Background: Menopause is a natural part of life which can affect a woman's physical and mental health. Women's experience and knowledge of menopause varies globally, and insufficient knowledge can lead to unnecessary suffering. Knowledge of the menopause is important, both for the women themselves and for the healthcare system in order to guide the women to appropriate self-care methods, which can be crucial to health in this new phase of life. Purpose: The aim was to account for the effect health education, has on health and quality of life onwomen in menopause. Method: A general literature study consisting of quantitative studies which included four randomized controlled studies, five quasi and one semi-experimental study, without a control group. Results: The results showed that the knowledge that the women acquired during the educational interventions had a positive effect by improving the women's awareness and attitude towards the menopause, which empowered them to improve their lifestyles, and through this develop an increased health and thus a better quality of life. Conclusion: Knowledge is the key to an improved quality of life. Through a structured education, the nursing care can increase the awareness and knowledge of women regarding their self-care during the menopause. This strengthens women's autonomy and is cost-effective for healthcare.

The Canadian healthcare system, by design, has been historically oriented to delivering acute and symptom-driven care; however, the current cost of treating chronic disease has risen to an average of nearly 45% of direct costs of the national health budget. As a consequence more attention is being directed to the diagnosis and treatment of chronically ill patients who also may suffer from disabilities, illiteracy, impairment in judgment, depression, or multiple co-morbidities. This has also resulted in a new emphasis on health and disease self-management, to help patients to mitigate and manage the impacts of chronic diseases. This approach affects and involves the patient’s entire circle of care including the patient, healthcare providers, and the patient’s family and friends. This study discusses how support elements (i.e. decision support, education and training, family and community support) and sustainability elements (i.e. recreation and entertainment, rewards systems, online social networks) combined with online technological support can help to support and provide motivation for chronically ill patients to adopt self-management in a sustainable manner. The PLS (Partial Least Squares) statistical approach was used to validate a proposed SEM (Structural Equation Model) research model with data collected from 198 participants across North America without any prior exposure to our proposed system. The research model hypothesized that support and sustainability constructs have a strong positive influence on the willingness of users to adopt and use the proposed system. The model results in a very good fit for Behavioural Intention to Adopt for patients with no caregiver support (R2=0.71), and for patients with such support (R2=0.65). The results clearly validate our proposed model including a high predictive relevance for endogenous variables. This research provides useful theoretical and practical insights and understanding for design, development and promotion of chronic care self-management systems as well as the perceptions of users regarding the adoption and use of such systems. / Dissertation / Doctor of Philosophy (PhD)

None / Introduction: As the prevalence of diabetes continues to rise in Canada, South Asians, as the largest visible minority group in Canada, are at higher risk for developing diabetes than the general population. Although diabetes self-management education (DSME) interventions for South Asians with type 2 diabetes (T2DM) have been researched, these interventions have not been assessed for their cultural congruency. Methods: This systematic review examined the effectiveness of DSME interventions for South Asians with T2DM. Electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL and CINAHL) were searched since inception, along with relevant reviews and guidelines. Title and abstract and full text screening were conducted independently by two reviewers; data extraction was done by one reviewer and confirmed by another. Quality assessment of the included studies was completed using the Cochrane Risk of Bias tool; cultural congruency was assessed using Leininger’s Sunrise Model. All results were synthesized narratively. Results: A total of 1259 studies were found in the search, of which only four randomized controlled trials (RCT) met the inclusion criteria. All studies were consistent in showing a reduction in A1C following the intervention; however only one study reported statistically significant reductions in A1C. Interventions were conducted in person, with follow-up periods ranging from six months to two years, with the use of South Asian community link workers in most interventions. Bias was identified across all studies for sequence generation, allocation concealment and blinding. All studies had limited evidence of cultural congruency, particularly for gender roles and responsibilities. Conclusions: This review found limited effectiveness of culturally specific DSME interventions for South Asians with T2DM. Furthermore, the interventions were scant in their description of cultural congruency. Future research ought to begin with designing interventions for cultural congruency and improved methodologies for DSME research to improve internal and external validity. / Thesis / Master of Science (MSc) / South Asians are the largest visible ethnic minority group in Canada and are at high risk of developing type 2 diabetes (T2DM). This research project aims to understand how diabetes self-management education (DSME) and support (DSMS) is delivered to South Asians with T2DM and how these practices are culturally tailored. The scientific literature was searched using electronic databases to find 1259 research studies, of which four examined the effectiveness of DSME/DSMS provided to migrant South Asians with T2DM. Only one study showed significant improvements in blood glucose control. All of the four studies contained several DSME/DSMS components and they all failed to address differences in gender roles and responsibilities in relation to South Asian culture. Thus, there is a need for future studies to design DSME/DSMS interventions that are culturally tailored to improve blood glucose control and thus, improve the health and well-being of South Asians with T2DM.

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