Research into the use of information by health care professionals has generally been conducted in countries dominated by the biomedical model. In these contexts, illness is considered to have a scientifically identifiable physical cause, and treatment practices within the formal health care sector are prescribed and managed in accordance with this definition. Yet there are also contexts where other belief systems inform and guide the way that people think about their health. In comparison to the biomedical model, these contexts have contributed very little to our understanding of how health professionals develop their knowledge. This research investigates how primary health care workers (PHCWs) in one such context, Papua New Guinea (PNG), develop their knowledge about the health services they provide. In order to discover and understand the differing views of these PHCWs, 69 semi-structured interviews were conducted in three culturally and geographically diverse regions of PNG. In explaining the diagnostic and treatment practices they use, these participants provided insights into not only how PHCWs engage with information but also how it informs their professional practice. These data were analysed, interpreted and discussed using a framework consisting of four, primary but interconnecting aspects: the context in which information was provided, the interactions with the sources of information, the processes by which information was understood, and the outcomes realized as a result of the information being used. Findings indicated that the majority of participants in this study acknowledged, if not incorporated, information pertaining to biomedicine, Christianity and Indigenous belief systems into their diagnostic and treatment practices. Even when these belief systems clearly contradicted each other, PHCWs did not in general feel the need to make a conscious choice between them. From their comments it would appear that four factors contributed to this ability to incorporate diverse and often conflicting ideas into the way that patients were cared for. First, all of the belief systems were considered legitimate by at least one group of people connected to the community in which the PHCW worked. Second, although varying in degrees of availability and accessibility, members of these groups were able to disseminate information pertaining to the belief system they supported. Third, the PHCW had no particular affiliation with any one of these groups but instead regularly interacted with a range of different people. Lastly, the PHCW worked in situations where health practices were not generally well supervised by their employers and therefore they were relatively free to choose between various diagnostic and treatment practices. The qualitative interpretive approach adopted in this thesis contributes to the field of human information behavior by affirming that conflict is in the eye of the beholder. When a number of belief systems coexist and all are considered legitimate, information about them is freely available, and the recipients actions are neither constrained by their own dogma, nor imposed upon by others, individuals may quite comfortably embrace diverse beliefs. These findings may also contribute to a better understanding of health management practices in developing countries by suggesting that health professionals are not merely personifications of a biomedical model. Instead, the study demonstrates that multiple belief systems can be combined by PHCWs, and that in turn this benefits the formal health care sector through increased treatment options that are both appropriate and effective in such circumstances.

This dissertation presents in the form of two distinct chapters conceptually related in nature. The first chapter integrates literature from various fields such as indigenous, womanist, and feminist lenses to propose nine principles when working with Muslim women. The purpose of the second chapter is to examine Muslim women’s experiences in therapy at university counseling centers. The study explores women’s experiences from a social determinants of health perspective and a narrative inquiry method—namely, how intrapersonal, interpersonal, institutional, community, and policy factors inform women’s experiences. Qualitative analysis from interviews with six women suggests Muslim women navigate multiple systems which inform their beliefs about health and their experiences in therapy.

<p>Preterm birth is the leading cause of newborn mortality, with 15 million babies born premature worldwide every year. Children that do survive early delivery are more likely to develop cognitive abnormalities, motor deficits, heart disease, cerebral palsy, and more. While little is known about the pathophysiology of preterm birth, several pregnancy-related complications are related to preterm birth, namely cervical insufficiency and preeclampsia. In the former, premature cervical remodeling and softening can result in the shortening of the cervix, increasing a woman’s risk of preterm birth; this condition is called cervical insufficiency (CI), which is the inability of the cervix to remain closed as a result of weakened tissues. CI is currently measured by a one-dimensional sonographic cervical length, where < 25 mm indicates shortening. Preeclampsia is a disorder that can be explained through the Page kidney phenomenon: compression of the left renal vein (LRV) causes renal venous outflow obstruction, leading to elevated intrarenal pressure and hypertension. The supine pressor test (SPT) is a diagnostic tool for preeclampsia where a positive test is defined by an increase of 20 mmHg in diastolic blood pressure (BP) when shifting from the left lateral recumbent to the supine position. Due to the intense risk of morbidity and mortality for both the mother and the fetus, the need to monitor BP changes is critical. Currently, there is an unmet clinical need to characterize the hemodynamic and geometric properties of the female reproductive organs throughout gestation. Utilizing ultrasound imaging can increase our knowledge about the 3D anatomy and systemic changes during pregnancy, unravel risk factors, establish preventative methods, and standardize treatment plans. In this thesis research, we developed a murine model to 1) examine the pathophysiology of renal vein stenosis, and 2) investigate the effects of stenosis on various cervical dimensions. Renal vein stenosis was found to greatly impact blood flow velocities, as well as cervical width (<i>p<0.05</i>). LRV and cervical area and height also trend towards significance, and there is negative damage to the left kidney and placentae within the stenosed cohort. We also conducted a human study that showed reduced change in postural BP in patients with higher body mass index (BMI). Systolic and diastolic BP in the supine position was significantly greater than in the lateral position for all BMIs with a baseline increase in BP of approximately 9-14 mmHg. These findings suggest that therapeutic positioning and close monitoring of BP could mitigate the risk of developing related disorders in pregnancy.</p>

The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.