The overall aim of this study was to understand the determinants of VCT uptake in the general population of Nigeria’s federal capital territory of Abuja. Uptake of VCT still remains low despite increased availability of VCT information and services in Abuja, Nigeria. A quantitative cross-sectional study was undertaken with 180 respondents from Abuja, using an adaptation of the Health Belief Model as conceptual framework, to elucidate the social demographics of respondents, their HIV/VCT knowledge, their perceptions of VCT facility design, societal support for VCT, and how HIV stigma shapes the phenomenon of VCT uptake in Abuja, Nigeria. The key findings were that a better understanding of HIV prevention, a perception of support from community and religious leaders, and access to HIV test services in government facilities are positive predictors of higher VCT uptake. Poor personal risk assessment and the cost of HIV testing were identified as the key barriers to VCT access. / Health Studies / M.P.H.

This study explored preparatory students’ perceptions of the risk of contracting the Human Immuno-deficiency Virus (HIV) and sexually transmitted infections (STIs) in Ethopia. It utilised a non-experimental exploratory survey methodology. A range of findings was revealed. Most respondents (67.14%) were knowledgeable about HIV/AIDS and more than half of the respondents knew about STIs. A significant number of respondents (67.1%) were able to describe HIV transmission prevention methods. Twenty one percent of respondents were sexually active and 17.0% of these reported to have used condoms. Twenty nine percent and 4.25% of the respondents had selfperceived risk of contracting HIV infection and STIs respectively. In spite of increased awareness of HIV/AIDS, school youths still engage in high-risk sexual activities and believe that they are unlikely to contract the disease. The study findings have implications for practice, and recommendations are offered for further research / Health Studies / M.A. (Public Health)

The study aimed to assess factors affecting the uptake of community-based Tuberculosis care (CTBC) as experienced by patients in Lobatse in order to make recommendations to enhance the uptake of CBTC in this area. A cross-sectional study was conducted, using structured interviews amongst 101 TB patients in Lobatse who registered for directly observed treatment (DOT) for TB in the GOB’s health facilities from January 2011 to August 2013. The SPSS (version 21) was used to analyse the data. Univariate logistic regression models were used. Participation in CTBC was an outcome. The main predictors for participation in CBTC included, knowledge and attitudes towards CTBC (p=0.0003), perceived barriers and enablers towards this programme (p=0.0279), and patient satisfaction with this programme (p=0.0315). The research findings pertain to TB services in Lobatse, because the study was conducted in government health facilities implementing the Botswana National Tuberculosis Programme (BNTP) CTBC guidelines only in Lobatse / Health Studies / M.A. (Public Health)

Free cervical cancer screening services are provided in Malawi’s public healthcare institutionssince 1999. Few women aged 42 and older, utilise these services. Cervical cancer continues to be a major cause of morbidity and mortality among this group of women. Structured interviews were conducted with 381 women who attended three healthcare centers in Blantyre and semi-structured interviews with 14 nurse/midwives working at the same centers. The results for both phases arepresented within the Health Belief Model’s constructs. Phase 1 revealed that women had low levels of perceived susceptibility to cervical cancer. Although the interviewed women perceived cervical cancer to be a serious condition, they did not regard themselves to be at risk of suffering from cervical cancer. Knowledge that cervical cancer screening could detect this cancer at an early stage, embarrassment, stigma, social support, financial costs, traditional practices and available sources of information, influenced women’s intentions to be screened for cervical cancer. In phase 2, the nurse/midwives indicated that Malawian women lacked information about cervical cancer, available screening tests and the purpose of such screening.These women perceived cervical canceras being incurable and linked to witchcraft. Women’s utilisation of cervical screening services was hampered by barriers relating to healthcare institutions, women themselves and nurse/midwives. Local radio and television broadcasts, friends and nurse/midwives motivated individual women to use these screening services.Women preferred receiving information about cervical cancer screening during community activities. Health education should be intensified, nurse/midwives should be more empathetic, clinic days and hours should be extended. Misconceptions should be addressed and more service providers should be trained. This would enable more Malawian women to use cervical screening services, enhancing early detection and treatment of cervical cancer and reducing the morbidity and mortality statistics related to this condition in Malawi. / Health Studies / D. Litt. et Phil. (Health Studies)

The study attempted to identify factors influencing women’s preference for home births in the Mutare District, Zimbabwe. A quantitative, descriptive, exploratory, cross sectional survey, gathering data by conducting structured interviews with 150 women, was used. All 150 women attended antenatal clinics but did not deliver their babies at health care facilities. The research results indicated that home deliveries might decline if: • the hospital/clinic fees were reduced or removed • transport would be available for women in labour to reach hospitals/clinics • shelters were built for pregnant women at hospitals/clinics • clinics were well equipped and had sufficient numbers of midwives • women had received more effective health education on the advantages of institutional deliveries and on the danger signs of pregnancy/labour complications • nurses/midwives would treat patients respectfully. Unless these factors are addressed, the number of home deliveries might not decline, and the high maternal/infant mortality and morbidity rates in this district will persist. / Health Studies / M. Public Health

<p>The overall aim of this thesis was to inestigate Swedish adolescents' perceptions and behaviours regarding sexual risk taking. Specific objectives were to explore teenagers' perceptions of contraceptive use, unintended pregnancy, and abortion; teenage girls' experiences of decision making process and support connected to abortion; and male adolescents' perceptions of sexual risk taking and barriers to practicing safe sex. Another objective was to evaluate the effect of advance provision of emergency contraceptive pills to teenage girls. The methodologies included focus group discussions, in-depth interviews, and a randomized controlled trial. </p><p>Among the adolescents in our studies, teenage parenthood was generally viewed as a "catastrophe", and the majority expressed supportive attitudes towards abortion (studies I-IV). Occasions of failure to use contraceptives were common, especially when sex was unplanned (studies I-V). Pregnancy prevention was perceived as the woman's responsibility. However, many girls were reluctant about using homonal contraceptives due to worries about negative side effects (I, III). Initiating condom use was difficult for girls, as well as for boys, for a number of reasons (I-IV): fear of ruining an intimate situation, associations with disease, distrust, pleasure reduction, and (for the boys) the fear of loosing one's erection. Males generally perceived personal and partner-related risks connected to unprotected intercourse as low. Few males were worried that an unintended pregnancy would be carried to term, and the majority would urge the girl towards abortion if she seemed ambivalent (II, IV). Girls viewed the abortion decision as a natural, yet difficult choice, strongly influenced by attitudes of partners, parents, peers and societal norms (III). Teenage girls provided with emergency contraceptive pills in advance used it more frequently and sooner after unprotected intercourse compared with controls, without jeopardising regular contraceptive use (V).</p>

Falling among older adults is a leading cause of concern due to the known impacts including physical injury, loss of independence, increased health care costs, and mortality. In efforts to decrease the numbers of falls experienced by older adults, healthcare providers assess individuals’ fall risks and provide corresponding fall prevention recommendations. The effectiveness however, of these recommendations, is only as strong as the level of adherence to those recommendations; which has proven low in recent research. Using the theoretical foundation of the Health Belief Model, this study quantified adherence to environmental fall prevention recommendations. Twenty-two community-dwelling older adults participated in this randomized control group study that took place across three home visits, scheduled approximately 30 days apart. Participants were interviewed regarding their recent falls and perceived susceptibility to future falls; then a home evaluation was conducted. Treatment group participants were provided personalized education explaining how and why environmental fall prevention recommendations were important to decrease their risk of falls while control group participants were provided general recommendations. A two-sample t-test for independent groups determined a statistically significant relationship: participants who received personalized education intervention were more likely to follow recommendations than those who received general education intervention. Multiple regressions were conducted to review relationships between an individual’s recent falls, and their perceived susceptibility to future falls, with their extent of adherence with fall prevention recommendations. No statistically significant relationship was found. This study suggests that providing personalized education for community-dwelling older adults regarding environmental fall prevention recommendations increases their extent of adherence with such recommendations.

The study aimed to assess factors affecting the uptake of community-based Tuberculosis care (CTBC) as experienced by patients in Lobatse in order to make recommendations to enhance the uptake of CBTC in this area. A cross-sectional study was conducted, using structured interviews amongst 101 TB patients in Lobatse who registered for directly observed treatment (DOT) for TB in the GOB’s health facilities from January 2011 to August 2013. The SPSS (version 21) was used to analyse the data. Univariate logistic regression models were used. Participation in CTBC was an outcome. The main predictors for participation in CBTC included, knowledge and attitudes towards CTBC (p=0.0003), perceived barriers and enablers towards this programme (p=0.0279), and patient satisfaction with this programme (p=0.0315). The research findings pertain to TB services in Lobatse, because the study was conducted in government health facilities implementing the Botswana National Tuberculosis Programme (BNTP) CTBC guidelines only in Lobatse / Health Studies / M. A. (Public Health)

Many adults are afraid of falling. While aging can affect one'€™s physical and cognitive abilities related to fear of falling (FOF), research has revealed that FOF increases risk of falls and adversely affects independence levels among older adults. The purpose of this study was to explore older adults'€™ perceptions of FOF and risk of falling. Guided by the health belief model, the research questions focused on older adults'€™ perceptions of FOF, contributing factors of FOF, and how FOF may affect independence levels. How older adults perceive FOF, and how FOF may affect an individual older adult'€™s fall risk and independence levels are not well known. Following face-to-face interviews with adults age 60 and older, Colaizzi'€™s data analysis strategy demonstrated thematic older adult reports of constant anxiety, loss of confidence, and activities of daily living (ADLs) avoidance as perceptions of FOF; traumatic health incidence, loss of health, and decreased quality of life as contributing factors in FOF; and depending on others, loss of muscle strength, and loss of balance as to how FOF affected older adult independence levels. Recommendations for future research include exploring the influence of gender, race, education level, and socioeconomic status on FOF in older adults. This study may enhance social change through greater FOF awareness and added context among caregivers.

The overall aim of this thesis was to inestigate Swedish adolescents' perceptions and behaviours regarding sexual risk taking. Specific objectives were to explore teenagers' perceptions of contraceptive use, unintended pregnancy, and abortion; teenage girls' experiences of decision making process and support connected to abortion; and male adolescents' perceptions of sexual risk taking and barriers to practicing safe sex. Another objective was to evaluate the effect of advance provision of emergency contraceptive pills to teenage girls. The methodologies included focus group discussions, in-depth interviews, and a randomized controlled trial. Among the adolescents in our studies, teenage parenthood was generally viewed as a "catastrophe", and the majority expressed supportive attitudes towards abortion (studies I-IV). Occasions of failure to use contraceptives were common, especially when sex was unplanned (studies I-V). Pregnancy prevention was perceived as the woman's responsibility. However, many girls were reluctant about using homonal contraceptives due to worries about negative side effects (I, III). Initiating condom use was difficult for girls, as well as for boys, for a number of reasons (I-IV): fear of ruining an intimate situation, associations with disease, distrust, pleasure reduction, and (for the boys) the fear of loosing one's erection. Males generally perceived personal and partner-related risks connected to unprotected intercourse as low. Few males were worried that an unintended pregnancy would be carried to term, and the majority would urge the girl towards abortion if she seemed ambivalent (II, IV). Girls viewed the abortion decision as a natural, yet difficult choice, strongly influenced by attitudes of partners, parents, peers and societal norms (III). Teenage girls provided with emergency contraceptive pills in advance used it more frequently and sooner after unprotected intercourse compared with controls, without jeopardising regular contraceptive use (V).