Internetbasierte Gesundheitsinterventionen (IGI) finden aufgrund ihrer Vorteile und Möglichkeiten eine zunehmende Verbreitung und sind zugleich ein innovatives Forschungsfeld. Sie ermöglichen eine schnelle und weite Verbreitung bei relativ geringen Kosten pro Teilnehmer/in. Die ortsunabhängige Zugänglichkeit der Gesundheitsangebote erleichtert die Versorgung auch im ländlichen Raum. Weitere Vorteile bestehen in der zeitlich unabhängigen Nutzung, die sich leicht in den individuellen Tagesablauf integrieren lässt, ebenso wie in der Wahrung der Anonymität der Nutzer/innen, die eine offene und ehrliche Auseinandersetzung mit potentiell schwierigen Themen in einer Gruppe erleichtern kann. Diese Erwartungen sind die logische Konsequenz von Befunden aus der Grundlagenforschung zu computervermittelter Kommunikation.

Different public health interventions such as social distancing, quarantine, use of masks in a public place, airport, and public transport restriction, closing of school, college, and shops, or even city lockdown were implemented around the world to control the spread of the highly transmissible virus ‘‘SARS-CoV-2’’, which is responsible for the current pandemic of Covid-19 disease. Like other countries, Sweden also introduced policies like banning public gatherings, commencing distance learning, keeping social distance in public places, suspending flights to and from different countries, closing religious places, banning visits to elderly homes, and many more. This paper examines if such action or recommendations are effective in controlling the spread of Covid-19 disease.The efficiency of these policies at each county in Sweden was evaluated and the effect of temperature on Covid-19 was analyzed using the data from the last week of December 2019 to the last week of September 2020. The statistical inferences were drawn from the multivariate time series model (hhh4) in R. Similarly, QGIS and ggplot2 library in R were used for descriptive analysis.Among all the studied policies, banning the crowd on restaurants and bars, and restricting the number of people for demonstration in Sweden were the most effective methods to reduce the rate of disease spread in almost all the counties. The number of ICU and death cases were low during high temperature in Sweden. The outcome of this study can be useful to implement health policies to manage similar disease outbreaks in the future.

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Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire; 2) Review the current literature on the availability and effectiveness of mobile phone interventions targeting sugar-sweetened beverage (SSB) consumption; and 3) Use the updated BEVQ-15 to conduct the Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The Healthy Beverage Habits study was an online randomized controlled pilot trial with an 8-week intervention and a 4-week maintenance period delivered through Instagram. The materials were adapted from the in-person SIPsmartER SSB reduction intervention. Data analysis included RM-ANOVAs to test for differences in beverage intake between the Instagram intervention group and the E-mail control group. Results: For the Healthy Beverage Habits trial, no significant between group over time differences were found. However, the Instagram group demonstrated a significant reduction in total beverage kcal (mean difference±SE=-156±48; p=0.049), and increase in total HBI scores (mean difference±SE= 11.9±2.3; p=0.025) from baseline to the end of the maintenance period. No within group differences were demonstrated for the E-mail control group over the intervention or maintenance period. The study retention rate was 38%, with 39 participants initially enrolled and 15 participants completing all study visits through maintenance. Results for the validity and reproducibility of the updated BEVQ-15 and a review of the availability and effectiveness of mobile phone interventions targeting SSB consumption are presented. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions. / Doctor of Philosophy / Background: Poor beverage consumption habits pose significant health concerns. Delivering health behavior change interventions via social media is an emerging area of health research and may provide a promising way to minimize barriers such as cost, intervention delivery time, and access. However, there is limited research on online social support health behavior change delivered through Instagram. Objectives: 1) Assess the validity and reproducibility of the updated BEVQ-15, a beverage intake questionnaire which estimates habitual average daily intake of 15 beverage categories as well as total sugar-sweetened beverages (SSB) and total beverages. 2) Review the current literature of the availability and effectiveness of mobile phone interventions targeting SSB consumption. 3) Use the updated BEVQ-15 to conduct The Healthy Beverage Habits pilot study, which is an online social networking worksite intervention aimed at improving Healthy Beverage Index (HBI) scores. Methods: The updated BEVQ-15 was assessed for agreement between the BEVQ-15 and dietary recalls. Researchers compared beverage intake between two BEVQ-15 administrations. The Healthy Beverage Habits pilot study was an 8-week intervention with a 4-week maintenance period. Data analysis included testing for differences in beverage intake between the Instagram group and the E-mail group. Results: The updated BEVQ-15 demonstrated moderate agreement between the BEVQ-15 and dietary recalls for total SSB intake and total beverage intake. All beverage variables were significantly correlated. For the systematic review, 11 of the 17 studies (65%) were successful in reducing SSB consumption through mobile phone delivery. The successful studies used multiple types of technology. There were no significant differences for any beverage variable between the Instagram and E-mail groups over time. However, for within group changes, Instagram significantly reduced total beverage kcals and improved total HBI score, while the E-mail group did not demonstrate any significant changes. Conclusions: Mobile phone-delivered interventions may be a promising method for improving beverage intake quality. Technologically-based interventions targeting beverage consumption should consider utilizing multiple forms of mobile-phone contact methods. The preliminary findings from the Healthy Beverage Habits pilot trial highlight the need for more rigorous studies that determine which technology and intervention components are most effective for mobile-delivered beverage consumption interventions.

Background: Public health interventions are any activity with the objective of improving human health such as preventing or curing disease, reducing the severity or duration of a disease, or assisting in regaining function after a disease or injury. These interventions are known to be impactful; however, those living with the highest burden of disease such as individuals in low- and middle-income countries have limited money and resources to successfully implement these interventions. Southeast Asian countries are among some of the middle-income countries effected by the lack of affordable interventions. The aims of this study were to assess cost saving and resource limited interventions and understand how sociodemographic and housing characteristics predict knowledge and attitudes of health and social issues. Methods: A scoping review was completed to synthesize literature regarding cost saving and resource limited global public health interventions following the PRISMA ScR guidelines. Data from the Demographic and Health Survey were used to conduct multivariable linear and logistic regression to assess the association of knowledge and attitudes of different health outcomes. Lastly, a pre- post- intervention analysis was conducted to assess the effectiveness of a solar light distribution program in a rural area of the Philippines. Results: The results from the scoping literature review highlighted the importance of handwashing as a cost saving and resource limited Water and Sanitation Hygiene intervention and that more researched should be conducted on interventions associated with access to light and women’s safety. The Demographic and Health Survey study found that there were statistically significant differences in people’s attitudes and knowledge chronic and infectious disease, water and sanitation hygiene and women’s safety based on their sociographic and housing characteristics. Finally, while the study sample size was too small to determine statistical significance of the overall program, participants did report improved outcomes after the solar light intervention in the Philippines. Implications: The findings from these studies highlight the need for additional cost saving and resource limited interventions in Southeast Asia. Continued research needs to be conducted to advance public health in underserved countries and communities.

Yes / Refugees often face barriers to accessing health services, especially after resettlement. The aim of this study is to identify key elements of effective public health interventions that address barriers to health services for refugees. Methods: Key online databases were searched to identify studies published between 2010 and 2019. Six studies met the inclusion criteria: two qualitative, one quantitative and three mixed-methods studies. An adapted narrative synthesis framework was used which included thematic analysis for systematic reviews. Results: Five themes were identified: peer support, translation services, accessible intervention, health education and a multidisciplinary approach. Conclusion: These key elements identified from this review could be incorporated into public health interventions to support refugees’ access to health services. They could be useful for services targeting refugees generally, but also supporting services targeting refugee resettlement programmes such as the Syrian resettled refugees in the UK. Future research is needed to evaluate the impact of public health interventions where these elements have been integrated into the intervention.

Young women are particularly vulnerable to HIV. Despite the successful HIV prevention efforts in Thailand in the past, young Thai women are at increased HIV risk and in urgent need of effective HIV interventions. Numerous studies have emphasised the importance of family in determining young people’s sexual behaviour. This thesis explores the roles of family in shaping young people’s sexual decisions and examines the potential of family-involved HIV interventions (FIHIs) for young Thai women. The thesis systematically examines studies across settings to determine whether involving family in HIV interventions could influence young people’s sexual behaviour. The findings suggest that FIHIs have a potential in shaping young people’s condom use practices. It identifies several key characteristics of effective FIHIs that can potentially be valuable for future HIV development in other contexts. Qualitative data collected from focus groups of young Thai women in Bangkok are analysed using the framework developed from the systematic review of qualitative studies. The findings highlight several challenges for future FIHIs for young Thai women. These are barriers to parent-child communication, a tension of coexistence of two divergent sexual norms - traditional/Thai versus modern/globalised, alternative sources of sexual health and HIV knowledge, the importance of family relationships, and the different circumstances and needs of young Thai women from different backgrounds. Future FIHIs for young Thai women should consider a comprehensive, structural and eco-developmental approach, simultaneously targeting both individuals and the wider environment. This thesis offers a new contribution to the HIV prevention and sexual health education literature and identifies the potential effectiveness of FIHIs tailored to young Thai women,constituting an important step in addressing the public health problems of HIV/AIDS infections in Thailand.

The study of health disparities and the social determinants of health has resulted in the call for public health researchers to investigate the mid- and upstream factors that influence the incidence of chronic diseases (Adler & Rehkopf, 2008; Berkman, 2009; Braveman P. , 2006; Braveman & Gottlieb, 2014; Krieger, 2011; Rose, 1985). Social ecological models (SEMs) provide important conceptual tools to inform this research and practice (Krieger, 2011; Golden & Earp, 2012; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008; Glanz, Rimer, & Lewis, 2002). These models can help us look at the social and physical environments in rural Arizona communities and consider how health policies and environmental interventions address mediating factors, such as disparities in access to fresh food, that contribute to ill health in marginalized, rural, populations. Rural residents are at greater risk for obesity than their urban counterparts (Jackson, Doescher, Jerant, & Hart, 2006; Story, Kaphingst, Robinson O'Brien, & Glanz, 2008). And while human life expectancy has steadily increased over the past thousand years, current projections indicate that the rise in obesity-related illnesses will soon result in its decline (Olshansky, et al., 2005). One reason for this decline, may be the reduced availability of healthy food – an important predictor of positive health outcomes including reduced obesity and chronic disease - in many parts of the United States (Brownson, Haire-Joshu, & Luke, 2006; Ahen, Brown, & Dukas, 2011; Braveman & Gottlieb, 2014; Braveman, Egerter, & Williams, 2011). The United States Department of Agriculture (USDA) defines food deserts as geographic areas in which there is limited access to grocery stores and whose populations have a high rate of poverty. In Arizona, 24% of the rural census tracts are considered food deserts; compared to an average of eight percent of rural census tracts across the nation (United States Department of Agriculture, 2013). Food deserts are one example of the upstream factors influencing the health of rural populations. Local health departments have been encouraged through the National Association for City and County Health Officials (NACCHO) and through the Public Health Accreditation Board (PHAB) to conduct community health assessments (CHAs) in order to identify unique contexts and community resources, health disparities, and the social determinants of health as well as potential areas for advocacy, policy change, environmental interventions, and health promotion interventions. Public health challenges like chronic diseases, which have multiple causes, can be explored in-depth through CHAs. CHAs often contain recommendations for action and/or are followed by community health improvement plans (CHIPs) which help local health departments prioritize resources and set measurable goals. In Florence, AZ recommendations made in a CHA are being acted upon by a non-profit agency, the Future Forward Foundation (3F). This investigation explores two interrelated issues regarding the use of CHAs and CHIPs as practical tools to set public health priorities. First, what makes a CHA useful to rural public health practitioners? What methods of conducting a CHA and subsequently analyzing the data results in actionable policy recommendations and/or environmental level interventions? Second, to what extent can public health agencies engage nontraditional partners to work in partnership to address the social determinants of health? As an example, I will look at the impact of a volunteer-based non-profit agency, located in a rural food desert on improving the social and physical nutrition environment as recommended by a local CHA. This inquiry will provide insights to public health practitioners seeking to identify and implement policy and environmental change addressing complex, multi-causal, public health issues, and provide insights regarding engaging nontraditional partners who may not self-identify as public health agencies.

Syftet: Var att beskriva äldres upplevelser av åldersrelaterad yrsel fysiskt, psykiskt och socialt samt att belysa vårdåtgärder som kan bidra till att förbättra dagligt liv. Metod: Examensarbetet genomfördes som en litteraturstudie med artiklar hämtade från databaser inom vårdvetenskap/medicinsk vetenskap. Resultat: Yrsel kan upplevas som en svår funktionsnedsättning att leva med. En samsjuklighet till somatiska sjukdomar och korrelation till psykisk belastning är vanligt. Påverkan på sociala faktorer medför en begränsning i att klara sitt dagliga liv och sitt förhållande till omgivningen. Många saknade bekräftelse från hälso- och sjukvården. Vestibulär rehabilitering förbättrade symtom, balans och yrselrelaterade handikapp. Likaså har kognitiv beteendeterapi i kombination med vestibulär rehabilitering visat sig ha positiv effekt. Det fanns ett behov av individuellt utvecklade åtgärder och stöd med ett tvärprofessionellt perspektiv. Slutsats: Yrsel är ett svårt handikapp att leva med och ger konsekvenser såväl fysiskt, psykiskt samt socialt. Det är viktigt med en utvecklad och strukturerad sjuksköterskeroll där den äldre får stöd och rådgivning med möjlighet att diskutera strategier för att lära sig hantera yrseln. Rehabilitering samt undervisning om hur balanssystemet fungerar har visat sig vara värdefullt samt är dessutom kostnadseffektivt. Vidare fanns ett behov av äldres perspektiv i utvecklandet av vårdåtgärder i tvärprofessionell samverkan och det är viktigt att inte underskatta äldres upplevelser av yrsel.

Purpose: This study was initiated to verify whether a remarkably high rate of postpartum depression (PPD), previously found in immigrant Hispanic women receiving health care at a community clinic, would also be found in a community sample with a similar demographic. Data Sources: Sixty immigrant Hispanic women who had recently given birth were recruited from local community settings. The Beck Postpartum Depression Screening Scale-Spanish version (PPDS-S) and the General Acculturation Index (GAI) were used to screen for PPD symptoms and to collect demographic data. These data were then compared with previously published data from the community clinic sample. Conclusions: Sixty percent of the immigrant Hispanic women in our community sample showed significant PPD symptoms as scored on the Beck PPDS-S. There was no significant difference found in demographics or in types of PPD symptoms between the clinic sample and the community sample. Of all the demographic data, the only statistically significant positive predictive factor for increased PPD symptoms was having a previous history of depression. In addition, 54% of the sample had an elevated symptom content profile score for suicidal thinking. Implications for Practice: Health practitioners should be aware of a potentially high rate of PPD in this population, especially in light of previously studied increased rates of suicide attempts in Latinas. If a prior history of depression is predictive of PPD, it is possible that many of the mothers in our sample suffered from depression prior to the postpartum period, but were not appropriately diagnosed or treated. Recommendations for outreach and further research are discussed. In particular, further research regarding the prenatal prevalence of depression in immigrant Hispanic women is recommended in order to further understand the high incidence of PPD.