Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 80-89). Also available on the Internet.

Thesis (M.S.)--University of Michigan, 1995.

Thesis (M.S.)--University of Michigan, 1994.

Thesis (M.S.)--University of Michigan, 1994.

The aims of this thesis are to investigate the factors influencing treatment fidelity of health behaviour change (HBC) interventions. The thesis will focus on HBC interventions delivered by practice nurses (PNs) and health care assistants (HCAs) to patients within general practice, although the findings will be explored within the context of the wider treatment fidelity literature. The thesis comprises five studies, focussed on exploring, enhancing and assessing fidelity of delivery and receipt of HBC interventions. Through developing an enhanced understanding of these areas of treatment fidelity, the thesis will also make recommendations for strategies to enhance and assess fidelity of delivery and receipt of future HBC interventions. Study one is a meta-synthesis of qualitative studies that explored the views and experiences of nurses who had delivered HBC interventions with a focus on how this can inform future delivery of HBC interventions. Study two is an Interpretative Phenomenological Analysis of PNs’/HCAs’ experiences of helping patients to change their health behaviours within the context of their routine care, and before and after delivery of an intervention to facilitate increased walking. Study three reports a quantitative assessment of delivery of intervention techniques to facilitate increased walking, as specified in an intervention protocol, by PNs/HCAs. Study four explores PNs’/HCAs’ views and experiences of the factors that influenced their delivery of the walking intervention. Study five investigates treatment receipt, by exploring patients’ understanding of, and experiences of receiving the walking intervention. The key findings from this research are that delivery and receipt of HBC interventions within general practice are influenced by a range of factors that include the providers’ confidence and skills, the patients’ expectations and/or engagement with the intervention and the general practice within which the intervention is delivered. A number of these factors are difficult to influence and so research teams need to develop a range of strategies to enhance delivery and receipt of HBC interventions. These may include appropriate preparation for providers to deliver the intervention, the provision of a simple intervention resource to support delivery of the intervention and the development of strategies to enhance patients’ understanding of intervention techniques.

published_or_final_version / Community Medicine / Master / Master of Public Health

This descriptive, correlational designed study was concerned with noncompliance with therapeutic regimens, a pervasive clinical problem which is confounded with the lack of a strong link among theory, research and practice. The focus was on one of the constructs included the Reciprocal Interaction Model of Compliance Behaviors, which was derived using a modified grounded theory methodology and following various theory building prescriptions. The overall purpose was to begin to evaluate the goodness-of-fit of this empirically, qualitatively and retroductively generated explanation of compliance behaviors. The specific aims were to develop, refine and test a 6-point response, 64-item Likert-type instrument, Olivas' Health Motivation Scale - OHMS, that adequately measures the construct, Health Motivation: the force within the patient which is developed as he/she gains experience with his/her illness as a function of time. It has two major dimensions: expectations and values. Health Motivation as indexed by an expectations/values interaction was predicted to impact compliance as measured by dietary and medication measures, both objective and subjective estimates. Using trait and nomological construct perspectives, the OHMS was systematically evaluated by internal and external association criteria and therefore validity and reliability estimates, with a purposive sample of 84 heterogeneous hemodialysis patients who represented two cultures (Anglo and Hispanic), varying in gender, age and length in hemodialysis. Internal consistency reliability and trait construct validity were derived through Cronbach's alpha and principal components factor analysis. Refined OHMS Scales had alphas and thetas ranging from .58 to .89. Explained scale variance ranged from .54 to .84. Epistemic coefficients, the validity links between concept and operational measures, ranged from .76 to .94. Internal validity of the design, estimated through multiple regression, was concluded to be satisfactory. External association assessment via multiple regression produced mixed findings. Select expectations, in linear combination with select values, explained varying degrees of the variance, in select compliance measures, R² = .11 to .44. Through empirical modeling via path analysis, select subject characteristics (ethnicity, length on dialysis, age) were found to have direct or indirect relationships with compliance. Theory, research, and practice based limitations and recommendations were made from the results of the study. (Abstract shortened with permission of author.)

Despite the fast-growing evidence of the importance of the psychosocial work environment for the health of adults there is a lack of research about the possible health effects of the work environment among pupils, that is, their school environment. This is especially true for the psychosocial aspects of the pupils' school situation. The overall aim of this thesis was to analyse the importance of the psychosocial school environment for the health of pupils in Swedish compulsory school from a gender perspective. Both quantitative and qualitative methods were used. A cluster sampling technique was used in order to select six different schools in three medium- sized industrial towns in the north of Sweden. The schools were chosen to represent different socio-economic areas. A three-year prospective study was started in 1994, including a cohort of 533 pupils (261 girls, 272 boys) in grade three and grade six. With age-adjusted questionnaires self-perceived health and psychosocial school environmental factors were measured at the baseline study as well as three years later. The total non-response rate was 0.9%. For the qualitative study, two classes (one from grade 2 and one from 5) were selected and followed with focus group interviews once a year for five years. Twenty-nine single-sex focus group interviews were conducted with themes such as: What they feel good and bad about at school; Strategies for enhanced well-being; What it means to have influence at school. High control in combination with low demands in the school situation was associated with the best health and feelings of self-worth. Multiple regression analyses showed that problems in relations with classmates was the most recurrent psychosocial factor at school pardy explaining ill health development and decreased self-worth. Girls had a more negative ill health development than boys between grades six and nine. A study of factors associated with ill health in grade nine showed that sexual harassment among girls and lack of classmate support among both boys and girls were significant risk factors for a high degree of psychological symptoms. Generally, social background factors were less important for pupils' health in this study than the psychosocial environment at school. The best predictors for health behaviour among boys and girls in grade nine were factors related to earlier health/health behaviour. The results also indicated that school-related factors could predict future health behaviour, especially in relation to low physical activity among girls. The qualitative study showed that the girls used 'alliance-building' and 'resistance', in order to increase their power, while 'responsibility-taking' and 'withdrawal' could mean maintained subordination. The boys used mastering techniques (various types of abuse, claiming to be the norm, acting-out behavior, blaming the girls, choosing boys only) to maintain their dominance. The girls' active actions for increased power could be of significant importance for their health. An interpretation of the boys' mastering techniques was that the boys' health would benefit if they gave up striving for power over others. Thus, the psychosocial school environment in regard of demand, control, classmate relations and sexual harassment seemed to matter for pupil's health. School health promotion need to be more gender sensitive, through increasing the awareness of the gender regimes at school and addressing the asymmetric and gendered distribution of power between pupils. Democratic strategies for increased power among pupils in subordinate positions should be encouraged and methods need to be developed in order to encourage health promoting femininities and masculinities at school. / <p>Härtill 5 uppsatser</p> / digitalisering@umu

The purpose of this study was to examine the relationship between health promotion and quality of life in noninstitutionalized older adults. The study was conducted within the framework of Nola Pender's Health Promotion Model.Approval for this study was obtained from the Institutional Review Board of Ball State University for human protection of the participants. Permission from the five churches' boards was obtained. Written assurance of anonymity of subjects was given.This study was descriptive and correlational. Quality oflife was the dependent variable and the independent variables were health promoting behaviors, importance of health, perceived health status, the number of chronic health conditions and any consequent disruption to life, prior involvement in a senior citizens' wellness group or with a health advisor, and demographic variables including age, gender, marital status, living alone or with a companion or family, and education. Volunteer subjects aged 65 and older from five church groups were asked to complete the following questionnaires: Health Promoting Lifestyle Profile, Quality of Life Index, Value Survey, and a demographic sheet. The demographic questionnaire included an item regarding self-perceived health status, whether or not the participant had been involved in a wellness group or with a health advisor for older adults, and a checklist of chronic health conditions and whether or not these had had debilitating consequences for the participant.Hypotheses included the following: (1) There is no correlation between health promoting behavior and quality of life among older adults. (2) There is no correlation between importance of health and quality of life among older adults. (3) There is no correlation between perceived health status and quality of life among older adults. (4) There is no correlation between the number of chronic health conditions and quality of life among older adults. (5) There is no correlation between disruption brought about by chronic health conditions and quality of life among older adults. (6) There is no significant difference between those older adults who had participated in a senior citizens' wellness group or with a health advisor and those who had not. (7) There are no significant differences in older adult males and females and those who live alone or with family or a companion regarding quality of life. (8) There is no correlation between age and quality of life among older adults. (9) There is no correlation between number of years of education and quality of life among older adults.Statistical significance was found between Quality of Life Index and Health Promoting Lifestyle Profile scores (r=0.24, p<0.05) and Quality of Life Index and self-perceived health status scores (r=0.33, p<0.01). Other correlations, t-test, and analyis of variance did not achieve statistical significance. / School of Nursing

The relationship between an individual's level of spirituality, health locus of control, and participating in wellness activity was investigated. The relationship between spirituality, health locus of control on physical health was also investigated. The research question was based on prior studies that reported people who are more spiritual are healthier. Does their spirituality lead to increased levels of health, or are individual's who are more spiritual more likely to proactively take control of their health and engage in health promoting behaviors? One hundred and fifteen male and female employees completed The Spiritual Involvement and Beliefs Scale (SIBS), a spirituality measure, The Multidimensional Health Locus of Control Scale, a measure of locus of control related to health and healthcare, and The Center for Disease Control's (CDC) Health Risk Appraisal, a self-report measure of participation in health behaviors. Physical measures of health were obtained by obtaining Body Mass Index, blood pressure readings, and a cholesterol screening. The current study looked at level of spirituality (internal, external), level of health locus of control (internal, powerful other, chance) and participation in wellness/health promoting behaviors and health. Correlational analyses were performed on the relationship between spirituality and health locus of control. Hierarchical multiple regressions were performed on the internal spirituality and internal health locus of control to examine the relationship between spirituality, health locus of control and positive health behaviors and level of physical health. Stepwise discriminant function analysis using spirituality and health locus of control as predictor variables for the health-behavior criterion variables were performed. Discussion of the results, limitations of the current study and recommendations for future research were presented.