To address the concern of school violence and mental health, the state of Florida implemented a statewide mandate requiring school personnel to be trained in strategies to identify and respond to the mental health needs of students. Existing research supports the effectiveness of Youth Mental Health First Aid (YMHFA), the training program selected by the Florida Department of Education to implement in public schools. To date, limited research has explored the implementation experiences of YMHFA trainers. This qualitative descriptive study explored trainers’ experiences implementing YMHFA within school settings. Semi-structured interviews were conducted with 18 YMHFA trainers employed in Florida public schools to explore how individual characteristics and system and organizational level supports and resources influenced the implementation of YMHFA training. Member checking was conducted with 22% (or n =4) of participants to verify shared experiences and perspectives. Two overarching themes were identified using a deductive thematic analysis approach guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework. In general, changes in the training certification process, lack of fidelity monitoring protocols, abrupt changes to training curriculum, limited guidelines on state mandate requirements, and the lack of communication, resources, and supports were perceived as barriers to implementation (Theme 1). Conversely, positive trainer attitudes, opportunities to practice skills learned, adequate resources, pro-mental health perceptions, and supportive working environments served as facilitators to YMHFA implementation (Theme 2). Study implications and future directions for research are discussed.

Sedentary behavior and an inactive lifestyle are a risk factor for chronic diseases and an increasing number of people are affected. Technologies and smartphone applications can help to support and increase awareness of sedentary behavior and thus, help users change their lifestyle and create a balance between sedentary time and physically active time. Based on Self-Determination Theory, this study aimed to identify user preferences and design features in technologies to support the awareness of sedentary behavior and explored the influence of design implementations towards motivation on sedentary behavior change. Data was collected and analyzed via a survey that was made available online. Participants were drawn from social media platforms and company email addresses. The survey was distributed to 97 people through a web-based tool which resulted in complete data from 84 responses. Results of the survey based on Self-Determination Theory indicated a positive influence of competition among users in screen-based sedentary behavior applications. These findings contribute to our understanding of how individuals can be motivated to use awareness-based sedentary behavior technologies by the implementation of design features.

This dissertation contains three distinct chapters considering different challenges faced by a developing country; India. Chapter 1. Food price spikes induced by hot weather could be a threat to food security, human health and poverty. It could exacerbate the health status of households by reducing the nutrient food choices, particularly among the vulnerable groups who already have a more frail status. This paper examines the first possible causal link between milk average market price and hot weather in the short run at the household level in India. Using Human Development Survey data, it is empirically showed that hot weather has a significant adverse impact on the price in rural India. The impacts are more pronounced for non-poor families in both rural and urban areas. The effects are robust to alternative heat metrics. The paper further investigates the effect of hot weather on households' milk consumption. Evidence suggests that low-income (poor) families with purchased consumption, both in rural and urban areas, are significantly adversely affected compared to those with homegrown product. Chapter 2. Health-related behaviour and, in particular, attending antenatal care during pregnancy is essential to reduce the risk of pregnancy complications, stillbirth, and maternal mortality. This paper estimates the causal effect of years of formal education on the likelihood that a pregnant woman in India attends natal care and screening services. Despite the importance, insufficient documents exist on the determinants of natal care usage in developing countries. The current study investigates for the first time the hypothesis that women’s schooling attainments might have a causal impact on natal care usage in India. Drawing on the nationally representative India Human Development Survey (IHDS-II) and instrumenting for years of schooling with plausibly exogenous variation in age at first menarche, I find that delayed age at menarche significantly increases formal education. Further, evidence suggests that an additional year of schooling significantly enhances the likelihood of uptaking the antenatal checkups. However, attending a sonogram/ultrasound does not appear to be significant. Chapter 3. Adolescent girls are amongst the vulnerable groups exposed to the risks that challenge their healthy development into young women. India's Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (SABLA) program was designed to address such challenges by building health awareness and encouraging decision-making autonomy as the first steps towards real change in women’s development. Using data from the nationally representative India Demographic and Health Survey (IDHS), with plausibly exogenous variation in the program’s rollout across districts and birth cohorts, we provide evidence that exposure to SABLA increases the likelihood of having knowledge of family planning and diarrhoea treatment, using contraception, and autonomy in personal financial decision-making for exposed women. The effects are more pronounced for women residing in urban areas, for women who have secondary education or higher, and primarily for Muslim women.

In November 2006, award-winning novelist, Bebe Moore Campbell died at the age of 56 after a short battle with brain cancer. Although the author was widely-known and acclaimed for her first novel, Your Blues Ain't Like Mine (1992) there had been no serious study of her life, nor her literary and activist work. This dissertation examines Campbell's activism in two periods: as a student at the University of Pittsburgh during the 1960s Black Student Movement, and later as a mental health advocate near the end of her life in 2006. It also analyzes Campbell's first and final novels, Your Blues Ain't Like Mine and 72 Hour Hold (2005) and the direct relationship between her novels and her activist work. Oral history interview, primary source document analysis, and textual analysis of the two novels, were employed to examine and reconstruct Campbell's activist activities, approaches, intentions and impact in both her work as a student activist at the University of Pittsburgh and her work as a mental health advocate and spokesperson for the National Alliance for Mental Illness. A key idea considered is the impact of her early activism and consciousness on her later activism, writing, and advocacy. I describe the subject's activism within the Black Action Society from 1967-1971 and her negotiation of the black nationalist ideologies espoused during the 1960s. Campbell's first novel Your Blues Ain't Like Mine and is correlated to her emerging political consciousness (specific to race and gender) and the concern for racial violence during the Black Liberation period. The examination of recurrent themes in Your Blues reveals a direct relationship to Campbell's activism at the University of Pittsburgh. I also document Campbell's later involvement in the National Alliance on Mental Illness (NAMI), her role as a national spokesperson, and the local activism that sparked the birth of the NAMI Urban-Los Angeles chapter, serving black and Latino communities (1999-2006). Campbell's final novel, 72 Hour Hold, is examined closely for its socio-political commentary and emphasis on mental health disparities, coping with mental illness, and advocacy in black communities. Campbell utilized recurring signature themes within each novel to theorize and connect popular audiences with African American historical memory and current sociopolitical issues. Drawing from social movement theories, I contend that Campbell's activism, writing, and intellectual development reflect the process of frame alignment. That is, through writing and other activist practices she effectively amplifies, extends, and transforms sociopolitical concerns specific to African American communities, effectively engaging a broad range of readers and constituents. By elucidating Campbell's formal and informal leadership roles within two social movement organizations and her deliberate use of writing as an activist tool, I conclude that in both activist periods Campbell's effective use of resources, personal charisma, and mobilizing strategies aided in grassroots/local and institutional change. This biographical and critical study of the sociopolitical activism of Bebe Moore Campbell establishes the necessity for scholarly examination of African American women writers marketed to popular audiences and expands the study of African American women's contemporary activism, health activism, and black student activism. / African American Studies

Purpose To evaluate the pelvic floor health knowledge base and presence of pelvic floor dysfunction (PFD) in women working in an office environment, and whether this knowledge significantly increases following a pelvic floor health education session and a re-education session. To assess whether this knowledge-acquisition leads to significant decrease in PFD. Participants Female volunteers (N=161), ages 18-69 years, were randomly allocated to Groups A, B or C. Methods Online surveys were completed by all groups on three occasions and included validated tools (Prolapse and Incontinence Knowledge Quiz, Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire-7) plus sexual function and pelvic floor muscle (PFM) exercise items. On completion of the baseline survey, an education session was given to Groups A and B only (Group C represented the controls). Following this, all participants completed the second survey. Two months later, to allow time for efficacy for the PFM exercises, a re-education presentation was given to Group A only, followed by the final survey administered to all. Analysis Of the 161 volunteers, 16 failed to complete all study requirements, leaving 145 questionnaires (Groups A and B n=48, Group C n=49) available for analysis using ANOVA and Descriptive Analysis. Results The knowledge base of the participants receiving the education showed highly significant improvement compared to the control group, and again for those receiving the re-education session. Although only 14% stated that they had PFD, the surveys revealed that 96% of the participants had PFD. The groups receiving the PFM exercise education and strategies to encourage healthier bladder and bowel habits showed significant decrease in PFD symptoms and increase in QoL. Education was successful in producing highly significant increases in knowledge, importance and commitment toward PFM exercise. Conclusion This study is unique as it evaluated pelvic floor health knowledge and presence of PFD of presumably healthy women within an office setting in contrast to patients seeking PFD medical attention. While further research is required, it is clear that low pelvic floor health knowledge was associated with high prevalence of PFD. Further, as knowledge/awareness significantly increased following education, so did QoL, while PFD significantly decreased.

Purpose To evaluate the pelvic floor health knowledge base and presence of pelvic floor dysfunction (PFD) in women working in an office environment, and whether this knowledge significantly increases following a pelvic floor health education session and a re-education session. To assess whether this knowledge-acquisition leads to significant decrease in PFD. Participants Female volunteers (N=161), ages 18-69 years, were randomly allocated to Groups A, B or C. Methods Online surveys were completed by all groups on three occasions and included validated tools (Prolapse and Incontinence Knowledge Quiz, Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire-7) plus sexual function and pelvic floor muscle (PFM) exercise items. On completion of the baseline survey, an education session was given to Groups A and B only (Group C represented the controls). Following this, all participants completed the second survey. Two months later, to allow time for efficacy for the PFM exercises, a re-education presentation was given to Group A only, followed by the final survey administered to all. Analysis Of the 161 volunteers, 16 failed to complete all study requirements, leaving 145 questionnaires (Groups A and B n=48, Group C n=49) available for analysis using ANOVA and Descriptive Analysis. Results The knowledge base of the participants receiving the education showed highly significant improvement compared to the control group, and again for those receiving the re-education session. Although only 14% stated that they had PFD, the surveys revealed that 96% of the participants had PFD. The groups receiving the PFM exercise education and strategies to encourage healthier bladder and bowel habits showed significant decrease in PFD symptoms and increase in QoL. Education was successful in producing highly significant increases in knowledge, importance and commitment toward PFM exercise. Conclusion This study is unique as it evaluated pelvic floor health knowledge and presence of PFD of presumably healthy women within an office setting in contrast to patients seeking PFD medical attention. While further research is required, it is clear that low pelvic floor health knowledge was associated with high prevalence of PFD. Further, as knowledge/awareness significantly increased following education, so did QoL, while PFD significantly decreased.

Syftet med studien har varit att belysa fenomenet hälsoism utifrån personliga tränares perspektiv. Tidigare forskning har påvisat att hälsoism är ett starkt växande fenomen i västvärlden. Utifrån syftet skapades tre frågeställningar; Hur diskuterar personliga tränare synen på sig som en förebild inom hälsa? Hur framträder hälsomedvetenhet i vardagen för personliga tränare? Vad innebär en hälsosam livsstil för personliga tränare? Undersökningen använde kvalitativ metod och bestod av fyra intervjuer. Informanterna var utbildade och arbetade med någon form med personlig träning. En del av resultatet visade att personliga tränare anser sig själv som förebilder och representanter för hälsa. Detta leder till att rätt beteende måste ske i en omgivning där kunder eller potentiella kunder kan hålla koll på en. Att inte ha rätt beteende i sådana situationer kan resultera i att man anses som en opålitlig personlig tränare. Ett annat resultat visar på att en hälsosam livsstil är viktigt för personliga tränare men att det är lika viktigt att inte ha för hälsosam beteende heller. Ett för hälsosamt beteende eller att ha hälsa som religion kan anses som osunt beteende. Slutsatsen i uppsatsen tyder på att personliga tränare är en del av hälsoismen och uppfyller en del krav på att ha hälsa som religion. Men det finns fortfarande en negativ inställning mot att ha hälsa som religion och att prioritera hälsa först. Detta kan förklaras utifrån att det inte är socialt accepterat än att ha hälsa som en religion kanske eftersom det är ett så pass nytt fenomen. / The aim of the study was to shed light on the phenomenon healthism based on personal trainers’ perspective. Previous research has shown that healthism is a rapidly growing phenomenon in the western world. Based on the purpose, three issues were created; How do personal trainers discuss their view as a role model in health? How does health awareness appear in everyday life for personal trainer? What does a healthy lifestyle for personal trainer mean? The study used the qualitative method and consisted of four interviews. The informants were educated and worked in some form of personal training. A part of the the results show that personal trainers consider themselves as role models and representatives of health. This leads to the proper behavior must occur in an environment where clients or potential clients can keep track of one. Not having the right behavior in such situations can result in being considered as an extremely unreliable personal trainer. Another result shows that a healthy lifestyle is important for personal trainers but it is equally important not to have too healthy behavior either. A too healthy behavior or to have health as a religion can be regarded as unhealthy behavior. The conclusion in the paper suggest that the personal trainer is part of the healthism and fulfill some requirements to have health as a religion. But there is still a negative attitude towards taking health as a religion and prioritize health first. This can be explained on the basis that it is not socially acceptable yet to have health as a religion perhaps because it is such a new phenomenon.

<p>The thesis presents three papers discussing some of the methodological issues regarding studies investigating complex community-based cardiovascular health interventions. All three studies involved the Cardiovascular Health Awareness Program (CHAP), a standardised blood pressure and risk factor assessment and educational sessions held in pharmacies or other locally accessible areas in small to mid-sized communities in Ontario, Canada.</p> <p>The first paper reviews the literature and proposes a guide on how to develop a theoretical framework for complex community-based interventions using CHAP as an example. The paper describes a stepwise process of developing a theoretical framework including challenges encountered and strategies employed to overcome them.</p> <p>The second paper presents how recently published randomized controlled trials evaluating complex community-based cardiovascular health interventions monitored and reported implementation fidelity based on a structured review of the published articles and a survey of their primary authors. The results showed that fidelity reporting of included studies was better than those described in previous reviews. Fidelity was verified through self-reports by implementers and supervision by researchers. Strategies described to standardize intervention delivery were through training of implementers and use of implementation guides. The authors’ survey results were consistent with the review results though there were some gaps which could be improved to strengthen fidelity reporting.</p> <p>A data analysis issue with studies investigating complex community-based interventions is that outcomes can be affected by factors from multiple levels. The third paper explores the association of individual, partnership, and community-related factors with CHAP participants’ use of health-related community resources and cardiovascular risk behaviours. This was a cross-sectional analysis of an on-going cohort study. The results showed that individual factors (age and self-efficacy) had the most consistent association with the outcomes. Community and partnership level variables showed less consistent association with the outcome. Methodological and analytical challenges were presented.</p> / Doctor of Philosophy (PhD)

Nurse Practitioners (NPs) comprise a significant portion of the U.S. primary care workforce and play an essential role in patients' health awareness, prevention strategies, disease management, and in providing appropriate provider referrals. Nurse Practitioners receive education on the oral-systemic connection, yet there have been limited studies on the clinical practice of NPs assessing the oral cavity to evaluate the condition of the teeth and the oral tissues. The purpose of this study was to explore the nurse practitioners’ knowledge and practice habits of assessing the oral cavity for diseases or abnormalities in the mouth that can, in turn, affect overall health. A total of 66 NPs were included in the study, primarily female (91%) with master’s degrees (77%). While knowledge and education were not significantly associated, this research found significant associations between confidence and assessments, less than one-third (30.3%) were confident in their knowledge and ability to evaluate oral abnormalities.