Electronic mail (e-mail) is an under-utilised resource of information and knowledge. It could be an important part of the larger so-called organisational memory (OM)—if it were not so disorganised and fragmented. The OM contains the knowledge of the organisation’s employees, written records, and data. This thesis is about organising and managing information in, and about, e-mail so as to make it retrievable and usable for task management purposes. The approach is user-centred and based on a conceptual model for task management. The model is designed to handle tasks that occur in the communications in an open distributed system, such as Internet e-mail. Both structured and unstructured tasks can be supported. Furthermore, the model includes management of desktop source information, which comprises the different electronically available sources in a user’s computer environment. The information from these is used in the model to sort information and thereby handle tasks and related information. Tasks are managed as conversations, that is, exchanges of messages. We present a language called Formal Language for Conversations (FLC), based on speech act theory, which is used to organise messages and relevant information for tasks. FLC provides the container for task-related information, as well as the context for managing tasks. The use of FLC is exemplified in two scenarios: scheduling a meeting and making conference arrangements. We describe a prototype based on the conceptual model. The prototype explicitly refines and supports the notion of threads, which are employed so as to give tasks a context. It integrates the use of FLC into the traditional threading mechanism of e-mail, in addition to matching on text in the body. An agent architecture is also described, which is used to harmonise the information in the heterogeneous desktop sources. Finally, human-readable filtering rules created by a machine learning algorithm are employed in the prototype. The prototype is evaluated with regard to its thread-matching capability, as well as the creation of usable and readable filtering rules. Both are deemed satisfactory.

The research reported in this thesis had two aims. To investigate how the variability and complexity of the mobile context of use should be addressed when capturing user needs for mobile products and to explore the role of indirect methods of data capture as tools for eliciting user needs in a form appropriate for informing the scenario based design of mobile products during the. earliest stages of product development. This research presents a novel scenario-based approach to eliciting and representing user needs in a form suitable for informing the earliest exploratory stages of mobile product design. Within this approach scenarios are used to provide snapshots of actual or envisaged product use that can be used to find a starting point for design when there is no clearly defined focus for innovation. Scenarios are organized into sets using scenario tables to structure consideration of key variables within the mobile context of use. These key variables are identified as: mobility, emotion, social relationship and communication purpose. Three user studies were conducted using UK undergraduate students as the study population. Study One explored use of schematic representations ('maps') of each participant's social communications and mobility as tools for eliciting user needs, both in relation to existing mobile product use and in relation to projected use of future mobile product concepts. Study Two used a diary study method to explore existing mobile communications use. Ways of structuring consideration of the mobile context of use were explored and the effectiveness of the diary as a tool for eliciting user needs and for scenario generation was assessed. Study Three extended the diary study approach to include consideration ofthe emotional context of product use and to include pictorial feedback of diary entries to study participants. These personal representations of product use were used to further explore user needs and to prompt participants to generate narratives describing motivations for product use suitable for presentation in scenario form.

Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings:  Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.

Asthma affects over 2.2 million people in Australia. Asthma morbidity is increasing while mortality is decreasing. People with asthma experience shortness of breath as their airways narrow and become inflamed. After an episode of acute asthma many patients experience a relapse requiring further emergency department care. Numerous studies have been undertaken to identify the determinants of asthma morbidity and these studies have primarily used asthma oriented and co-morbidity scales such as anxiety and depression indices. Other studies in this area have indicated psychosocial factors such as coping, asthma attitudes and beliefs that may be linked to people with asthma who are non-compliant or adherent to treatment. Currently, there is no research available that has examined the link between general health promoting behaviours, an individual’s risk behaviour assessment and a brief asthma education encounter that is patient-centred. This study provides a description of the health promoting and risk taking behaviours of people who attend the emergency department with acute asthma. Secondly, it examines the effectiveness of patient-centred education compared with standard education. One hundred and forty-six people with acute asthma who attended the emergency departments of the Princess Alexandra and Mater Adult Public Hospitals were enrolled in this study. Participants self-reported health promoting and risk taking behaviours by completing the questionnaire that contained the Health Promoting Lifestyle Profile (HPLPII) and the Health Risk Appraisal (HRA) instruments. The Hospital Anxiety and Depression Scale (HADS) was also incorporated into the questionnaire to ascertain levels of anxiety and depression in this acute asthma group of people. The asthma education curriculum had the same topics for both the standard education and the patient-centred groups. However, the patient-centred group were able to prioritise the order of the topics according to their identified need. Secondly, the patient-centred group were asked two questions to ascertain the most important issue and asthma issue for them at that point in time. Both groups of participants were educated using the Asthma Foundation Leaflet “Asthma - Basic Facts” during the individual education session. There were 56% females and 44% males with a mean age (+SD) of 34 (13.8) years with 70.3% reported year 12 or above education and 49% of participants earned less that $20,000. Nearly half of the participants were admitted to a hospital ward following emergency department assessment and care. A large proportion of the participants had either moderate or severe asthma. The health behaviour findings from this study suggest people with acute asthma follow preventive health recommendations and safety guidelines more so than the wider community. However, they did not self-initiate home based health actions such as breast self-examination. At the time of attendance to the emergency department with acute asthma there were no statistical difference between the patient-centred education and standard format education groups for age, gender, education, income, asthma control and previous emergency department attendances. The patient-centred education group had fewer re-attendances in the four months after the education intervention when compared with prior emergency department attendances than the control group (p=0.057; p=0.486). In conclusion, people with acute asthma report undertaking a number of preventive health behaviours and actions according to national guidelines and safety recommendations. They report a lack of self-initiated home based health behaviours. Further research is required to investigate the impact on the National Asthma Council’s recommendations of the importance of asthma action plans on people who follow preventive health guidelines and who lack self-initiative abilities. In terms of asthma education, patient-centred education when compared to standard format education may be useful in reducing further emergency department attendances for acute asthma. More research is required to identify other key education issues for people with acute asthma.

Ubiquitous computing aims to make human-computer interaction as naturalistic and functionally invisible as possible through embedding computing potential within a particular context to support human activity. However, much of ubiquitous computing research is focussed on technical innovation due to the challenges involved with deploying embedded computing, thereby reducing the commitment to the philosophical ideals of ubiquitous computing in research. This dissertation describes the investigation of a participatory approach to technically-complex research in order to understand how our view of the engineering and human challenges changes when the two are approached hand-in-hand. The domain chosen for this system was a dental surgery. Dentistry involves a complex workspace with computer interaction constrained by surgery hygiene. Ubiquitous computing offers a compelling interaction alternative to the keyboard and mouse paradigm in such an environment. A multi-method approach that employed ethnographic research and design prototyping was undertaken with dentists from several different private practices. A series of field studies used ethnographic methods such as observation and interview. Design events explored prototypes with activities such as design games, contextual interviews, role-playing and contextual prototyping. Activities were devised with the aim of providing a level playing field, whereby both designers and participants feel they can contribute equally, with their respective disciplinary knowledge. It was found that methods needed to be carefully chosen, devised and managed, in order to communicate complex concepts with participants and to constrain the design to technically feasible options. The thesis examines the design problem from the perspectives of a variety of different stakeholders within a participatory design framework, reflected upon by means of human-centred action research. Data was gathered through design speculations and observation, and explored using methods such as the Video Card Game and Video Interaction Analysis. Fieldwork was analysed using a multi-stage qualitative analysis process which informed further design collaboration with participants. The analysis of data gathered during design studies with dentists also contributed to the development of a prototype system to validate methodological contributions. The resulting prototype utilised off-the-shelf hardware and software which allowed for innovative customisation and development. In-situ prototyping (defined by the author as “participatory bootstrapping”) and a comprehensive knowledge of the domain afforded the creative application of technology. In addition to contributing to the prototype design, the interpretive understandings drawn from analysis identified how technical ideas were presented and utilised by participants of the studies, and how best to engage busy professionals. The final outcomes of the research were a multimodal ubiquitous computing system for interacting within a dental surgery; the development and implementation of a variety of methods aimed at communicating technical concepts and eliciting user motivations, practices and concerns; and a set of design principles for engineers engaging in design of systems for human use. The research presented within this thesis is primarily part of the field of human-computer interaction, but provides evidence of how engineering development can be influenced by a user-centred participatory approach. The benefits that derive from inclusive methods of design are demonstrated by the evaluation of a prototype that employed such methods. The contribution of this thesis is to demonstrate and delineate methods for developing ubiquitous computing technologies for the context of human use. This led to a set of design principles for the engineering of systems for human use: 1. Technology needs to be robust and simple to appropriate. This allows users to give insights on technology developments and also to allow users to discover for themselves how they would use the technology. 2. An evolving and carefully considered set of methods are needed to elicit communication between practitioners and across disciplines. The gaps in understandings and the different representations that arise across the disciplines provide essential clues to next steps in design. These gaps and differences form tensions that can be exploited productively. 3. Context is important for determining which design steps to take. Rather than abstracting a problem in order to solve it, as is usual in engineering design, the problem should remain grounded in the context of use. It reveals what the real problems are that need to be solved rather than the imagined ones. This requires an appreciation of the situated nature of action and of the variability of work. In turn it also requires an appreciation of what the human can and does do and what the machine should support. 4. Accountability in design is required. There is a fundamental tension between trying to make something work and seeing what really does work; specifically it is necessary to understand when automation is worth it in human machine systems. While engaged in the design process, engineers should ask how much technology should reconfigure human practices because of a useful outcome, rather than attempting to automate and converge devices for its own sake. A clear understanding of the constraints and workings of the work space needs to be balanced with the understandings of the limitations of the technology in order to design a system that improves work practice and empowers the practitioner.

Sufficient physical activity, a key prerequisite for health, is lacking in many teenagers. Limited knowledge, however, exists about who, when, why, and if New Zealand teenagers are getting their daily dose of health-related physical activity. At conception of this thesis, available information was predominantly survey-derived with no New Zealand data and few international studies that had assessed adolescent physical activity levels objectively. Data were collected from three projects. Convenience sampling was used across all projects to recruit students from low-decile high schools located in the Auckland region. For Project 1, 236 Year 9 to Year 13 students each wore a pedometer for five days (three weekdays and two weekend days) and reported their mode of transportation to and from school. To explore ethnic and sex-specific perceptions of physical activity among youth (i.e., barriers, benefits, potential physical activity enhancing strategies), Project 2 involved nine focus group discussions with 44 Year 9 and Year 10 students who identified as Māori or European. Project 3 was a large cross-sectional study of 3,451 high school students (Years 9 - 13) from seven low-decile schools. Through this project the following self-reported data were collected: demographics, physical activity levels during four school-day physical activity opportunities (i.e., active travel, lunchtime physical activity, recess physical activity, after-school physical activity), sedentary behaviour (i.e., school-day television (TV) watching), level of perceived encouragement to be active, and the presence of home policies regarding TV use. Analyses revealed low physical activity participation and high TV use behaviours. Pedometer data showed that only 14.5% of participants achieved a conservative criterion of 10,000 steps daily. Also, daily steps varied by age group (junior students: 11,079 ± 330; senior students: 9,422 ± 334), sex (males: 10,849 ± 381; females: 9,652 ± 289), time of week (weekday: 12,259 ± 287; weekend day: 8,241 ± 329), and transportation mode to/from school (walkers: 13,308 ± 483; car transit users: 10,986 ± 435). Low school-day physical activity levels emerged, especially during school hours (i.e., during recess and lunchtime). Based on dichotomised grouping (less active versus more active), the proportion of students in the ‘more active’ group during morning recess and lunchtime, after school, and as part of active travel to/from school were 26%, 32.4%, 56.3%, 58.1% respectively. Only 11.1% of participants were in the ‘more active’ group across all four physical activity opportunities. The focus group data revealed primarily social benefits of physical activity (e.g., meeting new people, fun). Barriers were mainly environment-related and included lack of peer support, low accessibility to and availability of physical activity opportunities, alternative sedentary activities, structure of physical education classes (females only), and distance between home and school (in terms of active transportation). Potential strategies to increase physical activity reflected the articulated barriers and benefits (e.g., increase peer support, parents to turn off the TV, organised activities at school, restructure physical education classes to allow student involvement in the decision-making process of class content). No ethnic and few sex differences in perceptions were found. Focusing on the verbalised importance of social support from the focus groups, Project 3 data showed that the strength of association between perceived encouragement from different support sources (i.e., parents, older siblings/cousins, peers, school) and physical activity participation varied by the physical activity opportunity examined. In particular, multivariate logistical regression showed reduced odds of being in the ‘more active’ group was associated with low parental encouragement (Juniors, OR: 0.47, 95% CI: 0.38-0.58; Seniors, OR: 0.41, 95% CI: 0.29-0.60) and low peer encouragement (Juniors, OR: 0.61, 95% CI: 0.51-0.74; Seniors, OR: 0.49, 95% CI: 0.35-0.69) for after-school physical activity, low peer encouragement (Juniors, OR: 0.39, 95% CI: 0.32-0.48; Seniors, OR: 0.41, 95% CI: 0.29-0.57) for lunchtime activity, and low peer encouragement (Juniors, OR: 0.78, 95% CI: 0.66-0.92) for active transportation (junior students only). No significant difference in physical activity was found between students who received high encouragement from two parents than students who reported high encouragement from their sole parent in a single parent family. Concentrating on the after-school period, Project 3 data were analysed to examined the relevance of the displacement hypothesis during this school-day period. The association between parental strategies (i.e., encouragement to be active and having TV limits) and youth after-school activity behaviours (i.e., hours spent viewing TV, physical activity participation) was also examined. Support for the displacement hypothesis emerged. In particular, compared to students who watched less than one hour of TV, those who watched greater than four hours of TV were half as likely to be in the more active group for after-school physical activity participation (adjusted OR: 0.51; 95% CI: 0.40-0.65). Comparing activity profile groups (i.e., based on combined TV use and after-school activity levels), compared to the participants in the ‘low TV/active’ group, participants in the other three activity groups (e.g., ‘high TV/low active’) were at least 1.28 times more likely to have parents that executed only one parental strategy and up to 4.77 times more likely to have parents that did not carry out either strategy. Substantive opportunities exist for youth to be active every day, and in different contexts and environments, yet a large proportion of young people are not maximising these opportunities to be active. If the health issue of inactivity is to be tackled in a comprehensive and efficient manner, a multi-strategy, multi-environment, coordinated approach among local authorities, government agencies, schools, families, and neighbourhoods is required to address the noted policy, physical, and social-related associates of an active lifestyle for youth. Future effort, whether in the form of strategy development, intervention work, or research, needs to be founded upon ecological theory, where both individual and a range of familial, social, and physical environmental factors (and there potential interactions) are considered. Lastly, equal research attention should be directed at improved physical activity levels, and just as importantly, reducing time youth spend in a sedentary state.

Coeliac disease is an intestinal disorder, requiring patients to maintain a life-long gluten-free diet to ensure better health and reduce the risks of osteoporosis, intestinal lymphoma and other associated diseases. Patients must have access to clear information about the disease and about what foods are safe to eat, detect foods that contain gluten and make adjustments that need to be made to their diet. There is very little well designed information currently available for Coeliac patients. Eating out and shopping in supermarkets can become a nightmare. A User-centred design approach was used to generate information and insights on the Coeliac disease and patients' needs to conceptualise, design and evaluate an information handbook that is both functional and pleasurable to use. Questionnaires, interviews and focus groups were used to generate empirical data that guided a participative design process before the evaluation of the handbook. This project consists of a handbook as practical work that represents the main body of applied research. The practical work and the exegesis constitute 50% each of the thesis value.

Increasing numbers of older patients with cognitive impairment and disturbed behaviour are likely to present to acute care hospitals in the future. Nurses are not well disposed towards care due to safety and morale issues caused by knowledge deficits, job stress, oppressed group behaviours and ageist attitudes. Patient outcomes are often poor with multiple adverse events, long lengths of stay and levels of mortality. Disturbed behaviour may be caused by delirium, depression or other mental disorders and dementia or all. The research question addressed was “Can the instigation of a person-centred approach to care of patients with cognitive impairment and disturbed behaviour result in decreased nursing stress, improved patient care practices, outcomes and relatives’ satisfaction?” A conceptual framework incorporating the constructs of Person-Centred Care, the Integrated Structural Model of Human Behaviour and Practice Development informed the action research methods utilised. The processes of facilitation were used to undertake four action research cycles incorporating plans, actions, observations and reflections in one 25-bed acute aged care ward in a large tertiary referral hospital The first cycle involved setting up the study, recruitment of nurses and patients, gathering of baseline data and application of nonparticipant observational studies of the quality of nurse-patient interactions which served to inform the plan for interventions. The following three cycles demonstrated efforts to undertake those interventions through strategies to increase nursing empowerment and knowledge in the context of constant staff turnover and diversions that compromised support and participation. During the study there were few apparent adverse patient outcomes with significant improvements in patient analgesic administration, relatives’ satisfaction with care, nursing care practices involving the completion of a Communication and Care Cues form and nurses’ interactions with the patients. New care planning tools were developed that will enable ongoing activities for practice improvement. Conversely, there was a significant increase in the nurses’ stress levels when caring for hypoactive delirious patients, a trend towards more emotional exhaustion, high nursing turnover and increased sick leave rates. Nursing care practices were unchanged and the new care planning tools were not well utilised. Reflection on the implications and limitations of action research methods supported by practice development strategies in the dynamic, often chaotic environment experienced during the study, suggested that if there is an absence of hierarchical managerial sponsorship for such activities, then sustainable change is difficult. Therefore, it was shown that a person-centred approach to care of patients with cognitive impairment and disturbed behaviour using action research methods in this environment, can result in some enhanced nurse-patient interactions, patient care practices, outcomes and relatives’ satisfaction. However, progress is likely to be slow and time consuming. Further improvements require attention to the well-being status of the nurses through actions that generate feelings of empowerment through individual recognition, knowledge enhancement, adequate access to patient information and sufficient time to undertake their duties as equal members of the multidisciplinary team.

Bakgrund: Närstående till en person som vårdas på en intensivvårdsavdelning fyller en viktig funktion för dennas sjukdomsförlopp, utfall och rehabilitering. Närstående har själva behov under denna tid och det är viktigt att även dessa tillgodoses av sjuksköterskor. Behovet av information har i många studier påvisats vara det mest betydelsefulla för närstående.   Syfte: Syftet med studien var att undersöka sambandet mellan närståendes uppfattning om information korrelerat till deras uppfattning om bemötande, förtroende, stöd och delaktighet. Vidare var syftet att belysa närståendes upplevelser av omhändertagandet på en intensivvårdsavdelning. Metod: Studien var en enkätundersökning med mixad metod. Resultat: 206 enkäter skickades ut och 47 % (n=97) av respondenterna valde att delta. Resultatet visade att det fanns svaga till starka samband mellan information och bemötande/förtroende/stöd/delaktighet. Starkast samband sågs mellan variablerna information och förtroende samt mellan information och delaktighet. Respondenternas upplevelser resulterade i två teman; information och bemötande. Närstående upplevde att information var fundamentalt inom intensivvården och den önskades vara ärlig, tydlig och ges kontinuerligt. Respondenterna upplevde att bemötandet de fått under intensivvårdtiden både varit positivt och negativt. Slutsats: Positiva korrelationer har påvisats mellan information och bemötande, förtroende, stöd och delaktighet. Studien belyser även att närståendes upplevelse av omhändertagandet kan påverkas både positivt och negativt av information och bemötande. Kännedom om detta samt med hjälp av en familjefokuserad omvårdnad kan möjliggöra för intensivvårdssjuksköterskan att främja närståendes upplevelse och uppfattning under vårdtiden. / Background: Relatives to a person who is cared for in a critical care unit fill an important function for the patient’s disease progression, outcome and rehabilitation. Relatives themselves have needs during this period and it is important that also their needs are met by nurses. The need to receive information has been shown to be the most meaningful to relatives. Aim: The aim of the study was to examine whether relatives’ perception of information correlated with their perception of treatment, trust, support and participation. Furthermore, the aim was to highlight the way in which relative’s experience care at a critical care unit. Method: The study was conducted as a mixed method survey. Results: 206 surveys were sent out and 47% (n=97) of the respondents chose to participate. The result indicated that there are weak to strong correlation between information and treatment/trust/support/participation. The strongest correlation was observed between the variables information and trust, as well as information and participation. The respondents’ experiences resulted in two themes; information and treatment. Relatives perceived information as fundamental within critical care and preferred it to be honest, clear and continuous. The respondents had experienced the treatment they received during the critical care period as both positive and negative. Conclusion: Positive correlations has been found between information and treatment, trust, support and participation. The study also highlight that a relative’s experience of the care is impacted both positively and negatively by information and treatment. Knowledge about this and with help from a family focused care can make it possible for critical care nurses to encourage relative’s experience and perception about the time of care.

Bakgrund: Demenssjukdomar är vanligt förekommande i Sverige och prevalensen beräknas öka. Många personer med demenssjukdom bor kvar i hemmet och anhöriga tar ett stort ansvar för vården av dessa personer. Att vara anhörigvårdare till en person med demenssjukdom innebär påfrestningar både fysiskt, psykiskt och socialt.Syfte: Att beskriva anhörigas upplevelser av att vårda en person med demenssjukdom. Metod: Litteraturöversikt med induktiv ansats baserad på 15 vetenskapliga artiklar med kvalitativ design, som har analyserats med Fribergs femstegsmodell. Resultat: I resultatet framkom huvudkategorierna: En förändrad livssituation, Att acceptera förändringen samt Anhörigas behov. Det framkom även åtta subkategorier: Förändrade roller i relationen, Förändrat socialt liv, En förändrad framtid, Förändrade känslor, Att acceptera rollen, Att känna meningsfullhet, Behov av egentid samt Behov av stöd.Slutsats: Anhöriga är i behov av stöd från hälso-sjukvården. Sjuksköterskan har en nyckelroll i att stödja anhöriga vilket kräver goda kunskaper om demenssjukdomar och om anhörigas upplevelser av att vårda en person med demenssjukdom. / Background: Dementia are common in Sweden and the prevalence is expected to increase. Many people with dementia live in their homes and relatives are responsible for the care of these people. Being a caregiver for a person with dementia causes great pressures both physically, psychologically and socially. Aim: To describe relatives experiences of caring for a person with dementia. Method: Literature review with inductive approach based on 15 scientific articles with qualitative design, which has been analysed with Friberg's five-step model. Findings: In the results, the main categories were: A changed life situation, To accept the change and Relatives needs. There were eight subcategories: Changed Role in Relationship, A changed social life, A changed future, Emotional attendance, Accepting the role, Feeling meaningful, Need to be for themselves, and Need for support. Conclusion: Relatives are in need of support from the health care. The nurse has a key role in supporting the relatives, which requires good knowledge of dementia and relatives' experiences of caring for a person with dementia.