Bakgrund: Endometrios är en kronisk inflammation som drabbar cirka en av tio personer i fertil ålder födda med en livmoder. Trots att sjukdomen är vanlig är det få som känner till den. Endometrios är inte svårt att diagnostisera men på grund av okunskap kring sjukdomen tar det lång tid för den drabbade att få en diagnos. Behandlingarna kan påverka den drabbade både fysiskt och psykiskt vilket leder till försämrad livskvalité. Det är därför viktigt att lyfta de copingstrategier som finns att tillgå. Syfte: Att sammanställa samt beskriva copingstrategier för personer som lever med endometrios. Metod: En beskrivande litteraturstudie utifrån elva tematiskt analyserade studier. Huvudresultat: Huvudresultatet av studien visade att problemfokuserade copingstrategier i form av egenvårdsmetoder och livsstilsanpassning minskade symtom, gav en känsla av kontroll och hade positiv inverkan på livskvalitén. Den mest användbara egenvårdsmetoden var värme från vetekudde, varma vattenflaskor och/eller kläder. Livsstilsanpassning i form av dietförändring samt planering av arbete och aktiviteter visade sig vara gynnsamt relaterat till smärtsymtom. Copingstrategierna var det som hade mest smärtlindrande effekt både före och efter bekräftad diagnos. Slutsats: Problemfokuserade copingstrategier i form av egenvårdsmetoder samt livsstilsanpassning var de mest användbara strategierna för symtomlindring vid endometrios. Det långa tidsspannet från första vårdkontakten till en säkerställd diagnos var psykiskt påfrestande. För att korta ner tiden mellan första vårdmötet och diagnossättningen samt kunna ge de drabbade tillfredställande information om vad sjukdomen innebär krävs utbildad vårdpersonal. Utbildning om endometrios behövs för vårdpersonal inom fler instanser utöver endometriosteamen eftersom en person med endometrios kanske söker vård på en akutmottagning eller en hälsocentral från början. / Background: Endometriosis is a chronic inflammation which affects one out of ten people who are fertile and born with a uterus. Despite the disease being common only a few people know about it. Endometriosis is not difficult to diagnose but due to the lack of knowledge about the disease it takes a long time for the person to get a diagnosis. The treatments affect the person physically and mentally which lead to lower quality of life and therefore it is important to enlighten available coping strategies. Aim: To compile and describe coping strategies for people living with endometriosis. Method: A descriptive literature study based on eleven thematically analysed studies. Main Results: The main result showed that problem focused coping strategies such as self-management and lifestyle adjustments decreased symptoms, led to a sense of control, and influenced positively on quality of life. It showed that the most useful self-management methods were the heat from heat pillows, warm water bottles, and/or clothes. Lifestyle adjustments that proved decrease in pain was diet change, scheduling of work and activities. The coping strategies were the most successful methods regarding painrelieving, both before and after confirmed diagnosis. Conclusion: Problem focused coping strategies such as self-management and lifestyle adjustments were the most successful strategies to decrease endometriosis related symptoms. The time span between the first contact with healthcare up until confirmed diagnosis was long and psychologically stressful. What is needed to shorten that time span and give pleasing information about the impact of the disease is educated healthcare workers. Education about endometriosis is needed in many units, not only in the endometriosis teams since people without a diagnosis might seek care in the emergency room or other instances to begin with.

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京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18467号 / 人健博第21号 / 新制||人健||2(附属図書館) / 31345 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 任 和子, 教授 横出 正之, 教授 田村 恵子 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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Supports to improve self-care or self-management are beneficial for many people living with health issues, especially chronic conditions. Yet, socioeconomically marginalized groups have often been neglected from self-management initiatives, despite experiencing an increased prevalence of chronicity and multimorbidity. To this end, there are several established critiques within the self-management literature that are addressed through this dissertation. First, limited attention has been given to equity considerations within self-management, thus there remain gaps in the evidence base around disadvantaged groups. Second, there is a lack of understanding about the mechanisms that make self-management supports work, as well as little evidence to explain the wide extent of non-participation, including understanding the impact of structural barriers. Third, the social embeddedness of self-care has received little attention, despite people highlighting social roles as important concerns within self-care. In addition, the grassroots history of self-care has been neglected, which has resulted in minimal recognition of the role of mutual aid/self-help groups. This dissertation includes two exploratory, qualitative studies that attend to these knowledge gaps: the first explored self-care experiences among people who use drugs with chronic health issues, and the second explored mutual support among people experiencing homelessness within the context of encampments during the COVID-19 pandemic. The study findings are also contextualized by worsening overdose and housing crises. I employed community-based participatory research methods and the transformative framework to contend with social injustice and power imbalance and amplify the worldviews of marginalized groups. We conducted in-depth interviews and reflexive thematic analysis to analyze data. Overarching findings demonstrate the importance of agency in shaping how marginalized groups manage their health and social needs, the critical structural limitations they face in doing so, and the substantial influence of their formal and informal social supports. Thus, findings show the importance of recognizing these groups’ alternative and holistic practices of care, the need to address structural and systemic barriers that inhibit their capacity for care, and the immense value of harnessing social support networks to meet care needs. Programs intended to support self-care among marginalized communities would benefit from incorporating a relational autonomy lens and community-centered approach.

Background: Over the last decade, diabetes health coaching, also referred to as diabetes coaching, has emerged as a patient-centered intervention to assist individuals with type 2 diabetes mellitus (T2DM) in acquiring independence with self-management. The structure and delivery of such interventions have varied greatly while showing improvements in glycemic control. However, literature continues to show a gap around the patient experience of receiving diabetes coaching support. Objective: To explore the perceived experience of receiving telephone-based diabetes health coaching among community-based adults with T2DM within the Canadian context. Methods: A qualitative exploration with an interpretive descriptive design was carried out. Participants from the intervention group of a larger randomized controlled trial who had received a telephone-based diabetes coaching intervention over one year were invited to participate in a telephone interview with open-ended questioning. Findings: A total of 12 participants were interviewed and four major themes were identified. (1) Adapting to life with T2DM reflects how coaching helped individuals to integrate diabetes into their lives by addressing misconceptions, providing knowledge, encouraging awareness, and easing transition onto insulin. (2) Heightened mindfulness of diabetes-related wellness captured the greater attention participants’ gave to their overall well-being and self-management behaviours. (3) Behaviour change guided by the participant highlights the differences in participants’ motivation, readiness to make changes, external factors that influenced their ability to make self-management behaviour changes. (4) Lastly, valuing a supportive relationship illustrates that participants felt the unique coach-client relationship was reliable, holistic, non-judgmental, and encouraging. Conclusion: Overall, participants found diabetes coaching to be positive and highlighted the various ways it was able to support their ability to more effectively self-manage their diabetes. / Thesis / Master of Science in Nursing (MSN)

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