conducted. I collected sociodemographic and clinical characteristics of participants, and barriers and facilitators to adherence. For the prescription refill data, I utilized the updated pharmacy refill records from the ART dispensary. Bivariate and multivariate analysis was performed to analyse the factors that influence adherence to ART. Results Participants in this study had been on therapy for a mean of 43±27 months. Total optimal self-reported adherence over the previous three days (not missing a dose, taking correct doses in the correct frequency and correct schedule) was 53.6%, compared with 62.5% adherence calculated by prescription refill. However, most (80.3%) participants achieved virologic suppression at a level of <400 copies/μl3. Reported barriers to adherence were: forgot (43%); travelled away from home (21%); ran out of medication (16%); busy at work (13%); lack of food (5%) and medication snatched by armed robbers (2%). Self-reported adherence over the previous three days was positively associated with age and viral load. Younger respondents (under 30 years) were 3 times more likely to adhere to their regimen compared with those older than 30 years (OR = 2.5; 95% CI = 1.26-4.61; p =

Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is the third leading cause of death and disability worldwide. The Uitenhage Provincial Hospital admits many stroke patients. To date, no in-depth study has been conducted on stroke patients admitted to the Hospital. This study identified the profile of stroke patients admitted to the Uitenhage Provincial Hospital and explored the challenges that these patients experienced post stroke. A concurrent mixed model design was used to collect the data. Firstly retrospective data was obtained by means of a quantitative data gathering instrument designed by the researcher. The information obtained, included data relating to demographic characteristics, reported risk factors relating to stroke, stroke onset-admission interval and length of hospital stay, as well as information relating to the process of physiotherapy. Secondly quantitative prospective information was collected by means of the Barthel Index, the Modified Rankin Scale and the Facilitators And Barriers Survey. The sample for the quantitative phase was drawn from medical records of 168 stroke patients admitted to the Uitenhage Provincial Hospital from the 1 of January 2008 up to and including the 31 of December 2009. For the second prospective quantitative part of the study, participants were selected conveniently from the admitted patients. In the qualitative phase, nine participants taken of the sampled participants were selected. The Microsoft Excel 2007 Package and the SPSS 18 for social sciences were used to analyse the quantitative data. Means, standard deviations, frequencies and percentages were calculated for descriptive purposes and the Chi-square test was used to test for associations between variables. Qualitative analysis began with the transcription of voice recordings and the translation of relevant Afrikaans transcription into English. Emerging categories were identified within the pre-determined themes. Permission and ethical clearance was obtained from the Higher Degrees Committee and the Senate Research and Grants and Study Leave Committee of the University of the Western Cape and permission to conduct this study was also obtained from the Medical Superintendent of the Uitenhage Provincial Hospital. Altogether 461 patients had been admitted with stroke during the relevant period, but only 168 could be included in the retrospective quantitative study. The mean age of the participants was 61,54 years; 59% were females and 41% males. The majority of the participants (86,9%) were admitted on the same day of stroke onset, and the mean length of hospital stay was 7,38 days. Hypertension was the most common reported risk factor, at 79%. Only 165 of the participants received physiotherapy while hospitalised, with the mean total physiotherapy sessions being 2,56 sessions. In 90% of the cases, physiotherapy sessions were discontinued due to the patient being discharged from the Hospital. The mean Barthel Index score was 81,46 and the family care domain of the Modified Rankin Scale was the most affected. Participants experienced participation restrictions and activity limitations due to stairs, gravel surfaces and kerb cuts. During the qualitative interviews participants reported activity limitations related to walking and activities of daily living. The participants also experienced participation restrictions, which included dependency on others, decreased social support and an array of emotions experienced post stroke. The current study’s findings suggest that the discharge of patients from the hospital post stroke should follow a mulitidisciplinary approach. Rehabilitation professionals should play an active role in the discharge process in providing patient and caregiver education.

Children with disabilities need physical activity in order to correctly develop, however, finding an adequate type of physical activity for children with disabilities can be a very complicated issue. Furthermore, trying to include them in an ordinary physical education class is even more difficult. We come across several barriers that impede their proper inclusion in physical activity. In order to enhance children with disabilities´ participation, it is important to know the barriers and facilitators that exist and take them into account. Therefore, the aim of the study is to explore what facilitators and barriers children with all kinds of disabilities can come across in order to get involved in physical activity. By doing a systematic review of articles that explain perceived barriers and facilitators, this paper is addressed to find out the barriers and facilitators children with all kind of disabilities can have. The results show that each kind of disability has different barriers and facilitators. While some disabilities focus more on physical facilitators and barriers, others find more important the logistical ones or the psychological aspects. Answers given from professionals, children and parents are very different and therefore shows a lack of communication between them as well as a need for cooperation and working.

Background: Children and adolescents with Cerebral Palsy [CP] are not as physically active as their typically developing peers, which contributes to reduced physical fitness. Previous studies about participating in physical activity [PA] and disability in general have identified barriers and facilitators. However, less research has been performed targeting persons with CP, the most common physical disability in childhood. Previous studies mainly focused on the parental perspectives of their child with CP. Aim: This systematic review aimed to identify and critically review the existing literature on barriers to and facilitators for children and adolescents with CP to participate in PA. Method: A literature search was carried out in four online databases for social and health sciences to select peer-reviewed qualitative articles, identifying barriers to and facilitators for children and adolescents with CP to participate in PA. Studies were identified following the pre-established selection criteria, resulting in eight qualitative studies.  Results: Various personal and environmental factors were identified working as either barriers or facilitators, and yielded into two sub-categories and codes for personal and environmental factors. Sub-categories of identified barriers and facilitators within personal factors were physical abilities to participate in physical activity and psychological factors, and acceptance and relationships and possibilities to participate in PA within environmental factors. Conclusion: Children and adolescents with CP are facing many personal and environmental barriers and facilitators to participate in PA. Further research is needed to develop an awareness program about CP to work with them, and to investigate the number of individuals required in a team to give this group the time and attention they need to master their skills. / Achtergrond: Kinderen en adolescenten met Cerebrale Parese [CP] zijn niet zo fysiek actief als hun typisch ontwikkelde leeftijdsgenoten, wat bijdraagt aan een verminderde fysieke conditie. Eerdere studies over deelname aan fysieke activiteiten [PA] en beperkingen hebben belemmeringen en mogelijkheden in kaart gebracht. Er is echter minder onderzoek gedaan naar CP, terwijl dit de meest voorkomende fysieke beperking in de kindertijd is. Eerdere studies richtten zich vooral op de ouderperspectieven van hun kind met CP. Doel: Het in kaart brengen en kritisch beschouwen van bestaande literatuur over belemmeringen en mogelijkheden om deel te nemen in PA voor kinderen met CP. Methode: Een literatuuronderzoek is uitgevoerd in vier online databases voor sociale en gezondheidswetenschappen om peer-reviewed kwalitatieve artikelen te selecteren die belemmeringen en mogelijkheden identificeren voor kinderen en adolescenten met CP om deel te nemen in een fysieke activiteit. Studies werden geïdentificeerd volgens de vooraf vastgestelde selectiecriteria, wat resulteerde in acht kwalitatieve studies.  Resultaten: Verschillende persoonlijke en omgevingsfactoren werden geïdentificeerd, werkend als belemmering of mogelijkheid, en resulteerden in twee subcategorieën en codes voor beide factoren. Belemmeringen en mogelijkheden binnen de persoonlijke factoren resulteerden in de subcategorieën fysieke capaciteiten om deel te nemen aan fysieke activiteiten psychologische factoren, en binnen de omgevingsfactoren in acceptatie en relaties en mogelijkheden om deel te nemen aan een fysieke activiteit. Conclusie: Kinderen en jongeren met CP worden geconfronteerd met vele persoonlijke en omgevingsbelemmeringen en mogelijkheden om deel te nemen aan PA. Er is verder onderzoek nodig om een bewustwordingsprogramma over CP te ontwikkelen om met deze doelgroep te werken en om te onderzoeken hoeveel individuen er nodig zijn om deze groep de tijd en aandacht te geven die nodig is om hun vaardigheden onder de knie te krijgen.

Positiva hälsoeffekter kopplade till kultur har lett till allt fler initiativ på temat kultur och hälsa inom inte minst vård- och omsorgssektorn. Syftet med föreliggande kvalitativa studie har varit att rikta fokus mot själva arbetet i sig med att implementera kulturaktiviteter inom en vård- och omsorgsverksamhet. Elva medarbetare med varierande roller inom en kommunal äldrevårdsorganisation har intervjuats kring sina upplevelser och erfarenheter av ett internt förändringsprojekt med målet att introducera vardagsnära och individanpassade kulturaktiviteter riktade mot de boende. Resultatet har analyserats med hjälp av tematisk analys. Studiens resultat identifierar både ett genuint engagemang men också tydliga hinder och utmaningar i projektet, både på individ- och organisationsnivå. Individens roll framstår som central i relation till en realisering av projektmålet. Både utifrån driv och motivation grundat i den egna övertygelsen kring projektets visioner och mål. Men också i relation till bristande engagemang och motstånd kopplat till bland annat osäkerhet kring projektets aktiviteter och rollkonflikter. Resultatet pekar också på en bristande samsyn kring formulerade målsättningar och realistiska förutsättningar att förverkliga projektresultatet ute i verksamheten, där tid- och resursbrist samt bristande struktur och uppföljning pekas ut som hindrande faktorer. En slutsats blir att organisationen har allt att vinna på att åstadkomma trygga team och en stödjande kontext som stöttar medarbetarna att agera självständigt och uppmuntrar till att våga utmana och ta risker i arbetet med kultur. Liksom att etablera tydliga strukturer för uppföljning och återkoppling kring genomförda insatser på alla nivåer för att skapa varaktigt lärande och engagemang. / Positive health effects linked to culture have led to more and more initiatives around culture and health not least in the health care sector. The purpose of the present qualitative study is to focus on the actual work itself of implementing cultural activities within a health care setting. Eleven employees with different roles within a municipal elderly care organization have been interviewed about their experiences from an internal change project with the goal of introducing individualized cultural activities for the residents on an everyday basis. The results have been analyzed using thematic analysis. The results of the study identify both a genuine engagement and clear obstacles and challenges in relation to the project, both at the individual and organizational level. The role of the individual appears central in relation to a realization of the project goal. Both from drive and motivation based on one's own convictions about visions and goals surrounding the project. But also, in relation to lack of commitment, and resistance linked to for example perceived uncertainty in relation to specific project activities and role conflicts. The result also points to a lack of consensus on formulated objectives and realistic conditions for realizing the project result in the actual setting, where lack of time and resources as well as lack of structure and follow-up are pointed out as hindering factors. One conclusion is that the organization has everything to gain from creating safe teams and a supportive context that supports autonomy and self-regulation in order to encourage challenge and risk taking in working with culture. And also establishing clear structures for follow-up and feedback around performed initiatives at all levels to create learning and commitment.

Bakgrund: Hemodialysbehandling innebär omfattande påverkan på det dagliga livet och kräver delaktighet i egenvård för att optimera måendet. Följsamhet till egenvårdsråd är en viktig faktor för att uppnå goda behandlingsresultat då det minskar sjukligheten och risken för död. Vilja att sköta dialysbehandlingen helt eller delvis samt följsamhet till egenvårdsråd varierar stort.  Syfte: Syftet med studien var att belysa möjligheter och hinder för egenvård vid hemodialys ur patientens perspektiv. Metod: Sökning i databasen Pub Med genomfördes för att finna artiklar passande till studiens syfte. Tio kvalitativa artiklar valdes ut och lästes flera gånger. Resultaten analyserades och sammanställdes. Resultat: Egenvården påverkas både av inre och yttre omständigheter. De inre omständigheterna var: Kunskap, upplevelse av kontroll och känsla och mående. De yttre omständigheterna var: Information och kommunikation, stöd och relation, och socialt och kulturellt.  Konklusion: Att belysa hemodialyspatienternas upplevelse av möjligheter och hinder i egenvården kan öka medvetenheten hos sjuksköterskan på vilket sätt egenvård kan främjas. Genom att stötta patienterna och deras anhöriga, bygga goda relationer och informera och kommunicera i vårdrelationen kan effekter ges på vilken kunskap patienten tillägnar sig, upplevelse av kontroll och hur patienten mår och känner.