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The widespread use of highly active antiretroviral therapy (HAART) has resulted in longer lifespans for HIV seropositive women in the United States, during which preventive health care is recommended. Failing to complete recommended cancer screening tests can result in cancer being diagnosed at a later stage with a poorer prognosis. The purpose of the study, based on the ecosocial theory, was to describe the sociodemographic and clinical variables of HIV seropositive women who failed to complete recommended screening tests for breast, cervical, and colorectal cancers, and determine if the presence of hypertension, obesity, diabetes, depression, or tobacco use impacted the completion of these screening tests. The electronic medical records of 142 HIV seropositive women were reviewed. Univariate analysis, bivariate analysis, and logistic regression were conducted to create a model associated with the completion of preventive health care screening tests. For breast cancer, cervical cancer, and colorectal cancer, 69%, 71.8%, and 69.7% failed to complete screening, respectively. Number of years living with HIV infection and HIV stage were associated with breast cancer screening; distance between residence and health care facility, and HIV stage were associated with cervical cancer screening; and age and marital status were associated with colorectal cancer screening. Addressing issues related to the completion of cancer screening tests over the lifespans of HIV seropositive women can result in positive social change by preventing disease and disability, which can negatively impact these women, their families, and their communities.

Indiana University-Purdue University Indianapolis (IUPUI) / The pursuit of a healthy lifestyle has become an important activity to large portions of the population. Health information and research has become readily available to the general public via the Internet and other communication vehicles and public health programs. As information becomes accessible, so too does the opportunity for individuals to take added ownership in seeking their own health care. The purpose of this research was to examine the role of gender in the decision that leads to individuals seeking regular health care. It focuses on the motivations that influence men and women when managing their regular preventative care. Despite the disparity in health care utilization between men and women, both positive and negative role models positively influence health and wellness. Constructs of masculinity and femininity continue to impact the utilization of health care procurement. Improving our health and providing a role model for our children offers the greatest potential for improving the health of our nation.

As the population of older adults in the US increases so do their rates of chronic disease (CDC, 2020). There is limited availability of occupational therapy led health promotion programs for older adults despite being shown to prevent and/or manage chronic disease while helping them thrive (Berger et al., 2018; Cassidy et al., 2017; Clark et al., 2012; Smallfield & Lucas Molitor, 2018b). Factors contributing to limited programming include lack of training for occupational therapy practitioners in preventive health (Metzler et al., 2012), occupational therapy having little recognition as a provider in preventive care amongst health professionals (Halle et al., 2018), and lack of referrals and reimbursement for occupational therapy services in preventive care (Hildenbrand & Lamb, 2013; Metzler et al., 2012). ageWISE is an innovative evidence-based preventive occupational therapy program developed to improve the mental and physical health of older adults. The six-month program develops participant efficacy in optimizing self-selected health behaviors through topics including fall prevention, sleep and rest, ADL performance, socialization, and navigating healthcare technology by utilizing a blend of didactic lecture, experiential learning, peer discussion, goal-setting, and journaling. Comprised of eight in-person group-based sessions and two telephone-based individual sessions, all ageWISE sessions are led by an occupational therapy practitioner and supported by an occupational therapy doctoral student. ageWISE is positioned to not only improve the health of older adults but to expand the reach of occupational therapy in a setting where its value is a necessity…preventive care.

Thesis (M. Med. Community Health)--University of Pretoria, 2003. / Includes bibliographical references (leaves 73-77).

Statement of Purpose The purpose of this study is to examine the impact of preconception health on adverse pregnancy outcomes through the theoretical lens of reciprocal determinism. Thus, this study aims to develop a preconception health conceptual framework that accounts for the interactive relationships among behavior, the environment, and the person. Rationale for the Study Women may not recognize a pregnancy until the first or second missed menstrual cycle, a full four to eight weeks or more after conception. Once a woman realizes the possibility of a pregnancy, it takes further time to confirm the pregnancy with a home pregnancy kit or a visit to the health care provider. In that time period, the woman may have unknowingly exposed her embryo to nutritional deficiencies, over-the-counter drugs, tobacco, alcohol, or other toxins. Because nearly half of all pregnancies are unintended, yielding about three million unintended pregnancies in the U.S. annually, there is a need to shift care to an earlier period in a woman's life cycle with greater potential to prevent birth defects and other adverse pregnancy outcomes, also known as preconception care. The preconception health movement began with the rationale that many adverse pregnancy outcomes are determined prior to prenatal care initiation. Thus, in addition to prenatal care, the need for preconception health arose. The empirical literature makes a strong case for the benefit of individual preconception health components and their effects on adverse pregnancy outcomes. However, the actual effectiveness of collective preconception health in reducing adverse pregnancy outcomes has not yet been demonstrated. In an effort to evaluate the impact of preconception health on maternal morbidity, infant morbidity, and infant mortality, this study examined the reciprocal relationships between environmental, personal, and preconception behavioral factors and their associations with adverse pregnancy outcomes. Methods A secondary data analysis was conducted using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2005-2008 to test a preconception framework. Project 1 examined all variables in the preconception framework among the following states: Maine, New Jersey, Ohio, and Utah. Project 2 examined all variables except of two among all PRAMS-participating states. All of the variables in the proposed framework were derived from questions in the PRAMS survey or from PRAMS-linked birth certificate data. The research questions posed in this study were resolved through the path analyses of reduced and full iterations of the preconception framework in Projects 1 and 2. Results In Project 1, list-wise deletion of missing data resulted in a decrease from the original 27,933 participants to 12,239 participants. In Project 2, this action resulted in a decrease from the original 200,008 participants to 128,551 participants. The analysis of the reduced frameworks for both projects revealed extremely low R-squared values (1.1% or less). Subsequent analyses examining the full framework in Projects 1 and 2, as well as an additional post hoc analysis with supplementary PRAMS variables, resulted in R-squared values of 13.1%, 11.4%, and 30.5%, respectively. Implications This study examined the impact of preconception health behaviors on adverse pregnancy outcomes through the theoretical lens of reciprocal determinism. Preconception health behaviors alone accounted for a negligible portion of the variance associated with adverse pregnancy outcomes. As hypothesized, preconception health behaviors work in concert with environmental factors, personal influences, prenatal and natal factors. Significant predictors supported in the literature included lower socioeconomic status, pregnancy intention, pregnancy history, older maternal age, black maternal race, Hispanic ethnicity, overweight maternal BMI, tobacco use prior to pregnancy, maternal complications, hospitalization during pregnancy, later prenatal care initiation, fewer prenatal care visits, plurality, and cesarean section. Even so, there is a large portion of the variance in adverse pregnancy outcomes that is not accounted for, and further examination is required.

Purpose To evaluate the impact of Laduma, a health education intervention, on the knowledge, attitudes, beliefs and practices regarding sexually transmitted infections among secondary school learners in KwaZulu-Natal. Objectives The objectives of the study were to determine knowledge, attitudes, beliefs, perceptions and practices of secondary school learners regarding sexually transmitted infections at baseline and post-exposure to Laduma; assess intended behaviour change regarding sexually transmitted infections and condom use as well as the awareness of skills to achieve such behaviour; assess learners' perceived vulnerability to sexually transmitted infections; assess comprehension, acceptability and appeal of the photonovella among learners and to assess whether learners can identify with the characters and situations in the photo-novella. Design This was an experimental study design. Setting Nineteen randomly selected secondary schools in the Midlands district of KwaZulu-Natal. Subjects Grade 11 learners, n = 1168, from randomly selected schools that were further randomised into intervention and control groups. Outcome Measures The learners had to complete three sets of questionnaires that elicited information about their biographical profile, knowledge, attitudes, beliefs, perceptions and practices regarding sexually transmitted infections, intention to change their behaviour with regard to sexually transmitted infections and condom use, as well as their skills to achieve such behaviour, their perceived vulnerability to sexually transmitted infections and their perceptions of Laduma. All of these outcomes were assessed at baseline (Tl), following the learners' exposure to Laduma (T2, three weeks after the baseline), as well as six weeks later (T3) in the case of the intervention group. With respect to the control group they had to answer the baseline questionnaire on all three occasions. Results The mean age of the respondents was 16.8 years with almost two thirds of the learners being between the ages of 15 - 18 years. Seventy percent were primarily Zulu speaking. Learners reported feeling personally scared of getting a sexually transmitted infection with 17.8% responding that they thought they could get a sexually transmitted infection in the next two years. There was a significant gender difference between male and female learners in their topics of communication to friends, parents and partners regarding HIV/AIDS, condom use, having sex or not having sex (p < 0.01). Although learners had adequate knowledge about the spread of sexually transmitted infections at baseline, the mean scores for the spread for the group exposed to Laduma differed significantly from the mean scores of the control group, both immediately after the intervention (p < 0.01) and six weeks thereafter (p < 0.001). Learners in the intervention group responded more positively towards condom use at time 2 (T2) than the control group and maintained this change six weeks later. Sexual activity and condom use at time 3 (T3) was not influenced by the intervention but was significantly predicted by past sexual activity (p< 0.001) and past condom use (p < 0.001) respectively. At time 3 (T3) significantly more learners in the intervention group intended to have sex with a condom (65.1 %) compared to the control group (52.3%, p < 0.05). Overall learners had a positive response to Laduma and appreciated it as a health education intervention. Conclusion and Recommendation The findings of this study provided important information about adolescent sexuality on a range of outcomes related to knowledge, attitudes and sexual behaviour. The findings also provided information on learners' gender differences about what they communicate and to whom, as well as their sexual behaviour. After a single reading of Laduma learners showed an increase in knowledge about the spread of sexually transmitted infections, a change in their attitude to condom use as well as an increased intention to practice safer sex. Laduma did not influence communication about sexually transmitted infections, sexual behaviour nor condom use. These are complex behaviours and indicate that interventions focussing on preventive sexual behaviour need to move beyond awareness and information dissemination towards being more intensive and skills focussed. Such interventions need to address the gaps between knowledge and practice and be facilitated in a context that supports such implementation. The specific recommendations made from the findings of this study therefore include, the development of a systematic health promotion programme that addresses the issues related to personal vulnerability, knowledge related to treatment of and protection against sexually transmitted infections as well as skills that promote safer sexual choice. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2005.

M.Cur. / Please refer to full text to view abstract

A reading of recent studies in preventative health care behavior recalls the proverb about the blind men and the elephant: each man is able to describe the part of the animal he is closest to, but none can see, and so none can put their diverse and often contradictory opinions together to come up with an accurate description of the whole elephant. Similarly, in preventative health care studies, each researcher or research group is able to observe the preventative health care utilization patterns of specific populations at particular times, but the conclusions reached are often based on less than complete knowledge. This is especially true of the research into what makes low income people use preventative services in certain ways.

Dissertation submitted in partial compliance with the requirements for the Master's Degree of Technology: Nursing, Technikon Natal, 2002. / The Integrated Management of Childhood Illness (IMCI) is an approach that aims to reduce the mortality and morbidity in children under the age of five years. When this programme was initiated, the conditions targeted were acute respiratory infections, diarrhoea, fevers associated with malaria and measles and malnutrition. As a result of the HIV pandemic in South Africa, the identification of children who are symptomatic of HIV infection was included. This study evaluates the use of the HIV portion of the IMCI algorithm by nurses in selected, public sector, primary health clinics in KwaZulu Natal. IMCI nurses were observed as they used the IMCI approach while consulting with sick children. Data was collected in relation to the accuracy with which the nurses used the algorithm and the extent to which the HIV portion of the algorithm was used to guide their management decisions when consulting with the children. Seventy-two observations were undertaken. In-depth interview were conducted with 13 IMCI nurses to establish factors that influenced the use of the HIV portion of the algorithm. The study showed a poor level of accuracy when using the HIV portion of the algorithm. In addition, as a result of poor accuracy when using the algorithm to assess and classify for symptomatic HIV infection, it appeared that nurses were not using the HIV portion of the algorithm to guide management decisions regarding children who were possibly symptomatic of HIV infection. I A general poor level of knowledge about HIV infection was identified which the researcher felt could be one of the factors influencing the use of the HIV portion of the algorithm. Death anxiety, low level of counselling skills and burnout also seemed to play some role in the use of the HIV portion of the algorithm.Recommendations were made to adapt future training of IMCI nurses and include an HIV training course and a course on growth monitoring of children in this age group. Further recommendations to continually evaluate the practice of nurses were made. Future areas for research were suggested. / M