The traditional model of Western mental health treatment for survivors of torture has focused mainly on posttraumatic stress disorder and related conditions. This model is symptoms-focused in which the goal is to reduce pathology. In this model, the mental health professional is the expert and the survivors learn from the professionals. Using grounded theory methodology, the current study seeks to expand the understanding for treatment of torture survivors by investigating, from the perspective of the torture survivors, the process of “getting better” after torture. By asking the survivors to explain this process, this study broadens the focus of areas of healing and intervention to include social, psychological, political, and biological aspects of their lives that need to be impacted in order for them to get better. Eleven adult torture survivors (9 men and 2 women) from various African and Asian countries described their process of getting better through qualitative interviews. A model of getting better was developed to describe this process. The central phenomenon of this process is moving on from difficult past experiences. Participants described a multi-dimensional process that includes various environmental factors and intrapersonal beliefs and coping strategies that promoted moving on and getting better. These multi-dimensional themes include using belief and value systems, establishing safety and stability, and establishing social support in order to move on. Once the survivors felt a sense of safety and support, they felt empowered to take action to move on from their past. These action strategies include disclosing torture experiences, controlling memories, supporting others, and utilizing available supports. Moving on led to improved relationships, more adaptive functioning, improved health, and release from emotional pain. Findings of this study were consistent with current literature documenting recovery after torture and other traumatic experiences. Implications for both theory and practice are discussed and directions for future research are delineated.

Submitted by Lidiane de Oliveira (lididuarte.oliveira@gmail.com) on 2017-05-30T14:17:09Z No. of bitstreams: 1 Lidiane_versão final.pdf: 1192433 bytes, checksum: 67cfa545ba2b857d12373b793715dea0 (MD5) / Approved for entry into archive by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br) on 2017-05-30T19:33:58Z (GMT) No. of bitstreams: 1 Lidiane_versão final.pdf: 1192433 bytes, checksum: 67cfa545ba2b857d12373b793715dea0 (MD5) / Made available in DSpace on 2017-06-22T17:29:19Z (GMT). No. of bitstreams: 1 Lidiane_versão final.pdf: 1192433 bytes, checksum: 67cfa545ba2b857d12373b793715dea0 (MD5) / Two thousand and fifty six Senegalese clients of a Microfinance Institution (MFI) participated in the experiment during four months. They were divided in three groups: a control group that did not receive any messages, and two treatment groups, one in which clients received generic messages that simply said they should save money, and another group in which clients received messages that referred to the savings behavior of individuals who live in their neighborhood. The goal of this study is to assess whether receiving additional information about other participants from the same area where the participants live (neighborhood social capital) affects savings behavior. The results of this study show no significant impact of generic messages on savings behavior. Social capital effectively encourages deposits, which also makes withdrawals more salient since the accounts are fully liquid, but only among female clients. Limited attention, psychological reactance, salience, and gender issues emerge as possible explanations.

Det är vanligt att gränssnitt utformas med komplexa interaktioner och större mängder information, där användare förväntas besitta typisk fysisk, psykisk och intellektuell förmåga. Designas gränssnitt utifrån dessa förväntningar kan resultatet bli att icke normtypiska användargrupper exkluderas, däribland individer med kognitiv nedsättning. Kognitiv nedsättning har i denna studie begränsats till de tre symptomen minnesbortfall, hjärntrötthet samt överstimulans. För att inkludera individer med kognitiv nedsättning i användning samt stödja minnesbortfall ämnar denna studie att genom en designorienterad ansats besvara frågeställningen “Hur kan en aktiv påminnelsefunktion designas för att stödja individer med kognitiv nedsättning”. Designriktlinjer har framtagits utifrån litteratur och utvärderats genom en prototyp med nio testpersoner som erfarit symptomen. Studien resulterar i kunskapsbidraget att en aktiv påminnelsefunktion bör designas med hänsyn till att dela upp information med minimalt krav på beslutstagande, kommunicera brådska, använda igenkänningsbara element samt ge användare kontroll och stöd för besluttagande. / It is common to design interfaces with complex interactions as well as large amounts of information, where users are expected to have typical physical, psychological and intellectual abilities. If interfaces are designed based on these expectations, the result may be that non-normative user groups are excluded, including individuals with cognitive limitations. In this study, cognitive limitations have been restricted to the three symptoms: memory loss, fatigue and overstimulation. To include people with cognitive limitations in use and to support memory loss, this study aims to answer the question "How can an active reminder be designed to support individuals with cognitive limitation" through a design-oriented approach. Design guidelines have been developed based on literature and evaluated through a prototype with nine participants who have experienced the symptoms. The study results in the knowledge contribution that an active reminder should be designed with divided information including minimal decision-making, communicate urgency, use recognizable elements and give users control as well as support for decision-making.

Sepsis is still a leading cause of death in the United States despite extensive research and modern advancement in technology. Early recognition of sepsis and timely management strategies are important for effective reduction of sepsis-related morbidity and mortality. Guided by the logic model, the purpose of this project was to evaluate the effectiveness of electronic reminders in enhancing clinical decision-making among 30 nurses in 3 medical-surgical units. The practice-focused question addressed the effectiveness of electronic reminders for early recognition and initiation of goal-directed treatment of sepsis in hospitalized patients on medical-surgical units in an effort to reduce sepsis mortality rates. Data were collected from a randomized convenience sample using a self-constructed questionnaire and through observation. The observations were aimed at assessing whether the nurses adhered to the sepsis protocol, while the questionnaire captured the participants' perceptions regarding the use of automated alerts measured on a 5-point Likert scale. Statistical analysis involved the use of frequencies and percentages, positive predictive value (PPV), and negative predictive value (NPV). The results indicated that all the nurses adhered to sepsis protocol. The sepsis-related mortality rate, mean response time, and rate of severe sepsis at the hospital were reduced by 17.2%, 14 minutes, and 11.1%, respectively. It was concluded that automatic alert systems improve nurses' ability to recognize early symptoms of sepsis and their ability to initiate Code Sepsis. However, replication of this study using a large sample size could provide findings that are more generalizable. Electronic reminders may promote positive social change because earlier recognition of sepsis by nurses may lead to a reduction of healthcare costs through improved management of sepsis patients in acute care settings.

Yes / Background: Interpreting evaluations of complex interventions can be difficult without sufficient description of key intervention content. We aimed to develop an implementation package for primary care which could be delivered using typically available resources and could be adapted to target determinants of behaviour for each of four quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing. We describe the development and prospective verification of behaviour change techniques (BCTs) embedded within the adaptable implementation packages. Methods: We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery mechanisms—mainly audit and feedback, educational outreach and computerised prompts and reminders. We drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the packages and compared them across the delivery mechanisms and four quality indicators. Results: Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of 16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. ‘graded tasks’ and ‘problem solving’ for educational outreach). BCTs addressing the determinants ‘environmental context’ and ‘social and professional roles’ (e.g. ‘restructuring the social and ‘physical environment’ and ‘adding objects to the environment’) were indicator specific. We found it challenging to operationalise BCTs targeting ‘environmental context’, ‘social influences’ and ‘social and professional roles’ within our chosen delivery mechanisms. Conclusion: We have demonstrated a transparent process for selecting, operationalising and verifying the BCT content in implementation packages adapted to target four quality indicators in primary care. There was considerable overlap in BCTs identified across the four indicators suggesting core BCTs can be embedded and verified within delivery mechanisms commonly available to primary care. Whilst feedback reports can include a wide range of BCTs, computerised prompts can deliver BCTs at the time of decision making, and educational outreach can allow for flexibility and individual tailoring in delivery / UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (Grant Reference Number RP-PG-1209-10040).

Research on persuasive technologies for promoting healthy behaviours has been surging in recent years, but these technologies have the risk of being perceived as undesirable meddling. The current study puts forward a non-coercive and libertarian paternalistic alternative - the nudge theory. The foundation of the nudge theory is informed by the dual processing theory and can be categorized in two types - Type 1 nudging and Type 2 nudging. As design tools, two Type 1 nudging methods: default setting and manipulation of accessibility; and four Type 2 nudging methods: reminders, prompts, framing and precommitment strategies were selected to be featured. Sleep was chosen as the use case for this study, for it is associated with a number of non-communicable diseases yet considerably few studies of persuasive technology are about sleep. Better sleep hygiene is a significant means to improve sleep, therefore used as the design goal. The current study explores possible solutions for persuasive technologies for improving sleep hygiene, and better understand the design potentials and the persuasive characteristics of different types and methods of nudging. The research methodology is informed by scenario-based design. Five (four male and one female) academic professionals with backgrounds in interaction design, human-computer interaction, artificial intelligence and robotics took part in the study. Seven scenarios and thirteen prototypes were created to illustrate the situations and present the possible solutions. Results also showed that Type 1 nudging is considered more convenient and effective. However, the sense of control is better preserved in Type 2 nudging. In regard to nudging methods, default setting is considered as the most eective method under the condition of goal-alignment, but prone to error. Manipulation of accessibility should be designed so that the navigation is intuitive and the integrity of availability should not be damaged. Timing is the most prominent factor for reminders, and the influence of reminders could be reinforced by prioritizing and cross-platform availability. The presence of prompts could be emphasized by purposeful placement, and appropriateness should be considered. The perception of framing is highly subjective, therefore it should be user-tailored and context-aware. The effects of precommitment strategies are able to access higher-level motivation, but should be reinforced with other methods. To summarize the design principles, when designing nudges in persuasive technologies, the following factors should be considered: goal alignment, intuitiveness, context awareness, availability and accessing motivation. / Forskning inom temat persuasive teknologi för hälsoinriktade beteenden har ökat under den senaste tiden. Dock kan sådana teknologier oftast uppfattas som en oönskad inblandning i människors privata liv. Denna studie föreslår ett otvingade och libertarianskt paternalistiskt alternativ för att påverka val och beteenden – nudge teorin. Flera tidigare beprövade designverktyg betonas i denna teori. Nudge teorin har en dual process teoretisk bakgrund och kan delas in i två typer av nudging –- Typ 1 nudging och Typ 2 nudging. Bland Typ 1 verktyg väljs default setting och manipulation of accessibility, och bland Typ 2 metoder väljs reminders, prompts, framing och pre-commitment strategies. I syfte att illustrera detta användes sömn som exempel, då det har länkats till flera icke-smittsamma sjukdomar och få studier har försökt att undersöka motiverande design i relation till sömn. Bättre sömnhygien är ett betydelsefullt verktyg för att förbättra sömn och användes därför som målsättning. Denna studie undersöker möjliga alternativ för persuasive teknologi i syfte att förbättra sömn. Dessutom undersöktes potentialen av olika typer av persuasive teknologi och metoder för nudging. Den valda metodologi är en informerad scenariobaserad design. Fem akademiskt anställda, fyra män och en kvinna, med bakgrund inom interaction design, human-computer interaction, artificial intelligence och robotics, deltog i denna studie. Sju scenarion och tretton prototyper utarbetades för att illustrera en situation och presentera en möjlig lösning där sömnhygien kunde förbättras igenom persuasive teknologi. Resultaten visade att Typ 1 nudging ansågs vara mer lämpligt och effektiv. Emellertid bibehålls känslan av kontroll mer inom Typ 2 nudging. Default setting ansågs som mest effektiv inom betingelsen goal alignment, men med risk för bakslag. Manipulation of accessibility bör designas så att navigering är intuitiv och att integriteten av tillgänglighet inte störs. Tajming är den mest framträdande faktorn för reminders och deras påverkan skulle kunna framhävas igenom prioritering och cross-platform availability. Prompts skulle kunna framhävas mer igenom igenomtänkt placering där lämplighet är en drivande faktor. Uppfattningen av framing är mycket subjektiv och bör vara anpassad till användaren. Pre-commitment strategier har tillgång till högre motivation men bör förstärkas med andra medel.

South Africa has one of the highest HIV prevalence rates globally, with nearly 2.5 million people accessing antiretroviral treatment (ART) at the end of 2013. Retaining patients on ART has become a major problem in this country. When patients no longer show up for ART for unknown reasons, they are considered lost to follow-up (LTF). LTF is the highest contributor to ART attrition. This study, guided by the health belief model, evaluated the effectiveness of a technology-based, mobile health (mHealth) appointment reminder intervention on LTF among patients accessing ART services. The study ascertained differences in 6- and 12-month LTF rates between patients enrolled in the mHealth intervention (n = 832) and those in the standard of care comparison group (n = 918). A quantitative, retrospective cohort approach was used to answer the research questions using binary logistic regression analyses. The mHealth intervention was found to be significantly linked to lower likelihood of 6- and/or 12-month LTF among patients. There were 2 other key findings: a positive correlation between pregnancy and LTF, and a positive correlation between viral load increases and LTF. This study added evidence to the existing literature on the effectiveness of using mHealth-based interventions to improve HIV/AIDS care. Based on these findings, professionals should pay special attention to pregnant women and those clients with increasing viral loads to ensure they are not LTF. Positive social change that may result from this study is better health outcomes for patients on ART due to reduced risk of HIV related complications and other illnesses. This awareness would improve the lives of the patients, and positively impact their families, communities, and ultimately the global community, by reducing the overall impact of HIV disease.

Abstract Information technologies have opened new opportunities to develop persuasive systems that support people to adopt and sustain healthy behaviors. Both web-based and ubiquitous information systems have shown promising results in supporting people to adopt healthy routines. Persuasive systems have therefore received increasing attention from researchers over the past decade. Behavior Change Support Systems are an object of persuasive technology. These systems are designed to facilitate behavior change process over an extended period of time. This dissertation comprises of six studies, including two investigative, two experimental, and two field studies. An effort has been made to consecutively build these studies to formulate a central research question: To what extent virtual rehearsal augmented with reminders influence overall efficacy of health Behavior Change Support Systems? The primary theoretical underpinning is the Persuasive Systems Design model, which highlights seven postulates and twenty-eight software features for developing Behavior Change Support Systems. However, in the presented work, reminders and virtual rehearsal are explicitly studied. The interplay between these software features is examined through using a mixed-method research approach, using qualitative methodology as a core research approach. The results indicate that carefully selected and integrated persuasive software features have significant impact on the overall efficacy of Behavior Change Support Systems. Presented work addresses health behavioral change as a critical aspect of healthcare, and also extends contemporary research on critical issues in healthcare including task adherence, attrition and compliance. / Tiivistelmä Uudet informaatioteknologiat ovat mahdollistaneet sellaisten vakuuttavien järjestelmien kehittämisen, jotka voivat tukea terveellisten käyttäytymismallien omaksumisessa ja niiden ylläpitämisessä. Sekä web-pohjaisilla että jokapaikan tietojärjestelmillä on saatu lupaavia tuloksia terveellisten rutiinien omaksumisessa. Vakuuttavat järjestelmät ovat näin viimeisen vuosikymmenen aikana saaneet kasvavaa huomiota tutkijoilta. Yksi vakuuttavan teknologian tutkimuskohteista on käyttäytymisen muutoksen tukijärjestelmät. Nämä järjestelmät on suunniteltu helpottamaan käyttäytymisen muutoksessa pitkähkön aikajakson kuluessa. Tämä väitöskirja koostuu kuudesta tutkimuksesta, sisältäen kaksi eksploratiivista, kaksi kokeellista ja kaksi kenttätutkimusta. Kyseiset tutkimukset on suunnitelut siten, että on voitu muodostaa yksi keskeinen tutkimuskysymys: Missä määrin virtuaalinen harjoittelu yhdessä muistutusten kanssa voi vaikuttaa käyttäytymisen muutoksen tukijärjestelmien tehokkuuteen? Pääasiallisena teoreettisena pohjana toimii vakuuttavien järjestelmien PSD-suunnittelumenetelmä (Persuasive Systems Design Model), joka korostaa seitsemää perusoletusta ja 28 ohjelmisto-ominaisuutta tällaisten käyttäytymisen muutoksen tukijärjestelmien kehittämisessä. Tässä väitöskirjassa on keskitytty tutkimaan erityisesti virtuaalisia muistutuksia ja virtuaalista harjoittelua. Kyseisiä ohjelmisto-ominaisuuksia on tarkasteltu käyttämällä mixed-method -tutkimustapaa erityisesti laadullisella tutkimusotteella. Tässä tutkimuksessa saadut tulokset osoittavat, että järjestelmien huolella valituilla ja toteutetuilla vakuuttavilla ominaisuuksilla on merkittävä vaikutus käyttäytymisen muutoksen tukijärjestelmien tehokkuuteen. Väitös osoittaa terveyskäyttäytymisen muutoksen olevan kriittinen osa terveydenhoitoa. Väitöstyö myös lisää terveydenhoidon tietämystä sen kriittisissä ongelmissa, erityisesti harjoituksiin sitoutumisessa tai vastaavasti harjoitusten tekemättä jättämisessä ylipäätään ja ohjeiden noudattamisessa.