This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective. The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate. The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings. Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake. In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload. This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.

In the absence of a cure and/or vaccine, the best approach to HIV is to focus on prevention. However, preventative measures that are presently available in Nigeria do not target persons with intellectual disability despite their vulnerability to HIV infection. This study sought to compare the HIV knowledge, attitudes, and sexual practices of mildly/moderately intellectually impaired learners (IIL) and mainstream learners (ML) in Nigeria; to explore the contextual factors informing these, as well as both groups‗ exposure to HIV education. It also tested the relevance of the I-Change Model in predicting sexual abstinence among learners with intellectual disability. Findings can assist in developing tailored HIV prevention education for Nigerian learners with intellectual impairment. This cross-sectional, comparative study utilised mixed methods to investigate HIV knowledge, attitudes, and sexual practices among mildly/moderately IIL and ML in Nigeria. Mildly/moderately IIL (300) and ML (300) within the age range of 12-19 years in special and regular schools completed a questionnaire based on the I-Change Model. Focus group discussions and in-depth interviews were used with learners to explore contextual factors informing their HIV knowledge, risk perception, sexual behaviours and access to HIV education and services. Key informant interviews were used as independent sources of the same information with their teachers. Learners with intellectual impairment were less aware of HIV/AIDS than their non-disabled peers (p < 0.001), had lower HIV knowledge scores (p < 0.001) and lower HIV risk perception scores (p < 0.001). Sexual experience was reported by 79 (26.3%) of the IIL sample compared to 48 (16.0%) of the ML sample (p = 0.002). Girls with intellectual disability were 3.71 times more likely to report a history of sexual abuse than non-disabled girls (p = 0.041). Inconsistent condom use with casual partners (p < 0.001) and non-use of condoms during the last sexual activity (p < 0.001) was higher in IIL. The I-Change Model was most effective in predicting sexual abstinence among IIL, particularly regarding factors related to motivation and intention. Intellectually impaired learners were more vulnerable to HIV infection due to neglect, poverty, sexual abuse/exploitation, stigmatisation, pressure from non-disabled peers, denial of HIV education, and inaccessible HIV-related services. Teachers only provided them with sexuality and HIV education when sexual activity was suspected and/or from age 18. The content of such education comprised mainly warnings, misinformation and corporal punishment to instil fear and desexualise them. Thus, this group of learners was limited in the way they experienced and expressed their sexuality. Unlike with their non-disabled peers, teachers attributed sexual activity among IIL solely to natural urges without emotional involvement. Contrary to teachers‘ opinions, some IIL were involved in symbiotic, loving relationships with their II peers. In addition, those that were not yet in such relationships expressed the desire to find non-discriminatory partners in the future. They explored their sexuality through intimate relationships, sexual intercourse, peeping at the opposite sex, pornography, and masturbation. Condoms were less available to IIL than ML, and they lacked the self-efficacy to use them. They were also less available to II girls than II boys. Female learners with intellectual impairment often had older sexual partners due to sexual abuse/exploitation, unlike their non-disabled peers, who embarked on such relationships for financial/material gains. The findings of this study indicated that IIL were sexual beings, just like their non-disabled peers, and at higher risk of HIV infection than the latter. Stigma and discrimination are the root causes of all the disadvantages/barriers that IIL experience in accessing HIV information, education and related services. Therefore, there is the need to put stigma reduction strategies in HIV response to safeguard the health of IIL. In addition, there is a need for the development of a gender-sensitive, tailored sexuality and HIV/AIDS educational format for learners with intellectual disability in Nigeria. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2011.

Bakgrund: Personer med Reumatoid Artrit (RA) lider av en kronisk inflammatorisk sjukdom och behöver vara fysiskt aktiva genom hela livet för att minimera symptomen. COVID-19 pandemin kan ha förändrat hur träningen planeras och genomförs, samt hur fysioterapeuter planerar träningen. Syfte: Syftet är att undersöka hur patienter med RA och fysioterapeuter vid reumatologisk klinik upplever att COVID-19 pandemin har påverkat patienters träning i rehabiliterande syfte. Metod: I en kvalitativ intervjustudie intervjuades två fysioterapeuter och fyra personer med RA vid en reumatologisk klinik. Intervjuerna genomfördes via telefon eller videolänk, utifrån en semistrukturerad intervjuguide. Analys av data genomfördes genom manifest kvalitativ innehållsanalys. Resultat: Sju kategorier framkom som beskriver faktorer som påverkar rehabiliterande träning för patienter med RA: betydelsen av träningsutrustning, följsamhet till träning, reaktioner på förändrade förutsättningar för träning, alternativa lösningar för att möjliggöra träning, träningslokalens tillgänglighet och betydelse, vädrets inverkan på upplevd möjlighet till träning och upplevda effekter av restriktioner för riskgrupper. Slutsats: Deltagarna var överlag positiva till träning under COVID-19 pandemin. Genomgående påtalades vikten av omgivningsfaktorer, som platsen där träning utförs och tillgänglig utrustning. Resultatet indikerar att oron för konsekvenserna av bristande träning var större än oron för att smittas av COVID-19 / Background: Individuals with rheumatoid arthritis suffers from a chronic inflammatory disease. It is important that they incorporate physical activity throughout their life to minimize symptoms. The COVID-19 pandemic may have changed how they maintain physical activity, as well as how physiotherapist plan exercise. Aim: The aim of the study was to investigate how individuals with RA and physiotherapists at a rheumatologic clinic experience that COVID-19 has impacted patients’ rehabilitation exercise. Method: In a qualitative interview study two physiotherapists and four individuals with RA at a rheumatologic clinic was interviewed. Interviews were carried out by phone or videolink using a semistructured interviewguide. Data analysis was a manifest qualitative analysis. Result: Seven categories describe factors that impacted individuals with RA’s rehabilitation exercise: the importance of training equipment, compliance with training, reaction to changing conditions for training, alternative solutions enabling training, the importance of locations for exercise and its availability, the impact of weather in relations to exercise, experiences of restrictions for individuals at risk. Conclusion: Participants were positively inclined towards exercise during the COVID-19 pandemic. The importance of environmental factors and the equipment availability was recurring. The results indicate that concern regarding the consequences of reduced exercise was greater than contracting COVID-19.