Background: Type 2 diabetes is a serious disease that is increasing globally. The focus of diabetes care has been to prevent diabetes related complications and thereby reduce mortality. An older population, the disease progression and decreased ability to perform self-management activities increases the risk for complications. Group education and patient-centred care are recommended to improve self-management through increased patient empowerment. Despite these recommendations, professionals have been reluctant to adopt these methods referring to lack of knowledge, time and tools to deliver patient-centred care in diabetes. Focusing on the patient’s illness integration process has in the literature been suggested to improve self-management and metabolic balance. Aim: The overall aim of the thesis was to describe the experiences of illness integration, self-management and support in type 2 diabetes and to evaluate the metabolic effects of a nurse-led patient-centred model for self-management support. Methods: The study setting was primary health care in Västerbotten County, Sweden. In total, 21 diabetes nurses (Study I) and 257 patients (Studies II-IV) participated in the four studies (Study II, n=44; Study III, n= 18; Study IV, n= 195). Data consisted of focus group interviews (Study I), individual semi-structured interviews (Studies II-III) and laboratory measurements (Study IV). Methods for analyses were qualitative content analysis (Studies I-III) and statistics (Study IV). Results: Study I revealed that diabetes nurses found the ideal diabetes care complex to achieve. Conflicting paradigms, power relations and departmentalisation of work were described. Study II describes a process whereby illness integration and self-management in type 2 diabetes develop simultaneously. When a turning-point occurs, people view self-management as both necessary and feasible. In study III, turning points in self-management are illuminated. Turning-point transitions include existential and emotional aspects that increase inner motivation and power for lifestyle change. Study IV evaluates the effects of a nurse-led intervention in which haemoglobin A1c (HbA1c) was significantly decreased at 12 months’ follow-up. Group intervention and individual intervention were both effective compared to traditional diabetes care. Conclusions: There is a potential for improvement of type 2 diabetes care. Increased patient-centredness is important to support patients towards illness integration and self-management. Focusing on the patients’ illness experiences, including the existential and emotional aspects of having and managing type 2 diabetes, in counselling can lead to improved self-management and glycaemic control. Patients’ experiences of illness are central to their inner motives for change, and patient-centred self-management support and patient education preferably emanate from this perspective. / Bakgrund: Typ 2 diabetes är en allvarlig sjukdom som ökar globalt. Fokus i diabetesvården har varit att förebygga diabetesrelaterade komplikationer och därmed minska dödligheten. En åldrande befolkning, progression av sjukdomen samt en begränsad förmåga att utföra egenvårdsaktiviteter ökar risken för komplikationer. Grupputbildning och patientcentrerad vård rekommenderas för att förbättra egenvården genom ökad empowerment. Trots dessa rekommendationer har läkare och sjuksköterskor rapporterats vara tveksamma till dessa metoder och hänvisat till bristande kunskap, tidsbrist och avsaknad av verktyg. Att fokusera på patienters sjukdomsintegrationsprocess har i litteraturen föreslagits förbättra såväl egenvård som metabol balans. Syfte: Avhandlingens övergripande syfte var att beskriva erfarenheter av sjukdomsintegration, sjukdomshantering och support vid typ 2 diabetes samt att utvärdera effekter av en sjuksköterskeledd patientcentrerad modell för egenvårdssupport. Metod: Studierna genomfördes inom primärvården i Västerbottens läns landsting. Totalt deltog 21 diabetessjuksköterskor (Studie I) och 257 patienter (Studie II-IV), i de fyra studierna (Studie II, n=44; Studie III, n= 18; Studie IV, n= 195). Data bestod av fokusgruppsintervjuer (Studie I), individuella halvstrukturerade intervjuer (Studie II-III) och laboratoriemätningar (Studie IV). Analysmetoderna var kvalitativ innehållsanalys (Studie I-III) och statistik (Studie IV). Resultat: Studie I visade att en ideal diabetesvård är svår att uppnå enligt diabetessjuksköterskorna. Paradigmkrockar, maktrelationer och splittrade arbetsuppgifter beskrevs. Studie II beskriver en modell där sjukdomsintegration och sjukdomshantering utvecklas samtidigt. När en ”turning point” nåddes såg patienterna sjukdomshanteringen som både nödvändig och möjlig att genomföra. I studie III belystes ”turning points” och som omfattar både existentiella och emotionella aspekter som kan öka inre motivation och egenkraft att utföra livsstilsförändringar. Studie IV utvärderade 12-månaderseffekterna av en sjuksköterskeledd intervention och HbA1c sänktes signifikant. Gruppintervention och individuell intervention visades vara effektiva metoder i jämförelse med traditionell diabetesvård. Slutsatser: Det finns en förbättringspotential inom diabetesvården och ökad patientcentrering är viktig för att stödja patienter att integrera sjukdom och egenvård i livet. Att i diabetesvården fokusera på patienters sjukdomsupplevelser inklusive de existentiella och emotionella aspekterna av att leva med och hantera en sjukdom kan innebära förbättrad sjukdomshantering och metabol balans. Patienters sjukdomsupplevelser är centrala för deras inre motiv till förändring och patientcentrerad egenvårdssupport och patientutbildning bör utgå från detta perspektiv.

This thesis investigates where the Years 4-10 Queensland French Syllabus is receiving support, by investigating groups of teachers with shared characteristics. In doing so, it aims to shed some light on why teachers have not embraced this new syllabus. Specific issues pertaining to the syllabus are investigated, such as the use of task-based instruction as the chosen methodology and of embedded content, as well as contextual issues, such as employment sector and levels taught. Teachers' reactions to change have also been investigated in relation to the introduction of this syllabus. In addition to this, the process involved in acceptance of an innovation has been explored which led to an examination of teacher understanding of the current syllabus. This study is divided into five chapters. Chapter one outlines the syllabus and context, as well as hypotheses for this study and rationale. Chapter two is a literature review which brings together previous research and links it to the current study. The chosen methodology is covered by chapter three, with chapter four being a detailed explanation of results received from the data collection. The final chapter, chapter five, discusses these results and the implications of these findings.

Nutzerzentrierung in der Produktentwicklung ist ein seit Jahrzehnten intensiv beforschtes Feld mit dem wesentlichen Ziel, Nutzeranforderungen möglichst ganzheitlich zu ermitteln und beschreiben. Damit soll den potentiellen Anwendern ein Produkt geliefert werden können, das einen tatsächlichen Bedarf bestmöglich adressiert oder entsprechende Begehrlichkeiten weckt und somit einen hohen Markterfolg verspricht. In der Praxis lässt sich dennoch beobachten, dass oftmals eine eher technische Perspektive, in welcher der Mensch irgendwie enthalten ist, den Entwicklungsprozess dominiert. Der Beitrag dient als Ergebnisbericht einer praxisbezogenen, interdisziplinären Lehrveranstaltung mit dem Ziel, bereits in der akademischen Ausbildung stärker für die Anwenderperspektive zu sensibilisieren. Die im Pilotkurs partizipativ gestaltete Lehrveranstaltung zu nutzerzentrierter Anforderungserhebung wurde im zweiten Durchlauf pandemiebedingt auf Remotelehre und virtuelle Kollaboration umgestellt. Die Effekte beider Formate werden im Beitrag unter verschiedenen Aspekten bilanziert und die Ergebnisbewertung erfolgt als Reflektion des Standardcurriculums.

Background - Patients as active partners in their personal healthcare are key drivers to reducing costs, securing an effective usage of resources, and ensuring patient-provider satisfaction. Even though these benefits are acknowledged, a theoretical framework for the plethora of concepts used in this context, such as patient engagement, patient empowerment, or patient involvement is missing. Furthermore, the heterogeneous or synonymous usage of these terms leads to miscommunication, missing standard conceptual measures, and a deficiency in theory building and testing. Our objective is to show what the relationships and distinctions between concepts focussing on patients as active partners in their personal healthcare are. - Methods - systematic literature review was conducted to consolidate terms related to patients’ having an active role in their healthcare. From 442 articles screened in PubMed, a final set of 17 papers was included. Any articles conceptualising or presenting relationships between the concepts were included. Information was synthesised, and contradictions were unravelled systematically. The concepts and their relationships are structured and represented by employing a concept map. - Results - Patient-centredness is a concept dominantly influenced by health care providers and can enhance patients’ competencies, attitudes, and behaviours towards their personal healthcare. Enabling patients to become more empowered can ultimately lead to their greater involvement and engagement. Fostering an active role of patients can also increase their adherence to the care pathway. In general, patient engagement seems to be the most conclusive and furthest developed concept in terms of turning patients into active partners in their personal healthcare. - Conclusions We plead for a stricter demarcation and therefore a terminological standardisation of the terms in the future to avoid further ambiguity and miscommunication. The concept map presents a basis for a uniform understanding and application of the concepts. Through a comprehensive understanding of the terms and their dimensions, relationships between the concepts can be utilised, measures can be derived, and theory building and testing can be enhanced, leading to better acceptance and utilisation of concepts in healthcare services. Furthermore, patient engagement is presented to be the most conclusive and furthest developed concept in the subject area.

The paradigm shift in teaching from the teacher-centred approach to the learner-centred approach in recent years has impacted on the way teachers go about their duties in the classroom. This paradigm shift necessitated this research with the aim of investigating how the Student Teams Achievement Division (STAD) technique can be used as a cooperative learning technique to teach EFAL in Kwazulu-Natal. The purpose of this study was to design a framework for the implementation of STAD as a cooperative teaching strategy for EFAL teachers by gleaning literature on teaching and learning, cooperative learning and STAD in chapters two to four of this study. Empirical research, by way of a survey and focus group discussions were also conducted in four out of the twelve districts in the Kwazulu-Natal Province to help solidify the framework designed in this study. In striving to get in-depth insight into this study, the post-positivist-constructivist paradigm, which calls for the mixed methods research design was employed for the collection and analysis of data. Specifically, the Likert scale survey questionnaire and focus group discussions were used to collect data, through the sequential mixed methods design for the quantitative and qualitative phases of this study respectively, from a sample of 220 respondents and twelve participants. The findings of this research indicated that the time spent in training teachers towards the implementation of the STAD technique was not adequate. That notwithstanding, it was indicative that teachers make efforts to implement the strategy in their teaching and the results proved to be very positive as the technique continues to help improve upon learners’ performances and builds in them qualities such as critical thinking skills, good discussion skills and positive collaborative learning. In the nutshell, the literature study, the findings of the empirical research and the recommendation of this study forms the basis for designing the framework for the implementation of STAD as a teaching strategy for EFAL teachers. / Curriculum and Instructional Studies / D. Ed. (Curriculum Studies)

The paradigm shift in teaching from the teacher-centred approach to the learner-centred approach in recent years has impacted on the way teachers go about their duties in the classroom. This paradigm shift necessitated this research with the aim of investigating how the Student Teams Achievement Division (STAD) technique can be used as a cooperative learning technique to teach EFAL in Kwazulu-Natal. The purpose of this study was to design a framework for the implementation of STAD as a cooperative teaching strategy for EFAL teachers by gleaning literature on teaching and learning, cooperative learning and STAD in chapters two to four of this study. Empirical research, by way of a survey and focus group discussions were also conducted in four out of the twelve districts in the Kwazulu-Natal Province to help solidify the framework designed in this study. In striving to get in-depth insight into this study, the post-positivist-constructivist paradigm, which calls for the mixed methods research design was employed for the collection and analysis of data. Specifically, the Likert scale survey questionnaire and focus group discussions were used to collect data, through the sequential mixed methods design for the quantitative and qualitative phases of this study respectively, from a sample of 220 respondents and twelve participants. The findings of this research indicated that the time spent in training teachers towards the implementation of the STAD technique was not adequate. That notwithstanding, it was indicative that teachers make efforts to implement the strategy in their teaching and the results proved to be very positive as the technique continues to help improve upon learners’ performances and builds in them qualities such as critical thinking skills, good discussion skills and positive collaborative learning. In the nutshell, the literature study, the findings of the empirical research and the recommendation of this study forms the basis for designing the framework for the implementation of STAD as a teaching strategy for EFAL teachers. / Curriculum and Instructional Studies / D. Ed. (Curriculum Studies)

Background: Antenatal Psychosocial Assessment (APA) has recently been introduced into routine antenatal care, but the ways in which maternity service providers assess and respond to maternal stress are subject of debate. There is a lack of consensus on the instrument(s) of choice and lack of evidence regarding appropriate interventions. Further, national guidelines have not kept apace with the conceptual shift from ‘postnatal depression’ to ‘perinatal anxiety and depression’. Adopting the Medical Research Council Complex Interventions Framework, the ARMS research aimed to inform the development of interventions that support women who are experiencing, or at risk of, mild-moderate mental health disorder in pregnancy. Methods: A mixed methods approach was adopted. In the quantitative element (Study Part 1) participants (n=191) completed a questionnaire when attending for their first formal antenatal appointment, using a procedure and materials that had been previously tested in a pilot study. Details including mental health assessment and referrals were obtained from their health records, following delivery. In the qualitative element (Study Part 2) a sub-sample of women (n=22) experiencing high levels of maternal stress took part in up to three serial in-depth interviews during pregnancy and the early postnatal period.Findings: Maternal stress was found to be common. Using the Edinburgh Postnatal Depression Scale (EPDS) threshold of ≥10, approximately 1 in 4 women were classed as high depression (halving to 1 in 8 at the more conservative threshold of ≥13). Almost 1 in 3 women were classed as high anxiety, using the state scale of the State-Trait Anxiety Inventory (STAI-S, threshold ≥41), compared with 1 in 5 using the two-item GAD (threshold ≥3). Fewer than half of the women identified as high anxiety were identified by both measures. Factor analyses of the symptom measures were consistent with wider literature suggesting a three-item anxiety component of the EPDS; however, concurrent validation using regression analyses did not indicate that the EPDS could be used as an anxiety case finding instrument. Women reported that maternal stress had significant impact on their lives that may not be captured with existing clinical approaches. Women commonly found it difficult to self-assess severity of maternal stress and the assessment process could itself act as an intervention. The research provided the first validation of the depression case finding questions in UK clinical practice. The Whooley items completed in clinical practice identified only half of the possible cases identified by the EPDS, at both commonly adopted EPDS thresholds. Inclusion of the Arroll 'help' question as a criterion improved specificity of the assessment completed in clinical practice but substantially compromised sensitivity, missing 9 in 10 possible cases. Women’s mental health history and treatment history were similarly under-reported, particularly concerning anxiety. APA was introduced into routine clinical practice without attention to topics of relevance to women, context of disclosure or to provision of adequate resources for consistently responding to identified need. Women experiencing, or at risk of, mild-moderate disorder were thus usually ineligible for further support. Implications: Care pathways are needed that encompass both assessing and responding to maternal stress, where communication with health professionals, subsequent referral and management are addressed. The development, implementation and evaluation of low-cost resources embedded in such pathways are a priority and the research presented in the thesis offers a foundation on which to build.