Purpose: The purpose of this study is to evaluate and compare the extent and potential correlates of sexual risk taking behaviors related to condom use and number of sexual partners among Haitians aged 15 to 49 years old living in the urban and rural areas. Methods: Data were obtained from the 2005-2006 cross-sectional survey conducted by the Demographic Health survey. Our study population (15143) was analyzed based on the Health Belief Model (HBM) theory using a bivariate and multiple logistic regression analysis with SPSS for windows. Results: In both rural and urban areas dwellers had an accurate knowledge of the disease. However, a small proportion in both areas used condoms during their last sexual intercourse. Perceiving the disease's severity was more likely associated with condom use in the urban (OR 1.36, p ≤ .01) and in the rural areas (OR 1.45, p ≤.05). Strong associations have been found between some variables of the HBM and condom use but none have been found associated with zero or one sex partner. Findings were similar in both areas Conclusion: Holistic approach should be considered in the prevention strategy conducted in Haiti to tackle other factors that may contribute in delaying responsible sexual behavior in that country.

The purpose of this capstone is to develop a program to address health literacy among African American adults. The social cognitive theory and the health belief model was used to create a model of an age appropriate, culturally sensitive program with a pre and post test to improve the health literacy in this population. The Community Health Literacy Improvement Program (CHIP) is a pilot program that will consist of a four week didactic intervention focused on combating prose, document, and quantitative health illiteracy. This program will be implemented through a community based nonprofit organization. Participants who complete the CHIP program will be able to identify risk factors for chronic diseases, assess their ability to avoid chronic diseases, and be able to locate community health resources. This proposed intervention will show that community based nonprofit organizations have an important role to play in building community buy in and establishing the agency necessary for community based, culturally sensitive programs such as CHIP to succeed.

This study examines the use of songs, poems and drama to raise awareness of, and respond to the HIV/AIDS epidemic in Nakuru, Kenya. The primary focus is that of youth-oriented interventions, but additional examples are also examined and analyzed. A qualitative approach is used and the study is based on semi-structured interviews with teachers, performers, students, NGO-representatives and former students conducted during four weeks in November and December 2012. Additionally, songs, poems and dramas have been collected and observed and finally analyzed using a theoretical framework that combines the Health Belief Model, the Social Cognitive Theory as well as principles of the research discipline of Medical Ethnomusicology. The study shows that songs, poems and drama are important methods to communicate messages and play an important role in shaping the local HIV/AIDS discourse. Due to its effectiveness, it is vital that the messages promoted are culturally appropriate as well as correct since the study shows that false information through these methods can hamper a desired behavior change.

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

Obstructive Sleep Apnoea (OSA) is a common sleep disorder for which Continuous Positive Airway Pressure Therapy (CPAP) is the standard treatment. Despite the effectiveness of this treatment, CPAP acceptance and adherence rates are generally suboptimal. The aim of this dissertation was to validate a new, inclusive Health Belief Model (HBM) for the prediction of CPAP acceptance and adherence. It was argued that the HBM could predict future adherence even before patients have experienced the treatment, thus providing valid intervention targets to improve CPAP acceptance as well as adherence. Modifiable constructs that are proximal to the decision making process for OSA patients, were identified from the literature (Chapter 1). Along with the generic HBM constructs of perceived benefits, barriers, severity, risk, self-efficacy and cues to action, additional predictors were incorporated in the OSA specific model. These included biomedical indices of objective disease severity and measures of psychological distress. Study One assessed 77 newly diagnosed, CPAP naïve OSA patients on a questionnaire battery at baseline (prior to CPAP treatment). The questionnaire included HBM measures which were available in the literature; benefits perception, self-efficacy, functional severity, and perceived risk of negative health outcomes. CPAP adherence was assessed at four month follow-up. This initial investigation found that health beliefs alone explained 21.8% of the variance in CPAP adherence, whilst health beliefs and biomedical indices together explained 31.8% of the variance in CPAP adherence. The greatest proportion of CPAP adherence was explained by higher benefits perception, greater severity and lower risk perception. Study Two reported on the development and validation of a measure of the barriers construct (as no measure of this existed). A sample of 113 newly diagnosed, CPAP naïve OSA patients completed a questionnaire containing potential items of the Barriers to CPAP Use questionnaire (BACQ) at baseline. Exploratory Factor Analysis (EFA) showed a two factor structure of the eight-item BACQ, with ‘Barriers’ and ‘Cost of Treatment’ subscales identified. The BACQ had an internal consistency of 0.82 and readability at a fifth grade reading level. The aim of Study Three was to develop a valid and reliable measure of the cues to action construct. A sample of 63 OSA patients (from the total 113 patients assessed in Study Two) completed a questionnaire containing potential items of the Cues to CPAP Use questionnaire (CCUQ) one month after being prescribed CPAP. EFA showed a three factor structure of the nine-item CCUQ, with ‘Health Cues’, ‘Partner Cues’ and ‘Health Professional Cues’ subscales identified. The CCUQ demonstrated modest internal consistency and split-half reliability, and readability at a seventh grade level. Study Four incorporated three sub-studies which assessed the accuracy of the fully articulated HBM (including the BACQ and CCUQ measures) in predicting CPAP adherence at two months. Study Four A reported on the same sample of 113 CPAP naïve patients (from Study Two). Structural Equation Modelling demonstrated the complex relationship between health beliefs, psychological variables, and biomedical indices in CPAP adherence. The full HBM predicted 24% of the variance in CPAP adherence at two months. Adherence was directly predicted by lower perception of treatment cost as a barrier to CPAP use, higher self-efficacy, and higher BMI. Study Four B reported on 63 patients who completed HBM questionnaires at one month. The model predicted 42% of the variance in CPAP adherence at two months. Adherence was directly predicted by greater benefits perception, greater psychological distress, and lower perception of the Health Professional as the important cue to action. Study Four C investigated changes in health beliefs between baseline and one month. By one month patients generally reported more positive attitudes to CPAP, and better overall functioning. These changes did not correlate with CPAP adherence. Those who used CPAP more than four hours per night demonstrated greater improvement in functional severity and in anxiety score. Study Five used the findings of the HBM studies in developing a theory-driven Motivational Intervention (MI) to target specific beliefs associated with poor adherence. 101 newly diagnosed, CPAP naïve OSA patients were randomly assigned to nurse-led MI + Standard Care (50 participants), or to Standard Care only (51 participants). MI patients received two sessions before starting CPAP, and one session one month after CPAP prescription. By three months, the MI group used CPAP 50% more of the time, and were six times less likely to reject CPAP. The MI group demonstrated greater self-efficacy and a lower perception of barriers to CPAP use. The findings were largely supportive of the HBM theory of CPAP adherence. The substantive findings of this dissertation were that patients do need relevant, timely and targeted support in order for them to effectively commence on CPAP and then continue to adequately adhere. At a minimum, psychological intervention, such as a Motivational Intervention, is likely to be needed for the subset of patients who report beliefs associated with poor adherence at pre-treatment.

Background: Systembolaget is one of the distinctive features of Sweden. It is the only store allowed to sell alcohol above 3.5% of alcohol by volume. The aim of this government-owned company is to educate Swedish customers to engage into responsible drinking patterns. To do so, they make use of advertising strategies depicted on several channels with the purpose of increasing individuals’ knowledge and thus, enhance public health. Besides, Scandinavian cultures are associated with high-risk behaviours regarding the average amount of alcohol drunk. Several studies underlined that students regularly engage into binge drinking and other irresponsible behaviours. Purpose: The aim of this study is to emphasize the effect of Systembolaget’s communication strategy on the attitudes, intentions, and behaviour of Swedish students. To fill the research gap and fulfil the objectives, a combination of the Health-Belief Model and the Theory of Reasoned Action is an adequate mean. Method: To gather the material needed for the research and uncover new insights, we chose an exploratory design. The semi-inductive approach allows to investigate the theoretical concepts while being able to use induction and thus, use the theory to both collect and analyse the data. We conducted semi-structured personal interviews on a sample of 20 Swedish students since they are familiar with Systembolaget and considered as a high-risk population in the drinking habits. To distil the data, we selected content analysis allowing the categorisation of the information in the different theoretical concepts. Conclusion: Systembolaget’s communication has a notable effect on Swedish students. It has been uncovered that the messages create favourable attitudes and thus, intentions to reduce alcohol consumption. Nevertheless, individual experiences, beliefs, and other factors of influence imply that there is an important intention-behaviour gap. Systembolaget displays information and appeals to influence the beliefs and knowledge of individual to educate them and not directly triggers specific behaviours.

Magister Curationis - Mcur / According to Brown (2010), influenza kills and hospitalises thousands of people every year, about thirty-five thousand and two hundred thousand respectively. Some studies have shown that one of the major reasons that people do not take part in preventative behaviour concerning influenza would be some misconceptions and lack of knowledge. The purpose of this study was to investigate perceptions and attitudes of nursing students at a University in the Western Cape about influenza and their prevention and health seeking behaviour against influenza infection. This topic is important as nursing students are a part of the population group that is frequently exposed to influenza, either at their institutions of learning or in the hospitals and clinics, where they come into contact with patients in their roles as health care workers. A comprehensive review of the literature around perceptions and attitudes and health seeking behaviours regarding influenza was undertaken and considered by the researcher. Most of the literature reviewed came from Western countries as not much research has been done in Africa on the topic. From the literature reviewed, the researcher decided to use the Health Belief Model as a conceptual framework for this study as it has proven to be relatively effective in previous studies of this nature as well as in predicting people's health seeking behaviours.

In Peru, lack of water, sanitation, and hygiene (WASH) results in 6,600 deaths per year that represents approximately 3.9% of total deaths. Three thousand and nine hundred of these deaths were due to diarrheal diseases (Prüss-Üstün et al., 2008). Systematic reviews suggest that interventions to improve microbial quality of drinking water are successful in reducing diarrheal diseases (Fewtrell et al., 2005; Clasen et al., 2007; Fry et al., 2013). Interventions for household water treatment and safe storage to ensure safe drinking water reduce diarrhea by 31-52% (WHO/UNICEF, 2013). The SAWYER PointONE filter, a portable and adaptable membrane filtration device as small as the hand, is one point-of-use (POU) technology option for populations that rely on unsafe water from an improved source, or for areas that still rely on unimproved water sources for drinking and cooking. The filter functions strictly through mechanical exclusion accomplished by a hollow fiber membrane. The filters are certified for 0.1 μm as the largest pore size; therefore preventing diarrhea-causing bacteria such as E. coli, cholera, and typhoid to pass through the membrane. This research focuses on SAWYER water filter users who use a filter purchased through a sales agent in Independencia, Ica, Peru. Fifteen households in 9 communities and a total of 39 individuals were surveyed with the overall goal of better understanding the adoption of the SAWYER water filter as a POU water treatment technology in relation to three themes of: 1) household socio-economic factors 2) water, sanitation and hygiene (WASH) related characteristic and behaviors of users, and 3) Health Belief Model factors. The results showed SAWYER water filter users to have higher socio-economic status on average. All households had a high Progress out of Poverty Index® (PPI®) score. The heads of households, both male and female, were found to be more educated than the national average. Female heads of house were more educated than the male heads of house. There was a significant difference in the education levels of the female heads of house as compared to the national levels (p =0.006), with the female heads of house in the study having superior university degrees at three times the national percentage. The heads of house were also married at a higher percentage than the national average. SAWYER water filter users also have greater access to media than the regional average. All homes were equipped with at least one TV with cable. Results showed a significant difference in households having a computer within the home as compared to the regional percentage (p < 0 .001) and also in having Internet in the home as compared to the regional percentage (p < 0.001). Most houses (13/15) have running water all the time and all have a sink, shower, and toilet. Indoor connection and sewage type were not found to be statistically different from national average. Most people (67%) reported to always use soap and several participants mentioned liquid handwashing soap. Users reported handwashing after going to the bathroom (64.1%) more than before eating (38.5%) or cooking (46%). The Health Belief Model survey revealed that SAWYER water filter users perceive diarrhea as more severe for children, even though they do consider themselves susceptible. Clear benefits of adopting the filter include saving money, improving water quality, and saving time, but the barriers to filter adoption were unclear. Most users had contact with another person who demonstrated or recommended the filter prior to adopting the filter, highlighting the importance of interpersonal contact for promoting filter use. Turbidity during rainy season was also found to be an important cue to action.

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

The present investigation assessed Health Belief Model (HBM) variables and a measure of physical activity for both younger and older adults. Results of discriminant analyses suggest HBM variables and physical activity can predict age-group membership with 89% accuracy. The younger sample (n = 88; M= 21.5 years) was significantly more anxious about aging, perceived more barriers to exercise, less control from powerful others, and more social support than the older sample (n = 56; M = 71.8 years). For the younger sample, those who perceived more benefits of exercise, had social support, were male, and were less anxious about aging were more active. For the older sample, those who perceived more benefits of exercise were more likely to be active.