The development of Type 1 diabetes has a profound impact on many aspects of everyday life, health and well-being. In this thesis the literature relevant to different aspects coping with Type 1 diabetes is reviewed. The research described in the thesis includes (i) a prospective assessment of how psychosocial factors affect diabetes-related outcomes in adults following the onset of Type 1 diabetes, (ii) qualitative analysis of interviews that were conducted to explore the patient's perspective of what it means to cope with diabetes, and (iii) the development, pilot testing, and subsequent partial validation of a diabetes-specific questionnaire. The Edinburgh Prospective Diabetes Study examines the relationships between psychosocial variables recorded at diagnosis and diabetes related outcomes recorded at four months (n = 69), 12 months (n = 65), 24 months (n = 56) and 36 months (n = 40) after diagnosis. The results showed that individuals who had a lower socio-economic status had consistently poorer glycaemic control at 24 months (p < 0.001) and at 36 months (p < 0.01) after diagnosis. Diabetes knowledge at four months after diagnosis was a significant predictor of glycaemic control at 12 months (r= 0.35, p < 0.01) and at 36 months after diagnosis (r = 0.35, p < 0.05). In adults, self-reported outcomes were significantly predicted by longstanding psychological (e.g. personality traits) and social factors (e.g. quality of life). There was some evidence to suggest that coping strategies have an intermediate position between psychosocial factors and diabetes-related outcomes. The results and their implications for future research are discussed in terms of existing theories of coping. To date there are few psychometrically sound instruments capable of assessing how well a person is coping with their diabetes. With this in mind, the present research was undertaken to develop a new diabetes self-report measure termed the Diabetes Impact, Adjustment and Lifestyle Scales (DIALS). The development, pilot testing and partial validation of the DIALS are described. Semi-structured interviews (n = 1 0) were conducted to explore the patients' descriptions of their adjustment to diabetes and the impact that diabetes has on aspects of their daily life. A grounded theory approach (Strauss, 1987) was adopted to analyse the data. Several domains were established, from which items were generated. Two studies, a small pilot study (n =57), and a large cross-sectional validation study (n = 246) were carried out to establish the underlying structure, internal consistency, partial validity, and stability of the DIALS. Principal components analysis of the DIALS identified five dimensions: Impact, Adherence, Information-seeking, Fear of complications and Diabetes-related distress. Overall, the results suggest that the DIALS is a valid, reliable and stable indicator of coping in adults with Type 1 diabetes. A hierarchal model of causal relationships between psychological constructs (i.e. personality traits and illness-related coping constructs) and the DIALS was formulated and tested formally using Structural Equation Modelling. There was considerable overlap in the constructs, with evidence for two latent variables relating to 'emotionoriented' and 'task-oriented coping'. In summary, coping variables may be important mediators in the link between antecedent variables such as longstanding character traits (e.g. personality) and self-reported outcomes of diabetes.

This study was undertaken to test the satisfaction process as it relates to the consumption of prescription medication. The disconfirmation of expectations model was used as a framework for the study. The study sought to evaluate the impact the provision of drug information has on the satisfaction/dissatisfaction process. To accomplish this, consumers recruited from two community pharmacies were provided with a scenario that described the purchase, and consequences of taking a prescription product intended for the treatment of migraine headache. Each subject received a scenario that contained one of four (4) levels of drug information. The four levels were: (1) no drug information; (2) information about side effects; (3) information about effectiveness; and (4) information about effectiveness and side effects. Each subject also received a scenario that described one of four therapeutic outcomes. They were: (1) no side effects with total elimination of headaches; (2) no side effects with partial elimination of headaches; (3) side effects with total elimination of headaches; and (4) side effects with partial elimination of headaches. The disconfirmation of expectation model was supported by the study. Using an ANOVA model, analyses revealed that the provision of drug information resulted in more positive disconfirmation and higher levels of satisfaction when the outcome of therapy was less than optimal. The measures of future intention were also affected by the provision of drug information. Further analyses revealed satisfaction was a function of expectation and disconfirmation.

No description available.

The purpose of this study was to describe family members' influence on medication adherence rates for schizophrenic clients following an educational program presented simultaneously to both client and family member. Three chronic schizophrenic clients participated in this study, two were females, and the other was male. The two family members who provided data were husbands of the two female clients. The obtained scores and responses of two questionnaires was indicative of improved medication adherence for clients and family members. The level of adherence was similarly perceived by the clients and their family members as obtained scores and responses were similar across both time periods. However, family members' attendance at the program presentation did not influence the level of reported medicated adherence behaviors of their wives as compared to the client who attended the program alone because the greatest increase in obtained scores was reported by the client who attended the program alone.

This study examined the difference among 3 patient education intervention strategies and compliance in the hypertensive elderly. The strategies were verbal instructions, written instructions and both verbal and written instructions. An ex post facto descriptive design was implemented based on a Cognitive Information Processing Theory of Learning. Forty subjects were recruited and interviewed. Data analysis revealed that compliance did not differ significantly with the type of educational strategy.

Heart failure is an illness that requires life-long treatment and often affects everyday aspects of a person’s life. Self-care is a significant part of the treatment. Good self-care resources make it possible for people with heart failure to make the lifestyle changes they often need to maintain or improve their level of health. Self-care means having knowledge of and being able to recognize the symptoms and signs of deterioration that can occur with heart failure, so that the person can take appropriate measures – and it also means knowing when it is time to seek professional help. The significance of self-care for heart failure has increased and will increase even more in the future, when monitoring one’s condition will be left more and more to the people themselves and those who take care of them. The object of the study was to learn what self-care measures people with heart failure say they apply in everyday life. The quantitative method of a questionnaire study (The European Heart Failure Self-Care Behaviour Scale) was used. Of the 94 people registered at a heart failure unit who were asked to complete the questionnaire, 58 of them consented. The results showed that more than 95% of the people with heart failure applied the recommended self-care measure of taking the medicines prescribed by their doctor. Many also applied the self-care measures of taking a rest during the day (83%) and taking it easy when they felt out of breath (78%). On the other hand, the self-care measures of daily weight control were applied only by 41%, daily exercise by only 48% and salt and fluid restrictions by only 59%. The self-care measures of contacting a doctor/nurse when noticing problems or symptoms of deterioration were applied by only 36% of those who felt out of breath and by only 43% of those who felt increased fatigue. The conclusion is that there is a need to improve the knowledge about and confidence in self-care treatment for people with heart failure. One way of achieving this is to show that people with heart failure check for symptoms and apply measures in their homes as part of the treatment and that this leads to an increased quality of life.

In this paper, a view of non-compliance in practical healthcare is provided that identifies certain non-compliant behaviours as rational. This view of rational non-compliance is used to update a current form of doctor patient relationships with the aim of reducing non-compliance. In addition to reforming one standard doctor patient relationship model, the normative implications of understanding non-compliance as a rational form of human behaviour are described.

Antiretroviral therapy has given hope and expectations for a better life to HIV positive individuals, however, HIV medication cannot be effective without HIV positive individuals’ compliance to it. This study investigated the ways in which living with HIV and taking medication is located within the psychological, social and cultural context of everyday life and relationships in Greece. It also examined gender and identity issues, which make compliance/non-compliance understandable from the HIV positive peoples’ perspective. In addition, emphasis was given to locating compliance to medical regimes in which the perspectives of HIV positive persons were prioritised and understood in relation to relationships with health care professionals. A mixed methods approach was undertaken to provide understanding of compliance and non-compliance factors to HIV medication in a holistic way. A self-completed questionnaire was used to examine the psychosocial factors underpinning compliance to medication. Face-to-face semi-structured interviews were used to explore issues of identity, gender, relationship between doctors and patients and social understandings of HIV. Finally, self-completed weekly diaries were used to document compliance actions, thoughts and feelings in order to reveal the ways medical regimes fit into everyday life. The study was conducted in three Public Hospitals, one Governmental Hospice and one Non-governmental Organization. Eighty (63 males and 17 females) Greek HIV positive patients completed the questionnaire. Interview sample consisted of 7 and 3 males and females respectively. Finally, 6 Greek HIV positive males and 3 females completed the diaries of the research. The questionnaire data was analysed using descriptive statistics via SPSS 11. In addition, a range of non-parametric tests (Mann Whitney and Kruskal Wallis) were used in order to check if ordinal variables influence compliance with HIV medication. Finally linear regression analysis was used in order to establish the influence of factors on compliance with HIV medication. Interviews and the diaries data were analysed though thematic analysis, focusing on identification of patterns and behaviours which were then interpreted in terms of themes. The findings of the study indicated that, when support was given from life partners compliance with HV medication was increased. However, when support was given from family members, compliance with HIV medication was decreased. According to the findings, family dynamics have changed in several cultures over recent decades, partner roles have changed especially in the west and in Mediterranean societies. In regards to 6 medicalization in everyday life, the study showed that when individuals were experiencing side effects, or had fears of future side effects, religious issues (punishment for homosexuality), loss of one’s freedom due to medication, non-compliant behaviours could occur. Finally, the study indicated that some HIV positive individuals perceived their health levels as good and believed that not taking medication once or twice a week was a compliant behaviour. Hence, false perceptions regarding health levels and compliance issues could lead to non-compliant behaviours. A further examination on the communication patterns of the family system and its impact on HIV positive individuals is recommended as it is clearly not very helpful any more. Further exploration of the general socio-cultural positioning of Greece is recommended as certain HIV positive individuals coped with HIV diagnosis and taking medication, by rejecting it. Finally, the need for psychological support is recommended as it is very rarely provided within the Greek health care system.

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de LL.M. en droit option droit des technologies de l'information" / La question posée est: le vote par internet à distance est-il conforme aux exigences du droit électoral québécois et canadien? Ce mémoire procède en trois étapes. Premièrement, nous déterminons quels sont les principes directeurs qui assurent à une élection sa légitimité. Deuxièmement, nous raffinons notre recherche en ne conservant que les principes qui demeurent pertinents dans un contexte électronique. Le vote doit répondre aux principes suivants: suffrage universel, périodicité, égalité, secret, liberté, sécurité et transparence du processus. Troisièmement, nous transposons les étapes du cycle électoral sur internet. Les problématiques identifiées relèvent davantage de facteurs politiques que techniques ou juridiques. Ainsi la cryptographie et l'introduction du vote individuel multiple, qui n'enregistre que le dernier vote effectué, serviraient la confidentialité du vote. La sécurité du processus pourrait être atteinte notamment par des mesures de protection physique des serveurs, une chaîne de contrôles continue et la diffusion du code source du logiciel du vote. L'accès à la technologie serait accru par la mise en place d'un réseau gratuit de points d'accès publics à internet et des activités de formation. Quant à l'accès aux handicapés, la conformité du logiciel de vote à des principes reconnus d'accessibilité y contribuerait. Pour l'identification, la stratégie des secrets partagés, entre électeurs et autorité électorale, permettrait de dématérialiser cette étape. En conclusion, les lois électorales ne s'opposent pas, dans leur esprit, au vote par internet à distance. Il suffirait de les actualiser dans leur forme. / To come to an answer, this thesis employed a three step approach; firstly, we determined the guiding principles which ensure an election's legitimacy. Secondly, we refined our research by retaining only the principles relevant in an electronic context. The vote must abide by the following principles: Vote for all, periodicity, equality, secrecy, freedom, safety and transparency of the process. Thirdly, we transposed the stages of the electoral cycle on the Internet. The identified problems are more political than they are legal or technical. For instance, the confidentiality of the vote can be helped with the use of cryptography, and the introduction of the multiple individual vote, which would make it possible to record only the last vote cast. The safety of the process can be reached by measures of physical protection of the servers, a continuous control mechanism and an access to the source code of the voting software. Accessibility to the technology could be increased with a network of public access points to the Internet, and with education clinics. With respect to the handicapped voters, the voting software should comply with recognised principles of accessibility. To identify the voters, shared secrecies between the voter and the electoral authorities could allow a dematerialisation of this procedure. In conclusion, the spirit of our electoral laws would allow for the introduction of an Internet voting process.

The Schedule for Affective Disorders and Schizophrenia-Change Version (SADS-C), the Social Adjustment Scale-Patient Version II (SAS-PATII) and the Command Hallucination Questionnaire (CAQ) were administered to 86 psychotic inpatients to investigate the relationship between command hallucinations, aggressive behavior, and compliance. Two SADS-C items ("severity of hallucinations" and "depersonalization") were useful as indicators of command hallucinations. Ninety-two percent had complied with their command at least once in the past month. Three SADS-C variables related to compliance with command hallucinations were identified: middle insomnia, the belief that the voice was acting in your best interest, and overt irritability. The patients' level of distortion of reality did not appear to influence compliance rates. Results also indicated that patients who experience command hallucinations were not significantly more or less dangerous than other psychotic inpatients.