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Free cervical cancer screening services are provided in Malawi’s public healthcare institutionssince 1999. Few women aged 42 and older, utilise these services. Cervical cancer continues to be a major cause of morbidity and mortality among this group of women. Structured interviews were conducted with 381 women who attended three healthcare centers in Blantyre and semi-structured interviews with 14 nurse/midwives working at the same centers. The results for both phases arepresented within the Health Belief Model’s constructs. Phase 1 revealed that women had low levels of perceived susceptibility to cervical cancer. Although the interviewed women perceived cervical cancer to be a serious condition, they did not regard themselves to be at risk of suffering from cervical cancer. Knowledge that cervical cancer screening could detect this cancer at an early stage, embarrassment, stigma, social support, financial costs, traditional practices and available sources of information, influenced women’s intentions to be screened for cervical cancer. In phase 2, the nurse/midwives indicated that Malawian women lacked information about cervical cancer, available screening tests and the purpose of such screening.These women perceived cervical canceras being incurable and linked to witchcraft. Women’s utilisation of cervical screening services was hampered by barriers relating to healthcare institutions, women themselves and nurse/midwives. Local radio and television broadcasts, friends and nurse/midwives motivated individual women to use these screening services.Women preferred receiving information about cervical cancer screening during community activities. Health education should be intensified, nurse/midwives should be more empathetic, clinic days and hours should be extended. Misconceptions should be addressed and more service providers should be trained. This would enable more Malawian women to use cervical screening services, enhancing early detection and treatment of cervical cancer and reducing the morbidity and mortality statistics related to this condition in Malawi. / Health Studies / D. Litt. et Phil. (Health Studies)

A quantitative, descriptive, explorative survey was conducted to explore and describe factors contributing to underutilisation of HIV testing services among tuberculosis patients and clients in Malawi. Sampled were 282 participants attending an outpatient clinic. A self administered questionnaire was used. The findings revealed that 80.5% of the respondents perceived themselves susceptible to HIV infection, 55% believed there were negative consequences of HIV Testing and Counselling (HTC), 87.6% perceived HTC had benefits, most of the respondents (76.8%) mentioned the benefit of knowing the HIV status helping one to plan life, 65% believed in themselves, that they could accept and undergo HIV testing with ease. The study recommends that all HTC providers be thoroughly trained in knowledge and skills to offer services with confidentiality and avoid stigma and discrimination of those found HIV positive. The importance and benefits of HTC should be emphasised in all behaviour communication messages / Health Studies / M.A. (Public Health)

Falling among older adults is a leading cause of concern due to the known impacts including physical injury, loss of independence, increased health care costs, and mortality. In efforts to decrease the numbers of falls experienced by older adults, healthcare providers assess individuals’ fall risks and provide corresponding fall prevention recommendations. The effectiveness however, of these recommendations, is only as strong as the level of adherence to those recommendations; which has proven low in recent research. Using the theoretical foundation of the Health Belief Model, this study quantified adherence to environmental fall prevention recommendations. Twenty-two community-dwelling older adults participated in this randomized control group study that took place across three home visits, scheduled approximately 30 days apart. Participants were interviewed regarding their recent falls and perceived susceptibility to future falls; then a home evaluation was conducted. Treatment group participants were provided personalized education explaining how and why environmental fall prevention recommendations were important to decrease their risk of falls while control group participants were provided general recommendations. A two-sample t-test for independent groups determined a statistically significant relationship: participants who received personalized education intervention were more likely to follow recommendations than those who received general education intervention. Multiple regressions were conducted to review relationships between an individual’s recent falls, and their perceived susceptibility to future falls, with their extent of adherence with fall prevention recommendations. No statistically significant relationship was found. This study suggests that providing personalized education for community-dwelling older adults regarding environmental fall prevention recommendations increases their extent of adherence with such recommendations.

Free cervical cancer screening services are provided in Malawi’s public healthcare institutionssince 1999. Few women aged 42 and older, utilise these services. Cervical cancer continues to be a major cause of morbidity and mortality among this group of women. Structured interviews were conducted with 381 women who attended three healthcare centers in Blantyre and semi-structured interviews with 14 nurse/midwives working at the same centers. The results for both phases arepresented within the Health Belief Model’s constructs. Phase 1 revealed that women had low levels of perceived susceptibility to cervical cancer. Although the interviewed women perceived cervical cancer to be a serious condition, they did not regard themselves to be at risk of suffering from cervical cancer. Knowledge that cervical cancer screening could detect this cancer at an early stage, embarrassment, stigma, social support, financial costs, traditional practices and available sources of information, influenced women’s intentions to be screened for cervical cancer. In phase 2, the nurse/midwives indicated that Malawian women lacked information about cervical cancer, available screening tests and the purpose of such screening.These women perceived cervical canceras being incurable and linked to witchcraft. Women’s utilisation of cervical screening services was hampered by barriers relating to healthcare institutions, women themselves and nurse/midwives. Local radio and television broadcasts, friends and nurse/midwives motivated individual women to use these screening services.Women preferred receiving information about cervical cancer screening during community activities. Health education should be intensified, nurse/midwives should be more empathetic, clinic days and hours should be extended. Misconceptions should be addressed and more service providers should be trained. This would enable more Malawian women to use cervical screening services, enhancing early detection and treatment of cervical cancer and reducing the morbidity and mortality statistics related to this condition in Malawi. / Health Studies / D. Litt. et Phil. (Health Studies)

A prévention de l'anorexie, et plus largement des troubles de comportement alimentaire, revêt un intérêt social et sociétal fort. Elle comporte également un intérêt académique, ce contexte étant sous-représenté en recherche. Les communications existantes sur la prévention de l'anorexie utilisent la stratégie de l'appel à la peur, malgré une littérature non consensuelle sur le niveau d'appel à adopter et sur le fonctionnement exact du mécanisme. La littérature propose également, pour expliquer l'échec de l'appel à la peur, l'existence d'une réactance situationnelle, sans que celle-ci n'ait jamais été validée. Quatre expérimentations auprès de jeunes femmes étudiantes, public particulièrement sensible dans ce contexte, permettent de comprendre et valider le fonctionnement de l'appel à la peur par médiations successives et en intégrant la réactance situationnelle. Il est montré que le message avec appel à la peur crée un état cognitivo-émotionnel composé de peur et de sévérité perçue qui vont influer de manière opposée sur la réactance situationnelle. Cette dernière influence à son tour la perception d'efficacité de la recommandation, qui déterminera ensuite le succès ou l'échec du message. En parallèle, le rôle médiateur, mais secondaire, de l'auto-efficacité sur l'efficacité perçue de la recommandation est révélé, de même que celui modérateur de la vulnérabilité perçue. En complément de ce résultat, chacune des études s'attache à manipuler, en plus du niveau d'appel à la peur, différentes composantes et caractéristiques du message, dont les effets sur le mécanisme d'appel à la peur permettent de résoudre, en partie, certains conflits existants dans la littérature. Ainsi, le rôle des composantes, visuelle et verbale, sur le niveau ressenti de peur est examiné (études 1 et 2). L'effet de la formulation de la recommandation (étude 2), de même que l'effet du type d'argument (étude 3) sur le processus de l'appel à la peur sont analysés. Enfin, l'ajout du dégoût à l'appel à la peur et la validation du fonctionnement du processus par une mesure comportementale affinent encore la compréhension des mécanismes d'action de l'appel à la peur (étude 4). Pour conclure, les clés d'une communication préventive de l'anorexie efficace avec recours à l'appel à la peur sont données et les résultats discutés et complétés par des voies de recherche possibles, dont certaines permettent de pallier les limites mentionnées pour la présente recherche. / Anorexia prevention or more widely disorder eating behavior, has a strong social and societal interest. It also presents an academic interest, since this context is under-represented in research. Existing anorexia prevention campaigns use the strategy of fear appeal, despite a non-consensual literature on the level of fear appeal to adopt and the exact functioning of the mechanism. The existing literature also suggests, to explain failure of fear appeal, that there is a situational reactance, even though this has never been validated. Four experiments on young women students, public particularly sensitive to this context, allow us to understand and validate the mechanism of fear appeal in successive mediations and while integrating situational reactance. Through these experiments, it is shown that the message with fear appeal creates a cognitive and emotional state of fear, and perceived severity that will oppositely influence situational reactance. The latter influences the perceived efficacy of recommendation, which in turn determines the success or failure of the message. In parallel, the mediator, but secondary role, of self-efficacy on the perceived efficacy of the recommendation is revealed, as well as the moderator of perceived susceptibility. Furthermore, each study attempts to handle, in addition to the level of fear appeal, various components and characteristics of the message, whose effects on the fear appeal mechanism solve in part, some existing conflicts in the literature. Thus, the role of the components, visual and verbal, on the level of fear felt is examined (studies 1 and 2). The effect of the wording of the recommendation (study 2), as well as the effect of the type of argument (study 3) on the process of fear appeal are analyzed. Finally, the addition of the disgust on fear appeal and the validation process by a behavioral measure yet refine understanding the mechanism of fear appeal (study 4). To conclude, the key preventive effective communication with anorexia use of fear appeals are given and results are discussed and complemented with possible future research directions, some of which are used to overcome the limitations mentioned on this research.

A random sample of 365 students attending a university in northern Texas returned a mailed questionnaire measuring the students' knowledge of Acquired Immuno-Deficiency Syndrome (AIDS), their perceived susceptibility to AIDS, and their sexual practices during the last year. The students had high knowledge levels about AIDS in general. However, 70% did not worry about getting AIDS. Collectively, there was a display of concern until it became a personal issue. The students (59%) saw themselves as less likely than most people to get AIDS. Although 70% of this sexually active group did not use condoms, they still did not perceive themselves as susceptible to AIDS.