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.

Intervening early in the course of psychotic illness (e.g. schizophrenia) may significantly improve prospects for the recovery, both in medical and psychosocial terms, of the individuals who experience these conditions. Engaging such individuals in care, however, remains a challenge. One barrier to engagement is lack of insight, or the low illness awareness that is considered to be a typical characteristic of people who experience psychotic illnesses, particularly in their early phases. The dominant view of this phenomenon is that it is primarily related to the illness itself and thus is biologically based. There is reason to believe, however, that understanding the psychosis experience is also an interpretive process, and that the meaning of this experience for the individual arises out of dialogue between the person, mental health professionals and significant others. There is also reason to believe that the relationship between insight and recovery may not be as straightforward as presumed. While the dominant view sees insight as a crucial condition for recovery, emerging evidence suggests that insight once gained may lead to depression and demoralization. Insight thus may be understood as an interpretive, dialogical process that is fundamentally narrative in nature, the consequences of which may be divergent. Using qualitative methods (constructivist grounded theory complemented by narrative analysis), the present study sought to understand the process by which insight developed in early psychosis, and sought to explore the relationship between insight and the early stages of illness management and recovery, as reflected by the written and oral accounts of twelve individuals who were within the first three years of illness. Overall, the results suggest that insight development in early psychosis can be conceptualized as the process of coming to an acceptable, adaptive explanation. More specifically, the results first of all suggest that insight development involves finding or negotiating an account of illness that fits or can be accommodated with the individual’s own story of the psychosis experience. The process also involves finding an account of illness and its treatment that can be envisioned as a helpful rather than disruptive aspect of the individual’s future biography.

Context Current care guidelines recommend that pregnant women receive advice about the important health behaviours which may influence pregnancy outcomes. These behaviours are associated with pregnancy-related and long-term health outcomes for both the mother and infant. Poor pregnancy outcomes can result in increased costs of health care delivery through longer hospital admissions and intensive care admissions. Although provision of behavioural advice to pregnant women is recommended, most educational materials provide limited and inconsistent information. There is a clear need for widespread delivery of evidence-based information and skill-development strategies to influence pregnancy health behaviours. One avenue of information is via the pregnancy health records (PHRs) provided by maternity health services that women carry for the duration of their pregnancy. Objective My research sought to develop, implement, and evaluate a handheld health record for use in pregnancy (the “Pregnancy Pocketbook”) in an urban population of women with a high proportion of disadvantaged women. Study Overview My research comprised two phases, a development phase, and an implementation and evaluation phase. I identified specific behaviours (cigarette smoking, fruit and vegetable intake, and physical activity) requiring intervention and reviewed evidence-based frameworks, behaviour change theories, and guidelines for the presentation of written information to support behaviour change. I developed and refined the Pregnancy Pocketbook through a number of studies. Studies 1, 2, and 3 The Pregnancy Pocketbook was refined through a qualitative evaluation of a PHR enhanced with behaviour change tools (Study 1), focus groups held with women from the target group to investigate PHR preferences (Study 2), and strategy testing of the Pregnancy Pocketbook activities with women from the target group (Study 3). The focus group results combined with those from the qualitative evaluation suggested the Pregnancy Pocketbook should be a women-held, woman-focussed resource providing essential and comprehensive information on recommended pregnancy health behaviours. It should include tools to facilitate appropriate behaviour changes and tools for women to monitor pregnancy progress and record questions and notes to facilitate communication with their health carers. Strategy testing demonstrated that the Pregnancy Pocketbook content, screening questions and activities were well received by a small sample of women, with minor changes made following testing to improve the understanding and usability of the various sections of the Pregnancy Pocketbook. The final intervention (Study 4) The final version of the Pregnancy Pocketbook was a 73-page interactive resource, designed to be used according to the 5As self-management framework (Assess, Advise, Agree, Assist, Arrange), with screening tools, information, goal setting and self-monitoring activities with information for further referral for greater support when required. It was presented in an A5 plastic ring-bound folder, with dividers, labelled ‘Your health goals’, ‘Tracking your health goals’, ‘Your first antenatal visit’, ‘Pregnancy progress’, ‘Birth summary’, ‘Glossary’, and ‘Emergency contacts and general numbers’. The Pocketbook was evaluated using a quasi-experimental two-group design. Women were recruited from two antenatal clinics within the same health service district. Women received the PP during their first antenatal clinic appointment in one clinic (PP:n = 163) and women in the other clinic received usual care (UC: n = 141). Smoking, fruit and vegetable intake, and physical activity were assessed at baseline (service entry), 12-weeks post-service-entry and 24 weeks post-service-entry. Behaviour-specific self-efficacy was also measured during pregnancy. I also assessed the PP implementation process through adherence of the staff and organisation to planned implementation processes. Results At 12-weeks post-service-entry, a significantly greater proportion of women in the Pregnancy Pocketbook (PP) group had stopped smoking (7.6% vs 2.1%), compared with the Usual Care (UC) group, p <0.05. There was a net (non-significant) increase of 5% more women meeting physical activity guidelines (PP: 1.2% increase vs. UC: 3.5% decrease) and a net 20 minute difference in median minutes of physical activity (PP: 10 minute increase vs. UC: 10 minute decrease). Both groups increased their fruit and vegetable intake. Approximately two-thirds of women reported receiving the Pregnancy Pocketbook, many without introduction or explanation. Few women completed sections of the Pregnancy Pocketbook that required health professional assistance, suggesting minimal interaction about the resource between health staff and the women in their care. Conclusion and future recommendations There were low levels of adherence to health behaviour recommendations for pregnancy in this sample. The Pregnancy Pocketbook produced significant effects on smoking cessation, even under limited delivery conditions. A refocus of antenatal care towards primary prevention is required to more consistently provide essential health information and behaviour change tools for improved maternal and infant pregnancy health outcomes. Future studies must include process evaluations and apply the theory of dissemination to enhance uptake of the interventions.

New Zealand is currently in the midst of a diabetes epidemic and it has become clear that the increasing prevalence of obesity and a sedentary lifestyle are inextricably linked to this escalating health crisis. Extensive research has long made clear that people of all ages can enhance their health by incorporating moderate levels of physical activity as part of their normal daily routine and physical activity is now recognised as a major therapeutic modality for type 2 diabetes. Despite such evidence, most people in the western world do not engage in sufficient regular physical activity and there remains a paucity of evidence that elucidates effective methods of achieving the required behaviour change over time. This study set out to demonstrate meaningful correlations between the psychosocial constructs optimism, exercise self-efficacy, goal-directness, stage of change, anxiety and depression, the biochemical measures HbA1c and BMI and also the behavioural outcomes of general physical activity and physical exercise participation, all within a newly diagnosed type 2 diabetic population. Participants (n=30, newly diagnosed adults with type 2 diabetes; mean age 61.46 years; BMI 31.43 Kg/m²[range 18.8-50.95 Kg/m²]) were recruited from attendees of the Christchurch Diabetes Centre's education seminars. The recruitment strategy was designed to search out diabetic patients as near as practicable to the point in time when they first became cognisant of their disease state. A battery of instruments was assembled into a researcher-administered retrospective questionnaire and this was completed with all subjects at baseline and again at six month follow-up. Additional data comprised subject's demographics and selected bio-chemical measures (subject height, weight, and blood Haemoglobin A1c). Descriptive, correlational and qualitative statistics were evaluated. The level of physical activity reported was significantly less than is required to facilitate the biochemical and psychological changes that are generally considered necessary to support optimal health. On average, study participants did not perform their planned physical activity tasks as well as they might have, despite being relatively optimistic and goal-directed at baseline. Many participants clearly indicated an inadequate understanding of exercise modalities and the intensity, duration and frequency of physical activity required to support optimal health. Generally, participants tended to overestimate their physical activity levels. Exercise self-efficacy emerged as an especially important psychological construct, and one that appeared to be among those central to the participants' relationships with physical activity and exercise. The study group demonstrated a relatively high prevalence of low level anxiety and depression, and even at these sub-clinical levels, anxiety and depression were significantly inversely related to optimism, goal-directness, goal-attainment, exercise self-efficacy and stage of change. The study findings illuminate the wide contextual variability among patients who are suffering from the same chronic condition. Further, the implications of conducting detailed pre-assessments of patients' personal characteristics and their psychological profiles, in order to guide intervention tailoring, are also outlined and discussed. Areas for future research are highlighted. In conclusion, meso and macro-level policy implications are discussed, with reference to an array of the broader determinants of health.

Thesis (M. Ed.)--University of Tasmania, 1996. / Library has additional copy on CD-ROM. Includes bibliographical references (leaves 89-108).

Thesis (PhD)--Macquarie University (Macquarie Graduate School of Management), 2006. / Bibliography: leaves 243-283.

Thesis (Ph. D.)--Oregon State University, 2009. / Printout. Includes bibliographical references. Also available on the World Wide Web.

Thesis (Ph.D.) -- University of Rhode Island, 2007 / Typescript. Includes bibliographical references (leaves 250-294).

Thesis (Ph. D.)--University of Missouri-Columbia, 2004. / Typescript. Vita. Includes bibliographical references (leaves 119-129). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2004. / Typescript. Vita. Includes bibliographical references (leaves 119-129). Also available on the Internet.