This exploratory mixed-methods study examines the experiences of Spanish-speaking patients seeking non-urgent care in an emergency department setting. Emphasis is placed on understanding variables that influence patient satisfaction among this particular special patient population. This study draws from the explanatory models of illness and perspectives of clinically applied anthropology in contributing to the limited body of scholarly work that utilizes ethnographic approaches in clinical spaces to investigate how patients experience seeking emergency care services. Health-related deservingness, social determinants of health, and health literacy are used as complementary frameworks in understanding the unique experiences of these patients. The combination of methodological approaches employed in this study included: participant observation (120+ hours), patient shadowing (40 hours, N=10), administration of a modified patient satisfaction survey (N=100), semi-structured interviews (N=25), and retrospective analysis of existing patient satisfaction data from the research site. Quantitative findings generally indicate high degrees of satisfaction among this particular patient population, with statistically significant differences when compared to English-speaking patients. Quantitative data also indicate how modality of communication with this patient population is important to consider in terms of patient comprehension and perceived levels of care/attention demonstrated by hospital staff. The qualitative findings from this project highlight the similarities in explanatory models of illness between this patient population and emergency medical providers. Qualitative data additionally elucidates many of the barriers Spanish-speaking patients face when seeking out non-urgent care such as: limitations in exercising individual autonomy when communicating with medical staff, self-blame for not being able to effectively articulate their symptoms and concerns, as well as lack of clarity in understanding follow-up care plans. The results from this study call for addressing issues pertaining to health literacy, specifically at the end of the clinical encounter when follow-up care and treatment plans are explained to patients.

The aim of this dissertation is to explore how informal caregivers for people with dementia (PWD), who are community dwelling (i.e., not in nursing homes), prepare and plan for disasters. The research site is a particularly hurricane-prone region of Florida, second only to New Orleans in its vulnerability. An underlying assumption of this research is that caregivers for PWD have to plan and anticipate problems that are unique to their role. The rationale for the study described here is that disaster planning and mitigation save lives (Tengs et al. 1995), but there is little or no literature on disaster planning for the frail elderly and their caregivers. Mixed methods design which includes: 1) participant observation; 2) staff interviews (n=8);3) preliminary caregiver interviews (n=5); 4) baseline chart/disaster plan review (n=290);5) intervention (presentation to staff and administration) and form revision; 6) follow-up chart/ disaster plan review (n=259); 7) caregiver survey(n=253);8) final caregiver interviews (N=15- total number of caregiver interviews 20); 9) disaster literacy testing (n=20); 10) final group interview with ACC administration. This work documents the way that caregivers talk about disaster planning and say they will do if a hurricane strikes and reflects on their past hurricane experiences. Major findings include gaps in the county run Special Needs Shelter services available in Florida for people with dementia. The response and difficulty that caregivers might face can depend on the stage of the disease.

Aim of the study. To analyze the impact of the factors influencing the mode of life on student resiliency. Methods. This work was carried out by analyzing scientific references. The anonymous questionnaire was also used to carry out the survey. The data received was processed using the statistics processing program SPSS 13.0 for windows. Results. The questionnaire survey of the first year full time students of Kaunas College was carried out. The survey included 382 students (129 male and 253 female). The received data showed that 34.8% of students think that resiliency depends on the influence of other people, 27.8% of students think that it depends on the environment and 16.5% identified that resiliency depends on personal characteristics. In order to regain resiliency the respondents usually use passive methods such as watching TV, listening to the music, communicating with friends. The majority of the respondents (66.7% male and 75.9% female) indicated that they either often or very often feel tired. After the analysis of the results the statistically valid connection between the experienced tiredness and nutritional habits, time allocated for sleeping, rest and entertainment has been observed (p<0.05). While assessing the psychological feelings of students in the learning environment we observed that 53.4% of students often feel peer support, 60% of students are successful in solving conflicts. However, the respondents having lower inner resiliency feel that the work load... [to full text]

BUT : Cette étude longitudinale a pour objectif d’évaluer l’impact à court terme des programmes d’enseignement sur l’autogestion du diabète dispensés par l’équipe multidisciplinaire de l’Unité de jour de diabète (UJD) de l’Hôtel-Dieu du CHUM. L'UJD offre une formation de 4 jours (F4), avec une intervention mixte de type individuelle et de groupe, et une autre de 2 jours (F2), avec une intervention de groupe uniquement. MÉTHODE : En plus des mesures liées au contrôle métabolique (hémoglobine glyquée, indice de masse corporelle), des outils validés ont été retenus afin d’évaluer le niveau de littératie des patients, de même que les connaissances, les comportements d’autogestion et les attitudes par rapport au diabète à 0, 1 et 6 mois d’intervalle. Un total de 43 patients a été recruté, dont 13 en F2 et 30 en F4. RÉSULTATS : Âgés en moyenne de 59 ans, 77% des participants aux formations ont une scolarité de niveau collégial et plus. Cela les situe à un niveau satisfaisant de littératie, c'est-à-dire au regard de l’aptitude à comprendre et à utiliser l’information écrite dans la vie courante. En revanche, 64% des patients qui ne se sont pas présentés au cours (N=11) avaient un niveau de scolarité équivalent ou inférieur à un secondaire cinq. Les données analysées à l’aide de tests non-paramétriques montrent que les formations permettent à court terme une amélioration significative du contrôle métabolique des patients (p=0,042; N=33) et une perte pondérale moyenne de 2,4 kg (p=0,004; N=27). Les deux types de formations favorisent l’augmentation des connaissances sur la maladie (p=0,000 2jrs/4jrs) et contribuent à faire progresser favorablement les attitudes, soit de façon significative dans le cas des participants à la formation de 4 jours (p=0,000). La formation de 2 jours s’avère particulièrement efficace pour améliorer les comportements d’autosoins comme la prise de glycémie et les soins des pieds, alors qu’elle n’a eu que très peu d’effet sur les comportements liés au mode de vie. CONCLUSION : Les résultats de cette étude sont en faveur d’une intervention de type mixte et d’un plus grand nombre d’heures de contact entre les éducateurs et éducatrices et la ou le patient. Les données suggèrent finalement que bien que les interventions soient efficaces, ce sont les patients déjà fortement scolarisés qui tendent à participer à ce type de formation structurée. / OBJECTIVES : The objective of this longitudinal study is to evaluate the short term impact of diabetes self-management programs given by the multidisciplinary team of the CHUM Hôtel-Dieu Diabetes Day-Care Unit over 2-days (T2) or 4-days (T4) training sessions. METHODS : A total of 43 patients were recruited; 13 in the 2-day program, providing only group intervention and 30 in the 4-day program, providing both group and individual interventions. Besides measures of metabolic control (glycated haemoglobin, body-mass index), validated tools were used to evaluate literacy, as well as knowledge, self-care behaviours, and attitudes towards diabetes (at 0, 1 and 6 months). RESULTS : The average age of patients participating in the training sessions is 59 years old, and 77% have reached collegial or higher educational levels. This gives them sufficient literacy skills in terms of capacity to understand and use written information in everyday life. However, 64 % of the patients that did not show up or complete the training (N=11) had educational levels equal or lower to secondary 5. Outcome data, analyzed with nonparametric tests, show that diabetes self-management education programs of the Hôtel-Dieu CHUM lead to significant short-term improvement of metabolic control in patients (p=0,042, N=33) and result in a average weight loss of 2.4 kg (p=0,004, N=27). Both types of training increase patients knowledge of the disease (p=0,000 F2/F4), and the 4-days training session significantly contribute to positive attitudes towards the disease (p=0,000). The 2-days training program is particularly effective in improving self-care behaviours such as blood glucose monitoring and foot care, but it had very little effect on behaviours related to lifestyle. CONCLUSION : These results show that the 4-day program has proven more effective in improving self-management competency suggesting that the duration of interaction time between educators and patient seems to be a good predictor of the impact of the training. Although interventions are found to be effective, outcomes ultimately suggest that it is mostly patients with higher education that tend to participate in this formal training. / Réalisé en collaboration avec l'équipe de l'Unité de jour de diabète de l'Hôtel-Dieu du CHUM: Hortensia Mircescu M.D., Françoise Desrochers, Michelle Messier et Stéphanie Chanel Lefort.

Current health literacy research is reconceptualizing health literacy and social learning. Theorists are situating health literacy in the contexts of digital media and critical sociocultural theories (e.g., Wharf Higgins & Begoray, 2012), based on the proposition that literacy is a complex and layered human involvement in socio-political contexts (e.g., Gee, 2000; Lankshear & Knobel, 2011; Levin-Zamir, Lemish, & Gofin, 2011; Nahachewsky & Ward, 2007). Research with adolescents in various contexts around the world has indicated that an empowerment approach to literacy education is effective for health literacy interventions (King, 2007). This study responds to the need to design and facilitate high school curriculum to empower adolescents to develop health literacy, and the study responds to the research participants’ choice of mental health as the topic of an interdisciplinary curriculum. Situated in the traditions of qualitative case study research methods, and positioned to engage the online social media contexts in which adolescents participate, this study explored how Critical Media Health Literacy (Wharf Higgins & Begoray, 2012) is expressed by a particular group of Burmese adolescents. The data reveal how the theoretical concept of Critical Media Health Literacy, when operationalized as a unit of analysis for the case study and a theoretical framework for the data collection methods of the case study, can be facilitated in a way that engages the research participants in specific skills’ practice and in cognitive, emotional reflection on their own health and literacies capacities. Data collection methods involved face-to- face interviews, online social media blogs, web page designs, and face-to-face group discussions. The analysis found optimism, anxiety, and taking action were major themes shaping the conditions for the adolescents’ development of health literacy, showing health literacy to be integral with media literacy and critical capacities, and indicating the concept of Critical Media Health Literacy has relevance for curriculum that engages adolescents who are situated in Burma/Myanmar to take action to improve the health of themselves and others in their social contexts. The findings indicate that this population and the applicability of Critical Media Health Literacy for high school curriculum in this setting requires further exploration to understand why social determinants of health are perceived as inevitable, how social pressures related to health are negotiated, and how digital structures influence the criticality of literacies of adolescents in Burma/Myanmar. Theoretical frameworks for further research are proposed for an exploration of the systems of relations in socio- political and economic contexts that influence the development and enactment of Critical Media Health Literacy and health promoting performances of adolescents in Burma/Myanmar. / Graduate / 0998 / 0573 / 0708 / beercm@gmail.com

Current health literacy research is reconceptualizing health literacy and social learning. Theorists are situating health literacy in the contexts of digital media and critical sociocultural theories (e.g., Wharf Higgins & Begoray, 2012), based on the proposition that literacy is a complex and layered human involvement in socio-political contexts (e.g., Gee, 2000; Lankshear & Knobel, 2011; Levin-Zamir, Lemish, & Gofin, 2011; Nahachewsky & Ward, 2007). Research with adolescents in various contexts around the world has indicated that an empowerment approach to literacy education is effective for health literacy interventions (King, 2007). This study responds to the need to design and facilitate high school curriculum to empower adolescents to develop health literacy, and the study responds to the research participants’ choice of mental health as the topic of an interdisciplinary curriculum. Situated in the traditions of qualitative case study research methods, and positioned to engage the online social media contexts in which adolescents participate, this study explored how Critical Media Health Literacy (Wharf Higgins & Begoray, 2012) is expressed by a particular group of Burmese adolescents. The data reveal how the theoretical concept of Critical Media Health Literacy, when operationalized as a unit of analysis for the case study and a theoretical framework for the data collection methods of the case study, can be facilitated in a way that engages the research participants in specific skills’ practice and in cognitive, emotional reflection on their own health and literacies capacities. Data collection methods involved face-to- face interviews, online social media blogs, web page designs, and face-to-face group discussions. The analysis found optimism, anxiety, and taking action were major themes shaping the conditions for the adolescents’ development of health literacy, showing health literacy to be integral with media literacy and critical capacities, and indicating the concept of Critical Media Health Literacy has relevance for curriculum that engages adolescents who are situated in Burma/Myanmar to take action to improve the health of themselves and others in their social contexts. The findings indicate that this population and the applicability of Critical Media Health Literacy for high school curriculum in this setting requires further exploration to understand why social determinants of health are perceived as inevitable, how social pressures related to health are negotiated, and how digital structures influence the criticality of literacies of adolescents in Burma/Myanmar. Theoretical frameworks for further research are proposed for an exploration of the systems of relations in socio- political and economic contexts that influence the development and enactment of Critical Media Health Literacy and health promoting performances of adolescents in Burma/Myanmar. / Graduate / 0998 / 0573 / 0708 / beercm@gmail.com

The aim of this diploma thesis was to assess a level of health literacy of patients with diabetes mellitus type 2, describe the nurse's competences in the field of patients' level of health literacy and map the occurrence of podiatric outpatient clinics in Czech Republic. In theoretical part, we were discussing the health literacy in nursing, what the health literacy means and why it is important to improve it. We mentioned the education and the role of nurse in nursing and how this role is related to health literacy. Then we focused on diabetes mellitus type 2, its characteristics, prevention, development of disease, treatment and the most common complications related to this disease. The lifestyle is closely related to this disease, therefore the rules of a healthy lifestyle are mentioned in the last section of theoretical part. Research part was divided into three areas. The first areas consisted of interviews with general nurses working in general practitioner's outpatient clinics. The second area consisted of two research groups. One group consisted of nurses working in inpatient wards and nurses working in specialized diabetological outpatient clinics. Second group consisted of patients with diabetes mellitus type 2. Third area was created with two interviews and participant observation. The research was conducted in cooperation Professor Kvapil and two nurse educators who are actively engaged in education of patients with diabetes mellitus and they are trained by Lilly Company. The research showed that increasing of health literacy depends by the greatest part on patient him-/herself, his/her interest, cooperation and attitude to change of his/her lifestyle. The most active nurses in the field of increasing health literacy were nurses working in specialized diabetological outpatient clinics, who are trying to increase the health literacy particularly by educational sessions with patients. Mapping the presence of podiatric outpatient clinics showed that these clinics are available in each region of Czech Republic. It is very important to improve the health literacy of patients with this disease thereby strengthening their health and reducing the risk of complications associated with this disease. The results of the research provide information about increasing the health literacy in relation to diabetes mellitus type 2.

The diploma thesis deals with health literacy of employees. Health literacy throughout the Czech Republic is very low. The diploma thesis has one goal: To map the health literacy of the employees. I chose three hypotheses in my research. Hypothesis 1: The expected health literacy of the staff of the selected teams is inadequate. Hypothesis 2: Women show higher levels of health literacy than men. Hypothesis 3: The level of health literacy depends on the level of education. The thesis is divided into the theoretical and practical part. The theoretical part defines the concept of health literacy, methods of development of health literacy, health promotion and prevention, including determinants of health and health of the population of the Czech Republic. Part of the work is also devoted to the work environment, risk factors and occupational medical care. The practical part was processed using the quantitative survey method using questionnaires. The data needed for the analysis were obtain from respondents from selected collectives who were informed about the anonymity of the questionnaire survey. The obtained data was processed in MS Excel and SPSS. The results of my work disproved all three hypotheses. Respondents in the research group are health literate, health literacy among the sexes is the same and health literacy is not dependent on the level of education. Work results can serve as a good source of information for the general public or employees and company employers.

Theoretical part of the thesis: The diploma thesis deals with the issue of health literacy with regard to its support for the elderly. Areas for explanation of this issue and the possibilities for health literacy are included in this work. In particular, we speak of the right motivation of the seniors, the education and the possibilities of education for seniors. What is also important is the activation that we can develop the capabilities and skills of the seniors. Aims: For the practical part of the thesis, one aim was set, to which 5 hypotheses belong. Aim: To describe how seniors support health literacy. Hypotheses: 1st The level of support for health literacy is affected by the health of the senior. 2nd Women are more interested in gaining information by visiting Days of Health than men. 3rd The method of promoting health literacy is different for seniors up to 70 years old and seniors over 70 years of age. 4th Senior citizens with higher levels of health literacy support consider health information from healthcare professionals to be more useful than older people with lower levels of health literacy support. 5th Men use Universities of the Third Age to promote health literacy more than women. Methodology: In the practical part of this thesis, a quantitative research was chosen in the form of structured interviews. A total of 23 questions were compiled, including identification data. The research team consisted of 100 elderly over 65 years of age from the South Bohemian Region, who, on the basis of their addressing and their voluntary decision, answered the given questions. The data obtained was further processed and evaluated. Results: According to the results, women and men have the same interest in Health Days. The level of support for health literacy does not have a different impact on seniors on evaluation of the usefulness of information from healthcare professionals, and men use Universities of the Third Age as well as women. Support for health literacy is influenced by the state of health of the elderly in the field of education, physical activity and adherence to doctor's recommendations. The way of promoting health literacy is different for seniors up to 70 years of age and over 70 years of age in the area of physical activity, information and health care for first aid and accident prevention, oncology prevention, skin protection and healthy eating. Conclusion: It is important to inform the elderly about the possibilities of promoting health literacy and to provide information on health promotion and disease prevention. The output of this work is material for seniors containing this information.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-09-05T19:01:34Z No. of bitstreams: 1 liviabotelhodasilva.pdf: 8120722 bytes, checksum: 750fa22b60b51e73fbc8076625e36499 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-09-06T11:35:21Z (GMT) No. of bitstreams: 1 liviabotelhodasilva.pdf: 8120722 bytes, checksum: 750fa22b60b51e73fbc8076625e36499 (MD5) / Made available in DSpace on 2017-09-06T11:35:21Z (GMT). No. of bitstreams: 1 liviabotelhodasilva.pdf: 8120722 bytes, checksum: 750fa22b60b51e73fbc8076625e36499 (MD5) Previous issue date: 2017-07-19 / Atualmente, observa-se um crescente interesse dos pesquisadores com relação ao Letramento em Nutrição (LN), que é definido como a capacidade do indivíduo de obter, processar e compreender informações básicas de nutrição e habilidades necessárias para tomar decisões alimentares saudáveis. Através da avaliação do LN, é possível a identificação da dificuldade do indivíduo em temas específicos da nutrição, o que, possivelmente, favoreceria as atividades de educação alimentar e nutricional. No entanto, no Brasil, não existe instrumento que avalie LN de maneira abrangente. Diante disso, o presente estudo objetivou a adaptação transcultural de um instrumento de avaliação do LN, desenvolvido originalmente para a população estadunidense. Na primeira etapa foram realizadas tradução e retrotradução por consenso e as adaptações conforme a realidade da população brasileira. A segunda etapa consistiu em validação de conteúdo, que foi realizada por um comitê de seis especialistas, sendo pelo menos um de cada região do Brasil. Logo após, na terceira etapa, foi avaliada a legibilidade, para identificação do nível de leitura do instrumento. E, por fim, na quarta etapa, foi realizado o pré-teste, para o qual foram selecionados usuários com doenças crônicas que foram submetidos a um questionário sociodemográfico, um teste de letramento em saúde (LS), e a uma avaliação cognitiva, além do teste de avaliação do LN para a população brasileira. Após adaptações, o instrumento foi considerado relevante pela maioria dos especialistas e apresentou-se adequado para 8ª a 9ª ano do ensino fundamental. No pré-teste, foram avaliados 30 usuários, dos quais 50% possuíam ensino fundamental incompleto. Foi observado LS inadequado em 60% e déficit cognitivo leve em 83,3%. O tempo médio de aplicação do instrumento foi de 50,57±15,45 minutos. Entre os usuários com LS inadequado, foi observado menor pontuação média no instrumento de avaliação do LN, com exceção do domínio “Medidas Caseiras”. Entre todos os usuários, o domínio “Grupos Alimentares” apresentou menor percentual médio de acertos. Conclui-se que o instrumento foi considerado relevante para a população brasileira, pela maioria dos especialistas, porém, diante do elevado percentual de nível fundamental incompleto, apresentado pelos usuários selecionados para o pré-teste, o presente instrumento apresentou um nível de dificuldade elevado para uma população com baixa escolaridade. Além disso, constitui-se uma limitação do presente estudo o longo tempo de aplicação do instrumento de avaliação do LN. Diante disso, observa-se a necessidade de maiores adaptações e ajustes, para que, após sua validação, o instrumento possa ser útil para atividades de educação alimentar e nutricional. / There is a growing interest among researchers regarding Nutrition Literacy (NL), which is defined as the individual's ability to obtain, process and understand basic nutrition information and skills which are necessary to make healthy eating decisions. Through NL evaluation, it is possible to identify the individual's difficulties in specific nutrition topics, which could favour food and nutritional education activities. However, in Brazil, there is no instrument that evaluates NL comprehensively. Therefore, the present study aimed at the cross-cultural adaptation of an NL evaluation instrument, originally developed for the US population. In the first stage, translation and back-translation were performed by consensus and the adaptations according to the reality of the Brazilian population. The second stage consisted of content validation, which was carried out by a committee of six experts, at least one from each region of Brazil. Then, in the third stage, readability was evaluated, to identify the reading level of the instrument. Finally, in the fourth stage, the pre-test was applied to selected subjects with chronic diseases, who were additionally submitted to a sociodemographic questionnaire, a health literacy test (HL), and a cognitive evaluation, in addition to the NL evaluation test for the Brazilian population. After adaptations, the instrument was considered relevant by the majority of specialists and suitable for 8th and 9th of elementary school. In the pre-test, 30 users were evaluated; 50% of them had incomplete elementary education. Inadequate HL was observed in 60% and mild cognitive deficit in 83.3%. The mean time of application of the instrument was 50.57 ± 15.45 minutes. The users with inadequate HL presented lower mean score in the NL evaluation instrument, except for the "Domestic Measures" domain. Among all users, the "Food Groups" domain had the lowest average percentage of correct answers. It is concluded that the instrument was considered relevant for the Brazilian population, by the majority of specialists, however, given the high percentage of users with incomplete elementary education selected for the pre-test, this instrument presented a high level of difficulty for a low educated population. In addition, a limitation of the present study is the long-time application of the NL evaluation instrument. In view of this, it is observed the need for greater adaptations and adjustments, so that, after its validation, the instrument may be useful for food and nutritional education activities.