Introduction: There is an urgent need to find new ways of improving the quality and safety of healthcare whilst achieving efficiencies of service. E-health technologies offer exciting opportunities to support patients in managing chronic disease. Following continuous advances and increasing use, the Internet provides an ideal platform to empower patients. Previous studies have demonstrated that people taking a more active role in managing their health, experience improved outcomes. Based on these principles and funded by Crohn's and Colitis UK, a new web-based care package was designed for adults with inflammatory bowel disease. Specifically 'My IBD Portal' aimed to provide greater access to information, improved communication and encourage greater engagement. Following its implementation at a single centre NHS Trust, the new IBD patient portal was evaluated in the clinical setting. Methods: Following a literature review and significant patient involvement, 'My IBD Portal' was designed and implemented within a single centre setting. The system was evaluated over a 6-month period using a pre-post observational designed study. The primary objective was to examine patient experience. Usage, usability and satisfaction were measured. Secondary objectives included assessing factors that predicted use, analysed using logistic regression models. Changes in IBD knowledge, patient engagement, medication adherence and health utilisation were also explored using univariate analysis and multiple regression models. Results: 183 participants enrolled in the 6-month observational study. 63.4% of participants visited the IBD Portal more than once and were defined as users. In total there were 2080 individual visits to the Portal. The mean number of logins was 11.4 (SD 21.5) and median 3 (IQR 1-12). The mean duration of each visit was over 5 minutes. Individual use was highly variable. Approximately a quarter of participants never or only once used the IBD Portal, with an equal proportion visiting over 10 times. Satisfaction amongst users was high. 98% of respondents were either satisfied or very satisfied. 90% perceived the IBD Portal supported their management and 32% felt it helped with treatment decisions. An overwhelming majority expressed a desire to continue using the IBD Portal after completion of the study. Viewing test results (23%) was the most common section visited, followed by clinic letters (21%). 29% of participants reported sharing their access with a partner or family member. The qualitative data supported the quantitative findings. Many users expressed considerable benefit from online provision to their IBD health record. Comparing users to non-users, logistic regression modeling showed active disease was significantly associated with use. Changes in health outcomes were explored using both univariate and regression analyses. Following multiple regression modeling, an increase in patient activation was significantly associated with Portal use (p < 0.02). A positive trend was observed in perceived support (p=0.06). Improvements in IBD knowledge and medication adherence were not observed. Health utilisation was greater amongst users with more frequent outpatient and helpline contacts observed. Conclusion: Design and implementation of an IBD Portal within the NHS setting is feasible. Technological, human and organisational factors need to be carefully considered during development to support adoption. The IBD Portal was used by a majority of participants and was perceived to support their care. Following adoption in other NHS clinical settings, a cluster randomised controlled study would provide the optimal study design to complete the evaluation process.

This study aims to contextualise my own photographic practice in relation to the interaction between mundane and sacred landscapes and the role that the transformative alchemy of light has on our perception of the ordinary. Reference will be made to the development of the genre of landscape photography, with particular reference to the selective aesthetic of pristine Wilderness, as embodied in the work of Ansel Adams, through the ‘man-altered’ landscapes of the New Topographics and Mark Klett’s rephotographic project, to discuss an aesthetic of the everyday. Reference will also be made to the benefits to health and wellbeing that can be achieved as a result of engaging in a state of mindfulness (Crane), also known as optimal experience or flow (Csikszentmihalyi) through photographic practice. Rather than narrowing the focus of the study by excluding relevant information to make the research less complex, the thesis comprises information from a diverse range of disciplines encompassing both the more obviously creative subjects of photography, aesthetics and poetry and areas such as health care. Given the parameters of the PhD process in relation to the breadth of the research undertaken, the specific study of each diverse element is, of necessity, not as detailed as it may have been had a single, more specifically defined, area of research been the entire focus of the research. The inclusive nature of the research presented in this thesis offers unique insights by providing direct comparisons and establishing new relationships between the theoretical and methodological approaches of a range of differing disciplines. While a written thesis forms part of the dissemination of the research findings the images that have emerged as a result of engagement with the study will be exhibited as an integral element of the outcome. The images that have been created as a result of the research process will take their place as objects within the world, offering viewers potential new ways of perceiving and experiencing what Rancière refers to as the ‘splendour of the insignificant’ within the landscape of their own everyday lives.

Neste trabalho, a contabilidade reveste-se de historicidade e insere-se no contexto da Economia Solidária (ES) como um fundamental instrumento de democracia e cidadania. Tendo como foco de estudo a relação entre Contabilidade e Autogestão (modelo de gestão da ES), o objetivo foi compreender e analisar a dimensão contábil nos processos de autogestão dos empreendimentos solidários, levantando desafios e demandas contábeis suscitadas nesse processo. Para tanto, foram criadas seis variáveis de análise que representaram aspectos da dimensão contábil, as quais são: 1) Forma de comunicação; 2) Conteúdo da informação; 3) Utilidade da informação; 4) Apropriação da informação; 5) Relação contador-usuário; 6) Legislação contábil. Os resultados obtidos, por meio do estudo de caso realizado em um empreendimento de ES, estão alinhados com estudos anteriores sobre o tema. As conclusões mais relevantes apontaram para confirmação das demandas e acrescentaram novas, dentre as quais destacam-se: a mudança da linguagem dos relatórios; criação de novos instrumentos contábeis apropriados à ES; novo perfil do profissional da área contábil; uma didática de formação em contabilidade adequada à realidade social dos trabalhadores; uma nova formação do contador baseada na realidade brasileira e preocupada com as questões sociais; e uma nova legislação contábil.Por outro lado, esta pesquisa indicou caminhos ou elementos à superação do hiato existente entre a realidade e necessidades destes usuários e as tradicionais posturas profissionais e instrumentos contábeis disponíveis à autogestão. Portanto, este trabalho contribui para a ampliação do campo de conhecimento sobre a relação contabilidade e autogestão, bem como para a reafirmação da contabilidade enquanto instrumento indispensável ao desenvolvimento econômico dos empreendimentos da ES e ao desenvolvimento de relações mais democráticas e solidárias. Entretanto, há necessidade de novas pesquisas para o aprofundamento das questões aqui levantadas e para desvelamento de outras faces do fenômeno. / In this work, accounting takes on historicity and places itself in the context of Solidary Economy (SE) as a basic instrument of democracy and citizenship. Focusing on the relationship between Accounting and Self management (the model of management of SE’s), the objective of the study was to understand and to analyze the reach of accounting in the processes of self management of the solidary enterprises, raising challenges and possible accounting demands within this process. For this purpose, six variables of analysis were created and they represent aspects of the accounting dimension. They are: 1) Form of communication; 2) Content of the information; 3) Usefulness of the information; 4) Appropriateness of the information; 5) Accountant-user relationship; 6) Accounting legislation. The results reached by means of a case study carried out in an SE enterprise, line up with previous studies on the subject. The most relevant conclusions point to a substantiation of the demands and add some new ones, among which we can highlight: the change in the type of language used in the reports; the creation of new and appropriate accounting tools to be used with SE’s; new profile of the professional of the accounting area; a didactics of education in accounting adequate to the social reality of the workers; new education for the accountant professional based on the Brazilian reality and concerned with the social matters, and new accounting legislation. On the other hand, this research showed ways or elements to overcome the existing gap between the reality and the necessities of these users and the traditional professional positions and accounting instruments available to selfmanagement. Therefore, this work contributes to the broadening of the field of knowledge on the relationship between accounting and self management, as well as to the reaffirmation of accounting as an instrument essential to the economic development of SE enterprises, and to the development of more democratic and solidary relationships. However, more research needs to be carried out for the deepening of the answers to questions raised here and for the unveiling of other aspects of the phenomenon.

Background: Self-management with an action plan, as opposed to passive self-monitoring, improves health outcomes. However, engaging patients is challenging. Mobile technology, incorporating education, personalised asthma action plans and facilitating professional support, is an option for supporting asthma self-management. Clinical research has focussed on health-related outcomes rather than informing the features that patients want and will use in a self-management app. Technology developers focus on user engagement as opposed to developing telehealth based on clinical evidence, leaving patients struggling to choose safe telehealth to support their asthma self-management. Risk aversion results in legislation that can be a barrier to the development of asthma apps. Aims and objectives: Using phases of the MRC Framework for developing complex interventions, and the Oxford app roadmap to develop a prototype app, I aimed, from clinical, patient, technology and legislative perspectives to: •(Phase 1) Identify the evidence base •(Phase 2) Model key aspects of app development •(Phase 3) Explore the feasibility of a mobile app to support self-management. Methods: •(Phase 1) Systematic review, online social forum analysis, asthma apps review, and legislation regulation review were used to identify evidence. Results were analysed with reference to the PRISMS taxonomy of self-management support. •(Phase 2) Using results from phase 1, and with the advice of lay and professional advisory groups, I made decisions about the design of the prototype app and the feasibility study in phase 3. I also reviewed the legislative issues regarding self-management app development. •(Phase 3) I undertook a feasibility study of using asthma mobile apps. Within the three-month feasibility study, five practices in Lothian/Oxford and Asthma UK's social media invited adults with active asthma to try out our prototype app. I observed patient's download rate and app usage. Of the patients recruited from practices, I purposively sampled patients (based on age/sex, experience of asthma, current self-management and technology use) and interviewed them before and after using the app for one month about their preferred features. Interviews were transcribed, and thematically analysed with reference to the PRISMS taxonomy of self-management support. Results: •(Phase 1) Telehealth was at least as effective as traditional approaches to supported self-management. Most asthma patients using online social forums commented on self-monitoring features, such as logging peak flow and symptoms, as opposed to self-management features. No one explicitly discussed asthma action plans though some patients were positive to the apps which had incorporated an action plan. Similarly the most downloaded asthma apps offered self-monitoring features rather than action plans. Current medical device legislation is ambiguous: it is unclear if apps with an action plan are 'medical devices'. •(Phase 2) The final prototype app included the Asthma UK asthma action plan and monitoring features such as the morbidity questions of the Royal College of Physicians three questions, peak flow, use of reliever inhaler, other medication use and lifestyle status. A mixed method approach was chosen for the feasibility study. •(Phase 3) 111 asthma patients used the prototype app. The ownership of action plans increased 43% to 63% after the study. Most patients preferred digital to paper action plans though the digital format did not improve usage. Action plans and monitoring features were the most 'wanted' features by patients, GPs, asthma nurses and the administration staff in the practices. Some patients also 'wanted' more advanced features such as predictive exacerbation warnings, identifying precise triggers, learning about what caused/affected their asthma. Conclusions: Mobile apps are a feasible option to support asthma self-management. Ease of access to download is the key to adoption as well as sufficient motivation (e.g. personal invitation from their GP or asthma nurse). Motivation (specifically GP and asthma nurse's encouragement and perception of benefit) is the key to adherence, but it will be more effective if the app is easy to use. Action plans and self-management features were the most 'wanted' features by patients and professionals. Other features that patients 'wanted' varied; one size does not fit all. Advanced features might encourage on-going use of asthma apps to support self-management. Choice of features, service promotion and service deployment should be considered carefully when implementing mobile app in 'real world' setting. The key technological barriers were to provide seamless Wi-Fi and to connect the app with the practice's software platforms. 'Medical device' legislation is currently a barrier for self-management app development, further discussions with all stakeholders is needed to reach consensus on risks involved in incorporating action plans in an app.

The present study aimed to examine factors that predict glycemic control in Hispanic youths. Secondary aims included developing and evaluating Spanish translations of three measures commonly used in research with youths with type 1 diabetes and examining factors associated with diabetes self-management in this population. Data was collected at three sites through interviews, questionnaires, and medical chart review. Participants included 117 Hispanic diabetic youths (10 to 17 years old) and their caregiver. 15% of the youths who participated were born outside of the continental U.S. and 57% were first generation born in the U.S. Translations of the Diabetes Self-Management Profile, Diabetes Social Support Questionnaire-Family version, and the Family Environment Scale?s Organization subscale had adequate reliability and showed evidence of concurrent validity. Primary analyses indicated that parent education, occupation, and household income are all significant predictors of glycemic control in Hispanic youth. In addition, global ratings of diabetes self-management on the DSMP predicted control in this population. Family factors did not contribute directly to glycemic control after controlling for sociodemographic and disease variables. However, older age, more acculturation, and language barriers were associated with poorer self-management. Additionally, family support and organization significantly contributed to self-management.

Cardiovascular disease (CVD) continues to be the leading cause of death of Canadian women and while treatment for CVD has improved dramatically, women typically fare worse than men with regards to morbidity following cardiac event. Cardiac rehabilitation (CR) is well established as a key intervention in the treatment of coronary artery disease and has been shown to be effective in both men and women. CR remains largely underutilized, especially in women who comprise only 12 – 24% of contemporary CR programs, even though the prevalence of CVD in men and women is similar. The objectives of this pilot trial were to test the feasibility of all procedures, specifically to determine: 1) an estimate of patient recruitment rates, 2) acceptability and feasibility of the intervention and 3) barriers to CR attendance and resources required. Additionally, exploratory research questions were used to determine the effects of telephone coaching on women’s attendance at CR intake appointment, self-efficacy for cardiac exercise and self-efficacy to attend CR. A RCT design enrolled women with CVD referred for CR at a single site in Ontario. Patients were randomized, stratified for age, to either a usual care group or an intervention group. Participants allocated to usual care received a referral to CR. In addition to usual care, women assigned to the intervention group received individualized telephone coaching, designed to support self-management prior to CR intake. Eighty-three patients were approached and 70 consented to participate (usual care n = 36, intervention n = 34). Participants in the intervention group were significantly more likely to attend CR intake (p = 0.048). Participants were highly satisfied with their coaching experience; they found the information provided to be helpful with goal setting, action planning and assisted them in their interactions with their health care providers. Barriers to attendance identified included transportation, health concerns, timing and lack of physician endorsement. Most common resources identified included problem solving support, assistance with communication with physicians and information concerning CR. The evidence obtained from this pilot trial suggests that a telephone coaching intervention designed to enhance self-management is feasible and may improve attendance at CR intake for women following hospital discharge with a cardiac event.

The purpose of this research was to examine the impact of self-management on daily net calories consumed by women who are overweight. Four white females between the ages of 35 and 41 with a self-reported BMI between 25 and 29.9 completed this study. A multiple baseline across participants design was used to demonstrate a functional relation between the independent variable (i.e., self-management) and the dependent variable (i.e., net calories consumed) for each participant. Three of the four participants decreased their daily net calories consumed after beginning the self-management intervention. This was the first single case research study to examine the effectiveness of self-management on daily net calories consumed (i.e., caloric intake minus caloric expenditure) and extended previous literature on white females who were overweight.

Background: Rural Saskatchewan cancer survivors have reported a lack of support once their cancer treatments have been completed. This problem is more acute the further away one lives from Saskatoon and Regina. A chronic disease self-management program titled LiveWell with Chronic Conditions (LWCC) is available to all people with any chronic condition in rural areas across Saskatchewan. This program addresses key areas of concern to survivors; however, participation is low for cancer survivors. Purpose: To determine how LWCC can reach and respond to the needs of rural cancer survivors in Saskatchewan. Objectives: 1. To gain an understanding of how the program responds to the needs of rural cancer survivors from the perspective of program leaders and cancer survivors. 2. To explore how the existing LWCC program could be enhanced in terms of content, format, delivery and marketing strategy. 3. Based on results, develop recommendations in coordination with agencies and institutions that provide services to cancer survivors. Methods: A mixed-methods case study approach was adopted. Needs questionnaires were completed by cancer survivors who participated in the LWCC program offered in rural health regions across the province (n=4). Consenting survivors who attended the program and several program facilitators, some of whom were cancer survivors themselves, were interviewed in order to provide their opinion regarding content, format, and other relevant feedback that would improve the fit of the program with the needs of rural cancer survivors (n=10). Results: Results indicate the material covered in the program is appropriate for cancer survivors who have finished acute treatment and are making the transition to life after cancer. Program benefits include improved self-efficacy and being able to manage emotional and physical issues from cancer including fatigue and pain. Rural survivors would like access to additional information to address issues specific to cancer survivorship including dealing with the fear of cancer recurrence, lymphedema and sexuality. A cancer specific rural health program would not be very feasible due to small populations. Cancer survivors felt comfortable in a group among people with other chronic conditions although support of another person with cancer participating in the LWCC group would be preferred. Knowledge Translation: A think tank was held with key stakeholders who provide services to cancer survivors to review these findings and form recommendations for improving rural cancer survivor care. These recommendations are: 1) to promote LWCC to rural cancer survivors who have finished acute cancer treatment, 2) to broaden the awareness of the program among cancer care providers, and 3) to refer cancer survivors to an existing cancer survivorship single day workshop after participation in LWCC. This workshop is available in up to 10 communities outside of Regina and Saskatoon. Conclusion: The Live Well with Chronic Conditions program is appropriate and beneficial for cancer survivors who have completed acute cancer treatments. As more cancer care providers make referrals to this program and an online version of the program becomes available, uptake will likely improve among rural cancer survivors in Saskatchewan.

Bakgrund: Låg medvetenhet om symtom och komplikationer hos patienter med typ 2-diabetes har identifierats som ett stort problem. Information, motivation och beteende är centrala begrepp för att utbilda patienter i diabeteshantering. Syfte Syftet med denna studie är att belysa omvårdnadsstrategier som visats sig lämpliga i vården av människor med diabetes typ 2. Metod: En litteraturöversikt med kvalitativ ansats gjordes på vetenskapliga artiklar där resultatens likheter och skillnader granskades och jämfördes. Resultat: Tre teman med omvårdnadsstrategier för typ 2 diabetiker identifierades; Motivation och beteendeförändringar, Utbildning och stöd samt Self-management. Diskussion: Diabeteshantering är en process där förändringar krävs. Processen börjar med identifiering av patientens utgångspunkter och följs av lämpliga omvårdnadsåtgärder. Vilken typ av omvårdnadsstrategi som är mest effektiv är svårt att avgöra, men patientens självbestämmande, i samråd med sjuksköterskan ger en indikation på hur diabetes-hanteringen bör fortlöpa. Konklusion: Omvårdnadsstrategier för typ 2 diabetiker följer en process som inleds då patienter blir diagnostiserade. Identifiering av patienters utgångspunkter bör följas upp med en identifiering av patientens omvårdnadsbehov. Baserat på behoven kan sjuk-sköterskor i samråd med patienten genomföra individualiserade åtgärder. Bakgrund: Låg medvetenhet om symtom och komplikationer hos patienter med typ 2-diabetes har identifierats som ett stort problem. Information, motivation och beteende är centrala begrepp för att utbilda patienter i diabeteshantering. Syfte Syftet med denna studie är att belysa omvårdnadsstrategier som visats sig lämpliga i vården av människor med diabetes typ 2. Metod: En litteraturöversikt med kvalitativ ansats gjordes på vetenskapliga artiklar där resultatens likheter och skillnader granskades och jämfördes. Resultat: Tre teman med omvårdnadsstrategier för typ 2 diabetiker identifierades; Motivation och beteendeförändringar, Utbildning och stöd samt Self-management. Diskussion: Diabeteshantering är en process där förändringar krävs. Processen börjar med identifiering av patientens utgångspunkter och följs av lämpliga omvårdnadsåtgärder. Vilken typ av omvårdnadsstrategi som är mest effektiv är svårt att avgöra, men patientens självbestämmande, i samråd med sjuksköterskan ger en indikation på hur diabetes-hanteringen bör fortlöpa. Konklusion: Omvårdnadsstrategier för typ 2 diabetiker följer en process som inleds då patienter blir diagnostiserade. Identifiering av patienters utgångspunkter bör följas upp med en identifiering av patientens omvårdnadsbehov. Baserat på behoven kan sjuk-sköterskor i samråd med patienten genomföra individualiserade åtgärder. / Background: Low awareness about symptoms and complications amongst patients with type 2 diabetes are identified as a big problem. Information, motivation and behavior are center concepts to educate patients in diabetes-management. Aim: To explore nursing strategies that proved to be advantageous in the care of people with diabetes type 2. Method: A literature review with qualitative approach was used. Scientific articles were examined where the results on the similarities and differences were examined and compared. Results: Three themes of nursing strategies for type 2 diabetics were identified; motivation and behavioral changes, education and support and self-management. Discussion: Diabetes management is a process where changes are required. The process begins with identification of the patient's situation to make use of nursing interventions. What type of nursing strategy that is most effective is difficult to determine, but the patient self-determination, in consultation with the nurse gives an indication of how the diabetes-management should proceed. Conclusion: Nursing Strategies for type 2 diabetics follow a process starting at the time patients are diagnosed. Identification of patients’ conditions should be followed up with an identification of patients' care needs. Based on the needs of care, nurse in consultation with patient can implement individualized actions.

Syfte: Syftet med litteraturstudien var att söka evidens för metoder som kan stödja patienter med typ-2 diabetes till livsstilsförändringar. Metod: En litteraturstudie, som innehåller 16 kvantitativa och kvalitativa vetenskapliga artiklar, som var publicerade mellan 2000-2010. Databasen som användes var Cinahl och sökmotorn Elin@Dalarna. Sökorden som använts var: diabetes type 2, type 2 diabetes, lifestyle changes, patient education, empowerment, health behaviour och self-management. Resultat: I resultaten kom uppsatsförfattarna fram till olika kategorier som visar olika åtgärder till livsstilsförändringar. Studierna baserades på olika åtgärder såsom; datorintervention, utbildningar, telefonsamtal, motiverande samtal, transteoretiska modellen och sjuksköterskespecialister. Empowerment var enligt uppsatsförfattarna det övergripande temat som de flesta studier baserade åtgärderna på.