The popularity of non-mainstream cancer treatments raises complex issues for patients and medical practitioners and it is vital to scientifically evaluate effectiveness and investigate mechanisms of action of complementary treatments. This thesis describes sociodemographic, medical and psychological characteristics of participants in The Gawler Foundation program, which incorporates meditation, social support, positive thinking and a vegetarian diet. It describes program impact in terms of: Profile of Mood States (POMS), Mini-Mental Adjustment to Cancer (Mini-MAC), Functional Assessment of Chronic Illness Therapy (FACIT) and salivary cortisol levels. Compliance with program recommendations for up to 12-months and effects on adjustment were explored. This thesis also describes the development of a scale to assess the effects of meditation. Program participants (n=112) were predominantly female, well-educated, younger in age with good social support. Over 60% reported metastatic disease and 50% had been diagnosed for over a year. Improvements in all measures were found at program completion, with Spiritual wellbeing particularly linked to improvement in quality of life (QOL). Those with higher levels of mood disturbance and lower QOL at baseline benefited more than those who were less well adjusted. Analysis of three, six, and 12-month follow-up data showed high compliance with program recommendations. Improvements seen at program completion were mostly not maintained at follow-up, although improvements from baseline were. These results suggest that the program has significant beneficial effects on adjustment but that these may not be fully maintained at follow-up, possibly due to difficulty incorporating program recommendations into everyday life and increasing disease severity. Study limitations include self-selection, high drop-out rates and lack of a control group. Initial investigation suggested that quality of meditation experience was linked to improved adjustment and this thesis describes the initial development of a scale to assess the effects of meditation, which was divided into two sections: Experiences During Meditation and Effects of Meditation in Everyday Life, and trialled on 236 participants. Scale evaluation involved factor analysis, reliability and validity analysis. The Experiences During Meditation scale had five subscales: Cognitive effects, Emotional effects, Mystical experiences, Relaxation and Physical discomfort. The Effects of Meditation in Everyday Life scale had a single factor structure, with the final scale consisting of 30 items. Construct validity was explored by assessing correlations with the measures: Perceived Control of Internal States, Mindful Attention Awareness Scale, FACIT Spiritual wellbeing subscale, POMS-Short Form and Physical Symptoms Checklist. It is anticipated that the scale may be useful for clinicians and researchers and may contribute to improved understanding of the effects of meditation practices.

The time of cancer diagnosis and treatment may be marked by an increase in stressors, which may be associated with poorer psychosocial and physical adaptation and increased sleep difficulty. Prior work has shown that psychosocial interventions that teach stress management skills can improve indicators of psychosocial and physical adaptation in women with breast cancer, mostly in cancer survivors who have completed treatment. The extant literature does not examine the effects of stress management on sleep, or the role that sleep plays in mediating psychosocial and physical adaptation outcomes, among women in the midst of treatment for non-metastatic breast cancer (BCa). Two hundred forty (240) women, recruited post-surgery from oncology practices, were randomly assigned to a 10-week group-based cognitive behavioral stress management intervention (CBSM; n = 120) or 1-day psychoeducation (PE) control (n = 120). The intervention consisted of didactics, CBSM techniques, and relaxation exercises, but did not specifically target sleep or sleep quality (SQ). Women assigned to the PE condition attended a one-day group seminar where they learned some of the material covered in the CBSM intervention, without the therapeutic group environment, role play techniques, and home practice. Participants completed self-report questionnaires at baseline, and at 6- and 12-month follow-ups. After controlling for days since surgery, participants in the CBSM group reported improved SQ, as well as increased positive states of mind, decreased disruption in social recreational functioning, and reduced fatigue-related daytime dysfunction for up to 8 - 12 months after baseline. There were marginally significant improvements in functional well-being and social functioning. CBSM was not associated with improvements in fatigue intensity. Improvements in SQ mediated CBSM-associated improvements in positive states of mind, social disruption, and fatigue-related daytime dysfunction. Thus, the CBSM intervention had beneficial effects on several indicators of functional adaptation that were in part explained by improvements in the quality of sleep. Future work should test the combined effects of stress management and sleep management interventions for women initiating treatment for BCa.

The Healthy Start Summer Program (HSSP) is a seven-week summer program that strives to provide health and wellness education in a manner that is applicable to everyday living. The primary goal of the HSSP is to improve physical fitness levels and the psychosocial variables associated with exercise in a minority adolescent population, while providing the tools necessary for students to maintain these changes for four months after the program. Participants and control subjects were evaluated at the beginning and end of their respective summer programs, then followed up four months post-program to evaluate the maintenance of these changes. The students who participated in both the HSSP and the control summer programs were primarily of Hispanic, African-American, or Haitian descent and were recruited from high schools that serve low socioeconomic areas. Participation in the HSSP was associated with improved physical fitness levels that remained elevated at the follow-up evaluation; however, physical fitness improvement during the program was negatively associated with maintenance after the program. In general, the expected associations between physical fitness and psychosocial variables were not found in our population, nor did psychosocial variables change significantly during or following the program. Findings indicate that the expected associations between physical and psychosocial variables are either not present or that the tools used to measure them were not sufficiently sensitive in this minority population. However, the fact that cardiovascular fitness remained elevated above baseline four months after the program represents an improvement from interventions previously reported in the literature. Future research should be conducted to more fully understand the factors related to the maintenance of physical fitness.

In this thesis coping shortly after diagnosis and psychosocial function during the acute and extended phase of survival was investigated for individuals struck by cancer during adolescence. Sixty-one participants were recruited and data were collected from four to eight weeks (T1) up to four years (T7) after diagnosis. Study I: the aim was to describe how participants (n=56) cope with cancer-related distress in response to closed and open-ended questions. In response to closed-ended questions, the majority reported emotion-focused strategies, and in response to open-ended questions they reported meaning-based and problem-focused strategies. Study II: the aim was to investigate nurses’ and physicians’ ability to identify which coping strategies participants (n=48) use. Neither nurses nor physicians were successful in identifying which strategies participants used, although physicians were somewhat better. Study III: the aim was to identify participants’ (n=61) psychosocial states. Three states were identified: poor (A), average (B), and good (C). From 18 months after diagnosis more participants than expected by chance were in state C. At T7 77% were in State C and 15% in State A. Female gender, divorced parents, and using distracting to cope was related to State A and B. Study IV: the aim was to describe negative and positive cancer-related consequences reported (n=32) three and four years after diagnosis and to establish whether using certain strategies at T1 was related to reports of certain consequences at T7. The majority reported negative and positive consequences and a relation between using distracting to cope at T1 and reporting bodily concerns at T7 was established. In conclusion: it is difficult for nurses and physicians to identify how adolescents recently diagnosed with cancer cope with distress; the majority of individuals diagnosed with cancer during adolescence experience a state of good psychosocial function during the extended phase of survival, and distress and personal growth often go hand in hand after cancer during adolescence.

Background: Patients and clinicians report pain and fatigue as key outcome measures in rheumatoid arthritis. Fatigue and pain are a major concern to patients. Aim: The objective of this study was to examine fatigue and pain in adult patients with rheumatoid arthritis (RA) and to investigate the association between pain and fatigue with body awareness, demographic, disease-related, emotional and psychosocial factors. Method: Data were collected from a sample of patients with RA (n= 120) recruited from a Rheumatology clinic in a large university hospital in Stockholm, Sweden. Eligible for inclusion were patients between 20 -80 years of age and with a confirmed diagnosis of RA. Fatigue was measured using the Multidimensional Assessment of Fatigue (MAF) scale, while the Visual Analogue Scale (VAS) was used to assess components of pain. A multiple stepwise regression analysis was performed to evaluate factors related to fatigue and pain. In the first step a univariate analysis of variance (ANOVA) was used for all relevant independent factors. In the next step backwards stepwise regression was applied. Result: Fatigue was significantly associated with the Disease Activity Score 28-joints (DAS 28) (p = 0.049), the Body Awareness Questionnaire (BAQ) (p = 0.006), the Positive Affect (PA) scale (p = 0.008) and no smoking (p = 0.021). Pain was significantly associated with the EuroQol EQ-5D (p = 0.008) and the DAS 28 (p = 0.001). The adjusted R-square was 28.6% for fatigue and 50.0% for pain. Conclusion: This study clearly demonstrates that fatigue and pain in patients with RA appear to be associated with disease-related factors. Furthermore, fatigue was related to body awareness and emotional factors, and pain was related to health related quality of life.

It is commonly believed that breast cancer dragon boating benefits survivors in a range of psychosocial areas, but there have been few empirical studies to investigate such relationships. An interpretive description design and a critical health promotion approach were used to explore the psychosocial experiences of women who breast cancer dragon boat. In-depth interviews with six participants were analyzed. Themes that arose from the data are: (1) moving past isolation — networks of like-minded support, (2) taking control,(3) journey into adventure, (4) affirmative outlook, (5) confronting painful experience, (6) rebuilding identity, (7) and spiritual engagement. The findings illustrate that dragon boating provides breast cancer survivors with a significant venue for change and the opportunity to move beyond traumatic elements of cancer.

Syfte: Syftet med denna studie var att beskriva hur mammor med synnedsättning och barn i åldern 0-16 år upplever sin psykosociala hälsa samt hur de hanterar sin situation. Metod: En deskriptiv studie med en kvalitativ ansats. Data analyserades med kvalitativ innehållsanalys enligt Graneheim och Lundman. Totalt analyserades intervjuer med åtta informanter. Resultat: Analysen resulterade i fem kategorier och 20 subkategorier: Att vara förälder med synnedsättning, att som synskadad möta sin omgivning, att få stöd, att hantera vardagen, att fysiskt och psykiskt påverkas av sin situation.  Resultaten visade att mammor med synnedsättning med barn i åldern 0-16 år utsattes för ökad psykosocialt stress. De höga krav de själva ställde på sig, den tid och energi som synnedsättningen tog i anspråk samt genom att de valde att inte berätta för sin omgivning att de hade en synnedsättning ansågs vara en del av förklaringen. Resultaten visade även att mammor med synnedsättning upplevde att de för det mesta blev bra bemötta samt att det sociala nätverket var viktigt för att få vardagen att gå ihop. / Aim: The aim of this study was to describe how visually impaired mothers with children aged 0-16 years experienced their psychosocial health and how they handle their situation. Method: A descriptive qualitative interview study.  Data analysis was performed by qualitative content analysis according to Graneheim och Lundman. A total of eight interviews were analysed. Results: The analysis yielded five categories containing a total of 20 sub-categories: to be a visually impaired parent, to encounter your environment, to get support, to handle everyday life, to be psychologically and physically affected by the situation. The study concludes that visually impaired mothers with children aged 0-16 years were more prone to psychosocial stress. This, according to the results, is due to the high demands they have on themselves, the time and energy everything takes when you are visually impaired and by choosing to not tell people around you about your visual impairment. The results also show that visually impaired mothers mostly experience positive attitudes and that the individual social network is important in order to make ends meet in everyday life.

This dissertation, containing two journal-formatted manuscripts, examines factors associated with international students' psychosocial adjustment to life in the United States. In the first manuscript, I systematically reviewed 64 studies reporting predictors of international student adjustment, which were published in English language peer-reviewed journals from 1990 to 2008. I summarized predictors by adjustment outcomes and assessed the methodological quality of individual studies. In the second manuscript, I investigated mechanisms through which acculturation influenced psychosocial adjustment of Chinese international students, by electronically surveying a sample of 508 Chinese international students from four universities in Texas. Specifically, the mechanisms investigated in this report refer to the mediating and moderating effects of social interaction and social connectedness with host nationals upon the acculturation-adjustment linkages. Results portrayed in the first manuscript showed stress, social support, English language proficiency, region/country of origin, length of residence in the United States, acculturation, social interaction with Americans, self-efficacy, gender, and personality were among the most frequently reported predictors of international students' psychosocial adjustment. The mean methodological score of the reviewed studies was 6.25 (SD=1.8; maximum possible score=11). The reviewed studies overcame selected methodological limitations pointed out by Church in his review, but show room for continued improvement. Results portrayed in the second manuscript showed social connectedness with Americans mediated the links between adherence to the host culture (acculturation dimension) and psychosocial adjustment. Social interaction with Americans moderated the association between adherence to the home culture (acculturation dimension) and depression. Findings from this dissertation have implications for health promotion research and practice. First, this dissertation calls for a revision in the sojourner adjustment framework to address the shared elements underlying both adjustment domains (psychological and sociocultural). Second, more studies are needed to a) examine macro-level factors and currently under-investigated micro-level factors, b) test theories that integrate micro- and macro-level factors, c) examine mediation and moderation effects, and d) systematically employ longitudinal designs and comparison groups. Third, health promotion professionals would do well to address predictors and mechanisms found in this dissertation when developing evidence-based interventions for international students.

This paper explores Mazo de la Roche’s peculiar articulation of the Bildungsroman in the first of Jalna’s sequels, Whiteoaks. It argues that the text’s psychosocially aberrant protagonist, Finch Whiteoak, is a Bildungsheld whose modern coming-of-age process of accommodation and assimilation into a socio-specific norm is not as much a progression toward the centre as it is a simultaneous progression/regression toward a reification of his exemplary marginal status as an other amidst others. This paper further contends that this unique process is made possible only by Finch’s particularly unstable and eccentric otherness—established through his treatment by his family as variously mentally ill rather than disabled—and that this process is both externally regressive in a vein similar to the modern, female Bildungsroman and internally progressive in the vein of the classic, male Künstlerroman. In order to accommodate this duality of publicly typical and privately subversive otherness, Finch must navigate the diegetic realm’s social boundaries and liminal spaces through a series of “double lives,” in which the other is ultimately found within the home context and potentially subversive centralities outside of Jalna are sacrificed for the sake of representative marginalities at home.

Vårdpersonal har i studier beskrivits utsättas för stress, emotionell utmattning samt utbrändhet genom lågt inflytande eller låg kontroll över ställda krav. Studier inom offentlig verksamhet visar också att det finns arbetstagare som befunnit sig i arbetsplatsinlåsning, yrkesinlåsning eller i dubbelinlåsning. Denna enkätstudie ämnade att med mätinstrumentet Psykosocial arbetsmiljökartläggning (PAK) mäta två klinikers psykosociala arbetsmiljö hos 109 undersköterskor och skötare på ett sjukhus i Mellansverige. Studien ämnade även att mäta om arbetsplatsinlåsning, yrkesinlåsning samt dubbelinlåsning förekom och om det fanns ett samband mellan den psykosociala arbetsmiljön och inlåsningsbegreppen. Resultatet av den psykosociala arbetsmiljöns mätning visade att egenkontroll, arbetsledning och arbetsbelastning skattades lågt medan stimulans och arbetsgemenskap skattades positivt. Antal inlåsta individer översteg 20 % på alla inlåsningsbegrepp. Studien fann även ett statistiskt signifikant samband mellan begreppet psykosocial arbetsmiljö och arbetsplats/-yrkesinlåsning samt dubbelinlåsning. Studien bör gå vidare med kvalitativ metodik, att hos arbetstagarna ta reda på de bakomliggande orsakerna till studiens resultat.