Bakgrund: Blöjavvänjning påbörjas allt senare i västvärlden och studier visar att det har negativa konsekvenser på barns hälsa. BHV-sjuksköterskan träffar familjen kontinuerligt och bör samtala om blöjavvänjning. Det saknas dock studier om BHV-sjuksköterskors arbete med blöjavvänjning. Syfte: Syftet med studien var att undersöka BHV-sjuksköterskors arbete med blöjavvänjning.  Metod: En kvalitativ metod med induktiv ansats baserad på tio intervjuer med distriktssköterskor verksamma inom barnhälsovården i Blekinge. En kvalitativ innehållsanalys gjordes utifrån Graneheim och Lundmans beskrivning. Resultat: Studiens analys resulterade i temat Det handlar om att kunna förmedla kunskap, se möjligheter och ta hänsyn till varje familjs förutsättningar samt fyra kategorier och elva underkategorier. Kategorierna var Samtal om blöjavvänjning med familjen, Konkret vägleda vårdnadshavare vid blöjavvänjning, Omständigheter som kan inverka vid blöjavvänjning samt Inhämta kunskap och ta hjälp av andra i arbetet med blöjavvänjning.   Slutsats: Resultatet visar att BHV-sjuksköterskor arbetar med blöjavvänjning utifrån varje enskild familjs behov. Studien kan användas för att öka kunskapen om BHV-sjuksköterskors arbete med blöjavvänjning och hur vårdnadshavare och barn kan mötas i samtalet.

Philosophiae Doctor - PhD / This study set out to develop an integrated model that could explain the sustainable adoption of mHealth, among the rural populations. With a penetration level of 130%, the ubiquitous mobile phone infrastructure was conducive to implementing mHealth even in the remote and rural regions of Kenya, which otherwise grapple with inequality and inequity of the healthcare system and a rising chronic diseases burden. Whereas mHealth could provide a suitable low-cost solution to disseminate targeted education to the grass-root masses in a short time, its uptake was reported to be low and short- lived. Therefore, the purpose of the study was to evaluate the factors that could explain the low levels of mHealth adoption for education on chronic diseases in the rural settings of the country. From a theoretical perspective, a combination of four social behaviour change theories, three technology adoption models, and two health behaviour change models guided the development of the theoretical framework. Seven factors were subsequently tested: perceived susceptibility, perceived severity, perceived usefulness, perceived ease of use, social influence, age, and language literacy, all of which measured mobile phone use for health literacy. Thirteen hypotheses were formulated from these factors.

BACKGROUND: Since 2010, nurses in Massachusetts public schools have conducted state-mandated Body Mass Index (BMI) screening of first, fourth, seventh, and tenth graders and communicated results in a letter to parents/caregivers. The objective of this study was to explore parents’ responses to the BMI letter and their experiences with weight-related language used by health professionals. These two areas were examined in the context of parents’ health literacy skills and readability of the letter. METHODS: Readability of the letter was calculated using five common formulas. One-hour focus groups were conducted using a semi-structured interview guide with a convenience sample of parents/caregivers of 8- to 14-year-old obese children participating in a weight management program. Parents were asked to share reactions to 10 weight terms in random order. Parents also completed a written version of the Newest Vital Sign (NVS) health literacy assessment. Focus group data were transcribed verbatim, and content analyses conducted to identify emergent themes. Descriptive statistics were calculated for NVS scores. RESULTS: Reading-level estimates of the BMI letter ranged from fifth to seventh grade. Twenty-nine individuals participated in eight focus groups (83% female, mean age 41 yrs+9 yrs, 59% self-identified as Hispanic/Latino). NVS scores for 12 participants (41%) indicated a possibility (n=7) or high likelihood (n=5) of limited health literacy. “Emotions” emerged as a major theme. Parents expressed concern, guilt, fear, anger, rationalization, skepticism, and acceptance regarding the letter and weight-related terms. Parents had mixed reactions to the letter: finding the information helpful, voicing concern about privacy and self-esteem, and displaying confusion when interpreting the weight status. A majority (67%) of parents who expressed confusion about the letter or weight terminology received an NVS score indicating a possibility or high likelihood of limited health literacy. Among the weight terms, parents preferred weight, weight problem, and unhealthy weight more than obese or extremely obese. CONCLUSIONS: This is the first known study to evaluate how parents respond to and comprehend the Massachusetts BMI letter. Emergent themes could be used to inform quantitative assessment of communication challenges associated with the letter. This study has implications for respectfully and effectively communicating BMI results nationwide.

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Efforts by policymakers to involve patients in treatment decision making are increasing worldwide. Some of these efforts must accommodate patients with different levels of health literacy, but do not specify if numeracy is part of health literacy. This research asked, How are health literacy and numeracy defined in the academic literature and what empirical relationship(s) do they have with the three stages of the treatment decision making process? I conducted a systematic review and two scoping reviews. In the systematic review, I identify definitions of health literacy used in the academic literature and interpretations possible for the most commonly used definitions. In the first scoping review, I map the empirical relationships between health literacy and the three stages of treatment decision making (information exchange, deliberation, and deciding on the treatment to implement). In the second scoping review, I map the empirical relationships between numeracy and the three stages of treatment decision making, and examine if, and how, numeracy has been mentioned in relation to health literacy. The systematic review identified 250 different definitions of health literacy and found the most commonly used definitions open to differing interpretations. The scoping reviews revealed a lack of: (1) agreement over the definition, measurement, and handling of health literacy and numeracy in studies, and (2) overlap in the relationship(s) examined. Health literacy and numeracy were largely treated as separate concepts. Knowledge gaps and measurement-related problems were identified. The findings from the systematic review pose significant challenges for the measurement of health literacy and for the implementation of health literacy-related policy initiatives. The meaning(s) of health literacy must be explicated by both researchers and policymakers. The findings from the scoping reviews indicate that the relationship(s) between health literacy, numeracy, and treatment decision making is unclear. Researchers must address the knowledge gaps and measurement-related problems identified. / Dissertation / Doctor of Philosophy (PhD) / Health literacy – the ability to obtain, understand, evaluate, and communicate information - is gaining increasing attention from both researchers and policymakers. This attention is important to efforts seeking to involve patients in their treatment decisions. Some of these efforts require attention to patients’ health literacy, but do not make clear if numeracy (or math skills) is part of health literacy. This research examines how health literacy and numeracy are defined. The relationship(s) that health literacy and numeracy have with the three stages of the treatment decision making process are also examined. The findings show that health literacy and numeracy have been: (1) defined and measured differently in studies, and (2) largely treated as separate concepts by researchers. The relationships between health literacy, numeracy, and the three stages of treatment decision making are also unclear because of knowledge gaps and measurement-related problems.

Asian immigrants are the fastest growing immigrant population in the United States. The literature documents that Asian immigrant parents of children with developmental disabilities (DD) face additional barriers when they access and utilize services in the United States, compared to U.S.-born parents. However, we have a limited understanding of how they respond to these barriers and what they want to achieve while supporting their child with DD, especially when their children transition from high school to adulthood. While there are some studies about Asian immigrant parents of children with DD, these studies singularly attribute barriers to cultural differences between Asian immigrant parents’ cultural backgrounds and the mainstream American culture. Furthermore, previous research has only documented parents’ experiences at one time point, thus limiting the understanding of the potential influence of acculturation when Asian immigrant parents support their child with DD in the United States over time. To achieve the goal of this dissertation, which is to understand how and why Asian immigrant parents are involved in the lives of their child in relation to their acculturation process, I conducted two qualitative studies grounded in role theory and acculturation theory. In study 1, I built on previous qualitative studies related to Asian immigrant parents’ experiences while accessing and utilizing services for their child with DD by conducting a meta-synthesis. I identified 11 qualitative studies for analysis, and examined these studies using a constant comparative approach and thematic analysis. Based on the analysis, I proposed a theoretical framework to describe parents’ role enactment as an evolving process influenced by acculturation that spirals them towards their ultimate parental goal of helping their child with DD thrive and live happily. The framework also describes how system factors are intertwined with parents’ individual factors to facilitate or impede their role enactment. In study 2, to address the lack of understanding of how Asian immigrant parents’ experiences while supporting their child with DD transition to adulthood, I conducted a narrative study with five Chinese-speaking immigrant parents whose children with DD were between 20 and 34 years old. Parents participated in a sequence of three, in-depth narrative interviews to share stories about how they perceived and enacted their parental role while supporting their child’s transition to adulthood. I used the listening guide to systematically analyze the data. Participants’ described their perceived parental role as helping their young adult child with DD live a happy and meaningful life. This role included two role facets: helping their child develop independent living skills and planning for their child’s adult life. Parents’ narratives revealed that their role enactment was not only influenced by their lifeworlds, but that parents could also actively shape their lifeworlds. Parents’ perceptions about their capacities to shape their lifewolds varied. Some parents were more empowered to change their lifeworlds, while other parents tended to adjust to their lifeworld. Parents’ cumulative interactions with American society gradually shaped how they framed their experiences of role enactment and the way they enacted their parental role. Parents felt it was “just harder” for them to enact their parental role as immigrants. Despite this, parents’ perceived the societal attitudes towards disability in American society positively influenced their role enactment and made them feel that the United States could be home for their family. Together, these two studies highlighted that parents’ role enactment is a dynamic temporal process, which is influenced by their cumulative interactions with components in their lifeworlds. Although Asian immigrant parents experience unique challenges related to their status as immigrants while enacting their parental role, they demonstrated resilience in the face of these challenges. The findings of this dissertation can inform researchers’ and practitioners’ understandings of how to develop parent interventions for Asian immigrant parents to help their child thrive and live happily and how to create a culturally safe environment to facilitate realization of their desired role.

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