<p dir="ltr">Undernutrition affects millions of children in low- and middle- income countries, causing poor growth, poor development, and increased risk of mortality. Many nutrition-sensitive interventions for rural areas increase household access to nutritious foods through increasing home production, a strategy that has small positive effects on child diets. However, there is growing evidence that local markets are also important for dietary quality. Despite the importance of rural markets, the rural food environment and food purchasing practices among rural households are not well-characterized in the literature. It is possible that promoting improved household food purchase practices is an effective method for improving child nutrition in rural areas. Tanzania experiences a high prevalence of undernutrition among children under the age of 5 years, particularly among rural populations. This dissertation utilizes data from the Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS), a cluster randomized controlled trial that was conducted in rural Mara, Tanzania. The EFFECTS trial promoted improved diets through both home production and through food purchases through a social and behavior change strategy. We measured changes in dietary diversity (a proxy for diet quality), children’s nutrient intake adequacy, and diversity of foods purchased and produced. This dissertation presents evidence that food purchase diversity is positively associated with dimensions of the rural food environment, including high market food diversity (+0.37 food groups, p=0.01), living within 30 minutes of a market (+0.36 food groups, p=0.001) and household purchasing power (+0.14 food groups per additional million Tanzanian shillings spent by the household, p<0.001). In turn, purchase diversity is positively associated with dietary diversity (b=0.22, p<0.001), and intake adequacy of folate, vitamin B12, and calcium (all p<0.05) among children 9-23 months. Promoting food purchase diversity was effectively integrated into the EFFECTS interventions, resulting in purchasing +0.54 food groups at endline compared to changes in the control (p<0.01), which mediated 25% of the total improvement in child dietary diversity. In contrast, production diversity was associated with increased intake adequacy of vitamin A only (p<0.05), households produced +0.44 food groups at endline compared to control (p<0.05), and this mediated 15% of the total improvement in child dietary diversity. These findings suggest that promoting diverse food purchases, alongside diverse home production, is an effective way to improve children’s diets in similar settings.</p>

The societal problem of pediatric obesity is growing in Sweden with more patients receiving pediatric treatment while the treatment measures have not improved to match the increase. This exploratory study examines a mobile application aiming to improve treatment for pediatric obesity. The study will evaluate the current application through the lens of HCI with a focus on self-care and will be based on digital behavior change intervention (DBCI), persuasive systems, and playful user-centered design (UCD), with design recommendations stated based on the evaluation. User-centered design is a design process involving end-users in the design process, the users were involved through semi-structured interviews. User-centered design is a large part of the study with user input laying the foundation for new design recommendations. Users thought that the application would benefit from having more short-term goals to boost motivation. Furthermore, a heuristic analysis was done to get an expert view on the user interface. The results were promising and indicated some potential improvements for the application, one suggested improvement was to provide more positive feedback to boost motivation. The thesis discusses how more visualization of data might have the potential to both boost motivation and result in a more playful user experience. / Samhällsproblemet med barnfetma växer i Sverige med fler patienter som får pediatrisk behandling samtidigt som behandlings åtgärderna inte har förbättrats för att matcha ökningen. Denna explorativa studie undersöker en mobilapplikation som syftar till att förbättra behandlingen av barnfetma. Studien utvärderar den aktuella applikationen och är baserad på digital beteendeförändringsintervention (DBCI), persuasive systems och lekfull användarcentrerad design (UCD), med designrekommendationer angivna baserat på utvärdering samt semistrukturerade intervjuer. Användarcentrerad design är en stor del av studien med användarinput som lägger grunden för nya design rekommendationer. Intervjuerna lyfte fram att applikationen skulle tjäna på att ha fler kortsiktiga mål för att öka motivationen. Resultaten indikerade potentiella förbättringar för applikationen, exempelvis att ge mer positiv feedback. Slutligen diskuteras hur en mer genomarbetad visualisering av data kan leda dels till ökad motivation och dels till mer lekfull interaktion.

Background: The prevalence of disability increases with age; therefore with an aging population, interventions to reduce disability are crucial. This thesis adopts a behavioural conceptualisation of disability. The theoretical frameworks of the International Classification of Functioning, Disability and Health (ICF), the Theory of Planned Behaviour (TPB) and the integrated ICF/TPB model are applied to investigate disability and physical activity (PA) behaviours. The thesis aims to: (1) identify the factors involved in the prioritisation of patients for total joint replacement; (2) classify patient pre-operative expectations of total hip replacement (THR) and investigate the relationship between expectations and recovery after surgery, and; (3) test whether the TPB and theory-based interventions can predict and explain PA within individuals. Method: Five studies were conducted. In the first study, health professionals judged whether the items from two prioritisation tools measured each of the ICF constructs. In the second study, surgeons ranked patient vignettes, which differed by constructs from the integrated model, in order of priority for THR. In the third study, a large cohort of THR patients reported expectations of surgery pre-operatively. Health and functioning were also reported pre-operatively and 1-year post-operatively. The fourth and fifth studies were a series of experimental n-of-1 studies using diary methods assessing TPB cognitions and PA behaviours. Results: There is a lack of agreement between judges in relation to the content of many of the items from prioritisation tools. Behavioural and psychological factors can influence prioritisation for THR. The majority of patient expectations of THR addressed activities and social participation; however, the evidence for a relationship between expectations and recovery was limited. The TPB can predict PA within some individuals but the evidence in support of interventions to increase PA was limited. Discussion: The findings provide important clinical and theoretical implications for understanding disability and physical activity behaviours.