Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: Hypertension is a risk factor for both cerebrovascular accidents and cardiovascular diseases, holistic and cost effective measure are called upon to reduce its impact on society. One of the methods advocated for achieving this is health promotion. Therefore, health professionals, including physiotherapists, are called upon to redirect their health care management approaches towards preventative care. Aim: The aim of this study was to determine the knowledge, attitude and practice as well as to explore the perceptions of physiotherapists regarding their role in the management of hypertension in Dar es Salaam, Tanzania.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree Of Master of Family Medicine Johannesburg, July 2014 / BACKGROUND Physical activity has been consistently shown to play an important role in healthy ageing. While motivators and barriers to regular physical activities among old people residing in old age homes have been studied in other parts of the world, the researcher found no studies on this subject in South Africa. Therefore, the aim of this research was to identify the motivators and barriers to regular exercise in elderly people residing in old age homes in Ekurhuleni Southern sub-district of Gauteng province. METHODS This was a descriptive cross sectional study conducted among elderly residents in old age homes in Ekurhuleni Southern Sub-district. A structured questionnaire was administered in the common languages: English, Afrikaans and Zulu. The data was collected by the researcher (assisted by research assistants) from 139 residents in seven old age homes. A Pearson chi square test was used to examine the relationship between participants’ characteristics with regular exercise. RESULTS This study showed that having knowledge of exercise benefits (P-value= 0.001) an opportunity to socialize (P-value= 0.001) was statistically associated with regular exercise. Similarly, younger age (P- value= 0.02), high educational attainment (P-value= 0.03), being of white race (P -value= 0.04) were the main motivators to regular exercise. In contrast, poor health (P-value=0.001) and lack of knowledge of exercise benefits (P-value=0.001) were the major barriers to regular exercise. CONCLUSION Increasing residents’ knowledge of the benefits of regular exercise, opportunity for socialization and providing support to elderly people are crucial in increasing the uptake and maintenance of regular exercise among elderly people living in old age homes in Ekurhuleni Southern Sub-district.

This research report submitted to the Faculty of Management, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Management January, 1995 / There is mounting concern about the increasing cost of healthcare, marketing it unaffordable for more people. Until recently, healthcare has been reactive and curative, in the main" as opposed to proactive and preventive. In the USA and Australia, much research has been undertaken on tne effectiveness of wellness programmes - any programme which aims to educate individuals On unhealthy practices and lifestyles, and thereby pre-empt or avoid severe ill1ness. In this country, wellness programmes are a relatively new approach. [Abbreviated Abstract. Open document to view full version]

Prenatal health programs and public health promotion provide strategies to mitigate modifiable risks to pregnancy. Women marginalized by race/ethnicity, disability, sexual identity, socioeconomic status, immigration, Francophone and Indigenous status experience barriers to prenatal service access. Multijurisdictional program evaluations were conducted to review prenatal health promotion, design, implementation and evaluation strategies for Canadian government-hosted websites, prenatal e-classes and international prenatal guidance documents. Gaps were noted in prenatal content targeted to non-Anglophone, immigrant, Indigenous and disabled women and LGBTQ communities. I recommend that prenatal program best practices consist of evidence-based, theoretical foundations which recognize the diverse interacting determinants of health across the lifespan. Intersectoral collaborations and integration of public health into primary care facilitates delivery of accessible, inclusive, woman-centred services. These best practices are anticipated to help harmonize prenatal programs across communities, which optimize maternal-child health and children’s long-term health outcomes.

The aim of this study was to investigate the sexual health needs of undergraduate women aged 18-25 years old who were sexually active but not married or cohabiting; in order to put forward recommendations for a health promotion intervention which may be applied in the practice setting. The thesis consists of three linked qualitative studies. The Part 1 study was an in-depth exploration of the women’s sexual lifestyles and behaviours to identify their health promotion needs. This study was conducted using a phenomenological approach employing Interpretative Phenomenological Analysis (IPA). The Part 2 study was the systematic development of theoretically robust, evidence based intervention to respond to the health promotion needs identified in the Part 1 study. The third study was a consultation review of the initial materials with focus groups of undergraduate women aged 18-25 years old. The aim of which was to refine and amend the intervention to reflect the women’s perspectives. To undertake these tasks Intervention Mapping (IM) (Bartholomew et al., 2006) a health promotion programme planning framework was used as a guiding framework for the thesis. This study revealed the women traversed different types of sexual relationships. Within all types of relationships the women reported being risk averse and valued positive sexual health. Where a threat to sexual health was identified, they took action to reduce the threat. The threats identified differed depending on the relationship type. The distinct relationship types presented differing patterns of decision making, influenced by their values, emotional salience of the relationships and perception of sexual health risk. As such the different sexual health practices presented differing sexual health challenges and health promotion needs. This thesis suggests a quaternary model of female sexual agency outlining four distinct types of relationships - type (1) sexual debut and initial relationships, characterised by high emotion, type (2) casual sexual relationships, characterised by increasing sexual confidence and hedonistic attitudes, type (3) established but not permanent relationships, characterised by relationship stability but not sexual exclusivity (i.e. biological concurrency/behavioural concurrency) and type(4) marriage/cohabitation type relationships, characterised by increased sexual exclusivity. Many women described moving from type 1 relationships into type 2 relationships and then onto a type 3 relationship. However, once beyond type 1 the relationship types were not linear, the women described movement back and forth between type 2 and type 3 relationships. These were frequently with different partners, but could be with the same partner, for example; previous type 3 partners (established) could become a type 2 (casual partner). The study brought to light differing social constructs and expressions of female sexuality and sexual agency within the different relationship types. This enabled the identification of risk behaviours and their determinants, which in turn facilitated the process of intervention development. This enabled the creation of a tailored response to the women’s sexual health needs; thereby assisting the women to make fully informed contraceptive and sexual health choices. The study revealed how each step of the IM process contributes to the whole, augmenting the potential efficacy of the health promotion tools produced.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A OrganizaÃÃo Mundial da SaÃde (OMS) define a faixa etÃria da adolescÃncia como sendo entre 10 e 19 anos e o Estatuto da CrianÃa e do Adolescente (ECA) entre 12 e 18 anos. à uma fase da vida em que ocorrem a maturaÃÃo sexual, o acirramento de conflitos familiares e a formaÃÃo e cristalizaÃÃo de atitudes, valores e comportamentos. Lidar com essas situaÃÃes exige das equipes de saÃde uma abordagem integral e interdisciplinar. A polÃtica nacional de saÃde do adolescente, oferece orientaÃÃes bÃsicas para nortear a implantaÃÃo e/ou implementaÃÃo de aÃÃes e serviÃos de saÃde aos adolescentes e jovens de forma integral, resolutiva e participativa. Reconhece como desafio o acesso de adolescentes a serviÃos de qualidade, com a compreensÃo do significado e importÃncia das dimensÃes econÃmica, social e cultural que permeiam a vida desse grupo. O estudo objetivou analisar as prÃticas de enfermeiras na promoÃÃo da saÃde do adolescente, adotadas na EstratÃgia de SaÃde da FamÃlia (ESF), visando à prevenÃÃo da gravidez na adolescÃncia. O mÃtodo utilizado foi descritivo- exploratÃrio, com abordagem qualitativa. Teve como ambiente investigativo oito Centros de SaÃde da FamÃlia (CSF) do MunicÃpio de Fortaleza. A populaÃÃo constou de enfermeiras vinculadas à ESF, cujo grupo pesquisado foi constituÃdo por oito participantes. A tÃcnica utilizada para a coleta de dados foi o grupo focal e, como mÃtodo de anÃlise dos dados, as prÃticas discursivas e produÃÃo de sentido no cotidiano, tendo como recursos os mapas de associaÃÃo de idÃias. Os resultados das discussÃes foram dispostos em colunas temÃticas e em categorias de anÃlise, previamente definidas como: ConcepÃÃo de saÃde; ConcepÃÃo de promoÃÃo da saÃde e AtuaÃÃo/prÃticas na prevenÃÃo da gravidez na adolescÃncia. O estudo aponta como resultado que as enfermeiras concebem a saÃde e a promoÃÃo da saÃde entre o conceito tradicional (prevenÃÃo da doenÃa) e o mais amplo, pautado na promoÃÃo da saÃde; o planejamento das aÃÃes de promoÃÃo da saÃde do adolescente na prevenÃÃo da gravidez na adolescÃncia à feito na maioria das vezes de forma contingÃnte e de cunho campanhista, sem privilegiar o indivÃduo em sua integralidade; fragilidade na organizaÃÃo do sistema de referÃncia e contra-referÃncia; as aÃÃes intersetoriais sÃo incipientes; hà necessidade de ampliar o conhecimento, por parte das enfermeiras, sobre as polÃticas pÃblicas voltadas ao adolescente. As aÃÃes de promoÃÃo da saÃde permeiam a consulta de enfermagem e as atividades em grupo, ressaltando o acolhimento e a Ãtica como dispositivos que contribuem para promover um ambiente favorÃvel à saÃde do adolescente. Recomenda-se que as diretrizes propostas pela polÃtica de saÃde do adolescente sejam fortalecidas, no Ãmbito municipal, de forma que proporcionem à enfermeira condiÃÃes de promover aÃÃes intersetoriais e interdisciplinares de educaÃÃo sexual na perspectiva de prevenÃÃo da gravidez precoce, que integrem famÃlia, escola, e comunidade, contribuindo para o exercÃcio de uma sexualidade mais responsÃvel e segura. / The World Health Organization (WHO) defines the age of adolescence as being between 10 and 19 years and the Statute of the Child and Adolescent (ECA) between 12 and 18 years. It is a stage of life that occur the sexual maturation, the fierce of family conflicts and formation and crystallization of attitudes, values and behaviors. Dealing with such situations requires of health teams an integrated approach, including the prevention of adolescent pregnancy. The national health policy for the adolescent, offers a basic guidelines to guide the implantation and / or implementation of actions and health services to adolescents and young people in integral, participatory and decisive way. Recognizes as a challenge the access of adolescents to quality services, with the understanding of the meaning and importance of economic, social and cultural fields that permeate the lives of this group. The study aimed to examine the practices of nurses in promoting health of adolescents, adopted in the Strategy of Family Health (SFH), aimed the prevention of teenage pregnancy. The method used was descriptive and exploratory, with a qualitative approach and had as investigative environment eight Family Health Centers (CSF) of the city of Fortaleza. The population consisted of nurses linked to the SFH, which the researched group consisted of eight participants. The technique used to collect data was the focus group and as a method of data analysis, the discursive practices and production of meaning in everyday life, having as resources, the maps of association of ideas. The results of the discussions were arranged in columns on topics and categories of analysis, previously defined as: Conception of health, Conception of health promotion and Practice / practices in the prevention of teenage pregnancy. The study points as a result the nurses concepts the health and health promotion between the traditional concept (prevention of the disease) and broader, based on health promotion and the planning of actions to promote the health of adolescents in the prevention of teenage pregnancy has been most often on campaigns, without focusing on the individual on its integrality; weakness in the organization of the reference and cross-reference system, the inter-sector actions are incipient, there is need to expand the knowledge, by the nurses, about public policies focused on the adolescent. The actions of health promotion permeate the nursing consultation and the activities in groups, emphasizing the reception and ethics as devices that help to foster an environment conducive to the health of adolescents. It is recommended that the guidelines proposed by the Health Policy of adolescent be strengthened, in the municipal level, in order to provide the nurse, conditions to promote inter-sector and interdisciplinary actions of sex education in the context of prevention of early pregnancy, which includes the family, school and community, contributing to the pursuit of a safer and more responsible sexuality.

This qualitative exploration takes place within the context of homelessness, oral health and health promotion. The idea for this work was associated with 'An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland', which identified homeless people as a priority group. This led to ‘Something to Smile About’ (STSA), a pilot oral health promotion intervention for homelessness sector practitioners and homeless clients. An evaluation of STSA, which was judged to have failed, highlighted the interplay between intervention design, and the two principal stakeholders: practitioners and homeless clients. The aim of the research was to explore the contextual and experiential elements of homelessness that influence homeless people’s engagement with health promotion. As the research progressed, these two factors were conceptualised as the public and private faces of homelessness. It became apparent that to fully understand the issues surrounding homeless people’s engagement, it would be necessary to explore the private, innermost elements of homelessness. Seventeen homelessness sector practitioners and 34 homeless people took part in a qualitative exploration, in order to examine the engagement process from the perspective of both stakeholders. It emerged that that the homelessness policy context, coupled with work environments and perceptions of clients, shaped practitioners’ interactions and thus influenced client engagement. Practitioners utilised a narrow ‘window of engagement opportunity’ within a wider framework of managing client health problems and preparation for engagement, engaging with clients, and finally, disengaging from clients. From the work with homeless people, a ‘journey’ through homelessness emerged, in the form of a trajectory from ‘deconstruction’ of pre-homeless identity, to ‘construction’ of a homeless identity, and finally, to ‘reconstruction’ of a post-homeless, ‘reclaimed’ life. Appropriate points for engagement on this trajectory were identified. The thesis ends with a set of recommendations to assist practitioners to engage their homeless clients, and from the client perspective, encourage and facilitate engagement with practitioners and health promotion services.

Popular education is a mode of teaching and learning which seeks to bring about more equitable social conditions by creating settings in which people can identify and solve their own problems. While the public health literature offers evidence to suggest that popular education is an effective strategy for increasing empowerment and improving health, there have been no systematic attempts to compare the outcomes of popular education to those of traditional education. The goal of La Palabra es Salud was to conduct such a comparison among Latino, parish-based Community Health Workers (CHWs). The study employed a quasi-experimental design, mixed methods, and a community-based participatory research (CBPR) framework. Results of a mixed factorial ANOVA revealed that both experimental groups made statistically significant gains in health knowledge when compared to a control group. Within-group comparisons showed that the popular education (PE) group made statistically significant improvements in self-reported ability to promote health, critical consciousness, and on a global measure of empowerment, while the traditional education (TE) group made significant gains in critical consciousness, control at the personal level, self-reported health status, and self-reported health behavior. Because the TE group was almost twice as large as the PE group, almost identical changes that achieved significance in the TE group did not achieve significance in the PE group. Results of the qualitative analysis validated the quantitative results, with members of the TE group reporting improvements in health knowledge and behavior while members of the PE group reported increased empowerment and ability to empower others. Our findings suggest that, when compared to traditional education, popular education can help participants develop a deeper sense of empowerment and community and more multi-faceted skills and understandings, with no accompanying sacrifice in the acquisition of knowledge. These results have their most direct implications for the education of adults from disempowered communities, where popular education shows promise for supporting community members to identify and organize around shared concerns. More broadly, the research suggests that wider use of popular education in mainstream educational settings could promote greater inclusion and increased success for students who have experienced marginalization, producing a more equitable society.

This research describes the design and evaluation of an internet-based universal program for use in schools with adolescent students to prevent common mental disorders and promote mental health. The research began in response to investigations that showed that rates of mental illness in Australian children, teenagers and adults were high, that these illnesses caused significant burden to individuals and society, and that there were insufficient services to treat. When current interventions are unable to alleviate disease burden it is important to focus on prevention. Mental health prevention should target youth before disorders cause disability and restriction of life choices. A review of the mental health prevention literature supported a universal cognitive behavioural approach in schools. Internet delivery was used to maintain content integrity, enable access to people living in regional and remote areas, and to appeal to young people. Internet delivery makes universal prevention cost effective and feasible. The Intervention Mapping approach was used to direct the design of the program. A feasibility study was conducted to gain opinions from students and teaching staff. Changes were made in light of results from this study and 463 students were then exposed to the program in an effectiveness trial. The effectiveness trial was a before-after design with no control group. Results from this trial provided evidence that the program was acceptable and effective for use by teachers in the intervention schools. Also student behaviour and mood changed in beneficial ways after program administration. Specifically, student reported significantly increased knowledge about stress and coping, use of help-seeking behaviours, and life satisfaction, and significantly decreased use of avoidance behaviours, total difficulties and psychological distress. The study design allows causal inferences to be surmised concerning exposure to the intervention and changes in behaviour and mood, but further evidence is needed before firm conclusions about effectiveness can be posited and generalizations made concerning different populations, settings and times. In conclusion, this thesis provides evidence that a computerised, cognitive behavioural mental health prevention program delivered to adolescent school students by teachers can potentially change student coping behaviours and mood in beneficial ways.

As a practitioner involved in the planning and development of educational activities in the field of public health, I have worked within many pedagogical traditions and program parameters. Through this work, I have experienced both subtle and radical shifts in the range of skills, knowledge and relationships required to collaboratively plan and evaluate educational work. In this professional and community-based landscape, competing and often overlapping models of education and evaluation have led to much conceptual confusion and ambiguity around narrowly defined notions of best practice, evidence and knowledge legitimacy. Drawing from Dorothy Smith’s (1999) standpoint theory from which my inquiry was developed as a result of my participation with colleagues in the field, I explore how three professional practice networks of learning and development practitioners speak of the skills, knowledge, relationships and worker identities in a changing field. This research seeks to explicate the kinds of informal and largely unarticulated knowledge that is produced through the changing contexts of work. This research maps the changing conditions of educational work through my own case stories of educational practice and uses these as a springboard for discussion among three diverse professional practice networks. The Story/Dialogue Method (S/D-M) developed by Labonte and Feather (1996), is a constructivist methodological approach that, in this application, structures group dialogue into reflective insights and theories about how educational work occurs in varied settings among different professional and community-based groups. A strong reliance on interpersonal skills was articulated by all three networks to build trust, assess individual and organisational learning needs, to build partnerships and to motivate learners. Skills were often described vaguely and summarised as a series of situational specific attributes. A valuing of reflexive, working knowledge as opposed to professional or discipline-based expertise was raised as an important aspect of partnership building and in negotiating program parameters. The need to build individual and organisational relationships through formal and informal encounters was cited as a series of legitimate yet often ‘behind the scenes’ professional practices. Aligning with the notion of worker identity described by Chappell, Rhodes, Solomon, Tennant and Yates (2003) as process, practitioners spoke of their identities as constructed and temporary, negotiated through newly emerging roles and changing relationships with peers and learners. This study suggests that evidence-based practice is a contested term drawing its meanings from multiple theoretical and pedagogical traditions including that of intuition. Perhaps unsurprisingly then, evidence guiding educational approaches is viewed as a pragmatic and eclectic mix of tools stored to be adapted for use in new ways. Additionally, this study concludes that all participants (including myself) regard educational practice as a collaborative and continually negotiated endeavour.