Aim: The overall purpose of this thesis was to increase the understanding of relatives’ changing life situation during the first six months of a person’s onset of stroke, with focus on learning. Furthermore, the purpose was to evaluate theprinted education materials (PEM) targeted at relatives at Swedish stroke units. Method: In paper I, 16 relatives were interviewed about the meaning of becoming a relative of a person affected by stroke. In paper II, 9 relatives were reinterviewed about what it meant to be a relative of a person affected by stroke. The interviews took place six months after the stroke survivors’ onset of stroke. Data from the two studies were analyzed by Lindseth and Norberg’s hermeneutic phenomenological method of analysis, inspired by Ricoeur. In paper III, 16 and 9 relatives were interviewed about what they wanted to know and understand during the first six months after the onset of the survivors’ strokes. Krippendorff’s method of qualitative content analysis was used to analyse data. In paper IV, 42 PEM:s from 21 Swedish stroke units were examined. Data were analysed by use of descriptive statistics and Krippendorff’s method of qualitative content analysis. Results: Becoming the relative of a person affected by stroke means to experience chaos but also to reach a turning point. The turning point is the start of a febrile activity that shows the relatives’ willingness to seek order in the chaotic situation (I). Being the relative of a person affected by stroke also means to be in a struggle for freedom. Relatives do not want to adapt to the stroke or its consequences. Instead, they prefer to choose their own way of life and to write their own history. Therefore, they strive to integrate the stroke and its consequences to their everyday lives (II). The information that the relatives wished to have was about the stroke survivor, the professionals and themselves. Moreover, the results showed that the relatives’ information quest was related to personal involvement, contextual factors, different knowledge needs and different ways to obtain information (III). The PEM:s, offered at Swedish stroke units, were adequate in terms of quality of suitability and readability. The content of the printed education materials offered to relatives varies with the stroke units. Conclusion: To become a relative of a person affected by stroke means to end up in chaos, but also to reach a turning point (I). At this turning point the person is prepared to adjust arrange his/her life to the new conditions. Therefore, nurses need to learn to identify these turning points and include support for relatives in their changing life situation. Being a relative during the first six months of a survivor’s onset of stroke means to fight for freedom (II) without abandoning the stroke survivor. In this process, it is important that the relatives learn to balance freedom with responsibility and life and care for the survivor with relations to other relatives. Relatives are capable as they are active, committed and social persons (I, II, III). This is why alternative pedagogic methods and approached need to be developed and tested. Nurses need training in using such alternative methods. The content of the printed education materials offered to relatives at Swedish stroke units varies with the unit. As a result, it would be useful to establish a national electronic centre.

Distance education is being used increasingly for both pre and in-service teacher education in both developed and developing countries (Robinson & Latchem, 2003; Kwapong, 2007; Perraton, 2010). In Rwanda, the Kigali Institute of Education (KIE) introduced its first distance education programme in 2001 with the aim of upgrading the qualifications of under-qualified high school teachers, including those who teach English, using printed materials as the main teaching/learning resource. This study has aimed to investigate the role of the 2010 version of these materials in addressing the professional needs of high school English teachers. It was centrally informed by theories of the sociologist of education, Basil Bernstein (1996, 1999), about curriculum and of the sociocultural psychologist, Lev Vygotsky (1978), on mediation, by Shulman’s (1986, 1987) work on pedagogic content knowledge and by literature on English language teaching, on language teacher education and on distance education materials design. The investigation involved textual analysis of a selection of KIE’s distance education materials for English teaching and focused on the content selected for these materials and on the mediation of this content on the page. After this analysis, one section of these was re-designed by the researcher. Nine teacher-learners enrolled in the programme for English teaching were interviewed to determine their responses to both the KIE materials and to the redesigned section. The findings suggest that Kigali Institute of Education’s distance education materials for English do not adequately address the academic and professional needs of high school English teachers for four main reasons. Firstly, the content selected for the materials does not respond sufficiently to the interests and needs of foreign language teachers of English. Secondly, it is not externally aligned to the curriculum at the level that these teachers are supposed to teach. Thirdly, the mediation of this content does not adequately support the development of subject and pedagogic content knowledge and skills of teacher-learners and encourages surface rather than deep learning (Biggs, 1987). Lastly, with the exception of sections on some literary genres, the materials list useful ideas and language teaching approaches and methods but consistently fail to explain to the teacher-learners how to teach different aspects of language. These findings suggest that these materials do not adequately assist teacher-learners to develop pedagogic content knowledge (Shulman, 1987) for the teaching of English. The limitations identified may result from a lack of knowledge, skills and experience in distance education materials and graphic design among the KIE materials designing team and from inadequate resource provision (including time) by the institution and suggest that there is a need for changes to the KIE distance education materials designing process.

International and local guidelines for designing distance education materials advise designers to use feedback from students in the redesign of their materials. This study is a response to the researcher’s failed attempt to elicit critical feedback from some of her students. It therefore sets out to devise a framework for a critical pedagogic analysis of distance learning materials designed for South African teacher education programmes. It draws on theorisations of pedagogy, principally from the work of the sociologist of education Basil Bernstein and the applied linguist Suresh Canagarajah, theorisations of mediation, originating in the work of Lev Vygotsky, and theorisations of subjectivity. It also draws on international and local conceptualisations of a knowledge base for teacher education. In the analysis of the selection and organisation of knowledge on the page, the study draws on Halliday’s systemic functional linguistics and the field of social semiotics to uncover the positions constructed for readers as students and as teachers in each multimodal design. A pedagogic analysis of distance education materials for pre-service or in-service teachers responds to a series of questions: What elements of a knowledge base for teacher education do designers foreground and background? What is the orientation of the materials to the relationship between knowledge and practice? How is knowledge mediated through in-text activities, pedagogic episodes and scaffolded readings? What roles do linguistic and visual design choices play in the mediation of knowledge? A critical pedagogic analysis interrogates the subject positions that the multimodal designs constitute for ideal readers as students and as teachers. In the study, all of these questions frame a detailed analysis of three sets of materials designed for South African teacher education programmes and, finally, a critical reflection on materials for which the researcher was the principal designer. The study concludes that a critical pedagogic analysis affords designers and evaluators the critical distance needed for evaluating the mediation of knowledge(s) and the constitution of readers’ subjectivities in teacher education materials. As an alternative (or in some circumstances, as an addition) to reader feedback it has the potential to inform redesigning for the original local context(s) of use or reversioning for use in broader regional or global contexts.

The purpose of this study was to identify factors that motivate or impede faculty use of learning object repositories (LORs). The unified theory of acceptance and use of technology (UTAUT) served as the theoretical framework for this study. Both quantitative and qualitative approaches were used in the study to explore two research questions relating to factors affecting faculty use of LORs. Research subjects were faculty and instructional staff users from two LORs: Orange Grove and Wisc-Online. This study was a two-phase design study. In Phase I, I conducted 13 interviews and analyzed data by a content analysis method. Phase II of the study was designed based on the results of Phase I. I collected data by a survey instrument from 38 respondents and analyzed the data by descriptive statistics and analysis of variance in Phase II. The results of the study indicated 22 factors as motivators for faculty use of LORs and 13 factors as barriers for faculty use of LORs. The study is the first to identify factors affecting faculty use of LORs from actual faculty users’ perspectives based on UTAUT. The study’s findings contribute to understanding the reasons that faculty use or do not use LORs and provide foundations for designing strategies to increase faculty use of LORs.

Hypotheses on the efficiency of evidence-based printed materials can be directed by health communication concepts. These concepts can provide a general framework that goes beyond the traditional vulgarization point of view: instead, it points towards a strategy to obtain health outcomes and provoke behavior change, from a disease prevention, management and health promotion perspective. The present study proposes a comprehensive framework based on concepts from health risk communication, Tarde's theory of social values, usability, readability and plain language. Using the mapping approach, an evaluation grid was applied to printed evidence-based materials with proven effectiveness, in order to reveal the underlying strategy and isolate the characteristics of effective materials. The results allowed us to define two types of printed evidence-based materials, according to the robustness of the evidence they contain and the target audience. It was also possible to identify indicators of notions that are translated into operationalized items, frequent in those materials that might be responsible for their efficiency: clear purpose of the documents, limited scope, learning motivation and correspondence to the logic, experience and language of readers. Effectiveness of printed evidence-based materials could also be correlated to numeracy, objectiveness, standard definitions, constant timeframes and denominators, risks enumerated in order of importance, effective response, and high degree of threat, urgency, novelty and visibility of the disease. It was also possible to identify some missing communication concepts: cultural diversity, narrative, increased easiness of procedures and aesthetic advantage for the patient. In the process of work, the theory of social values emerged as a dynamic component that can bring together and explain many concepts, as well as physician’s acceptance of the guidelines. Value in terms of usefulness and truth plays a major role in cognitive appreciation of the documents. This concept gives a strategic meaning to the whole work and allows us to better understand attitude and behavior change.

Denna uppsats har gjorts i hopp om att kunna bidra med kunskap om vad elever förväntas och vilka kunskaper de kan tillgodogöra sig genom undervisningen i svenskämnets språkhistoria. Studien har gjorts genom en dokumentstudie av tre samtida läroböcker för kursen svenska 3 för gymnasiet. Syftet med studien har varit att undersöka i vilket utsträckning läroböcker möjliggör språkhistorisk medvetenhet. För att besvara detta har huvudfokus legat på att ta reda på hur väl läroböckerna tillämpar begreppet och hur de motiverar nyttan i språkhistoria. Uppsatsens teoretiska ingång baseras på Jonathan Petterssons tankar om att undervisningen i språkhistoria kan bidra till att eleverna utvecklar en språkhistorisk medvetenhet. Det innebär att eleven kan sätta språkhistorien i relation till aktuella frågor i sin samtid och framtid, för att bygga upp ett förhållningssätt till sig själv och sin omgivning som språkvarelser. Undersökningen har visat att läroböckerna lyckas tillämpa begreppet i hög grad, genom att uppnå olika förutsättningar för att utveckla ett språkhistoriskt medvetande. Vad som är nyttan i det språkhistoriska ämnet är däremot inte något som tydligt motiveras i läroböckerna, vilket bekräftar tidigare forsknings tankar om att det råder oklarheter frågan. Avsaknaden av motiveringen speglar också nuvarande styrdokument som endast formulerar att de ska utveckla kunskaper i det svenska språkets ursprung. Sammanfattningsvis pekar därför studien på att läroböckerna i svenskämnet möjliggör utvecklandet av språkhistorisk medvetenhet. I ett större perspektiv antyder därför studien på att det finns goda möjligheter för begreppet språkhistorisk medvetenhet att ingå i svenskämnets språkhistoria, men att det fortfarande krävs att större forskning börjar intressera sig för frågan för att sätta större ljus på forskningsproblemet. Detta är också en nödvändighet för att möjliggöra en eventuell ändring i styrdokumenten i framtiden. / This essay have been written with hope in contributing with knowledge about what students are expected and what they can absorb through the teaching of the Swedish language history. The study has been done through a document study of three modern textbooks for the Swedish course 3 intended for high school. The purpose of the study has been to investigate the extent to which textbooks enable language-historical awareness. To answer this, the main focus has been on finding out how well the textbooks apply the concept and how they justify the usefulness in language history.  The theoretical approach is based on Jonathan Pettersson's thoughts of that the teaching of language history can contribute to the students developing a language-historical awareness. This means that the student can put the language history in relation to current issues in his or her contemporary and future, in order to build up an approach to themselves and their surroundings as language creatures.  The study has shown that the textbooks succeed in applying the concept of language-historical consciousness to a great extent, by achieving different conditions for developing a language-historical consciousness. What is useful in the language-historical subject on the other hand is not something that is clearly justified in the textbooks, which confirms the earlier research's thoughts that there are uncertainties within this question. The lack of justification also reflects the current curricula of Swedish that only states that they should develop knowledge in the origin of the Swedish language. To sum up, the study therefore indicates that the textbooks enable the development of language-historical awareness. In a larger perspective, the study therefore suggests that there are good opportunities for the concept of language-historical awareness to be included in the Swedish history language, but that it is still necessary for major research to start to take an interest in the issue in order to shed more light on the research problem. This is also necessary in order to enable a possible change in the curricula in the future.

Hypotheses on the efficiency of evidence-based printed materials can be directed by health communication concepts. These concepts can provide a general framework that goes beyond the traditional vulgarization point of view: instead, it points towards a strategy to obtain health outcomes and provoke behavior change, from a disease prevention, management and health promotion perspective. The present study proposes a comprehensive framework based on concepts from health risk communication, Tarde's theory of social values, usability, readability and plain language. Using the mapping approach, an evaluation grid was applied to printed evidence-based materials with proven effectiveness, in order to reveal the underlying strategy and isolate the characteristics of effective materials. The results allowed us to define two types of printed evidence-based materials, according to the robustness of the evidence they contain and the target audience. It was also possible to identify indicators of notions that are translated into operationalized items, frequent in those materials that might be responsible for their efficiency: clear purpose of the documents, limited scope, learning motivation and correspondence to the logic, experience and language of readers. Effectiveness of printed evidence-based materials could also be correlated to numeracy, objectiveness, standard definitions, constant timeframes and denominators, risks enumerated in order of importance, effective response, and high degree of threat, urgency, novelty and visibility of the disease. It was also possible to identify some missing communication concepts: cultural diversity, narrative, increased easiness of procedures and aesthetic advantage for the patient. In the process of work, the theory of social values emerged as a dynamic component that can bring together and explain many concepts, as well as physician’s acceptance of the guidelines. Value in terms of usefulness and truth plays a major role in cognitive appreciation of the documents. This concept gives a strategic meaning to the whole work and allows us to better understand attitude and behavior change.

Hypotheses on the efficiency of evidence-based printed materials can be directed by health communication concepts. These concepts can provide a general framework that goes beyond the traditional vulgarization point of view: instead, it points towards a strategy to obtain health outcomes and provoke behavior change, from a disease prevention, management and health promotion perspective. The present study proposes a comprehensive framework based on concepts from health risk communication, Tarde's theory of social values, usability, readability and plain language. Using the mapping approach, an evaluation grid was applied to printed evidence-based materials with proven effectiveness, in order to reveal the underlying strategy and isolate the characteristics of effective materials. The results allowed us to define two types of printed evidence-based materials, according to the robustness of the evidence they contain and the target audience. It was also possible to identify indicators of notions that are translated into operationalized items, frequent in those materials that might be responsible for their efficiency: clear purpose of the documents, limited scope, learning motivation and correspondence to the logic, experience and language of readers. Effectiveness of printed evidence-based materials could also be correlated to numeracy, objectiveness, standard definitions, constant timeframes and denominators, risks enumerated in order of importance, effective response, and high degree of threat, urgency, novelty and visibility of the disease. It was also possible to identify some missing communication concepts: cultural diversity, narrative, increased easiness of procedures and aesthetic advantage for the patient. In the process of work, the theory of social values emerged as a dynamic component that can bring together and explain many concepts, as well as physician’s acceptance of the guidelines. Value in terms of usefulness and truth plays a major role in cognitive appreciation of the documents. This concept gives a strategic meaning to the whole work and allows us to better understand attitude and behavior change.

The United States dedicates greater than 17% of its gross national product to healthcare. This percentage is expected to go up to 20% by 2018. Despite the high cost of care, the health care system remains inefficient and ineffective. Barriers include reduced access to care related to low health literacy. Complicating low health literacy is the high readability score of patient education materials. The high readability score is in part due to tools that are not standardized and measure different aspects of education materials creating varying readability scores. The purpose of this quality improvement project was to adopt a tool, the Clear Communication Index, which is evidence-based and standardized using the federal Plain Language Guidelines, to assess the reading score of educational materials in a 62-bed acute long-term care facility. The plan, do, study, and act model was used as a translational framework to guide this project, and the theory of goal attainment served as the theoretical support for the project. The Clear Communication Index worksheet was used to assess the readability of documents given to patients at discharge. Any score below 90% was considered difficult to understand and required revision. One month after implementation, patient satisfaction scores on 2 metrics showed improvement. The score for 'When I left the hospital, I clearly understood the purpose for taking each of my medications?' increased from 58.2% to 90.7%. The 2nd patient satisfaction survey metric, 'During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital?,' increased from 73.1% to 83.3%. The results may promote social change by providing equal care access to all through readable educational materials.

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