This dissertation consists of two empirical papers and one methods paper. The first two papers use quasi-experimental methods to evaluate the impact of universal health insurance reform in Massachusetts (MA) and Thailand and the third paper evaluates the validity of a quasi-experimental method used in comparative effectiveness research (CER).

There is some evidence about the efficacy of preferred music on agitation in elders with dementia; however, little is known about its effectiveness on agitation when implemented by nursing staff in long-term care facilities. Even less is known about use of preferred music for managing anxiety in those with dementia. This quasi-experimental study aimed to evaluate the implementation of a preferred music intervention delivered by nursing staff on agitation and anxiety of institutionalised elders with dementia. The sample comprised of 57 elders with dementia residing in two building complexes which provided similar care routines and staffing in a large Taiwanese residential care facility. These two building complexes were randomly assigned as the experimental and control group. Nursing staff in the experimental group received a facilitation program to prepare them for implementing the preferred music intervention; whereas nursing staff in the control group received no facilitation program. The music intervention based on each resident's music preferences was then provided by the trained nursing staff for 32 experimental residents twice a week for six weeks. Meanwhile, 25 residents in the control group only received the usual standard care without music. All residents were assessed by Cohen-Mansfield Agitation Inventory (CMAI) for overall and three subtypes of agitated behaviours and by Rating of Anxiety in Dementia for anxiety at baseline and week 6. Additionally, the modified CMAI measured the 30-minute occurrence of agitation at baseline, session 4, and session 12. The results indicate that institutionalised elders with dementia who received six weeks of preferred music intervention implemented by trained nursing staff had significant reductions on overall, three subtypes of agitated behaviours, anxiety, and 30-minute occurrence of agitation over time compared to those who received the usual standard care without music. Preferred music shows promise as a strategy for reducing agitation and anxiety in those with dementia when implemented by trained nursing staff. Such intervention can be incorporated into routine activities to improve the quality of care provided by nursing staff and the quality of life of those with dementia in long-term care settings. Our study results provide clinically relevant evidence which contribute to closing the gap between research and practice.

abstract: A major challenge in health-related policy and program evaluation research is attributing underlying causal relationships where complicated processes may exist in natural or quasi-experimental settings. Spatial interaction and heterogeneity between units at individual or group levels can violate both components of the Stable-Unit-Treatment-Value-Assumption (SUTVA) that are core to the counterfactual framework, making treatment effects difficult to assess. New approaches are needed in health studies to develop spatially dynamic causal modeling methods to both derive insights from data that are sensitive to spatial differences and dependencies, and also be able to rely on a more robust, dynamic technical infrastructure needed for decision-making. To address this gap with a focus on causal applications theoretically, methodologically and technologically, I (1) develop a theoretical spatial framework (within single-level panel econometric methodology) that extends existing theories and methods of causal inference, which tend to ignore spatial dynamics; (2) demonstrate how this spatial framework can be applied in empirical research; and (3) implement a new spatial infrastructure framework that integrates and manages the required data for health systems evaluation. The new spatially explicit counterfactual framework considers how spatial effects impact treatment choice, treatment variation, and treatment effects. To illustrate this new methodological framework, I first replicate a classic quasi-experimental study that evaluates the effect of drinking age policy on mortality in the United States from 1970 to 1984, and further extend it with a spatial perspective. In another example, I evaluate food access dynamics in Chicago from 2007 to 2014 by implementing advanced spatial analytics that better account for the complex patterns of food access, and quasi-experimental research design to distill the impact of the Great Recession on the foodscape. Inference interpretation is sensitive to both research design framing and underlying processes that drive geographically distributed relationships. Finally, I advance a new Spatial Data Science Infrastructure to integrate and manage data in dynamic, open environments for public health systems research and decision- making. I demonstrate an infrastructure prototype in a final case study, developed in collaboration with health department officials and community organizations. / Dissertation/Thesis / Doctoral Dissertation Geography 2017

Submitted by Loiane Maria Zengo null (lozengo@hotmail.com) on 2018-03-20T22:29:12Z No. of bitstreams: 1 DISSERTACAO - Loiane - versão final.pdf: 1813097 bytes, checksum: 4dfd6322a6b1157b60b478ae8f8b3e9f (MD5) / Approved for entry into archive by Satie Tagara (satie@marilia.unesp.br) on 2018-03-21T14:31:28Z (GMT) No. of bitstreams: 1 orbolato_lmz_me_mar.pdf: 1813097 bytes, checksum: 4dfd6322a6b1157b60b478ae8f8b3e9f (MD5) / Made available in DSpace on 2018-03-21T14:31:28Z (GMT). No. of bitstreams: 1 orbolato_lmz_me_mar.pdf: 1813097 bytes, checksum: 4dfd6322a6b1157b60b478ae8f8b3e9f (MD5) Previous issue date: 2018-02-26 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Os programas de Orientação e Mobilidade têm como o objetivo favorecer o desenvolvimento das habilidades de orientar-se e locomover-se, com maior eficiência e segurança, nos diferentes ambientes, por meio do treinamento de técnicas específicas de locomoção e do uso dos sentidos remanescentes. Apesar de ser um treinamento fundamental para a pessoa cega, os materiais nacionais sistematizados que discorram sobre seu planejamento e avaliação são escassos, principalmente em se tratando dos ambientes escolares. Neste sentido, a presente pesquisa foi elaborada com o intuito de auxiliar o profissional da área. O estudo teve como objetivo avaliar o treinamento das técnicas de Orientação e Mobilidade, em ambientes escolares, utilizando como procedimento metodológico para de coleta de dados os delineamentos pré e pós-teste nas Categorias Autoajuda e Bengala e intrassujeito A-B para a Categoria Guia Vidente. Um aluno cego e uma professora participaram deste estudo. Os resultados apontaram que após, aproximadamente, dois meses de treinamento, o estudante e a professora conseguiram melhorar os desempenhos ao executarem as técnicas básicas de locomoção. Conclui-se que o uso destes delineamentos foi uma escolha de sucesso para a avaliação do treinamento, uma vez que, além de demonstrar a mudança no nível de desempenho do estudante antes e após o treinamento nas Categorias Autoajuda e Bengala, foi possível identificar as nuances de ambos durante o processo de treinamento da Categoria Guia Vidente. Ademais, conclui-se que o ponto determinante para o êxito do treinamento foi a seleção adequada das estratégias, sendo as principais: 1) a instrução verbal; 2) a instigação física; 3) o oferecimento de modelos de execução; e, 4) a experimentação física. / Orientation and Mobility Programs aim to promote the development of the skills to orient themselves and to move, with greater efficiency and safety, in different environments, through the training of specific techniques of locomotion and the use of the remaining senses. Although it is a fundamental training for blind person, systematized national materials that discuss their planning and evaluation are scarce, especially when dealing with school environments. In this sense, the present research was elaborated with the intention to assist professional of the area. The aim of this study was to evaluate the training of Orientation and Mobility techniques, in school environments, using as a methodological procedure for data collection in pre and post test designs into Categories Self-help and Cane and AB single subject for Category Sighted Guide. A blind student and a teacher participated in this study. The results showed that, after approximately two months of training, the student and the teacher were able to improve their performances by performing the basic locomotion techniques. It is concluded that the use of these designs was a successful choice for the evaluation of the training, since, in addition to demonstrating the change in the student's level of performance before and after training in Categories Self-help and Cane, it was possible to identify the nuances of both during the training process of Category Sighted Guide. The research concluded that the determinant point for the success of the training was the adequate selection of the strategies, and the mains were: 1) the verbal instruction; 2) prompting; 3) the provision of execution models; and, 4) physical experimentation. / CNPq: 132912/2016-3

High-stakes testing and accountability have infiltrated the education system in the United States; the top priority for all teachers must be student progress on standardized tests. This has resulted in the predominance of reading for test-taking, (efferent reading), in the English, language arts, and reading classrooms. Authentic uses of print activities, like aesthetic reading, that encourage students to engage individually with a text, have been pushed aside. During a 3-week time period, regular level, English 3/American literature students in a Title I magnet high school, participated in this quasi-experimental study (N = 62). It measured the effects of an intervention of reading American literature texts aesthetically and writing aesthetically-evoked reader responses on students’ self-efficacy beliefs regarding their comprehension of American literature. One trained teacher and the researcher participated in the study: student participants were pre- and post- tested using the Confidence in Reading American Literature Survey which examined their self-efficacy beliefs regarding their comprehension of American literature. Several statistical analyses were performed. The results of the linear regression analyses partially supported a positive relationship between aesthetically-evoked reader responses and students’ self-efficacy beliefs regarding their comprehension of American literature. Additionally, the results of the 2 (sex) x 2 (treatment) ANCOVAs conducted to test group differences in self-efficacy beliefs regarding the comprehension of American literature between treatment and control groups indicated a main effect for treatment (but not sex; nor was there a significant sex x treatment interaction), suggesting the treatment was partially effective in increasing students’ self-efficacy beliefs. Seven of the twelve ANCOVAs indicated a statistically significant increase in the treatment group’s adjusted group mean self-efficacy belief scores as a result of being exposed to the intervention. In six of these seven analyses, increases in self-efficacy beliefs occurred in tasks that required three or more higher-order levels of thinking/learning. The results are discussed in terms of theoretical, empirical and practical significance. Future research is recommended to extend the intervention beyond the narrow confines of a Title I magnet school to settings where the intervention could be tested longitudinally, e. g., honors and gifted students, elementary and middle schools.

No description available.

No description available.

Die übergeordnete Zielstellung der vorliegenden Arbeit ist es, Bedingungsfaktoren erfolgreicher Teamarbeit anhand von Forschungsarbeiten aus unterschiedlichen Fachrichtungen herauszuarbeiten und diese anhand eigener Studien zu sogenannten Actionteams empirisch zu überprüfen. Hierfür wird auf Grundlage einer umfangreichen Literaturanalyse ein Rahmenforschungsmodell zur Teamarbeit synthetisiert sowie ein Verhaltensmarker Ansatz zur Erfassung und Bewertung von Team(arbeits)prozessen in kritischen Situationen entwickelt und erprobt. Demzufolge ist die Arbeit in zwei Teile aufgebaut: Im ersten Schritt wird theoriegeleitet ein Forschungsmodell zur Teamarbeit abgeleitet und durch sekundäranalytische Auswertungen von elitären Actionteams überprüft. Darauf aufbauend, wird ein Verhaltensmarker-Ansatz zur Messung und Bewertung von potentiell trainierbaren Team(arbeits)prozessen konzipiert und an Rettungsdienstteams in einer high-fidelity-Simulation experimentell evaluiert. Der Fokus im ersten Teil der Arbeit liegt auf der theoriegeleiteten Entwicklung des Forschungsmodells, welches Teamarbeit in folgende analytisch unterscheidbare Dimensionen differenziert: emergent states (shared mental models, mutual trust und group potency) und Teamprozesse (team orientation, team leadership, mutual performance monitoring, backup behavior, adaptability und closed loop communication). Dieses Forschungsmodell wurde mit einer Sekundäranalyse von Fragebogen- und Interviewdaten zu einer Stichprobe von elitären Actionteammitgliedern geprüft und empirisch bestätigt. Die quantitative Analyse von Fragebogendaten zeigt bei den elitären Actionteammitgliedern (n = 132) positive signifikante Zusammenhänge zwischen den emergent states und Teamprozessen. Im direkten Abgleich mit nichtelitären Actionteammitgliedern (n = 133) zeigten sich bei den elitären Actionteammitgliedern durchweg höhere Ausprägungen in den Teamarbeitsdimensionen (erste Forschungsfrage). Des Weiteren wurde untersucht, ob eine Beziehung zwischen Teamarbeitsdimensionen und verschiedenen Teamtypen (contending teams, critical teams und performing teams) besteht. Die inhaltsanalytische Auswertung von qualitativen Interviewdaten elitärer Actionteammitglieder (n = 51) wie auch statistische Analysen standardisierter Fragebogendaten elitärer Actionteammitglieder (n = 132) legen eine Beziehung nahe. Die Ergebnisse belegen, dass sich die beiden Teamtypen contending teams und performing teams am stärksten in den Teamarbeitsdimensionen team leadership und adaptability unterscheiden (zweite Forschungsfrage). Das Hauptanliegen des zweiten Teils der Arbeit besteht darin, zu testen, ob die im ersten Arbeitsteil als erfolgskritisch identifizierten Team(arbeits)prozesse, nach einer Schulungs- und Trainingsintervention mit einer erhöhten Leistungsfähigkeit einhergehen. Dazu wird aus den Erkenntnissen des ersten Teils und unter Rückgriff auf aktuelle Forschungsergebnisse ein Verhaltensmarker-Ansatz entwickelt. Zur Überprüfung, ob und wie durch eine Verbesserung der Team(arbeits)prozesse die Leistungsfähigkeit von Actionteams gesteigert werden kann, wurde eine quasi-experimentelle Simulations-Studie mit einem Experimental- und Kontrollgruppen-Design durchgeführt. Um mit dem entwickelten prozessanalytischen Messinstrument die Team(arbeits)prozesse praktizierender Rettungsdienstmitglieder in kritischen Situationen zu erfassen, wurde eine Simulation als Zwischenform einer Labor- und Felduntersuchung gewählt. Insgesamt nahmen 96 Teilnehmer an der Studie teil, die in zwei Gruppen aufgeteilt wurden. Der Teilnehmerkreis eins (T1; n = 47) erhielt vor der Simulation eine Schulungs- und Trainingsmaßnahme und der Teilnehmerkreis zwei (T2; n = 49) erhielt diese nachher. Anschließend wurde eine Teilstichprobe mit jeweils 10 Personen aus dem Teilnehmerkreis eins (T1) als Experimentalgruppenteilnehmer (n = 10) und aus dem Teilnehmerkreis zwei (T2) als Kontrollgruppenteilnehmer (n =10) zufällig ausgewählt. Die Experimental- und Kontrollgruppenteammitglieder absolvierten in einer high-fidelity-Simulation ein komplexes und mit kritischen Situationen konzipiertes Fallbeispiel. Die Bewertung der Team(arbeits)prozesse und des Teamerfolges erfolgte durch eine offene, passiv teilnehmende Beobachtung und wurde mittels Beobachtungsbogen von sechs Experten während der Simulation protokolliert. Des Weiteren wurde das Verhalten der Teammitglieder anhand aufgezeichneter Videodateien mit einer Videointeraktionsanalyse bewertet. Die Ratingübereinstimmung zwischen den Beobachtungsdaten der teilnehmenden Forscher vor Ort mit den Videoauswertungen der unabhängigen Experten im Nachgang lassen erkennen, dass das entwickelte prozessanalytische Verfahren zur Messung und Bewertung von Team(arbeits)prozessen geeignet ist, reliabel und objektiv die Leistungsfähigkeit von Rettungsdienstteams in kritischen Situationen zu erfassen. Die Befunde zeigen, dass die als erfolgskritisch und potentiell trainierbar identifizierten Team(arbeits)prozesse durch eine Schulungs- und Trainingsmaßnahme gesteigert werden konnten. Hierbei verdeutlichen die Ergebnisse des Experimental- und Kontrollgruppenvergleichs, dass insbesondere die Reflexions-, Teamführungs- und Koordinationsprozesse verbessert werden konnten. Auch lag der Teamerfolg, gemessen an der Anzahl richtig gewählter und ausgeführter Maßnahmen, die in einem zeitlich vorgegebenen Rahmen durchgeführt wurden, bei den Experimentalgruppen etwas höher als bei den Kontrollgruppen. Zusammenfassend liegen mit dieser Arbeit erste empirische Befunde eines quasi-experimentellen und multi-methodischen Forschungs- bzw. Evaluationsdesigns vor, die aufzeigen, welche erfolgskritischen Team(arbeits)prozesse die Leistungsfähigkeit von Actionteams in kritischen Situationen steigern können.

Recently, the numbers of Higher Education institutions that are using Web 2.0 technologies and social networking sites are increasing dramatically. These sites offer unique and diverse learning opportunities. There is evidence that a sense of community can be created online and that this community is connected with perceived learning. Garrison, Anderson and Archer (2000) introduced and developed the Community of Inquiry framework as a dynamic process model and a comprehensive framework to guide the research and practice of online learning communities, and to describe and measure elements supporting the development of these communities. This framework consists of three elements - social, teaching and cognitive presence - as well as categories and indicators to define each presence and guide the coding of transcripts. The categories of social presence are affective responses, open communication and group cohesion. The categories of teaching presence are instructional design and organisation, facilitating discourse and direct instruction. Previous studies suggest that a positive social climate on an online learning community is important as it can improve learning experience and cognitive presence. This study aims to explore and understand the nature of Community of Inquiry presences, in particular teaching presence and social presence. The aim of the study is to understand the influence of a different teaching presence on students’ development of social presence. This study provides a more comprehensive picture of developing students’ social presence over changing teaching presence in a social network environment in a Kuwaiti higher education context. In order to achieve the purpose of this study, the following research questions are explored: 1- How does a students’ sense of social presence change with a different teaching presence in the social network environment within a Kuwaiti higher education context? a. Does a students’ sense of social presence (affective responses, open communication and group cohesion) change as a result of a different teaching presence (facilitating discourse - direct instruction) in the social network environment in a Kuwaiti higher education context? b. Why do participants maintain or change their social presence level during the course? 2- How does the use of teaching presence promote the development of students’ social presence in a Kuwaiti higher education context within the social network environment? The study was conducted in the second semester of 2010/2011 at The Education Technology Department - The College of Basic Education - The Public Authority for Applied Education and Training (PAAET), within the State of Kuwait. The study was carried out on the Educational Communication module and involved 46 male participants. This study uses the equivalent of mixed methods design to answer research questions. The sequential explanatory strategy is embedded within an applied quasi-experimental approach. Quantitative data is collected and analysed, which is then followed by the collection and analysis of qualitative data. The researcher used a messages analysis and a content analysis approach to reveal the level of social presence in an online community and then develop stimulated recall interview questions. A combination of individual interviews and focus group interviews were used. Garrison et al.’s (2000) social presence coding schemes were developed to make them more suitable in the study context. Quantitative and qualitative data show that there is no significant difference between the effects of facilitating discourse and direct instruction in terms of students’ social presence level. Stimulated recall interviews reveal that most participants cannot distinguish between facilitating discourse and direct instruction. The participants believe that facilitating discourse and direct instruction are similar. The participants’ responses lead the researcher to search for other motives that could promote the development of students’ social presence in the higher education context in the social network environment. The study concludes that there are two factors that could promote the development of students’ social presence. First, instructional design and organisation, such as web design satisfaction, network effect, instructor responsiveness, the nature of the task and awarding degrees. Second, learner-specific matters, such as previous experience, peer influence, friendship, attitude, self-esteem and self-confidence and something I refer to as the Wave Effect.

The overall aim of the thesis was to investigate the experience of having an acute myocardial infarction in newly afflicted persons living in sparsely populated counties, and whether an intervention with peer mentors would provide support by affecting the perception of illness, health related quality of life and everyday life. The aim was also to describe the support of peer mentors from their perspective and what the mentoring meant to them. The thesis was based on four empirical studies (I-IV) and had a prospective, longitudinal, quasi-experimental, comparative design. A suitable sample was recruited, comprising 72 individuals who were newly afflicted with an acute myocardial infarction (AMI) for the first time; 34 of them were offered contact with a peer mentor, while 38 were not. Furthermore, 34 peer mentors participated in the project. The results were based on data collected from 28 individuals with mentors, 33 individuals without and 22 peer mentors. In studies I and III, qualitative approaches were used based on individual interviews with 20 newly afflicted individuals with (n=11) and without (n=9) mentors one year after AMI. The aims were to describe individuals’ perceptions of the psychosocial consequences of an acute myocardial infarction (AMI) and of their access to support one year after the event (I) and to describe individual perceptions of their lifestyle and support, 1 year after an AMI with or without mentorship (III). Study II was quantitative, consisting of data from questionnaires IPQ-R and SF-36 answered by 61 newly afflicted individuals with (n=28) and without (n=33) mentors. It aimed to investigate whether changes in illness perception and health-related quality of life occur over time after an intervention with peer mentors 1, 6 and 12 months after an AMI. Study IV had a mixed design and included peer mentors with the purpose to describing the personal meaning of being a peer mentor, for a person recovering from an acute myocardial infarction. Data consisted of individual interviews (n=15) and some data from IPQ-R and SF-36 that were provided on two occasions (n=22). All of the interviews (I, III, IV) were digitally recorded and analysed by qualitative content analysis, while the quantitative studies included descriptive data and were further compared using analysis of variance (ANOVA) (II) and the paired-sample t-test (IV).   The results from all four studies are interpreted and presented together, and they show differences and similarities between the newly afflicted with or without peer mentors and the peer mentors. The results comprise six main areas; the meaning of becoming a person with an AMI (I, II, III) pointed toward an awareness of the situation expressed both in positive and negative terms, as being thankful or of being afraid of having a second AMI. View at health care (I) indicated that follow-up after discharge was sometimes a positive experience but more often resulted in dissatisfaction with this part of the health-care system. Consequences (II) showed significant effects between groups in the dimensions ‘consequences’ and ‘timeline acute/chronic’ (IPQ-R), with higher mean values for those without mentors and a significant effect of time in both dimensions. There were also physical consequences for many of the participants (I, II, III, IV) as well as psychological consequences (I, II, IV). Everyday life (I, III) was affected by AMI that sometimes limited activities. There were demands to change areas of life-style that were perceived as both positive and negative. Health (II, III, IV) showed that health increased for most individuals during the year, as confirmed by significant values for time for those newly afflicted. The peer mentors showed a decrease in mean values but expressed that they felt healthier after compared with before their commitment. Meaning of support (I, IV) indicated that families and relatives had an important, supportive role for newly afflicted participants. The mentorship showed that the relationship was, in some cases and for different reasons, unsuccessful. However, most of them were satisfied, and new friendships arose. More of the mentors felt pride and were thankful because their experience was shown to be valuable to others in addition to themselves.  The results were synthesised using the Human Becoming nursing theory, which confirmed that recovery after an AMI is a process that occurs over time in which that those afflicted must accept and be comfortable being a person who is afflicted by an AMI. Some tendencies indicated an advantage for the newly afflicted participants who had received contact with a peer mentor. Conclusion: Because the mentor had experienced the same event, the relationship contributed to the security of the mentee. The peer mentors matured with the task because they felt that their experience was valuable and they felt unique. / Övergripande syfte i avhandlingen var att studera erfarenheter av att drabbas av en akut hjärtinfarkt (AHI) för nyinsjuknade personer, boende i glesbygdslän, och om en intervention med kamratstöd i form av mentorer skulle kunna innebära ett stöd, genom att påverka deras sjukdomsuppfattning, hälsorelaterade livskvalitet och deras vardagsliv. Syftet var även att beskriva mentorernas stöd utifrån deras perspektiv, och vad mentorskapet har betytt för dem.   Avhandlingen är baserad på fyra studier (I-IV) och har en prospektiv, longitudinell och kvasiexperimentell, jämförande design. Ett lämpligt urval utgjordes av 72 personer som nyligen hade drabbats av AHI första gången. Av dessa erbjöds 34 att få kontakt med en mentor medan 38 inte erbjöds detta. Dessutom deltog 34 mentorer. Det slutgiltiga resultatet i avhandlingen baserades på data som samlats från 28 personer med mentor, 33 utan mentor samt av 22 mentorer. Studie I och III utgick från kvalitativ metod, baserat på individuella intervjuer med 20 av de nyinsjuknade med mentor (n11), och utan mentor (n9) ett år efter deras AHI. Syftet var att beskriva individuella erfarenheter av psykosociala konsekvenser i samband med en AHI, och deras tillgång till stöd ett år efter händelsen (I), samt att beskriva individuella uppfattningar om deras livsstil och stöd ett år efter AHI, med eller utan mentorskap (III). Studie II var kvantitativ och utgjordes av data från enkäter; IPQ-R och SF-36, som besvarades av 61 nyinsjuknade, varav 28 med mentor och 33 utan mentor, i syfte att undersöka om förändringar i sjukdomsuppfattning och hälsorelaterad livskvalitet förekommer över tid, efter en intervention med mentorer 1, 6 och 12 månader efter AHI. Studie IV hade en mixad design och inkluderade mentorer med syfte att beskriva den personliga betydelsen av att vara mentor, under loppet av ett år, för en person under återhämtningen efter AHI. Data bestod av individuella intervjuer (n15) samt en del data från IPQ-R och SF-36, besvarat vid två tillfällen. Samtliga intervjuer (I, III, IV) spelades in digitalt och analyserades med kvalitativ innehållsanalys, medan de kvantitativa studierna innefattade beskrivande data, samt dessutom analyserades med variansanalys (ANOVA) (II) samt parvisa t-test (IV).   Resultat från samtliga fyra studier är tolkade och presenterade gemensamt, och visar på skillnader och likheter mellan de nyinsjuknade med eller utan mentor, samt mentorerna. Resultaten utgörs av sex huvudområden: Innebörden av att bli en person med en AHI (I, II, III) tyder på en medvetenhet om sin situation, och som uttrycks i både positiva och negativa ordalag, som att vara tacksam eller att vara rädd för att få en ny AHI. Syn på sjukvården (I) antyder att uppföljningen efter utskrivning i vissa fall var en positiv upplevelse, men flera av dem var missnöjda med den delen av vården. Konsekvenser (II) visade  signifikant effekt mellan grupperna för dimensionerna ’konsekvenser’ och ’tidslinje akut/kronisk’ (IPQ-R) med högre medelvärden för dem utan mentor. Dessutom var det signifikant effekt för tid i båda dimensionerna. Det förekom även fysiska konsekvenser för flera av deltagarna (I, II, III, IV) liksom psykologiska konsekvenser (I, II, IV). Vardagslivet (I, III) påverkades av AHI genom att den i vissa fall hindrade dem från fysiska aktiviteter.  Det fanns krav på dem att förändra delar i deras livsstil, vilket kunde uppfattas som både positivt och negativt.  Hälsa (II, III, IV) visade att de flestas hälsa hade förbättrats under året, vilket bekräftades med signifikanta värden för tid hos de nyinsjuknade. Mentorerna hade däremot sjunkande medelvärden men uttryckte att de mådde bättre efter sitt uppdrag, än innan. Betydelsen av stöd (I, IV) visade att familjer och närstående hade en betydelsefull roll för de nyinsjuknade. Mentorskapet för dem med mentor samt mentorerna visade att relationen i vissa inte hade fungerat, av olika anledningar. Trots allt var ändå de flesta tillfreds, och nya vänskapsförhållanden hade uppstått. Flera mentorer kände sig stolta och var tacksamma för att deras erfarenheter hade visat sig värdefulla för andra, men även för dem själva.   Resultaten syntetiserades med omvårdnadsteorin Human Becoming, som bekräftade att återhämtningen efter en AHI är en process som förekommer över tid, och innebär att acceptera och känna sig bekväm med att vara en person som drabbats av AHI. Det fanns vissa tendenser till att det var en fördel för de nyinsjuknade att ha kontakt med en mentor. Slutsatsen var att eftersom mentorerna hade genomgått samma händelse, bidrog det till trygghet. Mentorerna hade växt med uppgiften, eftersom de kände att deras erfarenheter var värdefulla, och att de var unika. / <p>Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 2 inskickat, delarbete 4 inskickat.</p><p>At the time of the doctoral defence the following papers were unpublished: paper 2 submitted, paper 4 submitted.</p>