According to Wilkinson and Marmot (2003), the area of ten social health determinants constitutes probably the most comprehensive approach to analysis to the individual's health condition. The goal of the dissertation consisted in assessing the social health determinants in the area of social support, stress, childhood and transportation. The quantitative investigation method of the research subject was implemented through questioning. The research set consisted of legally settled immigrants, living in the Czech Republic for more than one year, in age category of 18-65 years, of Vietnamese, Mongolian and Ukrainian nationality. The respondents lived in selected localities: capital of Prague, South Bohemian Region and Vysočina Region. 246 respondents in total were questioned. The investigation results show that Ukrainians perceive the Czech Republic as their home state more frequently than the Vietnamese and Mongolians. Relationship between selected characteristics of social support, subjective assessment of health, presence of depression and stress symptoms of psychic and physical origin was proved. The ability to communicate in Czech language was shown to be very important in the area of social support. One tenth of the respondents is daily exposed to effect of stress. The Mongolians reported most frequent exposure to stress situations, while the Ukrainians reported least frequent exposure. The most respondents have signs of depression. The respondents who have medium, serious or extreme depression assessed their health with higher statistically significant frequency as mediocre. More exacting movement activities are performed with higher statistically significant frequency by men, university graduates and intellectually working respondents. The immigrants who have reported to perform regular walking and movement activities assess their health as good and report absence of signs of depression. During pregnancy, the female respondents observed regular examinations and the course of their pregnancy was predominantly physiological. A high percentage of female respondents worked 9 and more hours during pregnancy. The health condition of the respondents' youngest children is good; most of them have suffered only common children's diseases. More than one tenth of the respondents' children have no health insurance and vaccination. The immigrants often find themselves in adverse social situation, and it is therefore important to adopt measures to eliminate its impacts. The crucial measures include for example social programs focused on immigrants, preventive programs focused on foreigners' children and increasing language knowledge of the immigrants.

Dental decay is a preventable disease, but it remains the most unmet healthcare need of American children. Untreated dental decay has adverse and long-lasting effects on a child's quality of life. Healthy oral habits among preschool children are essential for a healthy permanent dentition and are achieved primarily by 3 oral health related behaviors: proper dental hygiene, a healthy noncariogenic diet, and regular dental visits. This quantitative study, based on the theory of planned behavior, explored the relationship between these 3 oral health behaviors and 4 determinants: attitude, subjective norms, perceived behavioral control, and intention, using a 71-item questionnaire. The study utilized convenience sampling. A total of 436 parents or caregivers of children enrolled in the North East Independent School District Early Childhood Education program participated in this study; 81.5% were low-income, and 66% reported Hispanic identity. The relationship between variables was evaluated using multiple regression analysis. This study indicated that attitude alone toward a healthy diet and dental hygiene was not a significant predictor of behavior, but the attitude toward dental attendance was significant. Subjective norm, perceived behavior control, and intentions individually and combined were significant predictors of all 3 behaviors, except for subjective norm towards hygiene. Meaningful social change can be achieved by identifying and understanding the underlying motives that evoke planned and deliberate oral health behaviors among parents of preschool children. Targeted messages and cost-effective early interventions can be developed to prevent the onset of dental disease and improve the quality of life for low-income children.

Abstract: Aim: This study aimed at getting an understanding and critical analyses of the Ethiopian government empowerment strategy in improving maternal and child health in Ethiopia.Method: This is an ethnographic study, in which mainly un-structured interviews, focus group discussions and participant observation were conducted to collect data for the study. Results: The study concluded that the empowerment intiative has been promising to some extent in addressing the health concerns of women and children in Ethiopia. However, lack of bottom up health promotion strategies such as geniune community participation in the designing and implementation of the health program has greatly hindered the health promotion program from effectively improving the health status of women in the studied community.

Background: Along with the austerity measures introduced in many countries, the economic crisis affecting Europe since 2008 seems to have impacted many aspects of the health of the Spanish population and has had a negative effect on the provision health services. An increasing body of knowledge has shown a clear impact of the current crisis on suicidal behaviour and mental health, and a less consistent effect on physical health and access to healthcare. However, little is known about the impact of the crisis on social inequalities in health and healthcare access, an area on which the present study seeks to shed light in the context of Spain, and specifically Andalusia, a region hit very hard by the crisis. Objective: To study the impact of the economic crisis starting in 2008 on health, health inequalities and health service utilisation in Spain and Andalusia and the roles of socio-demographic factors in these associations. Methods: Death rates were analysed to study the annual percent change in overall and cause-specific mortality in Spain between 1999 and 2011, and the Longitudinal Database of the Andalusian Population was used to study educational inequalities in overall mortality from 2002 to 2010 (study 1). To calculate suicide attempt rates, information from 2003 to 2012 on 11,494 men and 12,886 women provided by the Health Emergencies Public Enterprise Information System in Andalusia was utilised. The association between unemployment and suicide attempts was studied through linear regression models (study 2). Two waves of the Andalusian Health Survey (2007 and 2011–12) provided data for the third and fourth studies of this thesis. Educational and employment status inequalities in poor mental health in relation with the crisis were analysed through Poisson regression models (study 3). The change in inequalities (pre-crisis–crisis) in health care utilisation outcomes (general practitioner, specialist, hospitalisation and emergency attendance) was measured by the change in horizontal inequality indices. A decomposition analysis of change in inequality between periods was performed using the Oaxaca approach (study 4). Results: Study 1: Overall mortality in Spain decreased steadily during the period, with annual percent changes of -2.44% in men and -2.20% in women. An increase in educational inequality in mortality was observed in men in Andalusia. In women, the inequalities instead remained stable. Suicide mortality showed a downward trend in both sexes in Spain. Study 2: A sharp increase in suicide attempts in Andalusia was detected after the onset of the crisis in both sexes, with adults aged 35 to 54 years being the most affected. Suicide attempts were associated with unemployment rates only in men. Study 3: Poor mental health increased in working individuals with secondary and primary studies during the crisis compared to the pre-crisis period, while it decreased in the university study group. However, in unemployed individuals poor mental health increased only in the secondary studies group. Financial strain could partly explain the crisis effect on mental health among the unemployed. Study 4: Horizontal inequality in utilisation changed to a greater equality or a more pro-poor inequality in both sexes. In the decomposition analysis, socioeconomic position and health status showed greater contributions to the changes in inequalities. Conclusion: This thesis illustrates the complexity of the influences of the current economic crisis on health inequalities in a Southern European region. Specifically, no noticeable effects of the crisis on overall and suicide mortality were detected; instead, increasing educational inequalities in mortality in men and a large increase in suicide attempts in middle aged men and women were observed. The deterioration in poor mental health was mainly detected in those of intermediate educational level. Economic conditions such as unemployment and financial strain proved to be relevant. Finally, in the light of no increased inequalities in healthcare utilisation, the universal coverage health system seems to buffer the deleterious effect of the crisis and austerity policies in this context.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

The aim of the study was to determine the practice of nurses employed in integrated care projects in New Zealand from late 1999 to early 2001. Integrated care was a major health reform strategy that emphasised primary health care as a means to improve service provision between the health sectors. An investigation of nurses’ practice sought to determine the extent to which primary health care principles had been adopted in practice, as a comprehensive primary health care approach has been advocated globally in the management of chronic conditions; the leading cause of disability throughout the world and the most expensive problems faced by health care systems. The philosophical basis of the research was postpositivism. The study employed a quantitative non-experimental survey design because it allowed numeric descriptions of the characteristics of integrated care projects to be gained for the purpose of identifying nurses’ practice. The unit of inquiry was the integrated care project, and 80 comprised the study population. Data were obtained on projects from expert informants (n=27) by telephone survey using a structured interview questionnaire developed by the researcher. Data obtained from interviews were statistically analysed in two stages. First, data were produced to comprehensively describe the characteristics of integrated care projects and nurses practice. The ‘Public health interventions model’ was used as a framework to analyses the interventions (activities) and levels of population-based practice of nurses. Following this, the social values embedded in nurses’ practice were determined using ‘Beattie’s model of health promotion’ as a framework for analysis. A strong association was found between nurses’ practice in projects and strategies used in integrated care, such as information sharing, guideline development and promotion, and case management, and projects with an ethnic focus, low income focus, chronic condition focus, and well-health focus. Whilst nurses undertook interventions most frequently at the individual practice level they were also strongly ii associated with the small proportion of interventions that were undertaken at the community level. The majority of interventions by nurses reflected the health promotion value of health persuasion, indicating a paternalist and individual-oriented philosophy. Nurses were engaged in two interventions that indicated a collectiveoriented philosophy - coalition building and community development, the latter reflecting health promotion values of negotiation, partnership and empowerment. The study demonstrated that nurses’ practice in projects was predominantly centred on individual-focused population-based practice suggesting the need for a framework to assist nurses to transition their practice to include more activity at the community and systems levels. Without a reorientation of practice, nurses will remain limited in their ability to achieve health gains for populations. In response to this conclusion, and drawing on research results and reviewed literature, a new model, The ‘Primary Health Care interventions model’ was constructed. Recommendations include advocacy for the acceptance of the model by the health funder, professional nursing bodies, health organisations, educational institutions, nurses, communities, and individuals.

This diploma thesis deals with the topic of health literacy level in the Czech population and its association with sociodemographic and lifestyle factors. The aim was to describe this association in the stages of health information processing, which are the stages of finding, understanding, judging and application of health information. The data from the Czech modification of the HLS-EU survey from 2014 was used. Lower level of health literacy was associated with older age, lower level of education, as well as lower self-assessed social status at all stages of health information processing. Lower self- assessed health condition was also associated with lower level of health literacy, especially in the phases of understanding and application of health information. Regarding the lifestyle factors, the association was determined in case of physical activity, most notably in the phases of understanding and application of health information. The association was also determined in the case of body mass index, but only in phases understanding and judging. Differences in health literacy levels between smoking categories as well as between gender were not been determined. Regarding the difference between phases of health information processing, the judging of health information seems to be the most risk.

Studier visar på att transpersoner i Sverige upplever sämre villkor för sexuell hälsa jämfört med övriga befolkningen. Den forskning som finns att tillgå pekar på att normer kring kön och sexualitet är en av de faktorer som influerar transpersoners upplevda sexuella hälsa. Mot denna bakgrund konstateras på flera håll att människobehandlande professioner behöver satsa på kunskapshöjning och kompetensutveckling för att förbättra transpersoners möjligheter till god hälsa. En förutsättning för detta är att det finns kunskap som representerar transpersoners egna erfarenheter av hur normer och förväntningar samspelar med sexuell hälsa. Det är något som saknas i nuläget. Studiens syfte är därför att fylla denna kunskapslucka genom att undersöka transpersoners subjektiva upplevelser av hur köns- och sexualitetsnormer påverkar förutsättningarna för sexuell hälsa. Uppsatsens empiri bygger på kvalitativa intervjuer med 8 personer som identifierar sig själva som transpersoner. Materialet har analyserats och tematiserats med hjälp av Sara Ahmeds (2006) queera fenomenologi och Gagnon och Simons (2005) teori om sexuella script. Resultatet visar att normer kring kön och sexualitet upplevs influera sexuella livsvillkor på komplexa och mångfacetterade sätt. Denna påverkan tycks ske genom att normer influerar såväl samhällsstrukturer, interpersonella möten som intrapsykiska attityder. Normer upplevs på så vis som ett yttre och inre tryck på samma gång. Studiens slutsats är att personer med normöverskridande könsidentiteter bemöts av omvärlden på ett sätt som begränsar förutsättningarna för sexuell hälsa. Samtidigt pekar resultatet på att normöverskridandet kan främja vissa aspekter av sexuell hälsa genom att det medför en vidgad horisont från vilken det blir möjligt att utforska sex och sexualitet bortom rigida genusnormer. Att existera helt bortom samhällets normativa strukturer upplevs dock som en omöjlighet. Det är därför tydligt att ett mindre cisnormativt samhälle krävs för att transpersoner ska kunna åtnjuta samma sexuella livsvillkor som den övriga befolkningen. Denna slutsats trycker på att det finns ett behov av att utveckla det sociala arbetets praktik för att säkra transpersoners rätt till jämlika levnadsvillkor. / Studies show that the transgender population in Sweden experience poorer conditions for sexual health compared with the rest of the population. The available research indicates that gender norms are one of the factors that influence transgender people's perceived sexual health. Against this background it has been argued that human service organizations need to invest in knowledge and skill development in order for transgender people’s sexual health to be improved. Knowledge that represents transgender people's own experiences of how norms and expectations interact with sexual health is needed for this to be possible. This knowledge is currently lacking. The purpose of this study is therefore to fill this gap by examining transgender people’s subjective experiences of how social norms affect the conditions for sexual health. The study is bases on qualitative interviews with 8 people who self-identify as transgender. The material has been analyzed and thematized based on Sara Ahmed’s (2006) queer phenomenology and Gagnon and Simon's (2005) sexual script theory. The results show that norms are perceived to influence sexual living conditions in complex and multifaceted ways. This influence seems to occur as societal structures, interpersonal encounters as well as intrapsychic attitudes are shaped by social norms. In this way, norms are experienced as an external and internal pressure simultaneously. The study concludes that transgender people are treated in a way that creates poor conditions for sexual health. At the same time, the results indicate that gender nonconformity can promote sexual health by creating space for sexual exploration beyond rigid gender norms. To exist completely beyond society's normative structures, is however perceived as an impossibility. It is therefore clear that a less cisnormative society is required for transgender people to be able to enjoy the same sexual living conditions as the rest of the population. This conclusion emphasizes the need to develop the social work practice to secure transgender people’s rights to equal living conditions.