Recently, researchers have begun to examine the impact of attachment on coping with a medical illness. It is hypothesised that a patient's responses to unusual or distressing physical symptoms and participation in the patient-clinician relationship can be understood by examining the nature of their attachments. Theoretical links between attachment style and affect regulation suggest that ‘internal working models’ developed in childhood may have implications, not only for the quality of close relationships, such as romantic love, but also for other significant interactions. In the domain of physical illness, patient-clinician interactions represent such a significant relationship. It is proposed that the attachment behaviour of the patient to the clinician in the context of chronic medical illness may impact on medical illness behaviour and illness outcome. This clinical portfolio reviews the literature on attachment theory, health behaviour and the implications of the patient-clinician relationship in the context of a chronic medical illness. Four case studies of different types of chronic medical illness were examined in relation to attachment theory. The cases included: Jenny, a 10 year-old girl with polycystic kidney disease; Angela, a 13 year-old girl with recurrent urinary tract infections; Aarron, a 36 year-old man with Human Immunodeficiency Virus; and Andrew, a 49 year-old man with multiple medical illnesses. It was concluded that attachment theory is a useful conceptual framework for informing clinical formulation and explaining the patient-clinician interaction among individuals with a chronic medical illness.

Introduction: This study explored the health behaviour of older adults with COPD. Objectives included: 1) to explore the process of successfully managing COPD; 2) to identify health behaviour strategies utilized; 3) to identify factors influencing health behaviour change; 4) to understand the impact of pulmonary rehabilitation (PR). Methods: Eleven community-dwelling older adults were interviewed following PR. Interviews were coded and analyzed using constant comparative analysis, comparing and contrasting incoming data with emerging theory. Findings: Two distinct models were developed representing participants’ experience with COPD and health behaviour change: Struggling with Living: Life with COPD before Pulmonary Rehabilitation; and Carrying on with Living: Life with COPD following Pulmonary Rehabilitation. Conclusions: Older adults with COPD engaged in a limited repertoire of health behaviour strategies which were relatively ineffectual prior to participation in PR. PR had a major impact on health behaviour strategies, and on the external and personal factors influencing health behaviour.

Introduction: This study explored the health behaviour of older adults with COPD. Objectives included: 1) to explore the process of successfully managing COPD; 2) to identify health behaviour strategies utilized; 3) to identify factors influencing health behaviour change; 4) to understand the impact of pulmonary rehabilitation (PR). Methods: Eleven community-dwelling older adults were interviewed following PR. Interviews were coded and analyzed using constant comparative analysis, comparing and contrasting incoming data with emerging theory. Findings: Two distinct models were developed representing participants’ experience with COPD and health behaviour change: Struggling with Living: Life with COPD before Pulmonary Rehabilitation; and Carrying on with Living: Life with COPD following Pulmonary Rehabilitation. Conclusions: Older adults with COPD engaged in a limited repertoire of health behaviour strategies which were relatively ineffectual prior to participation in PR. PR had a major impact on health behaviour strategies, and on the external and personal factors influencing health behaviour.

Die Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS) enthüllen Unterschiede im Gesundheitsstatus und Gesundheitsverhalten in Deutschland je nach Einkommen, Bildungsstand und Berufswahl der Kinder und Jugendlichen selbst bzw. von deren Eltern. Besonders stark ausgeprägt sind die sozialen Unterschiede im Hinblick auf den allgemeinen Gesundheitszustand, psychische und Verhaltensauffälligkeiten sowie Übergewicht. Auch in allen anderen europäischen Staaten kumulieren Mortalität, Morbidität und verhaltensbedingte Risikofaktoren in den unteren sozioökonomischen Statusgruppen. In Europa differiert die Lebenserwartung bei Männern in höheren und niedrigeren sozialen Positionen durchschnittlich um fünf Jahre. Die Entwicklung von Strategien zur Bekämpfung sozialer Ungleichheiten in der Gesundheit ist eine der größten Herausforderungen unserer heutigen Gesellschaft. / The national representative survey on the health of children and adolescents in Germany (KiGGS) revealed social inequalities in health and health behaviour in Germany according to income, education and occupation of both the children and adolescents themselves and their parents. Social inequalities in general health status, psychological or behavioural disorders, and overweight seem to be most alarming. Mortality, morbidity and detrimental health behaviour accumulate in the subpopulation with a low socioeconomic position (SEP) across Europe. The average difference in life expectancy in European men with a high and low SEP is 5 years. The development of policies and strategies to tackle this important public health issue is a major present and future challenge.

Changes in breastfeeding practices have been accompanied by profound changes in the daily context within which women make infant-feeding decisions. The availability and promotion of breast milk alternatives, the transmission of breastfeeding knowledge and skills, and the individual and societal value placed on breastfeeding and breast milk are all issues that need to be considered. In this seminar, Aleck will provide a brief history of breastfeeding trends and policies. He will suggest that a historical understanding of the relationship between socio-cultural trends and breastfeeding patterns is essential to informing current policy development and advocacy in the area of infant feeding. Finally, he will examine the context of policy development in the twenty-first century, including the possible challenges presented by international free trade agreements, questions about federal/provincial responsibility for breastfeeding promotion, the relationship between women’s productive and reproductive work, and the need to redefine breastfeeding success at a policy level.

Busy families of Nova Scotia and similar populations find it challenging to make healthy nutrition and exercise choices due to time constraints (Chircop et al, under review; Jabs et al, 2007; Devine et al, 2006). Smartphone application technology can provide health behavior change interventions in a mobile and fast format (Breton, Bernard, Fuemmeler, Lorien & Abroms, 2011). Using focus groups, this research addressed parent’s perceptions on how smartphone application technology can support nutrition and physical activity habits within their family and what, if any, barriers exist in adopting this form of health behavior intervention. Findings revealed this population believes smartphone health applications can improve family nutrition and physical activity as long as barriers are minimized and requirements for adoption are met. Diffusion of Innovations theory was used to understand the adoption rate within the target population. Thoughts on future work efforts for related health behaviour interventions is discussed.

Patient safety strategies have traditionally involved the promotion of provider-oriented practices aimed at reducing known risks associated with surgery, infection, and continuity of care. With the knowledge that patient safety incidents can significantly impact patients, providers, and health care organizations, greater emphasis on patient involvement as a means to mitigate risks warrants further research. The primary objective of this research was to determine the relationship between perceptions of patient safety and the likelihood of patient involvement in both factual and challenging patient safety practices. This mixed methods study was conducted at two tertiary hospital sites located in Atlantic Canada between February 2011 and January 2012. The study design was the sequential explanatory model of mixed methods design, integrating both quantitative survey methods and qualitative focus group methods for both patient and provider participants. Survey data were analyzed using descriptive statistics and partial least squares (PLS) analysis. Focus group sessions were transcribed and analyzed using thematic analysis. The development and analysis of this research was guided by the Health Belief Model. Overall, patients were more willing to engage in factual patient safety practices (e.g., asking questions of their doctors) than challenging patient safety practices (e.g., asking a provider if they have washed their hands). The patient PLS analysis revealed relationships between patient perceptions of threat and self-efficacy and the performance of factual and challenging patient safety practices, explaining 46% and 42% of the variance, respectively. The provider PLS model found that perceptions of safety culture accounted for 34% of the variance in perceptions of threat and 42% of the variance in perceptions of barriers versus benefits. Thematic analysis resulted in the identification of four major themes for both patient and providers related to the phenomenon of patient involvement. Quantitative and qualitative results were complementary in nature. Perceptions of patient safety were shown to influence both patient and provider likelihood in engaging in selected patient safety practices. Greater understanding of the roles that perceptions play in patient involvement in their care may help to improve the safety and quality of care delivered.

Motivational Interviewing (MI) is a person-centred and collaborative form of guiding individuals to elicit and strengthen their motivation for change. It has achieved success in the treatment of substance disorders, and has shown promise in several other areas of interest, such as behaviour management in chronic illness. The process through which MI exerts its influence on outcome however, is still in its infancy. This research set out to explore the nature of Type 1 and Type 2 diabetes patients‟ utterances in Motivational Enhancement Therapy (MET) sessions (Change Talk), and the associations between their Change Talk and diabetes outcome (clinically significant change in blood glucose levels). Data for this study was taken from a multiple baseline designed study in a diabetes clinic in Christchurch (Britt, 2008). Nine patients who were referred to the clinic for help with their diabetes self-management were administered MET by Diabetes Nurse Educators (DNEs) which comprised four sessions over a six week period. In the current study participants were divided into those who did (BG Change participants; n = 4) or those who did not (BG No Change participants; n = 5) achieve a clinically significant change in their blood glucose levels (HbA1c) post intervention. All client utterances from the 36 transcripts were coded with the Motivational Interviewing Skills Code, version 2.0 (MISC, 2.0), and data analysed accordingly. This is a unique study in that it investigated both the mean frequency and strength of Change Talk in the different participant sets, as well as their patterns of Change Talk within and across sessions. Trends and directions in data suggest support for parts of the theory of the inner workings of MI. In particular, the BG Change participants uttered stronger Desire Language, a higher frequency of Commitment language, and weaker Ability language than the BG No Change participants. In addition, a general increasing pattern of strength across and within sessions, and frequency across sessions was found for the BG Change participants, while a similar pattern was found for the BG No Change participants regarding strength, but not frequency. The role of Sustain Talk strength and its relationship to the findings is highlighted. Implications of findings, as well as limitations of the current research and suggestions for future areas of research are discussed.

Background: The majority of adults in the UK are overweight or obese, and many embark on weight loss attempts, often without professional support. This dissertation set out to hone in on the cognitive and behavioural strategies used by adults with overweight and obesity attempting to lose weight, particularly in self-guided attempts, and to test the relationship between use of these strategies and weight loss success. Methods: A new taxonomy and questionnaire were developed to provide a framework to identify the cognitive and behavioural strategies used by individuals during weight loss attempts. The taxonomy was used in a systematic review and meta-analysis of self-help interventions for weight loss and in a systematic review of qualitative studies of self-directed weight loss. The questionnaire was used in an observational cohort study in adults with overweight and obesity trying to lose weight. Results: The taxonomy and questionnaire consist of 117 strategies. The qualitative review illuminated a range of attitudes and beliefs towards these strategies and highlighted the centrality of interpretation of self-monitored data. The quantitative review found that self-help interventions led to greater weight loss than unsupported attempts to lose weight at six months. In the cohort study, despite heterogeneity in the strategies employed, coherent patterns of behaviours emerged for individual participants. Strategies related to motivational support, dietary impulse control, and weight loss planning and monitoring were associated with greater weight loss. Conclusion: This dissertation demonstrates that self-help interventions can lead to significant weight loss and provides results to guide the content of such interventions. It maps out a previously uncharted area and provides a set of tools for further research and intervention development.

Following the exposure of abuse of people with Intellectual Disabilities (ID) at Winterbourne View, the Government launched the Transforming Care programme, to support people to transition out of hospital into their own home. A literature review revealed limited research into people with IDs experiences of transitioning. The study aimed to explore how transitions through Transforming Care were experienced. Eleven people with ID were interviewed about their experiences, with ten nominating a Key Support Person to be interviewed alongside them on a second occasion. Interviews were analysed using a Social Constructionist Grounded Theory methodology. The model demonstrated that participants experienced transitioning as a highly complex process of managing change. In hospital, how participants were seen by significant others and how they saw themselves resulted in a 'restricted story'. In moving to the community, participants and those around them were able to shift ideas about who they were, allowing for a 'widening out' of their story. Participants discussed seeking a sense of safety in new relationships, managing loss, and going through uncertainty as part of the process of transitioning. The findings of this study demonstrate that transitioning is not a single event, but an ongoing process over time. Clinical implications include ensuring that people with ID feel prepared about their move and the importance of staff understanding peoples' behaviours within a wider context.