Hypertoni är en folksjukdom och en riskfaktor för hjärt-kärlsjukdom. Effektiva behandlingsmetoder finns men brist på följsamhet till behandlingsregimer vid hypertoni är ett stort problem, som utgör en risk för patienters hälsa. Bättre kunskap om vad som kan påverka patienternas följsamhet till hypertonibehandling är därmed av stor betydelse för sjuksköterskans hälsofrämjande arbete. Syftet med studien var att undersöka faktorer som påverkar patienters följsamhet till behandling vid hypertoni. Studien genomfördes som en litteraturstudie. Data bestod av 16 vetenskapliga artiklar som valdes ut, granskades och analyserades för att finna påverkande faktorer. De faktorer som framkom delades in i fem kategorier. Dessa var inställning till hypertoni och behandling, upplevelser av biverkningar, hälso- och sjukvårdens påverkan, omgivningens påverkan samt personliga faktorer. Misstro till diagnosen, behandling och hälso- och sjukvården samt rädsla för biverkningar utgjorde faktorer av vikt för följsamheten. Familjens engagemang var av betydelse för att hålla fast vid ordinationer och rekommendationer. En annan faktor av vikt var att patienter glömde ta sina läkemedel. Resurser i hälso- och sjukvården bör läggas på att utarbeta strategier för att effektivt kunna arbeta med hälsofrämjande arbete samt att optimera patientens delaktighet i beslut gällande den egna vården, detta för att öka följsamhet till behandling vid hypertoni. / Hypertension is a widespread disease and a risk factor for cardiovascular disease. Effective treatments are available but lack of compliance to treatment regimens in hypertension is considered a major problem that presents a risk to patient health. Better knowledge of what affect patients´ compliance to hypertension treatment is therefore of great importance to the nurse´s health promotion. The purpose of this study was to investigate factors that influence patients´ compliance to the treatment of hypertension. The study was conducted as a literature study. Data consisted of 16 scientific articles that were selected, reviewed and analyzed to find the influencing factors. The factors that emerged were divided into five categories. These were attitudes to hypertension and treatment, experiences of side effects, health care impact, impact of the surroundings and personal factors. Distrust of the diagnosis, treatment, health care and fear of side effects were factors of importance to compliance. The family´s involvement was important to adhere to prescriptions and recommendations. Another factor of importance was that the patients forgot to take their medicines. Resources in health care should be given to developing strategies to effectively work with health care promotion and to optimize the patient´s participation in decisions regarding their own care, this in order to increase compliance to hypertension treatment.

Bakgrund: Anledningen till att människor söker sig till sjukvården beror ofta på deras hälsobeteende. De behöver göra en förändring, men vad är det som får människor att göra förändringar? Syfte: Syftet med studien var att beskriva på vilka sätt motiverande samtal (MI) varit en användbar metod för att främja livsstilsförändringar. Metod: Studien utfördes som en allmän litteraturstudie. Åtta empiriska studier ingick. Sammankopplingar gjordes med tre teorier som MI bygger på Bems självuppfattningsteori, Roger´s teori om ”non-directive counselling” samt ”The transteoreticial model of behavior change”. Resultat: Sjuksköterskans användbarhet bestod i att använda sig av MI:s tekniker genom att lyssna aktivt, ställa öppna frågor samt att uppmuntra patienten till ett eget ansvar. Begränsningar ur sjuksköterskans perspektiv var svårigheter med nytt tänkande. Utvidgad utbildning och handledning i MI var viktigt vid implementeringen i verksamheterna. De studier som ingick visade i de flesta fall inte att MI som metod skulle vara effektivare än annan typ av rådgivning. Slutsats: I MI samtalet är det viktigt att sätta patienten i fokus, att hjälpa patienten att hitta motivationen samt självförtroende att genomföra förändringar. Vid implementeringen av MI är det viktigt med utbildning och handledning samt att praktik och teori går hand i hand. / Background: The reason of people visiting health care centers often depends on their health behavior. They often need to make a change. The aim of the study: The aim of the study was to describe in which way motivational interviewing has been successful to make lifestyle changes. Method: The study was carried out as a literature review. Associations were made with three of the theories which motivational interviewing is based upon: Bem’s “Self perception theory”, Roger’s “Non-directive counseling theory” and “The transtheoretical model of behavior change”. Result: The nurse made use of the MI techniques by actively listening, asking open questions and encouraging the patients to take their own responsibility. The limitations, from the nurse’s point of view were problems with the new way of thinking. Extended training and coaching in MI were important for the implementation activities. The studies included showed in most cases that MI as a method wasn´t more effective than any other type of counseling. Conclusion: In MI it´s crucial to put the focus on the patient, to help the patient find the motivation and confidence to make changes. For the implementation of MI it is important to include education, practice and coaching sessions.

Diabetes type 2 is a fast growing illness and a global health problem, often a result from less appropriate standard of living. Lifestyle changes related to diet and physical activity are important lifestyle changes regarding to get control of the self-management and to avoid vascular complications. Aim The aim of this study was to describe patient's experiences of lifestyle changes in diabetes type 2. Method A literature study was carried through based on 12 qualitative scientific articles. Results The analysis result into two main themes and eight subthemes. Main themes where barriers and motivators for lifestyle changes and the subthemes where struggle, denial, lack of knowledge, alienation, support, motivation, acceptance and knowledge. Conclusion This study shows that lifestyle changes are experienced different by patient with diabetes and nurses should therefore be aware of the unique and specific demands these patients require. This is important for providing a good diabetic healthcare and to help patients with their self-management

6 pp. / Research has shown a correlation between a healthy diet and reduced risk of breast cancer. Additional research is also demonstrating a link between regular physical activity and the reduction of breast cancer risk. A healthy diet is beneficial for the prevention of numerous diseases, including breast cancer. Regular physical activity is preventative for many diseases and health concerns, including breast cancer. This article outlines basic information about breast cancer, risk factors related to diet and physical activity, and breast cancer prevention through healthy diet and physical activity.

Background: Hypertension increases all over the world and with the disease there is a risk för complications and personal suffering. The treatment involves lifestyle changes and pharmacological treatment. The district nurse has an important role in care of patients with hypertension and through health interviews, the district nurse can create possibilities for lifestyle changes. Motivation plays an essential role in implementing lifestyle changes and it varies in between individuals. Aim: The aim of the study was to examine district nurse's perceptions of what motivates and what creates obstacles and holds back patients with hypertension to implement lifestyle changes. Method: Eight district nurses who on daily bases worked with patients with hypertension and lifestyle changes were interviewed. The interviews were analyzed by qualitative content analysis with an inductive approach to reach the aim of the study. Results: The district nurses experienced that both positive as well as negative factors were found to have an impact on a patient's motivation for lifestyle changes. These factors were both found in the district nurse and in the patient. The patient's inner drive force and the district nurse's professionalism created conditions for patients to implement lifestyle changes while as a patient's own negative attitude and a district nurse's lack of commitment and understanding created barriers for patients to implement lifestyle changes. Conclusion: The district nurses experienced that both the district nurse and the patient's involvement in health interviews influenced the patient's motivation for lifestyle changes.

Bakgrund: Hypertoni är ett folkhälsoproblem och utgör en stor riskfaktor för utveckling av hjärt-kärlsjukdom. Basen för omvårdnaden utgörs av livsstilsförändringar. Distriktssköterskors centrala roll innefattar att i jämlik, ömsesidig kommunikation ge råd, motivera och stödja till förändring av levnadsvanor samt främja patientdelaktighet och autonomi. Syfte: Syftet med studien var att belysa distriktssköterskors erfarenheter av att stödja patienter med hypertoni till livsstilsförändringar. Metod: Datamaterialet analyserades med kvalitativ innehållsanalys med en induktiv ansats. Åtta distriktssköterskor med ansvar för patienter med hypertoni intervjuades. Resultat: Ur analysen av datamaterialet framträdde tre kategorier; Initierar samarbete, Bekräftar individen och Anpassar omvårdnad för patienten, med sex underkategorier. Konklusion: Distriktssköterskorna upplevde sin roll central, viktig och ansvarsfull när det handlade om att ge råd och undervisning. De upplevde sig även vara en viktig länk mellan patient och andra aktörer. De ansåg att lyhördhet för patientens livssammanhang och en samtalsstrategi i kommunikationen vid livsstilsrådgivning var viktigt för främjandet av patientdelaktighet och autonomi. Att individuellt motivera till livsstilsförändring beskrevs som en svårighet och distriktssköterskorna uttryckte en frustration över att det var bristande tid för uppföljning. / Background: Hypertension is a public health problem and a major risk factor for developing cardiovascular disease. The basis for the nursing care is lifestyle changes. District nurses´ role includes to advise, motivate and support life style changes, as well as to promote patient participation and autonomy, through an equal and mutual communication. Aim: The aim of the study was to illuminate experiences of district nurses supporting patients with hypertension to make lifestyle changes. Method: The data were analyzed by qualitative content analysis with an inductive approach. Eight district nurses responsible for hypertensive patients were interviewed. Results: Three categories emerged from the data analysis: Initiates cooperation; Confirms the individual and Adapts nursing for the patient, with six subcategories. Conclusion: The district nurses perceived their role as central, important, and responsible when providing advice and instruction. They also considered themselves as an important link between the patient and other actors. Responsiveness of the patient's life context, as well as using a communication strategy when giving counseling on lifestyle changes were considered important to promote patient participation and autonomy. To motivate lifestyle changes individually was described as a difficulty and district nurses expressed frustration with the lack of time for follow-up.

Background: Lifestyle changes and drug treatment can improve the prognosis and quality of life for patients with coronary heart disease (CHD), but their co-operation with suggested treatment is often limited. The aim of this thesis was to study how patients and their spouses conceive CHD and its treatment. Material and Methods: The research design used was inductive and descriptive. The studies were based on three complementary sets of data. Patients with CHD (n=23) and spouses (n=25) were interviewed one year after an episode of the disease. Consecutive patients with CHD derived from another investigation were interviewed within six weeks or one year after the coronary event (n=113). All semi-structured interviews, tape-recorded or from notes taken by hand, were subjected to analysis within the phenomenographic framework. Findings: The patients’ conceptions of CHD varied and were vague, even as judged on a lay level. They were associated with symptoms rather than with the disease. Co-operation with drug treatment was rarely linked to improved prognosis. The patients’ descriptions of benefits from lifestyle changes and treatment did not give the impression of being based on a solid understanding of the importance of such changes. Incentives for lifestyle changes were classified into four categories, all of which contained both facilitating and constraining incentives. Somatic incentives featured direct and indirect physical signals. Social/practical incentives involved shared concerns, changed conditions, and factors connected with external environment. Cognitive incentives were characterised by active decisions and appropriated knowledge, but also by passive compliance with limited insights, and by the creating of routines. Affective incentives comprised fear and reluctance related to lifestyle changes and disease and also lessened self-esteem. All incentives mostly functioned facilitatively. The cognitive and the social/practical incentives were the most prevalent. Spouses’ understanding about the causes of CHD involved both appropriate conceptions and misconceptions. Drug treatment was considered necessary for the heart, but harmful to other organs. Spouses’ support to partners was categorised, and found to be contextually bound. The participative role was co-operative and empathetic. The regulative role controlled and demanded certain behaviours. The observational role was passive, compliant, and empathetic. The incapacitated role was empathetic, unable to support, and positive to changes. The dissociative role was negative to changes and reluctant to be involved in lifestyle changes. Conclusions: These results could be useful in the planning of care and education for CHD patients. The findings also emphasise the importance of adopting a family perspective to meet the complex needs of these patients and their spouses in order to facilitate appropriate lifestyle changes. / On the day of the public defence of the doctoral thesis the status of article V was Submitted.

Background: Diabetes type 2 is a increasing disease and societal problem. To be able to sustain a healthy life despite the disease, major lifestyle changes including dietary changes and physical activity is required. Aim: The aim of this literature review was to describe the experiences of persons living with diabetes mellitus type 2. Method: An inductive approach were used, qualitative articles were analysed by Fribergs Analysis model. Result: Three main themes was discovered; “Psychological effect of diabetes”, “Practical influence on the everyday life with diabetes” and “Social and existential influences of diabetes”. There were six sub-themes found. Conclusion: There were worries about the disease and complications. Motivation was an important factor for necessary self-care. Limitations in daily life was often related to diet and social engagements. High demands of managing lifestyle changes felt arduous. Nurses have an important role in encourage to self-management and should contribute to further individualization in diabetes care.The support was often found inadequate. / Bakgrund: Diabetes mellitus typ 2 är en växande folksjukdom och samhällsproblem. För att bibehålla ett hälsosamt liv trots sjukdomen behöver personerna ofta genomgå livsstilsförändringar i form av ändrade kost- och motionsvanor. Syfte: Syftet med denna litteraturöversikt var att beskriva personers upplevelser av att leva med diabetes mellitus typ 2. Metod: En induktiv ansats användes, kvalitativa artiklar granskades och analyserades genom Fribergs analysmodell. Resultat: Här återfanns 3 huvudteman; “ Psykisk påverkan vid diabetes”, “Praktisk påverkan i vardagen med diabetes” samt “Social och existentiell påverkan vid diabetes”. Det urskildes också sex stycken subteman. Slutsats: Det fanns en ständig oro över sjukdomen och eventuella komplikationer. Motivation och stöd var viktigt för nödvändig egenvård. Begränsningar i det dagliga livet var ofta relaterat till kost och sociala tillställningar. Krav på livsstilsförändringar upplevdes som svåra. Sjuksköterskan har en viktig roll för att uppmuntra till personernas egenvård och borde verka för att ytterligare individanpassa diabetesvården.

Bakgrund: Hjärtsjukdomar är en av de vanligaste sjukdomar som människor drabbas av i Sverige. Sjuksköterskor möter därmed patienter med hjärtsjukdom i de flesta vårdkontexter. Kronisk hjärtsjukdom kan upplevas som att leva med en livshotande sjukdom, som skapar begränsningar i vardagen. Sjuksköterskans ansvar blir således betydande gällande att informera och handleda patienter med hjärtsjukdom. Livsstilsförändringar är nödvändiga att utföra i syfte att förhindra försämring i sjukdomen. Sjuksköterskans kunskap och expertis är därför nödvändig för att hjälpa patienterna att hantera sjukdomen och utföra livsstilsförändringar.  Syfte: Syftet var att beskriva patienters upplevelse av att leva med hjärtsjukdom. Metod: En litteraturöversikt som baseras på Fribergs metod. Översikten innehåller elva originalartiklar som har sökts fram via databaserna CINAHL Complete och Academic Search Ultimate. Resultat: Sex teman identifierats gällande patienters upplevelse av att leva med hjärtsjukdom. De upplevelser som framkom beskrivs i följande teman: Upplevelser av förändrat liv, Strategier för att hantera hjärtsjukdomen, Patienters upplevelse av stöd, Behov av information, Patienters livsstilsförändringar och Hjärtsjukdom som motgång i livet. Diskussion: Resultatet diskuteras med anknytning till Roys adaptionsmodell och konsensusbegreppet människan. Modellen lyfter en förklaring av patienters upplevelser och hantering av hjärtsjukdomen genom ett förändrat liv och anpassning till den nya livssituationen. Dessa individuella upplevelser möter sjuksköterskorna i omvårdnaden av patienter. / Background: Heart disease is one of the most common diseases that people in Sweden suffers from. Nurses meet these patients in most contexts of caring. Chronic heart disease can be experienced as living with a life-threatening disease, which create limitations in everyday life. Nurses’ responsibility to inform and guide patients with heart disease is therefore important. Lifestyle changes are necessary to accomplish in order to prevent worsening of the disease. Nurses’ knowledge and expertise is therefore necessary in order to help patients manage the disease and make lifestyle changes. Aim: The aim of this study was to describe patients’ experience of living with heart disease.  Method: A literature review that is based on Fribergs method. The review is consisted of eleven original articles, which have been found through the databases CINAHL Complete and Academic Search Ultimate. Results: Six main themes was identified regarding patients experiences of living with heart disease. The experiences that emerged will be described in the following themes: Experiences of changed life, Strategies to manage the heart disease, Patients’ experiences of support, Information needs, Patients lifestyle changes and Heart disease as a adversity in life. Discussion: The results are discussed related to Roys adaption model and the consensus concept human. The model highlights an explanation of patients’ experiences and management of the heart disease through a changed life and adaptation to the new situation. These individual experiences encounter nurses in the care of patients.

I detta arbete bearbetas forskning om eHälsa, dess användande inom vården och motivationsteorierna Transteoretiska modellen, Maslows behovshierarki och självbestämmandeteorin. Vidare presenteras egna observationer på hur vården i dagsläget kan stötta patienter med hjärtkärlsjukdom till bättre levnadsvanor, samt intervju med uppföljning på hur en PCI-patient upplever att ta emot kost- och träningsrekommendationer via ett digitalt hälsoverktyg.   Syftet är att med en fallstudiedesign undersöka hur vården stöttar hjärtpatienter till bättre levnadsvanor och om digitala hälsoverktyg kan öka den upplevda motivationen hos PCI-patienter till att äta bättre och aktivera sig mer.   Metoderna som använts är kvalitativa, där resultaten bygger på en halvdags observationer på en fysioterapeutmottagnings arbete med hjärtkärlpatienter och en intervju samt uppföljning med en PCI-patient som använt ett digitalt hälsoverktyg under tio dagars tid.   Huvudresultatet från denna studie tyder på att någon form av stöd är viktigt för att uppleva sig kunna börja och klara en förändringsprocess. Motivationen tycks öka av socialt stöd eller stöd som bidrar till ökad kompetens och självbestämmande, varav det första exemplifieras vid observationerna av vården, och de andra två gick att se blev positivt påverkade hos PCI-patienten efter sin användning av det digitala hälsoverktyget. Patienten upplevde sig mer motiverad av att alltid ha informationen lättillgänglig, att det gick att individanpassa efter sig själv och gav inspiration, samt ett mervärde av kunskap.   Patienten började äta bättre och ta dagliga promenader på egen hand, från att tidigare upplevt sig ”glömma” och föredragit en bilresa till att få promenera med andra än att promenera själv. Patienten beskriver även ett förbättrat självförtroende och mer positiv framtidssyn.   Dock behöver detta testas i större skala för att kunna uttala sig om det skulle kunna ge effekter på en majoritet och om dessa effekter skulle vara bestående. Men en öppenhet för framtiden bör finnas för att eHälsoverktyg kan fungera som ett stöd, vara informerande och kanske till och med motiverande när det behövs. / In this study research about eHealth, its usage in health care and the motivation theories Transtheoretical model, Maslow’s hierarchy of needs and the self-determinant theory is processed. The study is also presenting results from personal observations on how the health care supports patients with cardiovascular disease to better habits and an interview with a follow-up on how a PCI-patient is experiencing receiving eating and exercising recommendations through a digital health tool.   The purpose of the case study is to find out how the health care supports patients with cardiovascular disease to better eating and exercising habits, and if digital health tools can increase the experienced motivation to eat better and exercise more.   The methods that have been used are qualitative, and the results are based on observations of the work with patients who have cardiovascular disease, conducted at a physiotherapist’s office and an interview with a follow-up with a PCI-patient who used a digital health tool for ten days.   The main result of this study indicates that some kind of support is essential to feeling able to start and make a process of change. The motivation seems to increase through social support or other support which contributes to higher competence and self-determination. The patient felt more motivated by always having the information easily accessible, the fact that the tool was customizable to his own needs and that it gave him inspiration and knowledge.   The patient began to eat better and take daily walks on his own. Previously he had ”forgotten” and preferred to drive to town just to walk together with other people rather than just walking by himself. The patient also describes an improved self-confidence and has a more positive vision of the future.   However, this needs testing in a larger scale to be able to express whether it could effect a majority, and if these effects would be permanent. Nevertheless, an openness for the future should exist regarding eHealth tools to work as a support, to be informative and perhaps even motivating when needed.