The purpose of this dissertation was to test the utility of theories across the development, implementation, and evaluation of three nationwide knowledge translation (KT) interventions in the physical disability community. Using a theory-based evaluation guided by the Theory of Planned Behaviour (TPB), Study 1 evaluates the effectiveness of an evidence-based, continuing education module designed to increase emergency health care professionals’ (HCPs) knowledge and use of clinical practice guidelines for managing patients with spinal cord injury (SCI) who present with autonomic dysrefexia. Findings suggest that behaviour change theory should be integrated into the intervention to change theory-based determinants of behaviour, and that information about intervention implementation may help explain observed outcomes. Study 2 examined the use of theory across three phases of research in the Canadian Paralympic Committee’s Changing Minds, Changing Lives (CMCL) intervention. Study 2.1 describes the restructuring of the CMCL curriculum to include research evidence and theory. Study 2.2 evaluates the short- and long-term effects of the CMCL intervention on HCPs’ social cognitions for discussing leisure-time physical activity (LTPA), and explores key implementation variables that predict changes in HCPs’ social cognitions. Overall Study 2 results suggest that: (1) using a KT framework and integrating stakeholders throughout intervention development increases the likelihood that interventionists will adopt and implement the intervention, and (2) real-world implementation is important to understanding intervention effectiveness. Study 3 examines the effectiveness, and its implementation correlates, of Get in Motion (GIM), a nationwide, LTPA-enhancing telephone counseling service for adults with SCI. Study 3 furthers our understanding of the relationship between implementation and effectiveness, and suggests key implementation ingredients that could be targeted in future refinements of GIM. Together, the dissertation studies contribute to our understanding of how to use theory when developing, implementing, and evaluating behaviour change interventions targeting HCPs and other end-users in the physical disability community. / Dissertation / Doctor of Philosophy (PhD)

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Inledning: Studier påvisar att livsstilsrelaterade sjukdomar ständigt ökar och att fysisk inaktivitet bidrar till detta, likaså att FaR ej används i den utsträckning som det skulle behövas. Syfte: Att belysa för distriktssköterskor vilka underlättande och försvårande faktorer sjukvårdspersonal kan uppleva vid förskrivning av fysisk aktivitet på recept, FaR. Metod: En empirisk fenomenografisk intervjustudie med kvalitativ ansats. Fokusgruppsintervjuer med nio deltagare utfördes på tre vårdcentraler. Huvudresultat: Underlättande och försvårande faktorer framkom inom organisation samt i mötet mellan sjukvårdspersonal och patient, exempelvis stöd från cheferna, utbildning och motiverade patienter var underlättande faktorer. Försvårande faktorer var exempelvis tidsbrist, avsaknad av teamarbete samt negativ inställning till FaR. Konklusion: Chefernas engagemang samt patienternas inställning till fysisk aktivitet och FaR var områden som framkom vara av stor betydelse när sjukvårdspersonal skulle förskriva FaR. Att chefer gav sjukvårdspersonalen resurser för att möjliggöra arbetet med FaR, i form av tid, utbildning och teamarbete ansågs vara en grundläggande faktor. Hälsofrämjande synsätt och prioritering av FaR hos cheferna ger spridning och förankring hos sjukvårdspersonalen. Patienternas inställning till egenvård och fysisk aktivitet var en betydande faktor vid förskrivning av FaR. Där har distriktssköterskor en huvuduppgift i att motivera patienterna till livsstilsförändringar och egenvård samt informera om fysisk aktivitets inverkan på hälsan. / Introduction: Studies indicate that lifestyle-related diseases is constantly increasing and that physical inactivity contributes to this, likewise that PAP is not used to the extent necessary. Objective: To highlight for district nurses what facilitating and aggravating factors health care professionals can experience about prescribing physical activity on prescription, PAP. Method: An empirical phenomenographic interview study with qualitative approach. Focus group interviews with nine participants were conducted on three health centers. Main Results: Facilitating and aggravating factors emerged in the organization and in the meeting between health care professionals and patient, for example support from the manager’s, education and motivated patients were facilitators. Aggravating factors was for example lack of time, lack of team work and negative attitudes toward PAP. Conclusion: The manager's commitment as well as the patient’s motivation towards physical activity and PAP was the areas that appeared to be of great importance when health care professionals prescribe PAP. Having managers who gave health care professionals resources in terms of time, training and teamwork was considered to be a fundamental factor and made it possible to work with PAP. A health promotion approach and prioritization of PAP from the managers leads to a spread and transmits to health care professionals. The patient's attitude towards self-care and physical activity were also a significant factor when prescribing PAP. There, district nurses have a major task in trying to motivate patients to lifestyle changes and self-care and to inform them about physical activities impact on health.

Pastarųjų metų Europos tyrimai rodo, kad psichologinis smurtas ir priekabiavimas sukelia didesnę grėsmę daugumai darbuotojų, nei fizinis smurtas. Priekabiavimas sukelia stresą, padidina psichologinę įtampą bei riziką darbe, įtakoja ligų atsiradimą. Darbo tikslas. Išanalizuot Kauno miesto sveikatos priežiūros įstaigos darbuotojų patiriamo priekabiavimo darbe paplitimą ir jų sąsajas su subjektyviu savo sveikatos vertinimu. Tyrimo metodika. Tyrime iš viso dalyvavo 226 sveikatos priežiūros įstaigų darbuotojai. Iš jų 176 Kauno miesto sveikatos priežiūros įstaigos darbuotojai ir palyginamosios grupės 130 sveikatos priežiūros specialistų. Tyrimas atliktas anoniminės apklausos būdu 2008-2009 m. rugsėjo - balandžio mėnesiais. Duomenų analizei naudotos programos SPSS 15,0 for Windows ir MS Excel. Rezultatai. Kauno miesto sveikatos priežiūros įstaigos darbuotojai statistiškai reikšmingai dažniau patyrė dažną priekabiavimą (5,8 proc.), nei palyginamoji grupė (3,8 proc.) (p=0,022). Pagal pareigas, dažną priekabiavimą patyrė 4,4 proc. slaugytojų ir 8,6 proc. kitas personalas. Gydytojai priekabiavimo darbe nepatyrė. Nustatytas ryšys tarp dažnai patiriamo priekabiavimo ir diagnozuotų sveikatos sutrikimų: kaklo/peties skausmų (p=0,047); traumų, lūžių, išnirimų, žaizdų, sužalojimų (p<0,000); plaštakos/rankos skausmų (p=0,028). 50 proc. slaugytojų, patyrusių dažną priekabiavimą, turėjo minimalių psichinės sveikatos sutrikimų (p=0,015). 28,6 proc. slaugytojų, dažnai patyrusių priekabiavimą... [toliau žr. visą tekstą] / Recent researches in Europe have shown that workplace bullying induces more intense threat in comparison with physical violence. Aim of the study. To make analysis of prevalence of undergoing bullying by the workers of Kaunas health care institutions and find out the links with self-reported health. Methods. The survey was conducted in one of the health care institutions in Kaunas and 96 workers of that institution were interviewed. Additionally, 130 nurses were randomly selected form the Kaunas district as control group. The questionnaire was composed of seven parts and 59 questions overall. The Negative Acts questionnaire, developed by S. Einarsen and H. Hoel, was used. The statistical software SPSS 15.0 for windows was used in the data analysis. Results. Less than one quarter of Kaunas health care institution workers admitted about undergoing bullying in the work place. Moreover, workers of Kaunas health care institution statistically significant more often have undergone bullying in workplace (5.8 %) in comparison with control group (3.8 %, p=0.022).Depending on position, repeated bullying have undergone 4.4% of nurses and 8.6% other staff. Occasional bullying have undergone 24.4% of nurses and 2.9% other staff. Medical doctors have not undergone any bullying in the workplace. Conclusions. Bullying in the workplace was common in both comparative groups of health care workers. Workers who have undergone repeated bullying in the workplace more often complained about... [to full text]

Background: in the late 1970s, HIV had a sudden outbreak in Africa, and in the late 1980 ́s the rest of the world was informed about the epidemic. Due to increased level of the infected people around the world HIV has been the cause of many deaths worldwide, and unfortunately HIV continues to spread. HIV is today, considered to be a incurable virus disease, but due to antiviral medication that allows individuals who are infected with HIV cancause of spreading HIV during 1980, which subjected these men to stigmatizing and discriminatory attitudes, especially in health care.  Aim: To explore how homosexual HIV-infected men describe their experiences of treatment from healthcare professionals. Method:  A literature review based on six qualitative articles, three quantitative article and one mixed approach article Results: The result consisted of one main themes and three subthemes. The first theme is experienced lack of knowledge with three subthemes: experiences of worthy care, experience of being denied care and the experiences of stigmatizing and/ or discriminatory attitudes. The main theme highlights how healthcare professionals lack of knowledge affects healthcare. The different subthemes discusses HIV-infected homosexual men ́s experiences of healthcare as both negative and positive. Discussion: The discussions are divided into four sections: the need for increased knowledge, experiences of being denied care and/or experiences of worthy care, stigmatization and discriminatory attitudes impact on patients care and geographical differences. This section was discussed by using Katie Eriksson nursing theory about care suffering, the background of the literature review and by using new research. / Bakgrund: I slutet av 1970-talet fick HIV ett plötsligt utbrott i Afrika, och i slutet av 1980-talet fick resten av världen höra talas om epidemin. Sjukdomen har orsakat många dödsfall världen över, och fortsätter att spridas sig. Idag anses HIV att vara en obotlig virussjukdom, som på grund av antivirala mediciner gör att individer som är smittade med HIV kan leva ett normalt liv. Homosexuella HIV-smittade män blev under 1980-talet skuldbelagda för att förorsaka HIV. Som resultat av detta har dessa män utsatts för stigmatiserande och diskriminerande attityder, speciellt inom sjukvården. Syfte: Att undersöka hur homosexuella HIV-smittade män beskriver sina upplevelser kring bemötandet från hälso- och sjukvårdspersonal. Metod: En litteraturöversikt som baserades på sex kvalitativa artiklar, tre kvantitativa artiklar och en mixad metod. Resultat: Resultatet bestod av ett huvudteman och tre subteman. Det första temat var: Upplevd kunskapsbrist, med tre subteman: upplevelsen av att få värdig vård, upplevelsen att bli vägrad vård samt rädsla för stigmatiserande och/eller diskriminerande attityder. Huvudtemat lyfter upp hur hälso- och sjukvårdspersonalens kunskapsbrist påverkar sjukvården. De olika subteman behandlar HIV-smittade homosexuella mäns upplevelser av sjukvården som både negativ och positiv. Diskussion: Resultatdiskussionen delades in i fyra avsnitt: upplevelsen av att bli nekad vård och/eller upplevelsen av att bli hörd, stigmatiserande och diskriminerande attityders påverkan på patientens vård, behov av ökad kunskap samt geografiska skillnader. Avsnittet diskuteras utifrån Katies Erikssons omvårdnadsteori om vårdlidande, litteraturöversiktens bakgrund samt med hjälp av ny forskning.

Probiotics are live microorganisms which confer a health benefit to the host. The literature strongly supports the benefits of probiotic therapy in preterm infant populations, specifically in the prevention of necrotizing enterocolitis (NEC) and mortality. To this end, probiotics are routinely given to premature infants in several European and Asian countries. However, in spite of the current evidence and neonatal feeding practices elsewhere, probiotic supplements are rarely prescribed in nurseries in North America. Furthermore, there is little or no literature on factors which affect clinical decision-making regarding probiotic supplementation. The study implemented a cross-sectional descriptive survey. The purpose of this study was to: (i) describe current practices involving probiotic supplementation of preterm infant enteral feeds; and (ii) identify factors that affect willingness of health care professionals to support the use of probiotics. Probiotic use was examined in Neonatal Intensive Care Units (NICUs) in Canada and the United States using two cross-sectional internet-based surveys. Survey #1 focused on current practices and targeted neonatologists who serve as clinical directors or department heads. The results were analysed using descriptive statistics. Survey #2 addressed factors that affect probiotic supplementation of preterm infant feedings, and had two versions: the first version targeted physicians and nurse practitioners whereas version 2 targeted neonatal nurses. The development of Survey #2 was guided by the Theoretical Domain Framework which evaluates factors which may affect the willingness of Health Care Professionals to support the use of probiotics in neonatal practice. The results of survey #2 were analysed using Chi-Square, Fisher’s Exact Test, and One-Way ANOVA. The results of the study indicated that only a small proportion of NICUs are administering probiotics to preterm infants and practices vary. The most significant factors influencing clinical decision-making regarding probiotic supplementation were knowledge about probiotics and the evidence, perceptions about the evidence and safety of probiotics, and knowledge about probiotics and clinical guidelines. Improving knowledge about probiotics, addressing safety issues of probiotics products, expanding the evidence base, and developing clinical guidelines may contribute to increased use of probiotics in NICUs. / October 2016

Introduction: It is important to treat youth with HIV and their families appropriately and to understand what they are going through. How can health care professionals work to promote a good health for the HIV positive youth? Aim: Describe health care professionals´ health promotion work among youth with HIV in Khayelitsha, South Africa. Method: Qualitative approach with semi-structured interviews. Content analysis was used to analyze the interviews. Results: The result was presented in one theme and three categories with eight associated subcategories. The main result was that Tender Loving Care is the core of the health promotion work. Another important factor is to encourage and support the patient as well as to give information. A holistic view of humanity is fundamental in health promotion work among youth with HIV in Khayelitsha, South Africa.  Discussion: It is important to promote a good health despite a chronic illness as HIV. Therefore, it is of great importance for health care professionals to have a sound knowledge of health promotion work regarding youth living with HIV. In Khayelitsha it is not always easy to target these youths and their families with health promotion work because of stigma in a dysfunctional society. The health promotion work for HIV occurs in the context of a dysfunctional society with damaged children and into that you put HIV. Conclusion: Health care professionals in Khayelitsha are struggling with multiple challenges in their health promotion work among youth. South Africa has been hard affected, even though apartheid ended in 1994 one can still see consequences from it. Poverty and prevalence of HIV is still high and it is an ongoing battle in the country to promote a good health among youth with HIV. One can not only look at the health promotion work without taking into account how the society looks.

Cultural competence and ethical decision making are two separate, yet intrinsically related concepts which are central to services rendered by all health care professionals. Cultural competence is based on ethical principles and informs ethical decision making. In spite of this important connection, the interrelationship of these two concepts does not receive the attention it deserves in the literature. This issue is addressed by appraising the training and assessment of cultural competence and ethical decision making in the health care professions. The integrated relationship of these two concepts is illustrated within the broader contexts of higher education, research and clinical practice. Health care professionals who incorporate cultural competence and ethical decision making will be empowered to provide the best services to their clients/ patients in multicultural contexts to ensure optimum outcomes.

Thesis (MPH.) --University of Limpopo, 2011 / Objectives: To assess the extent of HIV and AIDS related stigma among health care professionals, to identify factors that cause attitudes and perception towards HIV and AIDS related stigma and to determine if HIV and AIDS influence stigma. Study design: A descriptive cross sectional survey. Settings: Tshilidzini Hospital in Limpopo Province, South Africa. Subjects: A total of two hundred and sixty five health care professionals participated in the study. The study employed convenience sampling, when collecting data. The majority of health care professionals were females (77.7%). The average age of participants was 39.5 years with a standard deviation of 9.6. Outcome measures: Subject’s demographic information was determined by use of questionnaire. Age, gender educational level and race were included. Attitudes and perception towards HIV and AIDS patients were also assessed. Analysis: Data were analyzed by SPSS windows version 15.0. Means and frequencies were calculated. ANOVA and T test were employed to assess the comparison of attitudes between health care professionals. Findings: The results showed that the majority of health care professionals do not have negative attitudes towards people living with HIV and AIDS. Out of 265 health care professionals, 69% agreed that they needed to eliminate shame and rejection associated with HIV and AIDS, and 84% indicated that they needed more training to be more sensitive to the needs of people living with HIV and AIDS.Conclusion: Findings from the study showed high positive attitudes and perception among health care professionals towards people living with HIV and AIDS. Government should make provision of protective clothing a priority to reduce the perceived risk of HIV infection. Government should also introduce HIV and AIDS education at the primary level of health care.

The overall aim of this thesis was to provide knowledge on the one handSomalian-born immigrants´ experiences of living with diabetes mellitus (DM)in a new cultural environment, on the other hand their encounter with Swedishdiabetic care – this from both their own point of view and that of the health-care professionals. There was an endeavour to describe methodological aspectsof the interpreter´s role in respect of the trustworthiness of research performedin multicultural societies. A descriptive design was used, involving threequalitative interview studies with an interpreter (Studies II-IV) and onesystematic literature review (Study I). The latter served as a foundation forconducting the interviews with an interpreter and the Matrix Method was used.The same 19 patients with diabetes of Somalian origin participated in StudiesII-IV, joined by five health-care professionals in Study IV. The interviews weresubjected to qualitative content analysis in the case of Studies II and III, and to phenomenograpic analysis in the case of Study IV. In Study I, 13 empirical cross-cultural interview studies with aninterpreter involved were scrutinized. The findings showed that the interpreter’srole in the research process was given little attention. There was usually noaccount either of the style of interpreting, the interpreter’s previous experienceor the seating arrangements for the interviews. On the other hand most of thestudies offered direct or indirect information about the interpreter’s knowledgeof the aim of the research or participation in the transcription of the text or data analysis. The most frequent techniques used to established trustworthiness were prolonged engagement and member checks. A prominent problem for the participants in Study II was to give uptraditional eating habits. Difficulty in managing everyday life was mentionedespecially by women in connection with the need to keep to the diet regimebecause of a lack of understanding and support from family and friends. Tochanging lifestyle was considered as a hard work and a number of barriers wasmentioned especially when it comes to eating habits. The findings showed avariation how the participants managed the fasting month of Ramadan. Thosewho fasted did not see the diabetes as an obstacle, others did so and indicated that fasting was not compulsory for a sick person. In study III the findings showed that women used more supernaturalbeliefs than men when they described their experiences in connection with thediagnosis and their health beliefs. Most of the experiences of receiving thediagnosis consisted of ways of managing this information. Commonlymentioned by the participants, irrespective of gender, when they receiving thediagnosis was a attempt to find some advantages, or positive comparison. Other participants tried to repress the diagnosis and doubted it. Most of theparticipants, irrespective of gender, did not immediately respond with shock orother strong emotion when they received the diagnosis. In study IV the patients conceived the diabetes care as being of highquality but they also conceived limitation with the care. They conceived unmetneeds such as too long waiting times for appointments, not encountering thesame physician every time, lack of contact with specialists and failure toculturally adapt dietary advice. Health-care professionals conceived severalcultural challenges in the encounter such as managing language barriers,illiteracy and traditions such as fasting during Ramadan. In conclusion, this thesis generate knowledge which can serve as afoundation to securing the quality of diabetes care for this patient group andcontribute to working out local diabetic programmes for patients with anotherbackground than the Swedish. In addition the thesis can contribute to makingimprovements when it comes to working with an interpreter in qualitativeinterview studies as well as in clinical settings.