A thesis submitted in partial fulfillment of a PhD in Community Psychology at the University of Zululand, South Africa, 2012. / Ongoing global crises impact negatively on human health. International comparison studies may improve health promotion. A community psychology, appreciative inquiry was conducted into local staff perceptions of selected child and adolescent mental health interventions in the Kent and Zululand regions of the United Kingdom and South Africa respectively. The Kent findings, supported by a quasi-experimental investigation, indicated that intervention was beneficial, the mental health practitioner role had value and additional mental health practitioners should be employed. The Zululand findings, complemented by a single client case study, suggested that intervention provided a valuable people focused programme, and that additional emphasis should be placed on promoting the intervention, its structure and staffing. Evaluative comparisons thus illustrated the differential effectiveness of the respective interventions. The Kent service could learn from the way in which the Zululand intervention was people orientated and the Zululand programme could learn from the way in which the Kent intervention was structured and organized. Findings highlighted the ongoing need to evaluate existing models of community psychology, create new models, and the temporal and contextual nature of any such models.

Ecological interventions hold promise for meeting the needs of post-disaster communities, yet little systematic quantitative evidence is available about such programs. This study evaluated the short-term outcomes of participants in the Strategies for Trauma Awareness and Resilience (STAR) program, a novel and exemplar ecological intervention for helpers working in post-disaster settings. It is a one week training and support program for helpers working in disaster-affected communities. Changes in the psychological distress of 42 STAR participants, across four STAR sessions, were assessed and identified as primary outcome variables. Knowledge, attitude, and intended practice changes were also assessed, along with perceived support, using a pre (T1)/post (T2) design. These indicators were then tested as possible predictors of participants' changes in distress. An integrity check was conducted on a sample of the seminar modules to assess fidelity to the program manual. Qualitative data were also gathered from follow up visits conducted with two participants. These data were used to help interpret quantitative findings, as well as to plan for future studies of how STAR effects might extend out from helpers into their home communities. Results showed that participants exhibited significant changes in knowledge, attitudes, and intended practices from the beginning of the seminar to the end. Results also showed significant decreases in psychological distress over the STAR week. Regression analyses showed that changes in knowledge, attitudes, and practice, as well as perceived social support during the seminar, explained significant amounts of variance in self reported trauma symptoms at T2. Variance in T2 burnout and compassion fatigue explained by these predictors was notable but not statistically significant due to lack of power. Results suggest that STAR can change knowledge and attitudes of helpers from disaster communities and that participants in this program experience decreases in distress during their stay. The lack of a valid comparison group makes causal interpretations of these findings premature. Findings also suggest that changes in distress are not caused by, or even significantly related to, learning that takes place during the STAR week. The mechanism for distress reduction during the STAR week is an unresolved question. Other significant unresolved questions remain regarding the STAR intervention and ways the present findings can be generalized to ecological interventions more broadly. For example, while the current study suggests important changes occur in helpers during the STAR week, it is of central importance to explore how these changes translate into the disaster-affected home communities. Discussion also focuses on the difficulties involved in conducting systematic research with organizations and helpers whose primary goals are practical or clinical, not scientific. Despite the questions that remain, taken together, results point to the promise of STAR to address the mental health needs of helpers and perhaps eventually disaster communities. / Ph. D.

BACKGROUND:Over the past two decades, international health policies focusing on the fight against the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), malaria, and those diseases that address maternal and child health problems, among others, have skewed disease control priorities in China and other Asian countries. Although these are important health problems, an epidemic of chronic, non-communicable diseases (NCDs) in China has accounted for a much greater burden of disease due to the ongoing rapid socioeconomic and demographic transition.DISCUSSION:Although NCDs currently account for more than 80% of the overall disease burden in China, they remain very low on the nation's disease control priorities, attracting marginal investment from central and local governments. This leaves the majority of patients with chronic conditions without effective treatment. International organizations and national governments have recognized the devastating social and economic consequences caused by NCDs in low- and middle-income countries, including China. Yet, few donor-funded projects that address NCDs have been implemented in these countries over the past decade. Due to a lack of strong support from international organizations and national governments for fighting against NCDs, affected persons in China, especially the poor and those who live in rural and less developed regions, continue to have limited access to the needed care. Costs associated with frequent health facility visits and regular treatment have become a major factor in medical impoverishment in China. This article argues that although China's ongoing health system reform would provide a unique opportunity to tackle current public health problems, it may not be sufficient to address the emerging threat of NCDs unless targeted steps are taken to assure that adequate financial and human resources are mapped for effective control and management of NCDs in the country.SUMMARY:The Chinese government needs to develop a domestically-driven and evidence-based disease control policy and funding priorities that respond appropriately to the country's current epidemiological transition, and rapid sociodemographic and lifestyle changes.

Regular physical activity is associated with improved physiological and psychological wellbeing, by reducing the risk of chronic illnesses such as cardiovascular disease, cancer, obesity, diabetes, osteoporosis and depression. There is a common perception that physical activity levels in the population are declining, and one of the biggest changes affecting this is occupational based activity. Since adults spend on average over 50% of their waking hours at work, work sites have the potential to be an important setting for health promotion initiatives. Cognitions and behaviours are key causal factors behind many of today s most widespread health problems and illnesses. The stage of change model has been highlighted as having intuitive appeal because it considers the dynamic nature of attitudes and behaviour change. This thesis is concerned with the application of the stage of change model to an occupational health intervention promoting physical activity. Several research studies were undertaken to explore the experiences of employees with workplace health initiatives and investigate the strategies and practices used by occupational health to promote healthy behaviours. These research studies highlighted the barriers and facilitators to successful health interventions and contributed towards the design, development and implementation of an activity promotion intervention. Additional research was also conducted to develop information materials based on the stage of change model. The stage approach was simplified and intervention materials were classified based on whether employees were thinking about making a change or not thinking about making a change to their activity levels. In order to test the materials, a twelve month intervention was implemented in ten work sites across the UK that were allocated to one of three groups. Two groups received information materials and one group received no information during the intervention period (control group). The difference between the two groups who received information was that one group received standard activity promotion information (standard group) and the second group received tailored information based on their stage of change construct (staged group). Participants in the staged intervention group demonstrated significant decreases in body mass index, fat percentage, waist circumference, blood pressure and resting heart rate following the twelve month intervention. In contrast, reductions were identified for the standard intervention group for waist circumference and diastolic blood pressure. Finally, there were no long-term significant improvements identified for the control group. However, group comparisons revealed there were no significant differences between the intervention conditions. The intervention also recorded self-reported psychological outcomes, which demonstrated variations throughout the intervention period for all groups. The potential reasons for these inconsistent outcomes are discussed. A process evaluation following the intervention demonstrated employees valued the health screenings and identified issues relating to knowledge, behaviour change and health implications that were important outputs of the intervention. Based on these findings, the research concludes there is scope to make physical activity interventions in the workplace more effective by applying the stage of change approach. Using the process of simplifying the stages and focusing on whether employees want to change their behaviours or not allows occupational health to deliver information that could be more meaningful and have a significant impact on behaviour change. By understanding employees readiness to change their activity behaviours and targeting information based on their beliefs, attitudes and intentions to change may produce significant improvements in health outcome measures compared to standard information. The results also suggest there is potential for this type of tailored intervention to be extended to other occupational health issues.

The prevalence and incidence of breast cancer is an important issue that is affecting all women, but African American women have the lowest survival rates after breast cancer diagnosis. Historically, the Black church and faith leaders have been essential in promoting health in the African American community. Moreover, faith-based interventions have become more common within the African American community in addressing factors that affect survival rates such as early detection, cultural barriers, and education. Currently, there is not clear information on the perspectives faith leaders have on their experiences with implementing breast health interventions in their places of worship. This phenomenological study used interpretivism as the conceptual framework to understand the experiences of the faith leaders of African American congregations who participated in Worship in Pink, a faith-based breast health program implemented among congregations in metropolitan Atlanta. The research questions sought to answer what faith leaders' experiences were with participating in this intervention and what situations or contexts may have influenced their experiences. In depth, semistructured interviews were administered to a sample of 5 faith leaders who participated in Worship in Pink. There were 3 themes and 1 subtheme that emerged because of the study. The themes included partnership with Komen Atlanta, increased awareness, impact on the community, and resources. The positive social change implications include knowledge useful for faith leaders, program developers, health policy makers, health educators, and other researchers who are seeking to understand experiences of faith leaders in order to improve breast health and awareness of African American women.

In lifetime risk for Human Immunodeficiency Virus (HIV), Black men who have sex with men (BMSM) are at the greatest risk of all demographic groups. Creative modes of engagement have been established to reach this group in prevention efforts, including prevention programming in community-based organizations such as churches. Church-based HIV prevention is an emerging area of research and existing studies fall into one of three categories: BMSM’s perspectives on church and church-based HIV prevention, church leaders’ and members’ perspectives on HIV prevention in their congregations, and reported outcomes of HIV prevention interventions that have been conducted in church settings. Given the paucity of research in this area, a scoping analysis was conducted to survey the existing studies in order to identify overarching themes and gaps for future research efforts. In a review of the research, facilitators and barriers to successful implementation of HIV programming in churches emerged. Prominent barriers were stigmatizing sermons given in church and pastoral denial that HIV is a relevant issue to the Black community. Facilitators reported commonly were BMSM’s comfort found in faith and a pastor’s blessing of HIV prevention efforts in churches. Interventions primarily reported lessons learned in implementation of church-based HIV programs. A frequently reported lesson learned was the importance of close collaboration with participant churches to develop program curricula that were effectively couched within church doctrine, and that would be received well by church members. Some interventions also measured intervention efficacy outcomes, one of which showed a statistically significant decrease in HIV stigma post-intervention. This research has important implications for the effective development, implementation, and reporting of outcomes for future, church-based HIV interventions. As research in HIV prevention in the church continues to develop, it may be able to serve as a template for other community-based HIV prevention efforts and open doors for inclusion of other high risk groups such as injection drug users and sex workers.

No description available.

En la actualidad, la medicina no puede entenderse sin el apoyo de la tecnología. Las nuevas tecnologías forman parte del día a día de los profesionales de la salud y, cada vez más, de los usuarios de servicios médicos. Los avances en las tecnologías de la información y la comunicación (TICS) permiten una mayor interacción del personal médico con sus pacientes. El término e-Health se refiere a la aplicación de las TICS en el sector sanitario. Éstas permiten un fácil acceso a la información sobre salud, la posibilidad de interaccionar con otros pacientes y formar grupos de apoyo, la comunicación con profesionales de la salud y la utilización como herramienta en el seguimiento de patologías crónicas. El cáncer de mama es el tumor maligno femenino más frecuente. En España, una de cada ocho mujeres padecerá cáncer de mama en algún momento de su vida. Además, es una de las enfermedades más mediáticas y conocidas, con campañas de difusión sobre la prevención y el tratamiento del cáncer de mama en los distintos medios de comunicación. Todo esto lo convierte en un problema socio-sanitario importante. La fase diagnóstica de una lesión mamaria puede llegar a durar varias semanas, lo que influye en el bienestar psicológico de las mujeres que esperan el resultado definitivo de sus pruebas. La falta de información sobre los distintos pasos a seguir y el motivo de realización de los mismos aumentan la ansiedad en las pacientes, que tratan de indagar sobre su enfermedad por otros medios, siendo Internet la herramienta más utilizada en los últimos años. El objetivo principal de nuestro estudio es comprobar si la información y el seguimiento conjunto durante el proceso diagnóstico disminuye el nivel de ansiedad en mujeres con una lesión mamaria sospechosa. Para ello hemos creado una aplicación web con acceso personalizado, donde se dará información detallada de la patología de la paciente y de los distintos procesos diagnósticos que precisa cada una de forma individual. Como base del proyecto hemos desarrollado un proceso utilizando Bussines Process Management Notation (BPMN) con la aplicación BonitaBPM Community, que describe todas las fases del diagnóstico de una lesión mamaria y las distintas intervenciones de las partes implicadas para que la información se integre de manera eficaz a través de la web específicamente diseñada para nuestro proyecto. Diseñamos una aplicación web Isencilla, llamada “BreasTrack”, con acceso identificado personal, bilingüe (español/inglés), que incluye información general sobre patología mamaria, así como la información específica del proceso diagnóstico individual de cada paciente. Debido a una serie de problemas técnicos y de mantenimiento, finalmente utilizamos para este estudio una versión adaptada de “BreasTrack” a través de la plataforma MOODLE. La población elegida para la investigación son mujeres pertenecientes al Hospital de Torrevieja que presenten una lesión mamaria sospechosa que precisa la realización de una biopsia para su confirmación diagnóstica. Dividimos a las mujeres en dos grupos: un grupo control, que sólo debe completar el test de ansiedad de Spielberg (STAI) al inicio y al final del proceso diagnóstico, y un grupo de estudio, que además realizará el seguimiento de su proceso a través de la web. En una primera fase del estudio, analizamos y comparamos los niveles de ansiedad de cada grupo y las características socio-demográficas de las pacientes que presentan mayor nivel de ansiedad y en qué momento del proceso diagnóstico es más elevada. Por otra parte, evaluamos la usabilidad de nuestra aplicación web, tanto desde el punto de vista de las usuarias como de otros profesionales de la salud. Presentamos los resultados de una prueba de concepto con 29 participantes, 14 en el grupo web y 15 en el grupo control. La edad media de las pacientes fue de 59 años (36-75). La duración de la fase diagnóstica fue de 15,4 días (7-34). En global, todas las mujeres presentan un elevado nivel de ansiedad al inicio del proceso diagnóstico (72,17±4,34), que llega casi a normalizarse en el test final (56,24±4,34). No hay diferencias significativas entre el grupo web y el control, aunque el descenso en el nivel de ansiedad final es más importante en las mujeres que utilizaron la web, de un 78,57±6,25 en el test inicial hasta un 58,57±6,25 en el STAI final. Las participantes que presentaron el mayor nivel de ansiedad inicial en función de los factores socio-demográficos estudiados fueron: las mujeres menores de 45 años (92,16±9,55), las españolas por encima del resto de europeas (79,08±6,75), las viudas (93,5±16,53) y las separadas (74,66±13,5), las mujeres sin estudios (93,5±16,53), las mujeres con hijos (74,65±4,87) y las que practican algún deporte o técnica de relajación (74,2±5,23). Pocas diferencias en relación con el apoyo social o los antecedentes de cáncer de mama. En cuanto al tipo de tumor diagnosticado, las mujeres más ansiosas fueron el grupo de resultado benigno, pero de potencial maligno incierto, tanto al inicio (82±10,46) como al final del período diagnóstico (74,2±10,46). Entre las mujeres que utilizaron la web, la disminución de la ansiedad al final del proceso fue más evidente en mujeres de edad media (52,38±8,27), europeas (55,28±8,84), mujeres con estudios superiores (44±11,69), casadas (58,55±7,79), con apoyo social (52,28±6,75), sin antecedentes oncológicos (51±8,84) y las que practican deporte o técnicas de relajación (49,63±7,05). En comparación con el grupo control, no hubo grandes diferencias en ninguno de los factores estudiados, ya que en este grupo el nivel de ansiedad final también se mantiene o disminuye en muchos de los subgrupos, aunque en menor medida que en el grupo web. A pesar de estos resultados, la mayoría de las mujeres consideraron la web muy útil (57,14%) o útil (21,43%) durante la fase diagnóstica de una lesión mamaria. La valoración de la usabilidad por parte de profesionales de la salud concluye que “BreasTrack” es una aplicación w página web sencilla, intuitiva y útil, que cubre las necesidades del usuario. La adaptación en MOODLE no fue considerada tan fácil de utilizar al principio ni tan intuitiva, aunque si útil para las pacientes. Desde un punto de vista técnico se consultó con ingenieros aspectos sobre el desarrollo y el mantenimiento de la aplicación, concluyendo que el desarrollo de la aplicación web era más complejo que la adaptación (incluida la instalación) del MOODLE igual que su mantenimiento. En conclusión, “BreasTrack” es una herramienta web que ayuda a reducir el elevado nivel de ansiedad que presentan las mujeres durante la fase diagnóstica de una lesión mamaria sospechosa, independientemente de los factores socio-demográficos analizados en esta tesis. Es una web usable, útil y cubre las expectativas para las que fue diseñada. La implementación de la web original en un estudio con un mayor número de participantes permitirá una valoración más real del impacto de las TICS en la salud psicológica de nuestras pacientes.

Although the importance of physical activity (PA) on the overall wellbeing of children is well-documented, the ever-evolving digitalization of the world continues to promote sedentarism and exacerbate the pandemic of childhood physical inactivity. Physical inactivity can negatively impact a child’s mental and physical health and increases their risk of developing noncommunicable diseases (NCDs), such as obesity and diabetes. Establishing PA as a lifelong habit early in life is imperative to reducing the global burden of NCDs and improving population health. Marginalized populations, particularly newcomers, face unique structural barriers that hinder their access to PA opportunities. This study aims to describe existing PA interventions among newcomer families and children and provide evidence-based recommendations for future initiatives. Using a scoping review methodology, a systematic search of four databases, followed by eligibility screening, identified 21 articles to include in the final review. Data from each of the 21 articles was extracted and organized into two tables: one summarizing the study characteristics, and the other highlighting barriers, facilitators, and gaps. A thematic analysis of the extracted data revealed seven key themes: barriers to engagement, culturally tailored interventions, the role of social support networks, positive health outcomes, sustainability and scalability, acculturation stress and identity, and tailored communication strategies. The evident implications of the results suggest the critical need for more inclusive, longitudinal, and sustainable PA interventions that target newcomer families and children. The findings of this study hope to inform future research and policies that address the structural barriers faced by newcomer populations and reduce existing health disparities related to PA. Overall, the significance of this study lies in its scientific contributions to empower newcomer populations, improve their overall health outcomes, and create healthier, more active generations. / Thesis / Master of Science (MSc)

Obesity is currently viewed as one of the most important health concerns in the United States. Researchers have minimally investigated perspectives surrounding obesity within the African-American female population. This lack of research presented a gap in knowledge concerning the perceived social, environmental, and cultural influences of obesity within this population. The research questions asked African-American females about their views toward these influences. This research was guided by tenets of the social cognitive theory and the transtheoretical model for behavioral change. Thirteen African-American females participated in the interviews. The data collected were reviewed and coded using word frequencies and themes. Findings included recurring themes of cultural influences, social disparities, and the lack of access to healthy food sources and health providers. Positive social change could result from this research to help enlighten public health professionals and community planners to understand the perspectives of African-American women's belief systems surrounding obesity. The information delivered by this research could possibly empower the participants to address the issues within their communities with civic leaders and policy makers to create and sustain needed change.