Care work is emotionally and physically demanding and is coupled with organisational challenges. As such, care work has been associated with emotional exhaustion which not only negatively impacts staff but also the care that they provide. Greater understanding of the psychological health of dementia care staff and their perceptions of their work will provide insights into how this group may be better supported. The first paper provides a review of the literature relating to psychological outcomes in dementia care staff. The literature identified was viewed in terms of an existing model of psychological health, the BASIC Ph, with the aim of evaluating the evidence and enhancing understanding of psychological health in this group. The utility of this model was also evaluated. The model highlighted areas for potential intervention as well as those for future research. Clinical implications for Clinical Psychologists were also discussed. The second paper aimed to increase understanding of the experiences of dementia care assistants who perceived themselves to be competent in their role. Eight care assistants who had high levels of self-efficacy were interviewed. Interpretative Phenomenological Analysis (IPA) revealed four superordinate themes. Accounts of experiencing dilemmas provided important contextual information and constituted the first superordinate theme. The second theme 'togetherness and connection' described participants' experience of the need for support, closeness and the value of engaging with older people with dementia. The third theme encompassed the attunement between care assistants and the older people for whom they cared and described empathy, personal perspective-taking and circularity of emotion as guides to care. The final theme 'caring as part of life' described the link between caring and identity as well as a genuine interest in people, an accepting attitude and motivation to care. These themes provide fruitful areas for further research and have implications for care staff training.

Title from PDF of title page (University of Missouri--Columbia, viewed on Feb. 24, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Dissertation advisor: Dr. James Laffey. Vita. Includes bibliographical references.

Over the past 100 years the average life span of humans has increased in developed countries. Mortality rates have changed because of the virtual eradication of infectious diseases, such as polio and smallpox, and the increase in chronic diseases. Chronic diseases, such as coronary heart disease, are related to lifestyle behaviour, a factor over which the individual has some control. Matarazazo (1984) believes that 'behavioural pathogens are the key to understanding health behaviours of the individual and subsequently designing more effective methods of dealing with chronic disease and illness. Fries (1980) suggests another approach to dealing with chronic disease, through the strategy of 'compressed morbidity'. This refers to the postponement of chronic infirmity relative to average life duration. By achieving compressed morbidity, it is expected that health costs will decrease and improvement of quality of life will occur. This may be possible in at least two ways: firstly, by self-empowerment of the individual and secondly by the development of health self-efficacy. Thus giving the individual the power to act upon certain health-damaging behaviours as well as the confidence to influence behavioural change and persistence to cope with difficulties whilst the process of change is occurring. Thirdly, as a result of this, behaviour changes will occur and this would lead to a reduction in health cost which would be of overall benefit to the community. One method of reducing these health care costs is through health promotion and health education. Improvements in health knowledge and skills through health education and health promotion has been shown to facilitate changes in lifestyle and so reduce the incidence of various diseases. This study examined the effectiveness of two types of self-care models, health self-care and medical self-care. Health self-care refers to individuals assuming more responsibility for prevention, detection and the treatment of health problems using self-care information. Medical self-care involves the use of General Practitioners (GP) offering advice to their patients and subsequently patients making informed decisions about their health. The health self-care model Healthtrac, attempts to provide an effective use of the Australian health care system. Healthtrac is an information and skills based mail delivery program designed to assist individuals in elevating their perceptions of health self-efficacy and improve their lifestyle behaviours. Better Health is the medical self-care model which is designed with the perspective that GP's are the best suited as the initiators of change in individual health self-care. Participants (N = 864) are adult males and females. The methodology for this study involved 864 high risk of chronic disease participants who have been identified using the Healthtrac Health Risk Assessment (HRA) instrument. There were (n = 343) participants in the health self-care group, (n =66) in the medical self-care group and (n = 455) in the control group. This instrument was designed to identify individuals who have or are at high risk of developing chronic disease. These participants were part of the Better Health promotion program of a Health Insurance company. All the participants received a letter of advice detailing the presence of certain risk factors as determined by their health risk appraisal. They were requested to visit their local GP who recommended the necessary behavioural changes and medical support required for medically satisfactory outcomes. They were encouraged to follow the advice of the GP and received a second HRA after 6 months and again12 months after the start of the project. The Healthtrac component of the study involved 343 subjects who completed the HRA instrument. Participants in this group were matched with the Better Health subjects for variables such as age, gender, employment, disease or lifestyle and educational level. Baseline impact variables were calculated and compared with the same variables at 6 monthly intervals during the 12 month period of the study. Process variables such as user satisfaction were determined by a questionnaire. Investigation of the Health Benefits Organisation records were used to gather data on the number of claims for hospitalisation and other medical costs. A control group of 455 participants were matched with the same variables as those participants in the health self-care model and medical self-care groups. The analysis of results indicate that variables such as number of doctor's visits, days spent in hospital and total risks scores for the health self-care model were lower than the Medical model scores. The variable, cost of disease findings indicate that there were no significant differences between the two experimental groups, from the baseline data (Q1) to the 12 month period (Q3). The cost of diseases for heart disease was able to be lowered more by participants in the health self-care than the medical self-care model. The opposite occurred for the blood pressure condition. The health self-efficacy questionnaire results indicate that the health self-care group participants reported higher self-efficacy scores, therefore they were more confident about the self-management of their health behaviours than the members of the medical self-care group. No significant differences occurred among the experimental and control groups on such variables as achievement of outcomes and management of disease on self-efficacy scores. Both experimental groups, health self-care and the medical self-care model philosophies have strengths and weaknesses. Health self-care provides health information and support through printed materials whereas the medical self-care model provides health information through GP's. Both health promotion programs are important in making the individual aware of methods needed to improve health and in developing the knowledge necessary to modify clients health behaviours. This in turn is an important factor in the reduction of medical costs and the prevention of some diseases.

Smoking related conditions kill approximately 5,000,000 people every year. There is evidence that smoking behaviour varies for men and women. Yet, determinants of smoking remain poorly understood, especially by gender. This Ph.D. thesis remediates this important gap in the literature, adopting a novel, transdisciplinary approach. The thesis was an epidemiological investigation of the joint and separate utility of sociodemographic factors, mental health and Social Cognitive Theory constructs as predictors of smoking for men and women. Participants were 3,502 residents of Queensland, Australia, taking part in a larger statewide population-based study investigating cancer risk knowledge and behaviours. The study consisted of a CATI telephone interview and a subsequent battery of self-report questionnaires. The thesis entailed four empirical studies. Study 1 (Chapter Two) investigated the utility of sociodemographic factors as predictors of smoking status by gender and by area by gender. Results revealed that sociodemographic variables were poor predictors of smoking status and that predictors of smoking differed by gender when analyses were conducted separately. Younger men and men involved in a relationship were more likely to be smokers, while younger women and women who were well educated were more likely to be smokers. Gender differences were also present when analyses were conducted by area by gender. In addition, smoking status for urban women was not significantly predicted by any of the employed sociodemographic variables. These results indicated that additional determinants of smoking, such as mental health, should be investigated. Study 2 (Chapter Three) was a psychometric evaluation of a tool utilized in the thesis to measure symptoms of anxiety and depression, the Kessler Scale of Non-Specific Psychological Distress, also known as the K-10. Results revealed that the K-10 is a psychometrically sound scale, ideal for measuring symptoms of anxiety and depression in the general population. It was also concluded that the K-10 is multidimensional, and that the best model for its factor structure is a first-order model composed by four first-order factors: nervousness, restlessness, negative affect and fatigue. Study 3 (Chapter Four) evaluated the discriminant utility of mental health variables measured with the K-10, separately and jointly with sociodemographic variables, in predicting group membership. The study investigated whether these variables could discriminate between ever-smokers and neversmokers, and among ever-smokers, between current smokers and former smokers by gender. This was intended to provide a glimpse into smoking initiation and smoking persistence. Analyses classified only a small percentage of smokers correctly. Nevertheless, results showed that psychological distress examined alone predicted smoking uptake among women. In contrast, smoking initiation for men was vi predicted by sociodemographic variables. In addition, persistent smoking for men was predicted by psychological distress while that for women it was predicted by sociodemographic factors. Study 4 (Chapter Five) investigated the utility of Social Cognitive Theory (SCT) constructs as determinants of smoking. This last empirical study investigated whether the addition of self-efficacy and outcome expectancies to mental health and sociodemographic variables improved prediction of smoking behaviour. Study 4 examined the utility of three models as determinants of measures of smoking among current smokers (smokers who have never attempted to quit and those who attempted to quit and failed). Nicotine dependence, age of smoking initiation, number of cigarettes smoked per day and past quit attempt, as well as intention to quit were the measures of smoking investigated. Results indicated that the full social cognitive model (containing both self-efficacy and outcome expectancy) was the most robust model, although neither self-efficacy nor outcome expectancies as constructs were particularly strong predictors. Nevertheless, self-efficacy was generally better than outcome expectancies. Both self-efficacy and outcome expectancies predicted measures of smoking for men, while only self-efficacy predicted the same measures of smoking for women. None of the models predicted a quit attempt in the last year among males. For women, only decreased fatigue predicted a quit attempt in the last 12 months: In addition, analyses conducted to classify which smokers intended to quit smoking in the near future correctly classified only a small percentage of those who did intend to quit in the near future, but correctly classified most smokers who did not. Analyses investigating which quitting method was most popular among smokers revealed that “going cold turkey” was still the preferred quitting method of more than half of smokers who had attempted to quit in the past 12 months but failed. Less than 15% of those who “went cold turkey” had also employed a cessation aid. The thesis supports the hypothesis that determinants of smoking differ by gender. The role of psychological distress in smoking uptake among women and in smoking persistence among men warrant further investigation. Future research should also examine the effect of other types of selfefficacy upon smoking behaviour. Smoking prevention and/or cessation programs might be more effective if conducted for men and women separately, addressing the particular determinants of smoking for each gender.

Sleep disturbances are prevalent among primary care patients, and psychological dysfunction, including stress, anxiety, and depression, are robust contributors to poor sleep health. Yet, the presence of potential protective characteristics, such as health self-efficacy and engaging in adaptive health behaviors, may mitigate such outcomes. Gratitude (i.e., recognition and appreciation of experiences, relationships, and surroundings), a positive psychological cognitive-emotional characteristic, may serve as a catalyst of these beneficial downstream effects, given its association with improved health functioning and sleep. In a sample of primary care patients (N = 869) from 50 urban and 30 rural practices in Germany, health self-efficacy (i.e., belief in ability to perform necessary actions to manage health) and constructive health behaviors (i.e., actions taken to modify health positively), separately and together as parallel first-order mediators, and stress, anxiety, and depression, as parallel second-order mediators, were investigated as potential serial mediators of the association between gratitude and sleep disturbances. Participants completed self-report measures in person and online. Significant serial mediation was observed across models, although effects varied. In the first model, gratitude was associated with greater health self-efficacy and, in turn, to less stress, anxiety, and depression, and fewer consequent sleep disturbances. In the second model, health behaviors, and anxiety and depression, were serial mediators, but health behaviors and stress were not. In a final combined model, serial mediation occurred on two pathways, health self-efficacy and anxiety, and health self-efficacy and depression, and a specific indirect effect was found for health behaviors, but not self-efficacy. Gratitude was associated with reduced sleep disturbances through positive health behavior engagement, and via the serial mediation effects of greater health self-efficacy and lower psychological distress. Clinical interventions that enhance gratitude (e.g., gratitude listing or diaries), self-efficacy (e.g., disease self-management programs), or health behavior engagement (e.g., weight management programs) may promote favorable downstream effects on psychological distress and sleep disturbances among primary care patients.