Studiens syfte var att belysa hur idrottsföreningsaktiva 65+ beskriver erfarenheter avfysisk aktivitet och dess värde, och hur genusfaktorn skiljer grupperna åt. Teoretiskreferensram: En kombination av holistisk ansats, Bourdieus teori, genusteori ochsocialkonstruktivism. Metod: Idrottsföreningsaktiva 65+ rekryterades i denna studie,där damer kom från en golfförening och herrar från en frigymnastikförening. Totalt 3grupper deltog i denna studie där fokusgruppsintervjuer tillämpades för insamling avdata under två tillfällen. Dessutom skrev informanterna en dagboksanteckning, dettaför att i möte nummer två skulle diskussioner utgå de anteckningarna.Fokusgruppsintervjuerna spelades in med hjälp av digitala verktyg som sedantranskriberades noga och därefter analyserades med hjälp av kvalitativinnehållsanalys. Resultat: Analysen genererade två kategorier och sexunderkategorier, där resultatet visade att värdet av fysisk aktivitet handlar omfrämjandet av hälsa och det sociala umgänget, vilket var viktigt för de bådagrupperna. Samtidigt spelade det i detta avseende också roll vilka erfarenheter varjeinformant hade, detta då resultatet visade att de tyckte om att utföra fysiska aktiviteterutifrån eget intresse, behov, samt den miljö de befann sig i kombination med synen påkroppsideal. Det fanns tydliga indikationer på hur damerna och herrarna skilde sig åtgällande engagemang i fysiska aktiviteter som bland annat påverkas av smak ocherfarenheter beträffande sociala och kulturella aspekter. / The purpose of the study was to highlight how 65+ sports associated people describethe experience and value of physical activity, as well as how the gender factorseparates the groups. Theoretical Reference Framework: A combination of holisticapproach, Bourdieu's theory, Genus theory and Social constructivism. Method:Athletes 65+ were recruited in this study, ladies from a golf club and gentlemen froma free gym association. A total of three groups participated in this study where focusgroup interviews were applied for data collection on two occasions. In addition, theinformants wrote a diary, which meant that in the second meeting discussions wouldbe based on those notes. Focus group interviews were recorded using digital tools,which then where carefully transcribed and analyzed using qualitative contentanalysis. Result: The analysis generated two categories and six subcategories, wherethe results showed that the value of physical activity is about promoting health andsocial relations, which was important for both groups. At the same time the resultsshowed that they enjoyed performing physical activities based on their own interests,needs, view of body ideals and the environment where the performed the physicalactivity. There are clear indications of how the ladies and gentlemen involvement inphysical activities differ and how they are influenced by taste and social and culturalexperience.

Background: Breastfeeding confers health and social benefits on both mother and baby and is thus a key global public health priority, with exclusive breastfeeding for the first six months recommended. A variety of factors can influence a woman’s decision to initiate breastfeeding but a short duration of breastfeeding appears to be common in developed countries. In the UK, promotion of breastfeeding has been government policy since 1974 and gradually the incidence has increased. In Scotland in 2010 the incidence was 74% but by one week 17% of women had given up. A minority of women find that their babies attach easily at birth and more than half report problems at this time. The prevalence of exclusive breastfeeding falls sharply in the first few weeks and the introduction of formula is associated with a shorter duration. It is therefore crucial to understand what happens at this time to enable women to continue breastfeeding effectively. Study Aim: To use Social Cognitive Theory (SCT) to explore and help explain the expectations, knowledge and experiences of women and midwives with regard to breastfeeding initiation. Methods: A systematic review of qualitative studies synthesised using thematic analysis and SCT was conducted and afforded insight into what had been known before and highlighted further aspects that needed to be explored with a qualitative study. The qualitative study was comprised of five focus groups with ten antenatal women, eight postnatal women and eighteen midwives. Photographs included in a leaflet “Feeding cues at birth”, and the chart of “Feeding cues after the first few hours” were developed and used as focussing exercises during the focus groups and interviews. The focus groups and interviews were recorded, transcribed and analysed using a hybrid process of inductive and deductive thematic analysis which integrated data driven codes with theory driven codes based on SCT. Results: Twenty one studies were included in the systematic review and identified clear differences in the experiences of women when breastfeeding was going well as compared to when it was going wrong at the start. There were also differences in the midwives’ knowledge, experience and confidence when breastfeeding was going well in contrast to when it was going wrong. The synthesis did not identify any qualitative studies relevant to initiation which explored skin contact, instinctive behaviour or strategies to resolve failure to attach in the first few days after birth, from the perspectives of mothers and midwives. These topics were therefore explored in detail in the qualitative study. Few mothers recruited to my study experienced instinctive behaviour and successful attachment (in SCT enactive behaviour) at birth. The majority of mothers did not experience attachment at birth and struggled to persist and maintain their motivation to enable breastfeeding initiation in an unfamiliar environment. Midwives’ social expectations and environmental circumstances made women centred care difficult. Midwives considered that sleepy babies who were unable to feed were normal, but women were unprepared for this, compounding the difficulties in initiating breastfeeding. The triangulation of the findings from the systematic review and the qualitative study provide a more complete picture of contributory factors to understanding of difficulties in breastfeeding initiation. Conclusion: It is recognised that behaviour interacts with emotions, perceived abilities and the environment, as in triadic reciprocal causation, which affects peoples’ decisions, experiences and abilities to enable the successful initiation of breastfeeding. Social Cognitive Theory could be used as a framework to develop strategies and materials to enhance women’s confidence both antenatally and in the postnatal period. In a minority of women, breastfeeding goes well and is more likely when the baby is an active participant and the midwife a knowledgeable and confident supporter. This is not the case for the majority of women and babies or their midwives. There is a need to consider strategies to develop appropriate skills and environmental changes that would in turn lead to changes in behaviour and successful interventions. More emphasis should be made clinically on facilitating instinctive behaviour. The current position where babies’ sleepy behaviour is considered normal in this particular environment could be challenged. Social Cognitive Theory could be utilised in research to develop strategies to increase women’s and midwives’ confidence specifically in initiation.

Det overordnede målet med denne avhandling var å få en oversikt over ulike forstyrrelser i de nedre urinveier hos gamle. Dernest var målet å beskrive oppfatninger og barrierer som influerte på personalets muligheter for å gi riktig inkontinenspleie til beboere i sykehjem. Avhandlingen består av en kvantitativ studie (artikkel I, II, III), og en kvalitativ studie (artikkel IV). Artikkel I var en tverrsnittstudie. Artikkel II og III var en prospektiv tidsdesignstudie med en oppfølgingsperiode på ett år. 183 beboere fra seks sykehjem deltok i den kvantitative studien. I artikkel I ble prevalensen av urininkontinens hos norske sykehjembeboere evaluert. I tillegg ble det forsøkt å identifisere faktorer som var assosiert med urininkontinens i denne populasjonen. I artikkel II ble det undersøkt om residualurin var en risiko for å utvikle urinveisinfeksjon hos gamle på sykehjem. I artikkel III ble det undersøkt om bleiebruk per døgn er en pålitelig metode for å kvantifisere urininkontinens hos sykehjemsbeboere. Det ble også studert om det var sammenheng mellom urinveisinfeksjon, bleiebruk per døgn og væskeinntak. I den kvalitative studien var målet å identifisere oppfatninger og barrierer som influerte på pleiernes muligheter for å gi riktig inkontinenspleie. Fem avdelingsledere, fem sykepleiere og fem hjelpepleiere ble intervjuet i til sammen tre fokusgruppeintervjuer.Analysen i artikkel I viste at 122 beboere (69 %) var inkontinent for urin og 144 (83 %) brukte bleier. 14 % brukte bleier for sikkerhets skyld. Lav ADL-skår, demens og urinveisinfeksjon var assosiert med urininkontinens (P = <0.01). I artikkel II hadde 98 beboere (63.3 %) residualurin mindre enn 100 ml, og 52 (34.7 %) hadde residualurin på 100 ml eller større. I løpet av oppfølgingsperioden hadde 51 beboere (34 %) utviklet en eller flere urinveisinfeksjoner. Forekomsten av urinveisinfeksjon var høyere hos kvinnene enn hos mennene (40.4 % versus 19.6 %; P = 0.02). Det ble ikke funnet noen signifikant forskjell i gjennomsnittlig residualurin mellom beboere som utviklet og som ikke utviklet urinveisinfeksjon (79 versus 97 ml, P = 0.26). Residualurin på 100 ml eller større var ikke assosiert med større risiko for utvikling av urinveisinfeksjon.I artikkel III brukte 118 (77 %) av beboerne bleier. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Beboere som brukte bleier hadde en økende risiko for å utvikle urinveisinfeksjon sammenlignet medvibeboere som ikke brukte bleier (41 versus 11 %; P = 0.001). Daglig væskeinntak var ikke assosiert med urinveisinfeksjoner (P = 0.46). Antall bleieskift viste ingen korrelasjon med risikoen for utvikling av urinveisinfeksjon (P = 0.62). Bleiene som beboerne brukte per døgn, viste stor variasjon i inkontinensvolum. I den kvalitative studien ledet innholdsanalysen fram til tre emner og åtte kategorier. Det første emnet, Oppfatninger og barrierer assosiert med beboerne, inneholdt en kategori ”fysiske og kognitive problemer”. Det andre emnet, Oppfatninger og barrierer assosiert med personalet, inneholdt tre kategorier: ”manglende kunnskaper”, ”holdninger og tro” og ”manglende tilgjengelighet”. Det tredje emnet, Oppfatninger og barrierer assosiert med den organisatoriske kulturen, inneholdt fire kategorier: ”rigide rutiner”, manglende ressurser”, ”manglede dokumentasjon” og ”svakt lederskap”. Resultatene i denne avhandlingen viser at forekomsten av urininkontinens i sykehjem er høy. Absorberende produkter er hyppig brukt uten en kjent historie av urininkontinens. Fysisk svekkelse, demens og urinveisinfeksjon er assosiert med urininkontinens. Residualurin er vanlig hos beboere i sykehjem. Det ble ikke funnet noen sammenheng mellom residualurin og urinveisinfeksjon. Bruk av absorberende bleier er assosiert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn og væskeinntak var ikke korrelert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Funnene fra den kvalitative studien viser at det er mange barrierer som influerer på personalets evne til å gi riktig inkontinenspleie til beboere i sykehjem. Det kan likevel se ut som om personalets oppfatninger og holdninger, samt manglende kunnskaper om urininkontinens, er de viktigste barrierene for å gi riktig inkontinenspleie. / The overall aim of this thesis was to get an overview over different dysfunction in the lower urinary tract in the elderly. Also, we wanted to describe the perceptions and barriers that influence the nursing staff`’s ability to provide appropriate incontinence care in nursing home residents. The thesis includes one quantitative study (paper I, II, III), and one qualitative study (paper IV). Paper I was a cross-sectional study. Paper II and III were a prospective surveillance with a follow-up period of 1 year. 183 residents from six Norwegian nursing homes participated. In paper I, the prevalence of urinary incontinence in Norwegian nursing home residents was evaluated. The factors possibly associated with urinary incontinence were also studied. In paper II, we investigated whether residual urine was a risk factor for developing urinary tract infections in the elderly in nursing homes. In paper III, the objective was to determine whether pads per day usage is a reliable measure of urinary incontinence in nursing home residents. Furthermore, we wanted to study the association between urinary tract infections, pads per day usage and fluid intake. In the qualitative study, the aim was to identify perceptions and barriers that influence the ability of nursing staff to provide appropriate incontinence care. Five charge nurses, five registered nurses and five certified nursing assistants participated in the focus group interviews.The analysis in paper I, showed that 122 (69 %) of the resident were incontinent for urine and 144 used absorbent pads (83 %). 14 % of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine (P = <0.01). In paper II, 93 of the residents (65.3 %) had postvoid residual urine (PVR) < 100 mL and 52 residents (34.7 %) had a PVR 100 mL. During the follow-up period, 51 residents (34.0 %) had one or more urinary tract infections (UTI). The prevalence of UTI among females was higher than among men (40.4 % versus. 19.6 %; P = 0.015). There was no significant difference in mean PVR among residents that did or did not develop UTI (79 mL versus 97mL; P = 0.26). A PVR 100 mL was not associated with an increased risk of developing UTI`s (P = 0.59).In paper III, 118 (77 %) used absorbent pads. Residents that used absorbent pads were at increased risk of developing UTIs compared to residents that did notviiiuse pads (41 % versus 11 %; P = 0.001). Daily fluid intake was not associated with UTIs (P = 0.46). The number of pad shifts had no relation with the risk of developing UTIs (P = 0.62). Residents with a given pad per day (PPD) presented a wide range of incontinence volumes.In paper IV, three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: ‘physical and cognitive problems’. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: ‘lack of knowledge’, ‘attitudes and beliefs’ and ‘lack of accessibility’. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: ‘rigid routines’, ‘lack of resource’, ‘lack of documentation’ and ‘lack of leadership’.The results of the thesis show that the prevalence of urinary incontinence in nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are associated with urinary incontinence. is common in nursing home residents. No association between PVR and UTI was found. The use of absorbent pads is associated with an increased risk of developing UTIs. PPD and daily fluid intake are not correlated with the risk of developing UTIs. PPD is an unreliable measure of urinary incontinence in nursing home residents. The findings from the qualitative study shows that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about urinary incontince, are the most important barriers to provide appropriate incontinence care.