In recent years, there has been an increasing demand to study the information needs and information-seeking behaviour of doctors as an essential element in developing successful clinical information systems and improving the quality of healthcare services. This doctoral thesis focuses on exploring the information needs and information seeking behaviour of doctors in Kuwait government hospitals (KGH). The aims are to investigate the internal and external information sources used by doctors in Kuwait government hospitals and to analyse whether the existing clinical information sources meet their needs. A strategy of sequential, mixed-method procedures was followed to gather the research data using focus groups, a paper-based questionnaire and semi-structured telephone interviews. The participants of the research included all categories of doctors (consultants, senior specialists, specialists, senior registrar, registrar, assistant registrar and trainees), working in four government hospitals: Mubarak AI Kabeer, AI Sabaha, AI Farwania and AI Amiri in Kuwait. The findings of the study show that the most frequently mentioned need for information was to keep up-to-date to maintain good practice. It was found that interpersonal communication and a doctor's personal collection, consisting primarily of electronic resources, were the sources most frequently reported as used by the doctors. However, the degree of use of clinical information sources showed that doctors' information seeking varied depending on the clinical scenario. Doctors' knowledge and patient data were the doctors' most frequently used sources of information in the three clinical scenarios: outpatients, wards and the emergency department. There was a low use of knowledge-support resources such as the Internet and library resources in the outpatient and emergency rooms. However, use of the knowledge-support resources was highest in the wards. The results showed some contextual factors either supported or hindered doctors in seeking the information they need. The factors were categorised in the following contexts: a) Organisation context, b) Socio-cultural context; c) Information sources context and d) Scenarios context. Doctors made a number of suggestions for effective information communication and improving the information provision system in KGH. Two conceptual models result from the study findings: a clinical decision-making model scenario· and the overall conceptual model of information seeking by doctors in Kuwait government hospitals. The thesis concludes with recommendations and practical implications to enhance the information provision in KGH. Suggestions for further research are also given.

Background: This grounded theory study explored the views of adolescent boys aged 12 and 13 on the factors that influence their help-seeking decisions for less severe forms of psychological distress. Method: Semi-structured interviews with 12 participants from a local secondary school and a community setting were analysed according to grounded theory methods. The data analysis abstracted categories of data to construct a substantive theory of helpseeking. Results: Participants’ views revealed an interaction of ‘pressures and promoters’ that affected adolescent boys’ help-seeking decisions. These related to relationships with others, mental health support and education, being a boy, and individual factors. Conclusion: Mental health education and awareness should be promoted amongst adolescent boys and the adults and professionals that they encounter so that they may be encouraged to seek help for psychological distress.

This thesis presents an investigation into the high value of structured text (or form) in the context of genre within Information Retrieval. In particular, how are these structured texts perceived and why are they not more heavily used within Information Retrieval & Search communities? The main motivation is to show the features in which people can exploit genre within Information Search & Retrieval, in particular, categorisation and search tasks. To do this, it was vital to record and analyse how and why this was done during typical tasks. The literature review highlighted two previous studies (Toms & Campbell 1999a; Watt 2009) which have reported pilot studies consisting of genre categorisation and information searching. Both studies and other findings within the literature review inspired the work contained within this thesis. Genre is notoriously hard to define, but a very useful framework of ‘Purpose and Form’, developed by Yates & Orlikowski (1992), was utilised to design two user studies for the research reported within the thesis. The two studies consisted of, first, a categorisation task (e-­‐mails), and second, a set of six ‘simulated situations’ in Wikipedia, both of which collected quantitative data from eye tracking experiments as well as qualitative user data. The results of both studies showed the extent to which the participants utilised the form features of the stimuli presented, in particular, how these were used, which ocular behaviours (skimming or scanning) and actual features were used, and which were the most important. The main contributions to research made by this thesis were, first of all, that the task-­‐based user evaluations employing simulated search scenarios revealed ‘how’ and ‘why’ users make decisions while interacting with the textual features of structure and layout within a discourse community, and, secondly, an extensive evaluation of the quantitative data revealed the features that were used by the participants in the user studies and the effects of the interpretation of genre in the search and categorisation process as well as the perceptual processes used in the various communities. This will be of benefit for the re-­‐development of information systems. As far as is known, this is the first detailed and systematic investigation into the types of features, value of form, perception of features, and layout of genre using eye tracking in online communities, such as Wikipedia.

There has been a long history of studying library users and their information seeking behaviors and activities. Researchers developed models to better understand these information seeking behaviors and activities of users. Most of these models were developed before the onset of the Internet. This research project studied faculty members' use of and their information seeking behaviors and activities on the Internet at Angelo State University, a Master's I institution. Using both a quantitative and qualitative methodology, differences were found between tenured and tenure-track faculty members on the perceived value of the Internet to meet their research and classroom information needs. Similar differences were also found among faculty members in the broad discipline areas of the humanities, social sciences, and sciences. Tenure-track faculty members reported a higher average Internet use per week than tenured faculty members. Based on in-depth, semi-structured interviews with seven tenured and seven tenure-track faculty members, an Internet Information Seeking Activities Model was developed to describe the information seeking activities on the Internet by faculty members at Angelo State University. The model consisted of four basic stages of activities: "Gathering," "Validating," "Linking" with a sub-stage of "Re-validating," and "Monitoring." There were two parallel stages included in the model. These parallel stages were "Communicating" and "Mentoring." The Internet Information Seeking Activities Model was compared to the behavioral model of information seeking by faculty members developed by Ellis. The Internet Model placed a greater emphasis on validating information retrieved from the Internet. Otherwise there were no other substantive changes to Ellis' model.

This study explored university students' information needs and seeking behaviors on the Internet. A Web-based survey was administrated one time. Two hundred responses were received from the target sample within the two weeks period of the study. Data were analyzed with descriptive statistics, factor analysis, and graphical representation. The study explored various issues related to the usability, preferences, and activities of the Internet, such as searching tools, e-mail, search engines, and preferred primary sources of everyday-life information needs. The study explored the perceptions of the students toward the Internet and the traditional library. Kuhlthau's model of the information-seeking process, which includes six stages and affective components, was utilized and modified in the construction of the Web survey. A study by Presno (1998), which includes the four types of Internet anxiety, was utilized in the construction of the Web survey. With regard to the six stages of Kuhlthau model, the majority of the respondents experienced stage 5, which was about information gathering; stage 3 had the next highest number of respondents. Very few respondents experienced stages 1 and 2. There was a systematic pattern in which, the earlier the stages the respondents were in, the more negative adjectives they selected, and vice versa. The feeling adjectives section showed a difference in the behavior between males and females. The results indicated that most students had Internet time delay anxiety. In general, the study found that students have a great interest in the Internet and consider it an important source of information for their personal, educational, and communication activities.

Middle school student's interaction within a digital library is explored. Issues of interface features used, obstacles encountered, search strategies and search techniques used, and representation obstacles are examined. A mechanism for evaluating user's descriptors is tested and effects of augmenting the system's resource descriptions with these descriptors on retrieval is explored. Transaction log data analysis (TLA) was used, with external corroborating achievement data provided by teachers. Analysis was conducted using quantitative and qualitative methods. Coding schemes for the failure analysis, search strategies and techniques analysis, as well as extent of match analysis between terms in student's questions and their search terms, and extent of match analysis between search terms and controlled vocabulary were developed. There are five chapters with twelve supporting appendixes. Chapter One presents an introduction to the problem and reviews the pilot study. Chapter Two presents the literature review and theoretical basis for the study. Chapter Three describes the research questions, hypotheses and methods. Chapter Four presents findings. Chapter Five presents a summary of the findings and their support of the hypotheses. Unanticipated findings, limitations, speculations, and areas of further research are indicated. Findings indicate that middle school users interact with the system in various sequences of patterns. User groups' interactions and scaffold use are influenced by the teacher's objectives for using the ADL. Users preferred to use single word searches over Boolean, phrase or natural language searches. Users tended to use a strategy of repeating the same exact search, instead of using the advanced scaffolds. A high percent of users attempted at least one search that included spelling or typographical errors, punctuation, or sequentially repeated searches. Search terms matched the DQ's in some instantiation 54% of all searches. Terms used by the system to represent the resources do not adequately represent the user groups' information needs, however, using student generated keywords to augment resource descriptions can have a positive effect on retrieval.

Critical care nurses work in an environment rich in informative interactions. Although there have been post hoc self-report survey studies of nurses' information seeking, there have been no observational studies of the patterns and content of their on-duty information behavior. This study used participant observation and in-context interviews to describe 50 hours of the observable information behavior of a representative sample of critical care nurses in a 20-bed critical care hospital unit. The researcher used open, in vivo, and axial coding to develop a grounded theory model of their consistent pattern of multimedia interactions. The resulting Nurse's Patient-Chart Cycle describes nurses' activities during the shift as centering on a regular alternation with the patient and the patient's chart (various record systems), clearly bounded with nursing "report" interactions at the beginning and the end of the shift. The nurses' demeanor markedly changed between interactions with the chart and interactions with the patient. Other informative interactions were observed with other health care workers and the patient's family, friends and visitors. The nurses' information seeking was centered on the patient. They mostly sought information from people, the patient record and other digital systems. They acted on or passed on most of the information they found. Some information they recorded for their personal use during the shift. The researcher observed the nurses using mostly patient specific information, but they also used some social and logistic information. They occasionally sought knowledge based information. Barriers to information acquisition included illegible handwriting, difficult navigation of online systems, equipment failure, unavailable people, social protocols and mistakes caused by multi-tasking people working with multiple complex systems. No formal use was observed of standardized nursing diagnoses, nursing interventions, or nursing outcomes taxonomies. While the nurses expressed respect for evidence-based practice, there clearly was no time or opportunity for reading research literature (either on paper or online) while on duty. All participants expressed frustration with the amount of redundant data entry required of them. The results of this study have significant implications for the design of clinical information systems and library services for working critical care nurses.

This thesis aimed to study the actual and perceived quality of midwifery practices during childbirth at peripheral and central health care levels in two low-income countries, Angola (I-III) and Mozambique (IV-V). Theoretical models interpreting women's and midwives' views have been developed. Objectives: Study I evaluates midwives' use of an adapted model of the World Health Organization's partograph, a tool used to monitor the progress of labour. Study II describes midwives experiences of working without immediate medical assistance. Study III explores women's perceptions of care-seeking behaviour during childbirth. Study IV observes perinatal midwifery care routines and examine partograph documentation. Study V explores and develops a theoretical understanding of factors perceived to obstruct or facilitate midwives ability to provide quality of perinatal care. Methods: Study I: A one-group pre-and post-test interventional evaluation of 100 partographs from one peripheral delivery unit. Study II: Semi structured interviews with eleven midwives, analysed in a qualitative process comprising six steps. Study III. Ten focus group discussions with pregnant and non-pregnant women, analysed using the grounded theory technique. Study IV. Pre-and post intervention observation of midwifery care of 702 vs. 616 women during delivery and examination of the partographs. Study V: In-depth interviews with 16 midwives, analysed using grounded theory technique. Educational interventions were designed and applied in study II and IV. Results: Study I. Significant improvement of documenting was found in seven of the ten variables and more partographs were correctly documented in sample II compared to sample I. Missed transfers increased, however, in sample II. Study II: The midwives experiences were sorted under four main areas: (1) Society/culture (2) Significant Others (3) Personal Self (4) Professional Self. Confidence was felt in the role as autonomous midwives but dependency on various factors such as the partograph, a functional referral system, peer support, community trust and continuous supervision was emphasised. Socio-economic hardships were identified as major stress factors for themselves and the women. Study III: Women seemed compelled to "mould" their care seeking behaviour and four patterns, two 'avoiding' and two 'approaching' institutional care were identified. The salient features of each pattern were found to be "personal courage", [B1]"disempowerment", "discarding traditional practices" and "awareness and emancipation". Study IV. No improvements were found in quality of care following the intervention. Common problems proved to be hypothermia and rare initiation of the graphic part of the partograph, which monitors progress of labour. Study V. A process labelled "changing perinatal care management" emerged, which comprised four dimensions addressing aspects related to i) existing environment ii) midwives' interaction with women in labour, iii) midwifery profession and iv) caring technology in order to improve quality of care. Communication and collaboration were identified as change agents. Conclusions: The findings in this thesis indicate that midwives' ability to provide quality of maternal and perinatal care in lowincome and post-war affected countries is restricted by organizational, structural, educational as well as attitudinal aspects. Women in need of assistance during childbirth are negatively affected as a consequence of midwives reaction to the various constraints, which at times (Luanda) seems to oblige adverse care seeking behaviour. Midwives recognises the need for change, but change is found to be a slow and complex process, which requires engagement by all levels of the care chain. A model suggesting how to achieve quality of maternal and perinatal care in Safe Motherhood context is presented.

There is a general perception in the public that mental health problems scarcely exist among elite athletes. The aim of this thesis was to investigate mental health among Swedish elite athletes with a particular focus on depression, overtraining, help seeking and stigma. The sample consisted of 100 athletes; of these 32 % were male and 68 % female, 53 % team athletes and 47 % individual athletes representing 15 different sports. A cross-sectional research design using self-report measures examined variables associated with the mental health of athletes. Results showed the prevalence of depression in the sample was similar to that of the general population. Athletes who reported symptoms of overtraining also reported symptoms of depression. Depressed athletes showed significantly more symptoms of overtraining than non-depressed athletes. Athletes who reported greater symptoms of depression or overtraining also reported higher levels of stigma associated with the condition. In the sample 45 % of participants reported that it was unlikely or extremely unlikely that they would seek help for mental health problems. The results indicate that mental health problems among elite athletes do exist. Athletes that experience problems with their mental health also do not want to disclose these problems. The established relationship between depression and overtraining highlights the difficult in distinguishing between the concepts that may ultimately lead to misdiagnose and ineffective treatment of the symptoms. Sport specialization in health care is required in order to meet the needs of elite athletes. / Det finns en allmän syn i samhället att psykisk ohälsa bland elitidrottare är väldigt ovanligt. Syftet med denna studie var att undersöka psykisk ohälsa bland svenska elitidrottare med fokus på depression, överträning, hjälpsökande och stigma. Urvalet bestod av 100 elitidrottare; av dessa var 32 % män och 68 % kvinnor, 53 % lagidrottare och 47 % individuella idrottare vilka representerade 15 olika idrotter. En tvärsnittsstudie genomfördes med hjälp av självskattningsformulär vilka undersökte variabler förknippade med elitidrottares psykiska hälsa. Resultaten visade en prevalens av depression bland elitidrottarna motsvarande den allmänna populationen. Elitidrottare som rapporterade symptom på överträning rapporterade även symptom på depression. Deprimerade elitidrottare hade signifikant fler symptom på överträning än icke-deprimerade elitidrottare. Elitidrottare som rapporterade fler symptom på depression eller överträning rapporterade även högre nivåer av stigma. I urvalet rapporterade 45 % av deltagarna att det var osannolikt eller extremt osannolikt att de skulle söka hjälp vid problem med psykisk ohälsa. Resultaten visar på att psykisk ohälsa bland elitidrottare existerar. Elitidrottare med psykisk ohälsa är obenägna att avslöja dessa problem för andra. Den påvisade relationen mellan depression och överträning visar på att det är svårt att skilja mellan dessa koncept vilket i förlängningen kan leda till feldiagnostisering av symptomen samt att fel behandlingsinsatser sätts in. För att möta behoven från elitidrottare bör hälso- och sjukvården erbjuda idrottsspecifik behandling.

Despite demonstrating eating disorder rates equivalent to White women, African American and Asian American women are less likely to seek treatment and are more likely to terminate treatment prematurely. One of the most successful programs for eating disorder prevention has only focused on surface-level cultural adaptations. Prevention literature maintains that deep-structure cultural adaptation (e.g., integrating cultural values and beliefs) can enhance outcomes for ethnic minorities. This dissertation examined the feasibility of Sustainable Adapted Treatments for Eating Disorders (SATED), a pilot intervention that included a culturally- targeted pre-treatment to an eating disorder dissonance-based intervention. A sample of 72 women (ages 18-30) were recruited via the SONA pool, student organizations, and community organizations. In Study 1, 47 women participated in focus groups (i.e., 21 African American women and 26 Asian American women). Grounded theory was used to analyze data, and this data was then used to develop a culturally-informed pre-treatment. Pre-treatment protocols (30- 45 minutes) were developed for both African American and Asian American groups and were refined prior to implementing the intervention. In Study 2, a pilot intervention, 25 women were assigned either to a pre-treatment condition, or 30-45 minute, individualized session (N = 12) or a no pre-treatment condition (N = 13) prior to completing an eating disorder DBI which took place over two 2-hour sessions. Participants completed a battery of questionnaires at baseline, post-intervention, and at 2 to 3-month follow-up. Constructs assessed included eating disorder symptomatology, attitudes towards seeking professional psychological help, and body dissatisfaction. Overall feasibility and acceptability of the pre-treatment and pilot intervention were assessed via triangulation of methods including third-party observations, in-depth interviews, and fidelity checks. Preliminary findings from the questionnaires indicated that there was a general downward trend for eating pathology across both the pre-treatment and no pre- treatment condition, except for eating restraint. Body dissatisfaction decreased for both groups from baseline to post-test, but increased at follow-up. Attitudes towards treatment-seeking increased for both groups from baseline to follow-up. Results may inform feasibility issues that accompany translational research with ethnic minorities and inform a future definitive trial.