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Background: Autism and other neurodevelopmental disorders (NDD) are common in low- and middle-income countries (LMIC). However, services to address the needs of this group in LMIC are almost non-existent. The World Health Organization (WHO) developed the Caregiver Skills Training (CST) programme to be suitable for delivery in diverse global contexts. Ethiopia, the country of focus in this study, has a largely rural population and a lack of specialist service providers. Additional contextual challenges, including poverty, low literacy, limited access to healthcare and a lack of specialist child mental health services, may undermine the delivery of CST in this setting. This thesis, therefore, seeks to explore the acceptability and feasibility of non-specialist delivery of the WHO-CST from the perspective of providers and caregivers in rural Ethiopia. Methods: In Chapter one, a general literature review of neurodevelopmental disability and caregiver skills training is presented, with a focus on sub-Saharan Africa, to help contextualise the main qualitative study, outlined in chapter two. In-depth interviews were conducted with caregivers (n=19) who were all participants in two rural pilot studies of the WHO-CST programme. In addition, three focus group interviews were conducted with non-specialist facilitators (n=8), who facilitated the CST programme in two rural pilot tests. Data were analysed using the framework approach. Results: Findings were mapped onto the three framework themes created for this analysis: 1) Programme content: caregivers and facilitators uniformly indicated that the adapted programme addressed a need and was relevant for their context; caregivers emphasised how the programme helped them understand their child's problems and improve their skills to support their children; facilitators highlighted having acquired new knowledge and skills relating to NDD; 2) Programme facilitation: caregiver responses suggested that programme facilitation by non-specialists was acceptable; non-specialist facilitators emphasised the importance of support and supervision for the facilitators and simplification and modification of some concepts, such as the concept of play, and 3) CST training approach and delivery: participants indicated that the training modalities, including home visits and group training, were acceptable and feasible in the local context. Conclusions: This study suggested that, with some contextually appropriate modifications of programme content and delivery and continuing supervision of facilitators, the WHO-CST programme facilitated by non-specialists would be acceptable and feasible in rural Ethiopia. Results from this study may be useful to fine-tune the implementation of non-specialist delivery of the CST programme in Ethiopia, as well as other LMIC.

Homelessness in the youth population is associated with elevated rates of mental illness, substance abuse, and suicidality compared to the housed population in the United States (Berdahl, Hoyt, and Whitbeck, 2005; Hodgson, Shelton, Van den Bree, 2014; Hughes et al., 2010). With a survival-focused perspective, exacerbating issues, stigmatization, and transience housing; homeless youth require special consideration to meet their diverse health needs. When barriers impede homeless youth's access to necessary health resources, their health concerns are left untreated and impound until emergency services are required. This review of literature is focused on identifying and synthesizing barriers and facilitators for homeless youth to access and utilize mental health care services. When untreated mental illness reaches a crisis point, it becomes more expensive to treat (Taylor, Stuttaford, and Vostanis, 2006). For youth experiencing homelessness, various factors influence their decisions to wait until a crisis to reach out to emergency services. Within the literature, barriers and facilitators were bracketed into personal, social, and structural factors. These factors ranged from financial concerns, communication with health care providers and between health care service locations, stigmatization, lack of awareness, and administrative requirements. While further research is required, evidence from the literature shows promise in developing and altering interventions and communication to meet homeless youth's mental health and substance abuse needs.

Bakgrund: Prediabetes är en fas före typ-2 diabetes associerad med en avvikande glukoshomeostas. Livsstilsförändringar som viktminskning, kostförändring och regelbunden fysisk aktivitet minskar den relativa risken att utveckla typ-2 diabetes. Att förstå barriärer och facilitatorer för fysisk aktivitet underlättar ett salutogent förhållningssätt till en persons livsstil, psykiska välmående samt fysiska hälsa. Syfte: Syftet var att förstå och identifiera barriärer och facilitatorer för fysisk aktivitet bland personer med prediabetes och se vilka interventioner som studerats. Metod: Litteraturöversikt baserad på Polit och Beck’s modell (2021) med 15st vetenskapliga artiklar av kvantitativ, kvalitativ och blandad design som inkluderades efter sökning i databaserna PubMed och Cinahl. Resultat: Facilitatorer för ökad fysisk aktivitet finns hos de som upplevde en förbättring av sin hälsa, hade flera sociala kontakter som gav uppmaning och uppmuntran och hade bättre socioekonomiska förutsättningar. De barriärer som identifierats var hos de som rapporterade ohälsa, ej ville prioritera fysisk aktivitet eller hade sämre socioekonomiska förutsättningar, väder, brist på träningslokaler eller friluftsområden och demografiska faktorer (ålder, kön, ). De interventioner som identifieras syftade till att stärka egenförmåga, utvärdera tekniska hjälpmedel och riskmedvetenhet. Slutsats: Eftersom facilitatorer och barriärer för fysisk aktivitet varierar mellan individer med prediabetes bör god kommunikation och en bra relation med patienter vara av stor betydelse. Distriktssköterskor och annan hälso- och sjukvårdspersonal bör utforska patientens individuella uppfattningar om prediabetes och därmed riskmedvetenhet när de utformar insatser eller interventionsstrategier för att stärka egenförmåga, motarbeta barriärer och hjälpa till att utveckla och upprätthålla fysiska aktiviteter. / Background: Prediabetes is a phase before type 2 diabetes associated with an abnormal glucose homeostasis. Lifestyle changes such as weight loss, dietary changes and regular physical activity reduce the relative risk of developing type 2 diabetes. Understanding barriers and facilitators to physical activity facilitates a salutogenic approach to a person's lifestyle, psychological well-being and physical health. Purpose: The aim was to understand and identify barriers and facilitators to physical activity among people with prediabetes and see which interventions have been studied. Method: Literature review based on Polit and Beck's model (2021) with 15 scientific articles of quantitative, qualitative and mixed methods that were included after searching the databases PubMed and Cinahl. Results: Facilitators for increased physical activity are found in those who experienced an improvement in their health, had several social contacts that provided encouragement and encouragement and had better socio-economic conditions. The barriers identified were those who reported illness, did not want to prioritize physical activity or had poorer socio-economic conditions, weather, lack of training facilities or outdoor areas and demographic factors (age, gender, BMI). The interventions identified were aimed at strengthening self-efficacy, evaluating technical aids and risk awareness. Conclusion: Since facilitators and barriers to physical activity vary between individuals, good communication and relationship with patients is of great importance. District nurses or other health care professionals should look for individual perceptions of prediabetes and risk awareness when designing interventions to strengthen self-efficacy, counteract barriers and help develop and maintain physical activities.

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As new approaches to practice become available for school nurses, urban school districts must address the need to provide facilitators for the dissemination and adoption of new evidenced based practice models. With instructional capacity, curriculum challenges, and school climate at the center of the decision making of educational leaders, the needs of school health become neglected. As new innovations become available, school nurses working in urban school districts often rely on individual continuing education to access new ideas due to barriers that exist in urban schools with limited funding and resources. This dissertation research had two primary aims: (1) expand current research regarding specific barriers and facilitators to practice, and (2) to better understand the school nurses’ adoption of the Framework for the 21st Century School Practicing Nurse in an urban school district. This framework addresses the specific needs of the school nurse working in an evolving educational health setting. Using a descriptive and inferential quantitative design with a convenience sample of school nurses in the School District of Philadelphia (SDP), participants completed an online survey designed to examine awareness, agreement, and alignment with the framework, as well as barriers and facilitators of adoption. The results revealed differences in level of awareness of the framework across various demographic groups within the SDP. After presenting the framework to participants, school nurses agreed with the importance of fully aligning practice. Further, there were variations in level of importance regarding specific practice components of the framework. Participants identified facilitators and barriers that impacted their ability to fully align school nursing practice with the framework. / Urban Education

Yes / The profile of an effective facilitator has been likened to that of a saint, unfazed by ambiguity, undaunted by student irritation or personal frustration (Katz 1995, p 52). With the increasing popularity of using problem-based learning (PBL) within health professional curricula, it could be argued that the health lecturer’s role in education is changing. As a lecturer, I have only recently become involved in using PBL. With increasing exposure to the process and through reviewing the literature, I have come to realise that the role of the lecturer is fraught with difficulty. The literature is often conflicting with PBL meaning different things to different people (Barrows 1986). It provides no consistent guidelines as to how the lecturer should adapt to undertake this new role. This article explores the issues around the role of the lecturer within PBL and through reviewing the literature, investigates the level of intervention the lecturer should provide when students are undertaking the PBL process. Suggestions will be made to ‘facilitate’ the lecturer into facilitating an effective teaching strategy.

No / Relatives of people with dementia report that proxy decision-making is difficult and distressing. We systematically reviewed the literature about barriers and facilitators to family carers of people with dementia making proxy decisions, and interventions used to facilitate their decision-making. We searched electronic databases and references of included papers up to February 2014. Two authors independently evaluated study quality using a checklist. We included the 30/104 papers from our search which fitted predetermined criteria and prioritized higher quality papers. Family carers report that proxy decision-making is challenging and can be distressing, especially when decisions are made against the wishes of the care recipient and support from healthcare professionals is lacking. Decision-specific manualized aids have been developed, and while results for those supporting decisions about respite and percutaneous endoscopic gastrostomy (PEG) feeding have shown promising results in pilot trials, no intervention has yet been shown to significantly reduce decisional conflict or carer burden, or increase knowledge in randomized controlled trials; a decision aid for advance care planning increased decisional conflict. We recommend development and testing of decision aids targeting the decisions carers report finding most distressing, including those around where people should live, accessing services, and end of life treatments. Being provided with information to make decisions which have not previously been considered may increase feelings of conflict, suggesting these aids should be carefully targeted.

Chemical dependency in the health profession is a growing concern. With easy access to controlled substances, many nurses divert prescription drugs and even work while under the influence. Nurses who are under the influence and working with patients are an obvious public hazard. Many states in the USA have non-punitive programs to offer recovery to nurses with chemical dependency and return them to work. In California this program is named the Diversion Program. Part of the requirements of successful completion of the Diversion Program is to attend weekly meetings called support groups. These support groups are facilitated by other nurses experienced in the field of chemical dependency. This study explored the experiences of nurse facilitators of support groups for nurses with chemical dependency in the California, USA, Diversion Program. Data were collected through twelve individual interviews selected through purposeful, non-probability convenience sampling. A phenomenological research design was used that was descriptive, explorative, and contextual. The data analysis revealed four major themes: (1) experience of communication within the Diversion Program; (2) experience of the structure of the Diversion Program; (3) experience of their role within the Diversion Program; and (4) experience of facilitation of support groups. The study revealed that even though many of the nurse facilitators‟ experiences were positive with respect to the support groups they expressed concern about the communication patterns within the Diversion Program. To offer support for the nurse facilitators, guidelines and a conceptual framework were created to enhance their experience and mitigate their feelings of marginalization from the Diversion Program. / Health Studies / D.Litt. et Phil. (Health Studies)