Type 2 diabetes is a life-threatening condition, and it is rapidly growing in the world. If patients receive adequate education and support, they can manage their diabetes-related tasks effectively and reduce the severe complications of this disease. However, traditional self-management education and practices were not very effective in stimulating behaviour change and addressing patients’ diversified needs and expectations. Mobile text messaging is a promising method for type 2 diabetes self-management as it can provide continuous and customized support to these patients. However, there is a lack of knowledge about the optimal approach to designing and delivering mobile text messages. Hence, this dissertation aimed to define effective message strategies for mobile text messaging interventions targeting type 2 diabetes self-management. This manuscript-based dissertation consists of three complementary studies. The first manuscript includes a systematic review and a meta-analysis of tailored mobile text messaging interventions on type 2 diabetes self-management. It examines the tailoring strategies, message content, and structure and identifies the moderators of effectiveness in these interventions. The second manuscript includes a systematic review and a meta-synthesis of qualitative evidence on patients’ experiences and perspectives of mobile text messaging studies. The third manuscript consists of a prospective qualitative study to explore the text messaging design and delivery preferences of patients. In the first and second studies, the comprehensive search strategy included major electronic databases, key journal searches, and hand searches of the reference lists of related systematic reviews and meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Collaboration's guidelines and recommended tools were used for data extraction, risk of bias and critical appraisal assessments, data analysis and reporting. Within a social marketing framework, the third study included semi-structured interviews and a thematic analysis of the main findings. In the first manuscript, 13 eligible trials were included for the systematic review and 11 eligible trials were further analyzed in the meta-analysis. This study concluded that tailored mobile text messaging interventions could improve glycemic control in patients with type 2 diabetes. The subgroup analyses revealed the importance of some moderators such as message delivery, message direction, message frequency, and using multi-modalities. In the second manuscript, the systematic review included 14 eligible studies, and the thematic synthesis included 13 eligible studies. Patients emphasized the importance of tailored text message design and delivery. They felt “supported” by using text messaging and improved their communication with family/friends and care providers. Mobile text messaging increased patients’ self-awareness, knowledge and control of diabetes. The third study explored that mobile text messages could be more effective if they are gain-framed and written in a standard format. Patients favoured the text messages that included simple and direct tone and provided statistical evidence. The findings demonstrated patients’ needs and expectations for advanced tailoring strategies in both message content and delivery. Together, the manuscripts fill a significant gap and inform research and practice for the development of more effective message strategies that could lead to reducing the spread of type 2 diabetes worldwide. / Graduate / 2022-05-12

A Kaizen event (KE) may be defined as a structured improvement project that uses a cross-functional team and specific improvement goals to improve a targeted work area or process in an accelerated time frame. KEs, also known as Rapid Improvement Events (RIEs), have been utilized within hospitals to achieve beneficial operations, stakeholder (i.e., social), financial, and clinical outcomes. Due to their potential to achieve positive results in a rapid timeframe, understanding the determinants of KE success within a hospital environment is a valuable research undertaking. To date there has been limited rigorous empirical quantitative research focused on identifying success factors (SFs) influencing socio-technical outcomes of hospital-based KEs. Hence, this empirical research study seeks to determine the critical success factors (CSFs) for KEs in hospitals. For the first phase of this research work, a comprehensive systematic literature review (SLR) was conducted to identify the success factors (SFs) for KEs in hospitals as reported in the literature. This SLR resulted in the identification of 54 unique success factors mapping to four broad success factor categories, KE Task Design, KE Team Design, Organization, and KE Process. Thereafter, the second phase, which involved the variable reduction process, was performed to determine the strength of effect, or importance, of the SFs in order to determine a feasible number of SFs to include in further empirical work. Two robust methods were applied; a Meta-synthesis Evaluation and an Expert Survey, to query the SFs and to determine high priority factors for the empirical study. As a result, a total of 30 factors were finalized for empirical study. Next, the last phase, the empirical study to investigate and determine the CSFs for KEs in hospitals, was executed using a retrospective field study survey research design. Specifically, a survey questionnaire was designed to elicit feedback on perceptual measures from targeted hospital KE facilitators/leaders on the criticality of SFs on socio-technical outcomes for KEs in hospitals. Sixty usable responses were obtained, which were subjected to Exploratory Factor Analysis (EFA) and Partial Least Squares-Structural Equation Modeling (PLS-SEM), which were used to identify latent factor constructs and to determine the significance of the SFs, respectively. The results of this study identified seven significant direct relationships. Kaizen Event Design Characteristics (KEDC) and Target Area Buy-in (TABI) were found to have significant direct effects with both dependent variables, Performance Impact (PI) and Growth in Kaizen Capabilities (KCG). In addition, KEDC also had a significant direct relationship with Performance Culture (PC) and Team Dynamics (TD), respectively. Also, PC has a significant direct relationship with TD. Furthermore, Logistic Regression was utilized to test the SFs impact on the one objective technical outcome measure in the study, Goal Attainment (GOALATT). This analysis revealed one significant negative relationship occurring between TD and GOALATT. Overall, the study's findings provide evidence-based results for informing hospital managers, leaders, and continuous improvement practitioners on the key factors or value-added practices that can be adopted in their hospital KE initiatives to achieve beneficial socio-technical outcomes, as well as overall hospital KE success. Furthermore, this research can enable academia/researchers to strategize more confirmatory analysis approaches for theory validation and generalizability. / Doctor of Philosophy / The focus of this research study is to identify the most significant factors for Kaizen events (KEs) in hospitals, referred herein as critical success factors (CSFs). A KE may be defined as a structured improvement project that uses a cross-functional team and specific improvement goals to improve a targeted work area or process in an accelerated time frame. The aim of the study is to ultimately improve KE practice in hospitals through increased understanding of CSFs that can be planned or designed into KE processes to increase the likelihood of successful event outcomes. Various research formulation, development, and testing techniques are applied to frame the research study according to the aims and objectives and to achieve targeted research outcomes. The overall research design encompasses a retrospective study approach, performing a large-scale field study using a survey questionnaire to empirically identify the CSFs for KEs in hospitals. To help frame the research, a systematic literature review (SLR) along with bibliometric analyses were conducted. To help refine and select the success factors for empirical study, a meta-synthesis evaluation and an expert survey study were conducted. Exploratory factor analysis (EFA) and partial least squares-structural equation modeling (PLS-SEM) along with mediation analyses (MA) were performed to identify key factors, determine the significance of those factors, and to understand the influential relationships of those factors to hospital KE success. Results from this study aim to inform healthcare managers, healthcare improvement practitioners, researchers, and other relevant stakeholders about the critical components needed to achieve hospital KE success. The dissertation is documented according to a "manuscript style," using a journal/conference paper format to organize and report on the key findings and results obtained from the investigation. The Introduction chapter is provided to introduce the research study topic, study significance, indicate the overall research aims and objectives, present the overall research approach and design methodology, and to enumerate the main publication outputs and outcomes from this dissertation work. The Conclusions chapter summarizes the overall research outcomes, key study findings, study limitations, and provides areas for future research.

Lean Management and Lean Six Sigma (LM/LSS) are improvement methodologies that have been utilized to achieve better performance outcomes at organizational and operational levels. Although there has been evidence of breakthrough improvement across diverse organizational settings, LM/LSS remains an early-stage improvement methodology in public sector organizations, specifically within local government organizations (LGOs). Some LGOs have benefited from LM/LSS and reported significant improvements, such as reducing process time by up to 90% and increasing financial savings by up to 57%. While the success of LM/LSS can lead to satisfactory outcomes, the risk of failure can also result in a tremendous waste of financial and non-financial resources. Evidence from the literature indicates that the failure to achieve the expected outcomes is likely due to the lack of attention paid to critical success factors (CSFs) that are crucial for LM/LSS success. Furthermore, research in this research area regarding characterizing and statistically examining the CSFs associated with LM/LSS in such organizational settings has been limited. Hence, the aim of this research is to provide a comprehensive investigation of the success factors for LM/LSS in LGOs. The initial stage of this dissertation involved analyzing the scientific literature to identify and characterize the CSFs associated with LM/LSS in LGOs through a systematic literature review (SLR). This effort identified a total of 47 unique factors, which were grouped into 5 categories, including organization, process, workforce knowledge, communications, task design, and team design. The next stage of this investigation focused on identifying a more focused set of CSFs. This involved evaluating the strength of the effect (or importance) of the factors using two integrated approaches: meta-synthesis and expert assessment. This process concluded with a total of 29 factors being selected for the empirical field study. The final stage included designing and implementing an online survey questionnaire to solicit LGOs' experience on the presence of factors during the development and/or implementation of LM/LSS and their impact on social-technical system outcomes. Once the survey was concluded, an exploratory factor analysis (EFA) was conducted to identify the underlying latent variables, followed by using a partial least square-structural equation model (PLS-SEM) to determine the significance of the factors on outcomes. The EFA identified three endogenous and five exogenous latent variables. The results of the PLS-SEM model identified four significant positive relationships. Based on the results from the structural paths, the antecedent Improvement Readiness (IR) and Change Awareness (CA) were significant and had a positive influence on Transformation Success (TS). For the outcome Deployment Success (DS), Sustainable Improvement Infrastructure (SII) was the only significant exogenous variable and had the highest positive impact among all significant predictor constructs. Furthermore, Measurement-Based Improvement (MBI) was significant and positively influenced Improvement Project Success (IPS). Findings from this dissertation could serve as a foundation for researchers looking to further advance the maturity of this research area based on the evidence presented in this work. Additionally, this work could be used as guidelines for practitioners in developing implementation processes by considering the essential factors to maximize the success of LM/LSS implementation. Given the diversity of functional areas and processes within LGO contexts, it is also possible that other public sector organizations could benefit from these findings. / Doctor of Philosophy / Lean Management and Lean Six Sigma (LM/LSS) is an improvement methodology that is used by businesses and organizations to improve how they work and achieve better results. LM/LSS has been especially helpful in various organizations; however, the implementation of this improvement methodology has been limited by many challenges for public sector organizations, especially local government organizations (LGOs). The overall aim of this dissertation is to improve the success of LM/LSS implementation within the context of LGOs. More specifically, this dissertation systematically studied the critical success factors associated with LM/LSS success. Different research approaches, including research formulation, development, and testing techniques, were conducted to achieve the aim of this dissertation. Publications related to LM/LSS in LGOs have been rigorously analyzed to identify a comprehensive list of CSFs. To identify the most important factors, a meta-synthesis evaluation and expert survey assessment have been conducted. Following the refinement of the factors, a large-scale field study using a survey questionnaire has been designed and distributed to LGOs. Once the survey concluded, statistical methods that included Exploratory Factor Analysis (EFA) and Partial Least Squares-Structural Equation Modeling (PLS-SEM) were conducted. The former was used to identify the underlying latent variables, while the latter was conducted to examine the influence of the factors on social and technical outcomes. This dissertation could be used as a reference guideline helping practitioners to increase the success of LM/LSS implementation in LGOs. This dissertation can also guide scholars to potential research avenues that could advance this research area.

Yes / Physically active learning (PAL) - integration of movement within delivery of academic content - is a core component of many whole-of-school physical activity approaches. Yet, PAL intervention methods and strategies vary and frequently are not sustained beyond formal programmes. To improve PAL training, a more comprehensive understanding of the behavioural and psychological processes that influence teachers' adoption and implementation of PAL is required. To address this, we conducted a meta-synthesis to synthesise key stakeholders' knowledge of facilitators and barriers to teachers' implementing PAL in schools to improve teacher-focussed PAL interventions in primary (elementary) schools. We conducted a meta-synthesis using a five-stage thematic synthesis approach to; develop a research purpose and aim, identify relevant articles, appraise studies for quality, develop descriptive themes and interpret and synthesise the literature. In the final stage, 14 domains from the Theoretical Domain Framework (TDF) were then aligned to the final analytical themes and subthemes. We identified seven themes and 31 sub-themes from 25 eligible papers. Four themes summarised teacher-level factors: PAL benefits, teachers' beliefs about own capabilities, PAL teacher training, PAL delivery. One theme encompassed teacher and school-level factors: resources. Two themes reflected school and external factors that influence teachers' PAL behaviour: whole-school approach, external factors. Ten (of 14) TDF domains aligned with main themes and sub-themes: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, Beliefs about Consequences, Reinforcement, Goals, Environmental Context and Resources, Social influences and Emotion. Our synthesis illustrates the inherent complexity required to change and sustain teachers' PAL behaviours. Initially, teachers must receive the training, resources and support to develop the capability to implement and adapt PAL. The PAL training programme should progress as teachers' build their experience and capability; content should be 'refreshed' and become more challenging over time. Subsequently, it is imperative to engage all levels of the school community for PAL to be fully integrated into a broader school system. Adequate resources, strong leadership and governance, an engaged activated community and political will are necessary to achieve this, and may not currently exist in most schools. / European Union ERASMUS+ Strategic Partnership Fund as part of the Activating Classroom Teachers (ACTivate)- teachers on the move project (NO: 2019–1-NO01-KA203–060324)

Realizou-se estudo exploratório de revisão bibliográfica sistemática e metassíntese visando descrever e analisar aspectos das práticas educativas em saúde, voltados ao desenvolvimento de habilidades para a cessação do tabagismo, traduzidas na interpretação de autores de pesquisas qualitativas publicadas em periódicos entre 2000 e 2007. Concebeu-se a questão do tabagismo como um problema de enfrentamento complexo, que demanda intervenções em vários âmbitos. Destacou-se a educação em saúde, como campo estratégico e instrumental da promoção da saúde, que sob a perspectiva do \"empowerment\" e \"empowerment education\", é passível de atuação do profissional de saúde. Utilizando-se do instrumental metodológico da metassíntese qualitativa, descrito por Sandelowski e Barroso (2003), identificou-se a produção científica de pesquisas qualitativas originais sobre experiências relativas às práticas educativas na cessação do tabagismo, indexadas nas bases de dados eletrônicas MEDLINE, CINAHL e LILACS. Para tanto utilizou-se os descritores pesquisa qualitativa, educação em saúde e tabagismo, além de descritores de texto livre e palavras com truncamento, visando a identificação ampliada de artigos que pudessem ser relevantes. Mapeou-se os artigos selecionados para a amostra bibliográfica segundo suas características gerais, aplicando-se os critérios de qualidade, dados pelo instrumento \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002). Os resultados desta produção foram integrados através da análise de conteúdo descrita por Minayo (2004), de modo a buscar temas relacionados à educação em saúde, aos quais foram combinados atributos (ou sub-temas). A busca bibliográfica resultou na identificação de 989 citações nessa temática, das quais 634 foram consideradas relevantes. Após seleção com base na leitura do título, a seguir dos abstracts (340) e por fim dos artigos na íntegra (88), foram classificadas 14 publicações como pertinentes para este estudo. Na metassíntese os aspectos recorrentes e as diferenças entre os artigos foram agrupados em duas modalidades temáticas: contexto dos sujeitos (descrevendo os fatores facilitadores e dificultadores do processo de cessação do tabagismo) e abordagem educativa (com processos facilitadores e dificultadores dos programas de cessação do tabagismo e da relação profissional-paciente apresentados em quadro temático, com comentários). As estratégias de abordagem do processo educativo foram classificadas com base nos elementos da promoção da saúde e nos modelos educacionais. Conclui-se que a metassíntese apresenta-se como metodologia relevante no âmbito da enfermagem (que tem vasta produção de pesquisa qualitativa), pois favorece análises e interpretações com potencial de proporcionar visibilidade e impacto no processo de cuidar e ser cuidado, fornecendo elementos para tomada de decisão. A compreensão sobre temas relacionados às abordagens educativas em saúde, nos processos de cessação do tabagismo, e o seu significado para os pacientes foi ampliada / An explorative systematic bibliographic review and meta-synthesis was realized looking to describe and analyze aspects of the educational practices in health, directed to the development of abilities for the smoking cessation, translated through the interpretation of the authors of the qualitative researches published in journals from 2000 to 2007. The smoking question was identified as a complex approach problem, which requires interventions from various aspects. Health education was emphasized, which under the perspective of the empowerment and empowerment education, is liable to the performance of the health professional. Using the qualitative meta-synthesis instrumental method described by Sandelowski and Barroso (2003), it was possible to identify a scientific production of primary qualitative researches about educational practices in the smoking cessation, indexed in MEDLINE, CINAHL and LILACS databasis. For this was used qualitative research controlled vocabulary, health education and smoking, besides the free texts and words with truncation, looking to increase the identification of the studies that may be relevant. The selected studies were identified according to its general characteristics, having been applied quality criterias supplied by the \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002) instrument. The results of this production were integrated through the analysis of content described by Minayo (2004), in order to look for themes related to health education, of which had attributes (sub-themes) combined to them. The bibliographic research resulted in the identification of 989 citations about this theme, where 634 were considered relevant. After the selection based on the title of the studie, following the abstracts (340) and finally of the reading of 88 complete studies, 14 publications were classified as being pertinent to this study. In the meta-synthesis the reoccurring aspects and the differences between the studies were separated in two types of themes: context of the subjects (describing the facilitating and difficulting facts of the smoking cessation process) and education approach (with facilitating and difficulting processes of the smoking cessation programs and of the patient-professional relationship presented in a theme board, with comments). The strategies used in the educational processes were classified based on the elements of the health promotion and on educational models. We conclude that the meta-synthesis presents itself as a relevant methodology in nursing environment (which provides vast qualitative research productions), because it helps in analysis and interpretations with the potential of facilitating visibility and impact in the process of taking care and being taken care of, supplying elements for decision making. The comprehension about themes related to health educational approaches, in the smoking cessation processes, and its meaning to patients, has been increased

Realizou-se estudo exploratório de revisão bibliográfica sistemática e metassíntese visando descrever e analisar aspectos das práticas educativas em saúde, voltados ao desenvolvimento de habilidades para a cessação do tabagismo, traduzidas na interpretação de autores de pesquisas qualitativas publicadas em periódicos entre 2000 e 2007. Concebeu-se a questão do tabagismo como um problema de enfrentamento complexo, que demanda intervenções em vários âmbitos. Destacou-se a educação em saúde, como campo estratégico e instrumental da promoção da saúde, que sob a perspectiva do \"empowerment\" e \"empowerment education\", é passível de atuação do profissional de saúde. Utilizando-se do instrumental metodológico da metassíntese qualitativa, descrito por Sandelowski e Barroso (2003), identificou-se a produção científica de pesquisas qualitativas originais sobre experiências relativas às práticas educativas na cessação do tabagismo, indexadas nas bases de dados eletrônicas MEDLINE, CINAHL e LILACS. Para tanto utilizou-se os descritores pesquisa qualitativa, educação em saúde e tabagismo, além de descritores de texto livre e palavras com truncamento, visando a identificação ampliada de artigos que pudessem ser relevantes. Mapeou-se os artigos selecionados para a amostra bibliográfica segundo suas características gerais, aplicando-se os critérios de qualidade, dados pelo instrumento \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002). Os resultados desta produção foram integrados através da análise de conteúdo descrita por Minayo (2004), de modo a buscar temas relacionados à educação em saúde, aos quais foram combinados atributos (ou sub-temas). A busca bibliográfica resultou na identificação de 989 citações nessa temática, das quais 634 foram consideradas relevantes. Após seleção com base na leitura do título, a seguir dos abstracts (340) e por fim dos artigos na íntegra (88), foram classificadas 14 publicações como pertinentes para este estudo. Na metassíntese os aspectos recorrentes e as diferenças entre os artigos foram agrupados em duas modalidades temáticas: contexto dos sujeitos (descrevendo os fatores facilitadores e dificultadores do processo de cessação do tabagismo) e abordagem educativa (com processos facilitadores e dificultadores dos programas de cessação do tabagismo e da relação profissional-paciente apresentados em quadro temático, com comentários). As estratégias de abordagem do processo educativo foram classificadas com base nos elementos da promoção da saúde e nos modelos educacionais. Conclui-se que a metassíntese apresenta-se como metodologia relevante no âmbito da enfermagem (que tem vasta produção de pesquisa qualitativa), pois favorece análises e interpretações com potencial de proporcionar visibilidade e impacto no processo de cuidar e ser cuidado, fornecendo elementos para tomada de decisão. A compreensão sobre temas relacionados às abordagens educativas em saúde, nos processos de cessação do tabagismo, e o seu significado para os pacientes foi ampliada / An explorative systematic bibliographic review and meta-synthesis was realized looking to describe and analyze aspects of the educational practices in health, directed to the development of abilities for the smoking cessation, translated through the interpretation of the authors of the qualitative researches published in journals from 2000 to 2007. The smoking question was identified as a complex approach problem, which requires interventions from various aspects. Health education was emphasized, which under the perspective of the empowerment and empowerment education, is liable to the performance of the health professional. Using the qualitative meta-synthesis instrumental method described by Sandelowski and Barroso (2003), it was possible to identify a scientific production of primary qualitative researches about educational practices in the smoking cessation, indexed in MEDLINE, CINAHL and LILACS databasis. For this was used qualitative research controlled vocabulary, health education and smoking, besides the free texts and words with truncation, looking to increase the identification of the studies that may be relevant. The selected studies were identified according to its general characteristics, having been applied quality criterias supplied by the \"Critical Appraisal Skills Programme, CASP\" (© Milton Keynes Primary Care Trust, 2002) instrument. The results of this production were integrated through the analysis of content described by Minayo (2004), in order to look for themes related to health education, of which had attributes (sub-themes) combined to them. The bibliographic research resulted in the identification of 989 citations about this theme, where 634 were considered relevant. After the selection based on the title of the studie, following the abstracts (340) and finally of the reading of 88 complete studies, 14 publications were classified as being pertinent to this study. In the meta-synthesis the reoccurring aspects and the differences between the studies were separated in two types of themes: context of the subjects (describing the facilitating and difficulting facts of the smoking cessation process) and education approach (with facilitating and difficulting processes of the smoking cessation programs and of the patient-professional relationship presented in a theme board, with comments). The strategies used in the educational processes were classified based on the elements of the health promotion and on educational models. We conclude that the meta-synthesis presents itself as a relevant methodology in nursing environment (which provides vast qualitative research productions), because it helps in analysis and interpretations with the potential of facilitating visibility and impact in the process of taking care and being taken care of, supplying elements for decision making. The comprehension about themes related to health educational approaches, in the smoking cessation processes, and its meaning to patients, has been increased

In this thesis the intricacies of service user and staff perceptions of psychological interventions for mental health difficulties were explored. Expanding upon this theme, mothers and staff on a Mother and Baby Unit (MBU) were asked about their views regarding the acceptability and feasibility of the implementation of a parenting intervention, Baby Triple P Positive Parenting Programme (Baby TP). This investigation is presented as four papers: a literature review, two empirical papers (a & b) and, a critical review and personal reflection of the research process.The literature review, a meta-synthesis of qualitative studies, explores service user and staff perceptions of psychological interventions for mental health difficulties. Twenty-eight studies were synthesised to develop comprehensive understanding of subtle, specific and overlapping elements involved in the implementation of psychological intervention. Guided by Noblit and Hare’s (1988) approach, 11 over-arching themes and 25 sub-ordinate themes emerged from the synthesis. Findings provide a detailed description of the concepts pertinent to both service users and staff. Implications are identified for service managers and clinicians in obtaining optimum efficiency and outcomes of psychological intervention. The empirical study is a Q-methodological investigation into service user and staff perceptions of the acceptability and feasibility of a parenting intervention, Baby TP, on a MBU. This study is split into two population-specific papers. Overall five main factors were identified (service users: three; staff: two), which provides new insights into the acceptable and feasible elements of a parenting intervention within this specialist setting. The findings highlight a positive consensus as to the acceptability and feasibility of Baby TP in a MBU setting alongside a number of identified needs pertinent to service users, staff and the setting. Clinical implications and recommendations are provided to address identified areas of need for both populations within this setting. The third paper is a critical review of the thesis illustrated through personal reflections of the research process.

Bakgrund: Amning har en central del i spädbarns överlevnad, och har en rad hälsofördelar både för kvinnan och barnet. Stöd till kvinnan direkt efter förlossningen är en viktig del för att initiera och etablera amningen. Svenska barnmorskor vill främja kvinnans önskemål om amning även om amningssvårigheter finns. Syfte: Syftet var att beskriva kvinnors upplevelser och erfarenheter av amning, för att främja barnmorskors förståelse och möjlighet att ge det stöd kvinnor önskar och behöver kring amning under nyföddhetsperioden. Metod: Designen är en kvalitativ metasyntes som baseras på 20 vetenskapliga, kvalitativa artiklar som kvalitetsgranskats och analyserats via meta-ethnografi. Resultat: Resultatet bestod av tre huvudteman; fysisk prestation, existentiell utmaning och yttre influenser. Fysisk prestation belyser upplevda kroppsliga effekter och amningsrelaterade svårigheter och hinder, som smärta, sår och utmattning. Existentiell utmaning beskriver upplevelser kring viljan att göra det bästa för sitt nyfödda barn, känslor som uppstår i samband med amning samt misstro till den egna kroppen. Yttre influenser beskriver sociala förväntningar på ammande kvinnor samt kvinnors upplevda behov och brister av stöd. Slutsats: Kvinnors upplevelser av att amma sitt nyfödda barn skiljer sig åt, och påverkas av fysiska och sociala utmaningar. De positiva hälsoeffekterna med amning är uppenbara, och kvinnor står inför olika utmaningar och hinder angående amningen. Även om kvinnor har stark avsikt att amma får misslyckanden dem att känna sig frustrerade och skyldiga. Praktiskt stöd, emotionell vägledning samt individanpassad undervisning och information kan hjälpa kvinnor att övervinna många av de interna och externa hinder som de står inför. Klinisk tillämpbarhet: Barnmorskan har en primär roll vid den perinatala vården. Om barnmorskan har kunskap om kvinnors upplevelser av amning skapas möjligheter hos barnmorskan att påverka amningen till det bättre, genom att undervisa, förebygga komplikationer och individanpassa vården, för bästa möjliga amningsinitiering. / Background: Breast milk has a central part in infant survival and has a number of health benefits for both the woman and the baby. Support for the woman immediately after the birth is an important part of initiating and establishing breastfeeding. Swedish midwives strive to promote the woman's desire for breastfeeding despite potential difficulties in breastfeeding. Purpose: The aim was to describe women's experiences of breastfeeding, to promote midwives' understanding and opportunities to provide the support women want and need around breastfeeding during the neonatal period. Method: The design is a qualitative meta-synthesis based on 20 scientific, qualitative articles that have been quality reviewed and analyzed via meta-ethnography. Results: The result was designed by three main themes; physical performance, existential challenge and external influences. Physical performance highlights physical effects and breastfeeding-related difficulties and obstacles, such as pain, sores and fatigue. Existential challenge describes experiences around the desire to do the best for one's newborn child, feelings that arise in connection with breastfeeding and mistrust of one's own body. External influences describe social expectations of breastfeeding women as well as women's perceived needs and lack of support. Conclusion: Women's experiences of breastfeeding their newborn baby differ, and are affected by physical and social challenges. The positive health effects of breastfeeding are obvious, and women face various challenges and obstacles regarding breastfeeding. Although women have a strong intention to breastfeed, failures make them feel frustrated and guilty. Practical support, emotional guidance and individualized information can help women overcome many of the internal and external obstacles they face. Clinical applicability: The midwife has a primary role in perinatal care. If the midwife has knowledge of women's experiences of breastfeeding, opportunities are created for the midwife to influence breastfeeding for the better, by teaching, preventing complications and adapting care to the individual, for the best possible initiation of breastfeeding.

Bakgrund: Polycystisk ovarialsyndrom (PCOS) är den vanligaste hormonella rubbningen hos fertila kvinnor, ändå är den okänd för många. Det finns ett flertal symtom där dessa varierar från kvinna till kvinna. Okunskap kring PCOSförekommer både i vården liksom i samhället och diagnosen kan därför vara svåratt upptäcka. Att leva med symtomen från PCOS kan påverka negativt både kroppsligt och psykiskt. Hur kvinnor med diagnosen upplever PCOS behöverlyftas fram och förståelsen för dem behöver ökas både inom vården liksom förkvinnorna med PCOS. Med ökad förståelse kan ett bättre bemötande och vård ges.Syfte: Syftet är att beskriva kvinnors upplevelser av att leva med Polycystiskovarialsyndrom. Metod: Kvalitativ metasyntes med metaetnografisk analysmetod.16 kvalitativa artiklar är inkluderade i resultatet och samtliga artiklar hargenomgått en kvalitetsgranskning. Tre databaser användes vid insamling av data; Cinahl, Medline och PubMed. Resultat: Resultatet lyfter fram att flertalet kvinnorfick diagnos efter en lång tid och där kvinnorna ibland behövde vara påstridiga,medan i andra fall diagnosticerades PCOS som bifynd. Vissa kvinnor kände inte till att deras symtom kunde vara något avvikande och sökte sig därför inte till vården. Information om PCOS från vården mötte inte alltid patienternas behov.Fertilitetsaspekten ansågs vara det som fokuserades mest på från vårdens sida ochatt de psykologiska aspekterna glömdes bort. Symtom som övervikt och hirsutism påverkade det sociala livet negativt och psykisk ohälsa är vanligt förekommande.Slutsats: PCOS behöver uppmärksammas mer och normaliseras. En mer holistiskvård där fokus inte enbart ligger på det medicinska aspekterna, utan även ser till individens behov av stöd och information hade gynnat bemötandet och vårdandet till kvinnor med PCOS. / Background: Polycystic ovary syndrome (PCOS) is the most common hormonal condition amongst fertile women, yet it is still unknown for many. There are several symptoms that may vary from woman to woman. Ignorance of polycystic ovary syndrome occurs in healthcare and in society and can be difficult to detect.Living with the symptoms of PCOS can have a negative effect both physically andmentally. How women with the diagnosis experience PCOS needs to be highlighted and the understanding of them needs to be increased, both inhealthcare and for the women with PCOS. With increased understanding, bettertreatment and care can be provided. Aim: The purpose was to describe women’sexperiences of living with Polycystic ovary syndrome. Method: Qualitative meta synthesis with meta ethnographic analysis method. A total of 16 articles wereincluded and all passed through a quality critique checklist. The articles werecollected from three databases: Cinahl, Medline and PubMed. Findings: It couldtake a long time for a diagnosis to be made and sometimes the women had to be persistent, while others could be diagnoses as an incidental finding. Some womendid not know that their symptoms were not normal and therefore did not seekmedical care. Information about PCOS from the health care did not always meetthe patient’s needs. The fertility aspect was thought to be the main focus from the health care providers and that the phycological aspects were forgotten. Symptoms like overweight and hirsutism affected the social life in a negative way and mental illness was common. Conclusion: Polycystic ovary syndrome needs to be brought more attention to and to be normalized. A more holistic care where not only the main focus is on the medical aspects of PCOS, but instead also sees that the individuals need for support and information can be met.

Bakgrund: Den psykiska ohälsan har ökat stadigt det senaste decenniet i Sveriges befolkning. Efter 65 års ålder är depression den vanligaste psykiska sjukdomen. Symtomen för depression hos äldre ser oftast annorlunda ut jämfört med hos yngre och kan därför vara svåra att upptäcka. Majoriteten av de som får vård av den kommunala hälso- och sjukvården är 65 år och äldre, vilket medför att sjuk­sköterskorna har ett stort ansvar när det gäller att identifiera tecken på depression hos dessa patienter. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av och förutsättningar för att identifiera symtom på depression hos äldre patienter inom kommunal hälso- och sjukvård.  Metod: En systematisk litteraturstudie enligt SBU:s (2017) beskrivning av en systematisk litteratursökning. Tio artiklar syntetiserades i en metasyntes som inspirerades av Howell Major och Savin-Badens (2010) innehållsanalys för kvalitativa studier. Resultat: Metasyntesen resulterade i följande tre teman; tid, holistiskt perspektiv samt kunskap och erfarenhet. Tid och kontinuitet var väsentligt för att skapa en trygg och tillitsfull vårdrelation. Det holistiska perspektivet underlättade upptäckten av symtom på depression hos äldre och möjliggjorde personcentrerade omvårdnadsinsatser. Sjuksköterskorna upplevde att både de själva och de äldre hade bristfälliga kunskaper om depression. Sjuksköterskorna önskade få ökad kunskap i ämnet. Slutsats: Tidvattenmodellen kan genom sitt holistiska perspektiv och sin syn på tid, ge stöd i sjuksköterskans omvårdnadsarbete kring att identifiera symtom på depression hos äldre. Vidare kan en psykiatrisjuksköterska i kommunal hälso- och sjukvård bidra med att kunskapen om depression ökas både hos sjuksköterskor, annan vårdpersonal och hos patienter. / Background: Mental ill-health has steadily increased over the past decade in Sweden's population. After the age of 65, depression is the most common mental illness. The symptoms of depression in the elderly usually look different compared to the younger ones and can therefore be difficult to identify. The majority of those receiving municipal health care are 65 years and older, which means that the nurses have a great responsibility when it comes to identifying signs of depression in these patients. Aim: The aim of this study was to describe nurses' experiences of and prerequisites for identifying symptoms of depression in elderly patients in municipal health care. Method: A systematic literature according to SBU’s (2017) description of a systematic literature search. Ten articles were synthesized in a meta-synthesis inspired by Howell Major and Savin-Badens (2010) content analysis for qualitative studies. Result: The meta-synthesis resulted in the following three themes; time, holistic perspective and knowledge and experience. Time and continuity were essential to creating a safe and trusting care relationship. The holistic perspective facilitated the detection of symptoms of depression in the elderly and enabled person-centered nursing care. The nurses felt that both themselves and the elderly had insufficient knowledge of depression. The nurses wanted to gain increased knowledge in the subject. Conclusion: The Tidal model can, through its holistic- and time perspective, provide support in the nursing work when it comes to identifying symptoms of depression in the elderly. Furthermore, a psychiatric nurse in municipal health care can help to increase the knowledge of depression in nurses, other healthcare professionals and in patients.