The aim of this thesis was to examine different approaches to support the self-care of persons with Type 2 diabetes, with special reference to practical, social, and sexual aspects of women's self-management. The methods to elucidate this comprised: evaluating a new model for diabetes patient education; designing a model to analyse the role of social networks in women's diabetes; conducting individual and focus group interviews for deeper understanding of the social and sexual aspects of diabetes; and collecting questionnaire data as a complement to the above. The experience-based educational program led by pharmacists was found to improve participants' subjective control over diabetes and to provide important emotional support and encouragement to continue self-care. Metabolic control as measured by HbA1c temporarily improved. The social network model elucidated potential mechanism leading to conflict of disease and social demands in women's diabetes. Qualitative analysis of the focus group interviews pointed to the role of guilt, shame, and social taboo in connection with the women's diabetes and sexuality. Borderland is the metaphor I have chosen to describe the space between the traditional health care system and the everyday self-care of people with chronic disease. Using Borderland as a framework, a future model for diabetes management, anchored in our own and other's findings, is outlined and the concept of "Disease Manager Role" is introduced. The vision of a self-care support center in Borderland addresses such issues as accessibility, continuity, equitable provider-user relations, shared care plans, and strengthening social support.

Patientutbildning är en viktig del av behandlingen vid typ 2 diabetes. Det finns dock ingen samlad kartläggning av vilken patientutbildning som bedrivs sedan tidigare. Syftet med studien var att kartlägga hur patientutbildning för personer med typ 2 diabetes bedrevs inom primärvården i Sverige år 2006 samt studera om det fanns något samband mellan hur patientutbildning bedrevs och personernas metabola kontroll. Totalt deltog 684 vårdcentraler/hälsocentraler/mottagningar (mottagningar). Data erhölls både från en enkät och Nationella diabetesregistret som omfattade 91 637 patienter med typ 2 diabetes. Resultatet analyserades genom kvalitativ innehållsanalys och med multipla linjära regressionsanalyser. Resultatet visade att den vanligaste formen av utbildning var patientutbildning med förutbestämt innehåll som bedrevs individuellt på 362 mottagningar, utav dessa mottagningar bedrev 108 kompletterande grupputbildning. Patientutbildning utifrån patienternas behov bedrevs individuellt på 55 mottagningar och utav dessa bedrev 12 kompletterande grupputbildning. Ospecificerad patientutbildning förekom på 267 mottagningar. Ett statistiskt signifikant samband konstaterades som indikerade att patienternas HbA1c var lägre på de mottagningar som bedrev individuell utbildning utifrån patientens behov, vilket förekom på 55 av mottagningarna. Studien har visat att vid patientutbildning var det främst vårdgivaren som bestämde vad patienten behövde veta och utgick ifrån någon form av checklista. Få vårdgivare utgick utifrån patientens behov och intresse. / Patient education is an important part of the treatment in type 2 diabetes. Today there is no collected survey of patient education. The aim of the study was to survey how patient education for persons with type 2 diabetes was carried out within the primary care in Sweden and study if there was some relation between how patient education was carried out and persons' HbA1c, BMI and physical activates. Totally 684 health care centres participated. Data was received from a questionnaire and the national diabetes register that covered 91637 patients with type 2 diabetes. Data was analyzed through qualitative content analysis and with multiple linear regression analysis. The result showed that most common form of education was "Patient education with a predestined content", that was practiced individually in 362 of the health care centres, 108 of these also practiced complementary group education.  "Patient education based on the patients needs" was carried out individually at 55 health care centres, 12 were also carried out complementary group education. "Unspecified patient education" was practiced in 267 health care centres. A statistical significant relation was found indicating that patients  receiving individual education based on the patient's needs HbA1c was lower (55 health care centres). The most common procedure was a checklist in which the care provider decided what the patient needed to know.  Most of the care providers in patient education disregarded the patient's needs and interest.

Bakgrund: Att leva med långvarig sjukdom innebär förluster för individen och krav på anpassning. En viktig del i sjuksköterskans arbete med att stärka hälsa hos personer i behov av vård är att stötta lärande. En viktig del i lärande är interaktion och delaktighet. Som vårdvetenskaplig utgångspunkt har Dorothea Orems “Teori om omvårdnadssystem” använts och denna teori beskriver interaktionen mellan sjuksköterskan och de personer hon vårdar. Syfte: Syftet var att nå kunskap om hur sjuksköterskan kan arbeta med lärande i grupp hos personer med långvarig sjukdom utifrån Dorothea Orems ”Teori om omvårdnadssystem”. Metod: En litteraturöversikt har genomförts där tio kvantitativa studier har sammanställts genom analys med Dorothea Orems “Teori om omvårdnadssystem” som utgångspunkt. Resultat: Resultatet visar hur de olika programmen i studierna arbetat med lärande i grupp bland personer med långvarig sjukdom, där det framkommer skillnader och likheter i deltagarnas och sjuksköterskans roller. Likheter fanns i programmens fokus på interaktion mellan deltagarna såväl som på sjuksköterskans faciliterande roll. En viktig skillnad fanns i utsträckningen av deltagarnas påverkan på innehållet i gruppträffarna, där vissa program lät deltagarnas behov och intresse styra medan vissa program i förväg hade bestämt innehållet. Diskussion: I resultatdiskussionen argumenteras för att människans egenidentifierade lärandebehov bör styra lärandet. Lärandet bör främja utvecklandet av självstyrning hos personen. Resultatet visar att deltagarna i interaktionen mellan varandra har inneboende resurser som används för att främja individens och andras lärande. I metoddiskussionen uppmärksammas styrkor och svagheter kring val av metod för denna litteraturöversikt. / Background: Living with long term illness means losses for the individual and demands for adaptation. An important part of the nurse's work on strengthening the health of people in need of care is to support learning. An important part of learning is interaction and participation. As a nursing-science basis Dorothea Orem’s "Theory of nursing system" has been used and this theory describes the interaction between the nurse and the person she cares for. Aim: The purpose was to gain knowledge about how nurses can work with learning in a group of persons with long-term illness with basis in Dorothea Orem’s "Theory of nursing systems." Method: A literature review was carried out where ten quantitative studies have been compiled through analysis with Dorothea Orem’s "theory of nursing system" as a basis. Results: The results how how the various programs of the studies worked with learning in a group among people with long-term illness, where similarities and differences in the roles of the participants and the nurses emerged. Similarities were found in the programs focus on the interaction between participants as well as on the facilitating role of the nurse. An important difference was revealed in the extent of participants' influence on the content of the group sessions, where some programs let participants' needs and interests guide while some programs previously had determined the content. Discussions: In the discussion of the results it is argued that man's self-identified learning needs should direct learning. Learning should encourage the development of the person’s self-direction. The results show that participants in the interaction between each other have inherent resources used to promote learning among themselves and others. Strengths and weaknesses regarding the chosen method for this literature review are highlighted in the method discussion.

Backround. Based of my personal observations when employed as a pharmacist in a Saudi hospital it was clear that there were problems with medicine supply to outpatients. This thesis was designed to scientifically investigate the types of shortages, the reason(s) for such problems and potential solutions to the problem. Methods . This study was undertaken using a variety of experimental techniques to determine the views and perceptions of patients, pharmacists, physicians and administrative staff of the hospital under examination. To establish the scale of the problem: focus groups (n=25), structured questionnaires, structured interviews/meetings for health care professionals and a national survey (n=650) were the research tools used to objectively determine the relevant data. The data were analyzed by appropriate statistical methods. Results and Discussion That there was a real problem was quickly established in the data obtained from patients. A similar finding was made for each of the 'professional groups'. The central problem was one of shortages of medicines for prescriptions presented by outpatients. It was not a case the medicines were simply not available because they were never stocked but rather a simple shortage in the dispensary stock. It was established the lack of medicines was not due to central budget arrangements but involved prescribing quantities outside of the hospital guidelines which no degree of planning could accommodate. There was also the very unexpected finding that a prescription could be filled in a variety of hospital dispensaries as individuals could access more than one hospital or they could consult more than one physician for the same condition and obtain effectively double the supplies. Communications between the hospital and patients and the health care professionals could all be improved by perhaps increasing the knowledge of the patient about the correct use of medicines. Recommendations. A series of recommendations for future work is provided

The purpose of this naturalistic inquiry was to understand factors that influence patients’ commitment to colorectal cancer screening, specifically colonoscopy. Fifteen personcentred interviews were conducted: 10 with individuals who had completed screening, and 5 with individuals who declined. Three subthemes (relationship, motivation, and human agency) were associated with the overarching theme of regard or disregard for vulnerability. Participants who perceived a disregard for their vulnerability by their health care provider (HCP) frequently chose to decline screening even though they showed a high level of commitment to health promotion. Participants who perceived a regard for vulnerability by their HCP frequently chose to accept screening. The nursing profession can show a regard for patient vulnerability by enhancing communication techniques and concentrating on being attentive to patient concerns which will build a trusting relationship with patients and enhance screening rates. Persistence in the relationship can change a patient’s decision in time. / 132 leaves : col. ill. ; 29 cm

Hensikt: Å kartlegge hvilken kunnskap norske pasienter med ankyloserende spondylitt har om sykdommen og i hvilken grad deres tiltro til egen mestringsevne påvirker deres helserelaterte livskvalitet.Metode: Tverrsnittstudie i form av en spørreundersøkelse for å kartlegge og beskrive deltagernes kunnskap om sykdommen og hvordan denne kunnskapen påvirker deres livssituasjon. Studien ble gjennomført på 150 pasienter i forbindelse med deres deltagelse på en behandlingsreise til utlandet.Resultat: Pasientene var mest fornøyde med den informasjonen de fikk fra spesialist i revmatologi og fysioterapeut. De anga også medpasienter som en viktig kilde til informasjon. Deltagelse i mestringskurs og informasjon fra sykepleier var de informasjonskildene færrest respondenter var fornøyde med. Respondentene hadde mest kunnskap om sykdommens symptomer og trening, mens kunnskap om medikamenter og hjelpemidler/tiltak for tilrettelegging hjemme og på arbeidsplassen var de temaer de hadde minst kunnskap om. De som var mest fornøyde med den kunnskapen de hadde om sykdommen, hadde en signifikant bedre tiltro til at de kunne påvirke sine smerter og sykdomssymptomer.Konklusjon: Kunnskap om sykdommen bidrar positivt til å påvirke pasientenes helserelaterte livskvalitet. Læring gjennom utveksling av kunnskap og erfaringer med andre i samme situasjon, synes å være en riktig og positiv måte å tilrettelegge pasientundervisningen på. Målgruppen bør imidlertid kartlegges, slik at undervisningen kan tilpasses deltagernes utdannelsesnivå. Likeledes bør helsepersonellets roller og funksjoner avklares og tydelig defineres. / Aims: This study sought to explore the knowledge Norwegian patients with ankylosing spondylitishave about the disease and to what extent belief in their own capacity to master the disease affectshealth-related quality of life.Methods: We used questionnaires to explore and describe participants’ knowledge about ankylosingspondylitis. The questionnaires also assessed how this knowledge affected participants’ lifesituations. The study included 150 patients who participated in a rehabilitation programme abroad.Results: The patients were most satisfied with information provided by rheumatologists andphysiotherapists. They also considered fellow patients as an important source of information. Lesssatisfactory was information provided by nurses and courses in disease mastery. Respondents werevery knowledgeable about disease symptoms and physical exercise. However, they described theirknowledge about medication and appliances designed for use at home or in the workplace as limited.The patients who were most satisfied with their knowledge about the disease had a significantlybetter belief in their ability to cope with pain and disease-related symptoms.Conclusions: Knowledge about their disease contributed positively to patients’ health-related qualityof life. Sharing knowledge and personal experience with others who are in similar situationsenhances learning and appears to be a useful and positive way of providing patient education.However, adapting training to the educational background of participants will require carefulassessment of the target group. Similarly, the roles and domains of health care professionals requireclear definitio / <p>ISBN 978-91-85721-82-5</p>

The introduction of newborn screening for hearing has refocussed attention on the information and support needs of families with deaf children. The Internet is providing an additional resource for families to access timely and relevant information and advice. However, the experiences and attributes of parents of deaf children who search the Internet for information and support remain largely anecdotal. This study aims to bridge some of this knowledge gap. Parents of deaf children were recruited to complete two online surveys. The Parent Survey sought to establish the demographic details and Internet use patterns of parents who use the Internet to search for information about deafness. The online Support Group Survey asked parents about their experience of participating in online support groups. One hundred and sixty-three respondents completed the Parent Survey. Analysis of the data found Internet use is unrelated to the age of the parent, the age of their child, where they live or their employment status. Their use of the Internet is also unrelated to the type of hearing loss of their child, if their child has a cochlear implant or an additional disability or medical condition, or the method of communication used by the child. Education level of the parent, however, does influence the level of Internet use. Qualitative data indicates the need for unbiased information that is evidence-based on a range of issues that are important for families to make informed decisions regarding raising a deaf child. Twenty parents responded to the Online Support Group Survey. They participate in online support groups for the wealth of information and the support and understanding they receive from other parents. All respondents would recommend an online support group to other parents. The respondents indicated that the benefits significantly outweighed the limitations. The two major issues this study has highlighted is the need for parents of deaf children to receive unbiased and evidence-based information from a variety of sources, including the Internet and online support groups, and the need to ensure that parents have access to timely and reliable information irrespective of education level, socio-economic status and ethnicity. This study provides a foundation of knowledge for service providers and hearing professionals developing Internet resources for parents of deaf children in Australia.

Thesis (Ph.D.) -- McMaster University, 2005. / "Health Research Methodology". Includes bibliographical references. Also available via World Wide Web.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2004. / Härtill 4 uppsatser.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2008. / Typescript. Includes bibliographical references (leaves 92-94).