Made available in DSpace on 2015-05-08T14:47:40Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1042215 bytes, checksum: 5a288f1af2a8d293145f46e75bcc68f0 (MD5) Previous issue date: 2014-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: The physical and cognitive sequelae caused by CVA compromise the functional capacity, and the independence and autonomy of the person affected by the CVA, causing changes in the dynamics of life not only of the individual affected, but also the family, especially for the main caregiver. Objectives: evaluating the health-related quality of life of family caregivers of patients with sequelae with CVA. Methods: the research was descriptive, transversal type, with a quantitative approach, held at the domicile of patients with sequelae by AVE, in the city of João Pessoa-Paraíba, in the period between the months of February and April 2013. The population of the study consisted of 136 family caregivers of patients affected by stroke. For data collection, there was used a structured instrument, contemplating closed issues relating to variables of the study and the specific measures to assess, respectively, the physical capacity of individuals with sequel by CVA, the overload and health-related quality of life among caregivers: Barthel index, Burden Interview Scale and Short Form-36. The analysis was performed using three techniques: statistical descriptive analysis and exploratory data analysis and Association through the Chi-square test and the T-test and F for comparisons of the averages. The project was submitted to the ethics committee of the Centre for Health Sciences, Federal University of Paraíba Health and approved under protocol number 0279/13 and CAAE: 13778313.3.0000.5188. Results: commitment was evidenced in almost all domains of quality of life of family caregivers, among them, those who were presented with lower average were: Pain (40.16), Mental Health (53.62) and Social Aspects (54.12). Characteristics of individuals with sequel by CVA, which is related with the domains of quality of life, one can find out that those who were below the age of 65, were married and had highest level of schooling, major averages, respectively, in the fields of Social Aspect, Emotional and Mental Health Aspects. Caregivers of people with higher level of dependency to the basic activities of daily living had lower average in the mental health field. Regarding the characteristics of the caregiver, major averages were caregivers under the age of 40 years old and married in the field, Functional Capacity, those who had a profession, on emotional aspects and those who had higher income, in the areas of mental health and vitality. There was also an association between overload and worse health-related quality of life in the areas of functional capacity, physical aspects, emotional aspects and Pain. Conclusion: the results of the study allowed understanding the different dimensions and specificities in the context of the health-related quality of life, evidencing the need for redirection of the look to public spheres for the recognition of the problems faced by the family when individuals are affected by a disabling disease, such as CVA. / Introdução: As sequelas físicas e cognitivas provocadas pelo AVE comprometem a capacidade funcional, a independência e a autonomia da pessoa acometida e acarreta alterações na dinâmica de vida não só do indivíduo acometido, mas também da família, sobretudo na do cuidador principal. Objetivos: Avaliar a qualidade de vida relacionada à saúde de cuidadores familiares de pacientes com sequelas com AVE. Metodologia: A pesquisa foi do tipo descritivo, transversal, com abordagem quantitativa, realizada no domicílio dos pacientes com sequela de AVE, no município de João Pessoa PB, no período de fevereiro a abril de 2013. A população do estudo foi composta por 136 cuidadores familiares de pacientes acometidos por acidente vascular. Para a coleta dos dados, foi utilizado um instrumento estruturado, contemplando questões fechadas relativas às variáveis do estudo e às medidas específicas para avaliar, respectivamente, a capacidade física dos indivíduos com sequela de AVE, a sobrecarga e a qualidade de vida relacionada à saúde entre os cuidadores: índice Barthel, Burden Interview Scale e o Short-Form-36. A análise foi realizada através de três técnicas: estatísticas: Análise Descritiva e Exploratória de Dados e Análise de Associação por meio do Teste de qui-quadrado e o Teste T e F para comparações das médias. O projeto foi encaminhado ao comitê de ética do Centro de Ciências da Saúde da Universidade Federal da Paraíba e aprovado sob o protocolo n 0279/13 e CAAE: 13778313.3.0000.5188 Resultados: Foi evidenciado comprometimento em quase todos os domínios da qualidade de vida dos cuidadores familiares. Entre eles, os que se apresentaram com menor média foram: Dor (40,16), Saúde mental (53,62) e Aspectos sociais (54,12). Quanto às características dos indivíduos com sequela de AVE, que se relacionaram com os domínios de qualidade de vida, conclui-se que os que tinham idade inferior a 65 anos eram casados e tinham um nível mais alto de escolaridade, obtiveram maiores médias, respectivamente, nos domínios Aspecto sociais , Aspectos emocionais e Saúde mental . Os cuidadores de pessoas com nível mais alto de dependência para as atividades básicas de vida diária tiveram menor média no domínio Saúde mental . No concernente às características do próprio cuidador, as maiores médias foram relativas aos cuidadores com menos de 40 anos e os casados, no domínio Capacidade funcional , os que tinham uma profissão, no domínio Aspectos emocionais , e os que apresentavam maior renda, nos domínios Saúde mental e Vitalidade . Constatou-se também uma associação entre a sobrecarga e pior qualidade de vida relacionada à saúde nos domínios Capacidade funcional , Aspectos físicos , Aspectos emocionais e Dor . Conclusão: Os resultados do estudo permitiram compreender as diferentes dimensões e especificidades no contexto da qualidade de vida relacionada à saúde e evidenciou que as esferas públicas precisam redirecionar o olhar para reconhecer os problemas enfrentados pela família quando indivíduos são acometidos por uma doença incapacitante como o AVE.

Bakgrund: Den palliativa vården syftar till att förbättra livskvalité för patienter och närstående och erbjuda dem stöd. Stöd till närstående kan ske på olika sätt, där god kommunikation är av betydelse för att minska oklarheter. Inom den palliativa vården förekommer det en rad samtal och ett av dem är närståendesamtalet som är ett kliniskt verktyg för att kommunicera med närstående. Forskning beskriver närståendesamtalet som användbart för vårdpersonal för att förmedla information och planera vården. Det finns ett behov av mer forskning som inriktar sig på närståendes perspektiv och undersöker vilken stödjande funktion samtalet kan ha. Syfte: Att beskriva närståendes förväntningar och upplevelser av ett närståendesamtal under pågående vårdtid. Metod: Studien har en explorativ design, där närståendesamtalet utforskas för att få ny kunskap. Femton individuella intervjuer genomfördes med närstående efter att de har deltagit i ett närståendesamtal inom specialiserad palliativ sluten vård. Intervjuerna transkriberades Verbatim och analyserades genom Sally Thone tolkande beskrivning. Resultat: Närståendes förväntningar och upplevelser presenteras utifrån fyra mönster som är närståendes behov av att få en förståelse av situationen, faktorer som kan inverka på upplevelsen av närståendesamtalet, närståendes situation och behov av stöd och till sist närståendes råd och förslag till förbättring av närståendesamtalet. Närståendes förväntningar inför närståendesamtalet grundar sig i en ovisshet och en främmande situation. Deras upplevelser av samtalet är avhängigt av en rad aspekter och resulterar i ett behov av att individanpassa närståendesamtalet. Diskussion: Resultatet diskuteras till viss del utifrån den teoretiska referensramen delaktighet i ljuset, delaktighet i mörkret. Närståendes medverkan i forskningen lyfts fram och diskuteras likaså ”insider forskningen” när studien genomförs inom den egna verksamheten. / Background: The palliative care aims to improve the quality of life for patients as well as their families, and to offer them support. Family members can be supported in several ways, where good communication is important to reduce uncertainties. In the course of palliative care, there will be held multiple conversations and one of these is the family conversation which is a clinical tool to communicate with the family members. Research describes this conversation as useful for healthcare professionals to relay information and planning care. There is a need for more research focused on the perspective as seen from the family members and which can further investigate which supporting function the conversation can have.Purpose: To describe family members´ expectations and experiences of a family conversation during the ongoing palliative care. Method: The study has an explorative design, where the family conversation is explored to reveal new knowledge. Fifteen individual interviews were conducted with family members after they had participated in a family conversation within specialist palliative inpatient care. The interviews were transcribed verbatim and analysed using Sally Thone's interpretive description. Results: The family members´ expectations and experiences are presented on the basis of four patterns: family members´ need to get an understanding of the situation, factors that may affect the experience of the family conversation, family members´ situation and need of support and finally family members´ councils and suggestions for the improvement of the family conversation. Family members´ expectations prior the conversation are based in an uncertainty and an unfamiliar situation. Their experiences of the family conversation were highly individual and depend on several aspects, which results in a need to individualise and adapt the conversation on the unique situation. Discussion: The result is to a certain degree discussed with the basis in the theoretical reference framework participation in the light, participation in the darkness. Family members´ involvement in research is emphasised and discussed as well as "insider research" when the study is conducted within the frame of the own setting.

Magister Public Health - MPH / This was a descriptive qualitative study. Eight people living with HIV, four of which had disclosed their status, were individually interviewed. Two focus group discussions (each comprising 6 participants) were also conducted with health workers. The study was based at an urban TB hospital which is currently providing a range of HIV-related services including HIV Voluntary Counseling and Testing, case management and treatment. / South Africa

Bakgrund: Befolkningen i Sverige blir allt äldre och fler önskar vårdas och dö i hemmet. Idag vårdas många inom allmän palliativ vård med stöd av distriktssköterskor. I den tidigare forskningen inom palliativ vård i hemmet har framför allt den specialiserade palliativa vården beskrivits. Få studier har undersökt mötet mellan distriktssköterskor och patienter och närstående inom allmän palliativ vård. Syfte: Att beskriva distriktssköterskors erfarenheter av mötet med patienter och dess närstående vid allmän palliativ vård i hemmet. Metod: Empirisk kvalitativ studie, deskriptiv design. Semistrukturerade intervjuer med åtta distriktssköterskor. Intervjuer mellan 35 till 45 minuter. Texten transkriberades och kategoriserades. Resultat: Sex kategorier bildades: Att skapa förtroende i mötet, att vara närvarande och vårdande i mötet, att vara familjefokuserad i mötet, förutsättningar i mötet, erfarenheter vid frustration och etiska dilemman i mötet, att pendla mellan bekräftelse och motgång i mötet. Det var viktigt att bygga relationer med patienter och närstående, skapa förtroende. Närvaro var förutsättningen för ett bra möte. Distriktssköterskorna visade hänsyn till närstående som genomgick en svår tid, närstående kunde ha svårt att hantera situationen. Patienterna hade behov av längre hembesök och prioriterades. Tillfredsställande att vara nära familjen, få deras förtroende. Distriktssköterskorna räckte inte alltid till, känslan av att inte räcka till var svår. Slutsats: Distriktssköterskors erfarenheter visade att närvaro var en förutsättning för ett bra möte. Det var betydelsefullt att skapa förtroende hos patienten och dess närstående. Det fanns ökat behov av stöd och omvårdnad. Inga extra resurser var avsatta trots att patienter inom palliativ vård skall prioriteras enligt prioriteringsordningen för svensk sjukvård. Klinisk betydelse: Distriktssköterskors arbete inom allmän palliativ vård behöver uppmärksammas för att säkra likvärdig vård till alla i livets slut. / Background: The population in Sweden is getting increasingly older and more elderly people wish to be nursed and to die in their homes. Today many people receive health care within the public palliative health care with support from district nurses. In earlier research within palliative health care at home has above all has the specialized palliative health care been described. Few studies have explored the encounter between district nurses and patients family members within public palliative health care. Aim: To describe experiences of the district nurses and their encounter with patients and family members related to palliative health care at home. Method: Empiric qualitative study, descriptive design. Semi-structured interviews were carried out with eight district nurses. Interviews lasted between 35 and 45 minutes. The text was transcribed and categorized. Result: Six categories were created all related to the encounter: to build confidence, to be present and caring, to be family focused, conditions of the encounter, experiences of frustration and ethical dilemmas, to vacillate between confirmation and setback. It was important to build relations with patients and family members, create confidence. Presence was a condition for a good encounter. The district nurses showed respect to family members who went through a difficult time, family members might have difficulties to handle the situation. The patients needed longer visits and this was prioritized. It was satisfying to be close to the family, to get their confidence. The district nurses sometimes had a feeling of insufficiency, which was hard to accept. Conclusion: The experiences of the nurses showed that presence was a condition in order to achieve a good encounter. It was important to build confidence towards the patients and family members. There was an increased need of support and care. No supplementary resources were allocated even though patients in the palliative health care should be prioritized according to the rule of prioritization of Swedish health care. Clinic signification: More attention should be drawn to the work of the district nurses within the palliative health care in order to ensure equal health care to all individuals at the end of life.

Äldre personer påverkas ofta av sina anhörigas välbefinnande. Studier visar på att avsaknad av trygghet kan orsaka lidande både för den äldre och dennes anhöriga. Anhöriga känner sig ofta otrygga då deras närstående flyttar in på äldreboende, men trots det finns det begränsat med forskning om hur vårdpersonalen kan hjälpa de anhöriga att känna sig trygga med den nya situationen. Studiens syfte var att beskriva anhörigas upplevelser av trygghetsbehov när deras närstående bor på äldreboende. Studien hade en kvalitativ design med en induktiv ansats. Fyra anhöriga med närstående boende på kommunens äldreboenden intervjuades enskilt. Kvalitativ innehållsanalys användes och resulterade i fyra huvudkategorier: Den närståendes vardag och vård, Personal, Kommunikation och Organisation. Resultatet visade att anhöriga lade stor vikt vid att den omvårdnad och vård deras närstående fick var personcentrerad och av god kvalitet för att kunna känna en trygghet. Personalens kompetens och kontinuitet hade betydelse för trygghetskänslan liksom att anhöriga hade en bra kommunikation med personalen på äldreboendet. Anhöriga lyfte även att organisationens arbete för att ständigt förbättra den omvårdnad som ges ökade deras trygghetskänsla. Sjuksköterskans betydelse och ansvar i att uppfylla anhörigas trygghetsbehov sågs dels i sjuksköterskans omvårdnadsansvar för att vården skulle vara personcentrerad och hålla en god kvalitet. Även sjuksköterskans betydelse i handledningen av personal och förbättringsarbeten inom organisationen för att förbättra kvaliteten av vården framkom. Detta relaterades även till hållbar utveckling där behovet av ett helhetsperspektiv belyses för att kunna uppnå ett hållbart äldreboende och en trygghet hos anhöriga med närstående boende på äldreboende. / A lack of security can cause suffering for older adults and their relatives. Relatives often feel insecure when their older family members move into elderly homes, however there is limited research on what the caregiver can do to help relatives feel a sense of security with the new situation. The aim of this study was to describe the relatives' experiences of their need for security when their older family members lives in elderly homes. A qualitative design was used with an inductive approach. Four relatives with older family members living in elderly homes were interviewed. Qualitative content analysis was used and resulted in four main categories: The family members’ daily life and care, Staff, Communication and Organization. The results showed that in order to feel secure the relatives placed importance in that their older family members received person-centred care of good quality. The staff's competence and continuity were important to the feeling of security, as well as that the relatives had good communication with the elderly home’s staff. Relatives also emphasized that the organisation's work to continuously improve the care provided increased their sense of security. The registered nurse's importance in meeting relatives' need for security was seen in the care of the older family members and in the supervision of staff and conduction of improvement work within the organization. Related to sustainable development, there’s a need for a holistic perspective in order to achieve sustainable elderly homes for elderly family members and to achieve security for relatives.

Background: Patients who receive palliative home care are in need of support from their family members who take on great responsibility related to the patients’ care but who often feel unprepared for the situation. An increasing number of interventions aimed at supporting family members in palliative care have been described and evaluated. It is not known whether and how these interventions actually affect the care or support provided to the patient. It has been suggested that family members are likely to provide better support or care with positive experiences for the patients after intervention participation. However, this has not been studied from the perspective of the patients themselves. Aim: The aim is to explore patients’ experiences after their family member participates in apsycho- educational intervention during palliative care. Method: This study has a qualitative approach and interviews were conducted with eleven patients whose family members had participated in a psycho-educational intervention during palliative home care. The interviews were analyzed with interpretive description. Results: Patients’ experiences are represented by three themes: Safe at home; A facilitated and more open communication; and Feeling like a unit of care. Patients experienced that their needs were better met and that their family members became more confident at home without risking their own health. Patients felt relieved when their family member was given the opportunity to talk and reflect with others in the same situation and hoped that the intervention would contribute to a more honest communication between them and their family member. Further, it was of great importance to the patients that their family members got the attention and were confirmed and supported by the healthcare professionals. Conclusion: These findings show how an intervention targeted at family members during palliative home care also benefited the patients. The findings are therefore useful when developing support to family members in palliative care. / Bakgrund: Patienter som erhåller palliativ hemsjukvård är i stort behov av stöd från sina närstående, som ofta tar ett betydande ansvar för patientens vård. Dock känner sig  närstående ofta otillräckligt förberedda för situationen. Ett ökat antal interventioner som syftar till att stödja närstående i palliativ vård har beskrivits och utvärderats. Det är inte känt om eller hur dessa interventioner påverkar patienten men det har föreslagits att närstående troligtvis ger bättre vård och stöd med positiva erfarenheter för patienten. Detta har dock inte studerats från patientens perspektiv. Syfte: Att undersöka patienters erfarenheter av vård och stöd i hemmet efter att deras närstående deltagit i en intervention under pågående palliativ vård. Metod: Studien har en kvalitativ utgångspunkt och är designad utifrån tolkande beskrivning. Intervjuer genomfördes med elva patienter vars närstående deltagit i ett stöd och informationsprogram under pågående palliativ hemsjukvård. Resultat: Patienternas upplevelser presenteras genom tre teman: Trygghet i hemmet, En underlättad och mer öppen kommunikation och Känsla av att vara en enhet för vård. Patienterna upplevde att deras behov blev bättre tillgodosedda, deras närstående fick mer självförtroende hemma och vården skedde utan att riskera närståendes hälsa. Patienterna kände sig lättade över att deras närstående fick en möjlighet att tala och reflektera med andra i samma situation och hoppades att interventionen skulle medföra en förbättrad och ärlig kommunikation mellan dem och deras närstående. Vidare så var det viktigt för patienterna att deras familjemedlem fick uppmärksamhet och blev bekräftade och stöttade av vårdpersonalen. Slutsats: Dessa resultat visar hur en intervention riktad mot närstående under palliativ hemsjukvård även kommer patienten till nytta. Resultatet kan bidra med kunskap för utveckling av stöd till närstående i palliativ hemsjukvård.

Bakgrund: 1995 års psykiatrireform har inneburit en förändring där den psykiatriska vården numera bedrivs till största del inom primär-/ öppenvården och från patientens hem. Anhöriga till personer med psykisk sjukdom har fått en ny roll, från att ha varit utestängda från psykiatrin ska de numera ses som en resurs och vara en del av sin närståendes vård. Konsekvensen av detta har medfört att anhöriga känner ett stort ansvar för deras nära som är psykiskt sjuk.  Att dela vardagen med en närstående som är psykiskt sjuk kan medföra en påverkan på det dagliga livet i form av konstant oro och stress men även påfrestningar på familjerelationerna. Syfte: Syftet är att belysa upplevelser hos anhöriga till personer med psykisk ohälsa samt deras erfarenheter av kontakten med den psykiatriska vården. Metod: Litteraturöversikt bestående av 12 stycken kvalitativa artiklar granskade enligt Fribergs (2012a) steg för analys. Funna likheter har sammanställts i teman och subteman. Den teoretiska utgångspunkt som valdes är Joyce Travelbees mellanmänskliga relation då den beskriver mötet mellan människor och förklarar etablerandet av en vårdrelation. Resultat: Anhöriga upplevde sig ha ett behov av bekräftelse, få tydlig information, känna delaktighet och bli erbjudna stöd för att lindra bördan. De ville ha ett fungerande samarbete med sjuksköterskan och bli sedda som en resurs. Samarbetet skulle grunda sig i en kontinuerlig kontakt där ömsesidigt utbyte av kunskap tas tillvara. Vid tillfällen då de anhöriga kände sig bekräftade och involverade av sjuksköterskan resulterade det i positiva erfarenheter som ledde till att situationen kändes hanterbar. Diskussion: Sjuksköterskan har en viktig uppgift i att samarbeta med anhöriga och få de att känna sig delaktiga. Känner de anhöriga att de får stöd kan de lättare hantera situationen vilket medför att en återhämtning är möjlig. Då de anhöriga upplever ett utanförskap bör sjuksköterskan hjälpa de anhöriga att finna strategier för att hantera detta och för att göra situationen mer hanterbar och begriplig.

Cette thèse explore l’identité organisationnelle des entreprises familiales à travers le prisme des employés non familiaux. L’identité familiale de ces entreprises constitue pour elles à la fois un atout – « action intangible » difficilement imitable – et en même temps un enjeu, puisque l’imprégnation de la famille et de ses valeurs au sein de l’entreprise pose question à mesure que sa croissance l’amène à intégrer des membres extérieurs. Cet enjeu est d’autant plus sensible que la famille dirigeante cherche souvent à maintenir son influence identitaire sur l’entreprise, leurs histoires et réputations respectives étant intimement liées. Pour autant, peu de travaux ont jusqu’à présent étudié le rôle des employés non-familiaux dans l’identité de ces entreprises. Cette thèse interroge la façon dont les employés non-familiaux contribuent à la perpétuation de l’identité familiale de l’entreprise, à travers l’étude du cas d’une entreprise familiale française. Trois résultats principaux découlent de ce travail. D’abord, l’exploration des perceptions identitaires des employés non-familiaux révèle que la famille est, à leurs yeux, indissociable des éléments caractérisant leur entreprise. Les mécanismes conduisant à ces perceptions sont ensuite examinés : incarnation, rappel, diffusion et adaptation sont identifiés comme « amenant » dans l’entreprise une image spécifique de la famille, de ses valeurs et de son rôle. Ensemble, ils constituent le processus de « familisation » de l’entreprise. Enfin, une typologie est proposée pour classer les employés non familiaux selon leurs motivations et capacité à contribuer à ces mécanismes. Deux catégories d’employés (les adoptés et les convertis) jouent un rôle déterminant dans ces mécanismes. Occupant une place prédominante dans le top management, ils utilisent cette famille comme outil de management ayant une fonction d’exemple incarnant un système de valeurs qu’ils associent à la Famille comme entité générique. Les apports théoriques et pratiques, ainsi que les limites de ces résultats sont discutés en conclusion. / This dissertation explores family firms’ organizational identity from a non-family member’s perspective. The family identity of these firms constitutes both an intangible asset, that is difficult to imitate – and a crucial stake as during their growth process, family firms incorporate external members who tend to progressively represent the majority of the payroll. This stake is even more salient as owning families aim at durably influencing their firms’ identity since the family’s and the firm’s history and reputation are interrelated. However, the role of non-family members’ in the family firm’s identity has not been directly investigated by researchers so far. My dissertation aims at filling in this gap, by investigating the way non-family members contribute to enacting the family identity of the firm. The case study I conducted in a French family firm leads me to formulate three main sets of results. First, the exploration of non-family members’ perceptions of the firm reveals that they associate what they consider to be the core attributes of the firm with the owning family. Secondly, I investigate the mechanisms leading to such perceptions and identify that the family’s image and values are “brought” into the organization through four mechanisms – embodiment, reminding, spreading and adaptation – that together constitute the overall process of “familization” of the firm. Lastly, I suggest a typology of non-family members depending on their motives for contributing to “familization” mechanisms. Two categories (the adopted and the converted) play a crucial role in these mechanisms. Moreover, I show that the top management is composed of adopted and converted, who use this specific family of owners as a managerial tool having a role-modeling function. They do it because they perceive this family as embodying an axiology that is symbolized by the Family – as a generic entity –, an axiology that they consider to be valuable in an organizational context. The theoretical and practical contributions of these results are discussed.

Thesis (Ph.D. (Public Health)) -- University of Limpopo, 2022 / Background: The increase in diabetes prevalence is often accompanied by comorbidities and complications, which negatively impact on the quality of life of patients. Poor dietary intake and physical inactivity lead to obesity and contribute to diabetes prevalence and poor outcomes. Non-diabetic family members of patients are already at risk of developing diabetes due to a family history of the disease. Therefore, this study was aimed at developing and implementing a family-centred nutrition and exercise diabetes care programme for better outcomes and fewer new cases. Methodology: This study employed a mixed method approach, where convergent parallel design was used where quantitative and qualitative data were collected. For the quantitative strand, 400 subjects participated in the study (i.e., 200 diabetes patients and 200 family members). Diabetes patients were selected using stratified random sampling from rural clinics, while family members were selected using the sampled patients. For the qualitative strand, 17 diabetes patients were purposively sampled, and data saturation was reached. Two set of questionnaires (for patients and family members) were used to collect quantitative data, while one-on-one interviews with patients were used to collect qualitative data. Phase 2 involved development and validation of an intervention program. The validation involved a process where professional experts were used for validation using Delphi technique. Phase 3 included implementation and program evaluation wherein post-implementation quantitative survey was conducted on 100 participants (50 patients and 50 family members), who were purposively sampled from list of those who participated in Phase 1. Quantitative data was analysed using SPSS Software v27.0, while qualitative data analysed using 8 Steps of Tesch’s inductive, descriptive open coding technique. Results: In Phase 1, the results showed that over half of patients (57%), compared to 38% of family members, were obese; and that most patients (75%), compared to 55% of family members, had abdominal obesity. Close to half of patients (45%), compared to 31% of family members, had overall excellent nutrition and exercise diabetes care knowledge. The majority of patients (73%), compared with 25% of family members, had overall positive attitudes towards nutrition and exercise diabetes care. Only 15% of diabetes patients compared with 9% of family members had overall good practice vi related to nutrition and exercise diabetes care. In Phase 3, it was reported that the majority of both patients (84%) and family members (100%), respectively indicated that the organization of the educational intervention was commendable. All patients (100%) and family members (100%) indicated that the health education strategies used stimulated their interest and were very helpful to their learning. Conclusion: A family-centred nutrition and exercise diabetes care programme was developed, implemented and evaluated. Diabetes patients and family members indicated that the intervention was helpful to their learning and met their expectations. Therefore, there is an urgent need for the adoption of the family-centred nutrition and exercise diabetes care programme to achieve healthy eating and increased physical activity. The adoption of healthy eating and physical activity among diabetes patients and their non-diabetic family members will subsequently lead to better diabetes outcomes, and minimizing new cases, respectively.

The study was undertaken to identify the factors that influence standard seven pupils when they choose whether to continue with mathematics at senior secondary level or not. The relative importance of the factors was also determined. The literature study identified the following factors: attitude towards mathematics, utility of mathematics, family members' influence, mathematics teacher's influence, peer group influence, achievement and gender. The empirical study dealt with the following: * A 77 item questionnaire was completed by 201 standard seven pupils. * The statistical analysis revealed significant differences between pupils who chose mathematics and those who did not, with regard to all variables except gender. * A regression analysis identified the most influential factors as achievement, family members' influence, attitude and the mathematics teacher. * The overall implications were: - Pupils be made to experience success so that their attitudes may change. - Parents must be involved in their children's education. / Psychology of Education / M. Ed. (Psychology of Education)