People who are diagnosed with or suspect endometriosis or polycystic ovary syndrome (PCOS) are rarely included in the design of reproductive health applications, leading to a lack of functions useful to this user group. Non-normative user groups in general, including those experiencing endometriosis or PCOS, are also rarely mentioned in research of reproductive health applications or Human-Computer Interaction. Based on user requests, the aim of this thesis was to design new functions within the application Read Your Body aimed at their users experiencing endometriosis or PCOS. The project consisted of an iterative design process including research for design, sketching, prototyping, and user tests. It was found that this user group mainly wanted to track their symptoms and cycle to gain health insight, and a large number of tracking options and easy customisation was requested. The design process resulted in a design prototype that includes the ability to track symptoms, triggers, self-care practices and treatments as well as visualising and exporting data for personal health insight or to communicate with others. Knowledge created on the non-normative user group, their goals for tracking, and how to design reproductive health tracking applications for non-normative users could be useful in future research and design projects. The functions designed could improve understanding of self and communication with healthcare professionals, and inform diagnosis, treatment plans and self-care practices.

SAMMANFATTNING  Det förekommer en ökning med sexuellt överförbara infektioner (STI), främst gonorré bland ungdomar i Sverige. För att minska förekomsten av STI bland ungdomar krävs effektiva preventiva åtgärder, kontroll och ett effektivt samarbete. Sexuell och reproduktiv hälsa är lika viktigt som den psykiska, fysiska och sociala hälsan, samt utgör en grundläggande del av människors allmänna hälsa och välbefinnande.   Syftet med studien är att undersöka aktörers uppfattningar om ungdomarnas kunskap om STI-prevention och hur aktörerna arbetar förebyggande med STI. För ett systematiskt tillvägagångssätt i studien används en kvalitativ metod baserad på målstyrt urval för att besvara syftet. Därmed genomfördes en semistrukturerad intervju vid datainsamlingen med totalt sex deltagare från professioner inom ungdomsmottagning och elevhälsan i två olika regioner. Därefter analyserades den insamlade data med en manifest innehållsanalys där två huvudkategorier; Aktörerna vill arbeta med STI-prevention och Ungdomars kunskap om STI och STI-prevention räcker inte framkom.    Resultaten visar att ungdomars kunskap om STI varierar enligt aktörernas uppfattning, trots kunskaper underskattar ungdomar ofta risken att drabbas av STI. Det framkom också att ungdomarnas kunskap om STI-prevention påverkas av olika riskfaktorer såsom alkoholkonsumtion, vänskapskretsen och tidig sexuell aktivitet, vilket hindrar effektiviteten av skyddsfaktorer. Aktörerna vill arbeta med STI-prevention på olika arenor och har specifika insatser för olika grupper. Dock framkom brist på samverkan som ett hinder för att nå ut till fler. För ett effektivt förebyggande arbete krävs det en gemensam riktlinje och strategier i aktörers arbete som skapar bättre förutsättningar för ungdomar kring STI. / ABSTRACT  There is an increase in sexually transmitted infections (STI), mainly gonorrhea among young people in Sweden. To reduce the incidence of STIs among adolescents, effective preventive measures, control and effective cooperation are required. Sexual and reproductive health is as important as mental, physical and social health, and makes a fundamental part of people's well-being and overall health.   The aim of the study is to investigate actors' perception of adolescents' knowledge of STI-prevention and how they work preventively with STIs. For a systematic approach in the study, a qualitative method based on purposive sampling is used. Thus, a semi structured interview was carried out during the data collection with a total of six participants from professions in youth health clinics and school health services in two different regions. Then the collected data was analyzed with a manifest content analysis where two main categories; The actors aim to work with STI-prevention and Adolescents' knowledge of STIs and STI-prevention is not enough emerged.   The results show that adolescents' knowledge of STIs varies according to the actors' perception, despite knowledge adolescents often underestimate the risk of contracting STIs. It also emerged that adolescents' knowledge of STI-prevention is affected by various risk factors, which hinders the effectiveness of protective factors. The actors aim to work with STI prevention in different arenas and have specific initiatives for different groups. However, a challenge in reaching out to more people has risen due to a lack of cooperation. Effective preventive efforts require a common guideline and strategies in the work of actors that create better conditions for young people around STIs.

The concept of youth activity centre (YAC) has not yet been evaluated. The purpose of this study was to evaluate the YAC in Botswana. Accordingly, the researcher explored and described the lived experience of young people utilising the YAC as well as the perceptions of service providers at the Mochudi Centre in the Kgatleng District, in Botswana. Furthermore, the objective was to develop and describe guidelines for the facilitation of youth-friendly services (YFS) at YAC. A phenomenological, qualitative, explorative, descriptive and contextual research design was used to extract young people’s experiences and perceptions of service providers. Thirty-two young people and 27 service providers (peer educators and service delivery officers [SDOs]) were purposefully selected. Methods of data collection used were unstructured individual in-depth interviews, focus group discussions and observations in the forms of field notes. The data, mainly tape-recorded interviews and field notes were transcribed verbatim for data analysis. Tesch’s eight-step data analysis model (Creswell 1994:155) was used. One major theme, youth friendliness emerged with three categories, namely: physical, administrative, and psychological aspects of youth-friendly services. All the respondents indicated that they benefited and affirmed they were empowered and better people after using the facility. However, limited access to the facility by the target group due to location, cost of reaching the facility, and attitudes of service providers as well as failure to implement planned activities due to financial and staff shortage were obstacles to youth friendliness of the YAC. Based on the findings and literature review, the researcher developed guidelines to facilitate YFS and improved access to the YAC. Recommendations made are for practise in the YAC, education of SDOs and for further research. / Health Studies / D. Litt. et Phil. (Health Studies)

Today, 1.2 billion adolescents stand at the challenging crossroads between childhood and the adulthood. Driven by a combination of biological, psychological and social forces, adolescence is a period of “stress and storm” for many adolescents predisposing them to risky behaviours with long term consequences. Adolescence is not only a time of vulnerability; it is also an age of opportunity for investment in sustained health and wellbeing through education and preventive efforts to help them navigate risks and vulnerabilities. Evidence-based sexuality education programmes are a cornerstone in reducing adolescent sexual risk behaviours and promoting sexual health. A qualitative, grounded theory study was undertaken to explore and describe experiences of adolescents, teachers and perceptions of parents of school-based sexuality education (SBSE). An indepth literature review through concept analysis on the phenomenon was conducted to assist the researcher with theoretical sensitivity and theoretical saturation. In-depth Individual interviews and focus group interviews were conducted to generate data. Interviews were audio-taped and transcribed by the researcher verbatim. The direct quotes of participants were coded and arranged into meaning units for analysis. A constant comparison method of data analysis was applied by following a Strauss and Corbin (1998) analysis process of open, axial and selective coding to analyse textual qualitative data until themes, categories and sub-categories were identified and developed. Data analysis revealed that adolescents benefitted from SBSE but the implementation of programme was undermined by challenges at national, institutional, community, family and individual levels enshrined in the physical. There were also challenging contextual factors at various levels that influenced the benefits of the SBSE. It is recommended that there is need to review the teaching and learning resources and to fully integrate sexuality education into the formal curriculum. The ministry of education in Uganda should take a leadership role in fostering engagement and participation of major stakeholders, particularly teachers, parents and other community groups in delivering school-based sexuality education that addresses the needs of the schoolgoing children / Health Studies / D. Litt. et Phil. (Health Studies)

The study examined the sexual and reproductive health needs of adolescents infected with HIV and AIDS. This was a qualitative study that involved semi-structured interviews and observation. The sampling method used was purposive and it entailed 10 adolescents (4 boys and 6 girls) who are living with HIV at Chiedza Child Care Centre in Zimbabwe. This study revealed that adolescents’ sexual and reproductive health needs are the desire to have sex, desire to have children, the need for prevention of unwanted pregnancy and care and treatment support. However, their knowledge of HIV and AIDS was inadequate. Adolescents also revealed their lack of proper information regarding their health care and treatment needs. However, adolescents illustrated an adequate knowledge of the services available for them for their health, treatment and care needs. The study recommended that there is need to strengthen the provision of information and services on adolescents’ sexual and reproductive health issues. The study also recommended that counsellors should improve their counselling skills so that they can empower adolescents living with HIV to be able to negotiate condom usage, matters of dating and handling relationships. / Sociology / M. A. (Social Behaviour Studies in HIV and AIDS)

The concept of youth activity centre (YAC) has not yet been evaluated. The purpose of this study was to evaluate the YAC in Botswana. Accordingly, the researcher explored and described the lived experience of young people utilising the YAC as well as the perceptions of service providers at the Mochudi Centre in the Kgatleng District, in Botswana. Furthermore, the objective was to develop and describe guidelines for the facilitation of youth-friendly services (YFS) at YAC. A phenomenological, qualitative, explorative, descriptive and contextual research design was used to extract young people’s experiences and perceptions of service providers. Thirty-two young people and 27 service providers (peer educators and service delivery officers [SDOs]) were purposefully selected. Methods of data collection used were unstructured individual in-depth interviews, focus group discussions and observations in the forms of field notes. The data, mainly tape-recorded interviews and field notes were transcribed verbatim for data analysis. Tesch’s eight-step data analysis model (Creswell 1994:155) was used. One major theme, youth friendliness emerged with three categories, namely: physical, administrative, and psychological aspects of youth-friendly services. All the respondents indicated that they benefited and affirmed they were empowered and better people after using the facility. However, limited access to the facility by the target group due to location, cost of reaching the facility, and attitudes of service providers as well as failure to implement planned activities due to financial and staff shortage were obstacles to youth friendliness of the YAC. Based on the findings and literature review, the researcher developed guidelines to facilitate YFS and improved access to the YAC. Recommendations made are for practise in the YAC, education of SDOs and for further research. / Health Studies / D. Litt. et Phil. (Health Studies)

Today, 1.2 billion adolescents stand at the challenging crossroads between childhood and the adulthood. Driven by a combination of biological, psychological and social forces, adolescence is a period of “stress and storm” for many adolescents predisposing them to risky behaviours with long term consequences. Adolescence is not only a time of vulnerability; it is also an age of opportunity for investment in sustained health and wellbeing through education and preventive efforts to help them navigate risks and vulnerabilities. Evidence-based sexuality education programmes are a cornerstone in reducing adolescent sexual risk behaviours and promoting sexual health. A qualitative, grounded theory study was undertaken to explore and describe experiences of adolescents, teachers and perceptions of parents of school-based sexuality education (SBSE). An indepth literature review through concept analysis on the phenomenon was conducted to assist the researcher with theoretical sensitivity and theoretical saturation. In-depth Individual interviews and focus group interviews were conducted to generate data. Interviews were audio-taped and transcribed by the researcher verbatim. The direct quotes of participants were coded and arranged into meaning units for analysis. A constant comparison method of data analysis was applied by following a Strauss and Corbin (1998) analysis process of open, axial and selective coding to analyse textual qualitative data until themes, categories and sub-categories were identified and developed. Data analysis revealed that adolescents benefitted from SBSE but the implementation of programme was undermined by challenges at national, institutional, community, family and individual levels enshrined in the physical. There were also challenging contextual factors at various levels that influenced the benefits of the SBSE. It is recommended that there is need to review the teaching and learning resources and to fully integrate sexuality education into the formal curriculum. The ministry of education in Uganda should take a leadership role in fostering engagement and participation of major stakeholders, particularly teachers, parents and other community groups in delivering school-based sexuality education that addresses the needs of the schoolgoing children / Health Studies / D. Litt. et Phil. (Health Studies)

In this dissertation, we base our experience of carrying out participation in 4 EU-funded projects: EUROFETUS (Cost-Effectiveness of ultrasound screening for congenital anomalies); MOMS-B (MOther Mortality and Severe morbidity); PERISTAT(Monitoring and evaluating perinatal health) and EUPHRATES (EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System), an online questionnaire survey for researchers and a literature review, to provide results which will help us to understand the added value and the challenges of the EU collaboration research and the challenges of EU collaboration research in improving the quality and the accessibility of reproductive healthcare.<p>The EUROFETUS project showed that, despite the fact that the birth prevalence of congenital anomalies has been declining during the last twenty years, they are still a major cause of perinatal mortality and childhood disability in Europe. Congenital heart defects were among the most frequent and the most severe malformations, but were the least diagnosed prenatally. There was large variation between and within countries regarding the proportion of cases diagnosed prenatally and the proportion of cases resulting in termination of pregnancy. From the data available in Eurofetus, such variation might result from the cultural differences underling policy or on ultrasonographer’s expertise, or on differing interpretation of scientific evidence in the design and implementation of screening.<p>The MOMS-B project allowed population-based comparisons between countries by using the standardised definition that showed the three conditions (pre-eclampsia, postpartum haemorrhage and sepsis) selected to as markers of acute severe maternal morbidity are not rare in Europe. Severe haemorrhage was the most common of severe maternal morbidity condition, but its incidence varied widely between European countries.<p>The PERISTAT project on the indicators of unfavourable maternal health outcome showed that the maternal mortality ratios (per 100, 000 live births) for early obstetric death ranged from 2.8 to 11.4 across European countries studied. Such variation reflected different resources and systems in place with varying level of ascertainment in addition to difference in the number of maternal deaths.<p>The EUPHRATES project on a survey of current practice in relation to management of the third stage of labour and the immediate management of postpartum haemorrhage in 14 European countries showed that there were considerable differences in policies for managing the third stage of labour between and within the countries studied.<p> The online questionnaire survey for researchers showed that almost all researchers were satisfied with their participation in EU-funded project; the main benefits for them were transfer and sharing of experience and knowledge between researchers, but the administrative procedures should be simplified in the future. The description of the process needed to obtain ethical approval for a cluster randomized trial in the EUPHRATES project showed that there was considerable variation in time required and the criteria used amongst 14 European countries, with consequential delay in research and exclusion of one country from the trial. <p>Overall, we conclude that Community Framework programmes offer new opportunities to connect researchers from all over Europe to share expertise and resources, including computing tools, and make a real contribution to the creation of the European research area. The added value of EU collaborative research is particularly well positioned for improving foetal and maternal health, from the perspective of harmonizing case definitions, collecting the necessary number of cases within a limited period of time, comparing data between regions and countries, meeting the specific needs of the EU and giving a common response to European reproductive health questions. On the other hand, epidemiological data from multiple countries has advanced our understanding of important health-risks and their geographical distributions across Europe and provided the evidence to help people make better decisions about healthcare in the field of reproductive health for the future research.<p>We focus on reproductive health but believe that this approach could be adapted to other fields when appropriate./Dans cette thèse, nous avons basé notre expérience sur notre participation dans 4 projets européens (EUROFETUS, MOMS-B, PERISTAT et EUPHRATES), un questionnaire en ligne vers les chercheurs, et une revue de la littérature pour fournir les résultats qui nous aideront à comprendre la valeur ajoutée qu’apporte la recherche collaborative et les défis de cette recherche pour l’amélioration de la qualité et de l’accessibilité de la santé reproductive.<p>Le projet EUROFETUS montre que, en dépit du fait que la prévalence des anomalies congénitales à la naissance diminue depuis une vingtaine d’années, elles restent une cause majeure de mortalité périnatale et de handicaps infantiles. Les malformations cardiaques congénitales sont parmi les plus fréquentes et les plus sévères des malformations, mais aussi les moins diagnostiquées. Il y a de larges différences entre et à l’intérieur des pays concernant la proportion de cas diagnostiqués en prénatal et la proportion de cas résultant en interruption de grossesse. D’après les données disponibles dans EUROFETUS, de telles variations pourraient résulter de politiques de santé différentes, reflétant des divergences culturelles, de variations dans l’expertise des échographistes, ou encore d’interprétations divergentes de preuves scientifiques dans la conception ou la mise en place du screening.<p>Le projet collaboratif européen sur la Mortalité et la Morbidité Maternelle sévère (MOMB-B) a permis des comparaisons en population entre pays en utilisant une définition standardisée qui a montré que les trois pathologies sélectionnées (pré-éclampsie, hémorragie, sepsis) comme marqueurs de la morbidité maternelle sévère n’étaient pas rares en Europe. L’hémorragie sévère était la pathologie la plus fréquente, mais son incidence variait très fort d’un pays à l’autre.<p>The PERISTAT project on the indicators of unfavourable maternal health outcome showed that the maternal mortality ratios (per 100, 000 live births) for early obstetric death ranged from 2.8 to 11.4 across European countries studied. Such variation reflected different resources and systems in place with varying level of ascertainment in addition to difference in the number of maternal deaths.<p>Le projet EUPHRATES, par une enquête de pratique concernant le management de la troisième phase du travail et du management immédiat de l’hémorragie du postpartum dans 14 pays européens, a montré qu’il y avait des différences considérables dans les pratiques entre et à l’intérieur des pays en Europe.<p>Le questionnaire en ligne auprès des chercheurs a montré que la plupart étaient satisfaits de leur participation à des projets européens, les principaux bénéfices étaient le transfert et le partage d’expériences et de connaissances entre chercheurs mais que les procédures administratives devraient être simplifiées dans le futur. La description de l’utilisation des comités d’éthique dans l’essai EUPHRATES a montré de très grandes divergences.<p>En général, nous concluons que les programmes-cadres européens offrent de nouvelles opportunités aux chercheurs européens de partager l’expertise et les moyens, en ce compris les outils informatiques et contribuent à la création d’un espace européen de la recherche. La valeur ajoutée de la recherche collaborative est particulièrement importante pour améliorer la santé fœtale et maternelle par l’harmonisation de la définition des cas, la collecte du nombre nécessaire de cas dans une période déterminée, la comparaison des données entre les régions et pays, pour rencontrer les besoins spécifiques de l’Union Européenne et donner une réponse commune aux questions de santé reproductive en Europe. D’autre part, les données épidémiologiques de nombreux pays ont fait avancer notre compréhension de risques importants de santé maternelle et leur distribution géographique à travers l’Europe et apporté la preuve de la nécessité d’aider les gens à prendre la meilleure décision en ce qui concerne les soins en santé reproductive pour de futures recherches. <p>Nous nous sommes concentrés sur la santé reproductive mais nous croyons que cette approche pourrait être adaptée à d’autres domaines.<p><p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

Despite all the legislative efforts regarding child protection and campaigns to prevent and combat early marriage and maternity, Mozambique was ranked 9th globally in terms of the prevalence of early marriage, with 48% of girls aged 20-24 marrying before the age of 18 years. The aim of this study was to develop a strategic alignment framework for the prevention and combat of early marriage and maternity in Zambézia Province, Mozambique. This study used a two-stage equal-status concurrent sequential mixed-method design. Data were collected through a cross-sectional survey, administered to 383 early married, maternity and pregnant girls; life story interviews with early married, maternity and pregnant girls (25) aged 10-19 years; semi-structured interviews with professionals from the education and health sectors, local authorities, families of the early married, maternity and pregnant girls (37), and group discussions with members of a child committee (16). The results indicated that the majority of early married, maternity and pregnant girls only completed primary education (55.9%), followed by secondary education (39.9%), and higher education (2.9%). About 65% of adolescent girls became pregnant at the age of 15-17. Among adolescent girls, 18.8% had their first baby before the age of 15 years and 99.2% had their first baby before they were 18 years old. Among the early maternity girls (362), 24.3% responded “yes” to the questions about health complications during their first baby’s birth and 75.7% of the respondents said “no”. Socio-cultural meanings, such as socialisation into roles, legitimising having children, the value and benefits of the bridewealth, the role of initiation, the social meaning of the first menstruation, geographical and transport issues were the main drivers for school dropout, forcing adolescent girls to marry. Engaging in sexual practices was found to provide the girls a sense of meaning and purpose, or as a result of poverty. Physical aspects, interpersonal relations, education, work, and emotional distress were some of the negative consequences of early marriage and maternity. There were some relevant interventions and efforts to prevent and combat early marriage and maternity in Maganja da Costa and Morrumbala districts in Zambézia Province, Mozambique. However, the alignment of the activities implemented by different NGOs and CBOs to MNSPCM (2016-2019) was still a challenge. Only World Vision was implementing programmes aligned to the National Strategy. Based on the results, I developed a strategic alignment framework for the prevention and combat of early marriage and maternity in Zambézia Province, Mozambique. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this research study is to determine the factors influencing reproductive health choices of women living with HIV attending primary health care services. The need for this research study is evident in that most women attending health care services at primary health care clinics, and who are HIV positive report unintended pregnancy. The study sought to provide answers to factors influencing their reproductive choices. A quantitative, descriptive and cross-sectional research study was used in this study. The sample consisted of 83 females between the ages of 18 and 40. The findings of the research study provided the researcher with adequate evidence on the factors influencing reproductive health choices of women living with HIV attending primary health care services. The approach to reproductive health services was still acceptable but needs to be improved. Moreover, the identified factors therefore influenced one’s perceptions on reproductive health decisions among HIV-infected women. / Health Studies / M.A. (Public Health)