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Bakgrund: Prevalensen av övervikt och fetma hos barn har ökat över hela världen de senaste årtionden. Primroseprojektet är ett forskningsprojekt som studerar möjligheten att förebygga barnfetma genom föräldrasamtal på barnavårdscentralen (BVC). Sjuksköterskans compliance till den interventionsmanual som används förväntas vara viktigt för resultatet. Syfte: Att inom ramen för Primroseprojektet bedöma hur föräldrar och BVC sjuksköterskor, i samband med att barnet genomgår hälsoundersökning vid tolv månaders ålder på barnavårdscentralen, följt Primrosemanualens instruktioner. Metod : Matdagbok och målformuleringsblad granskades utifrån om de var ifyllda enligt manualens instruktioner . Målformuleringsbladet poängsattes också utifrån den detaljnivå målen var formulerade. Resultat: Nästan 75 procent av de inkomna matdagböckerna var ifyllda på ett korrekt sätt. Resultatet av poängbedömningen av målformuleringsbladen visade att sjuksköterskan tillsammans med föräldern inte hade formulerat detaljerade mål i den omfattning som var önskvärd. Slutsats: Instruktionerna för hur matdagböckerna skulle fyllas i var tydliga. Den låga graden av detaljerade mål tror författarna beror på en bristande överensstämmelse mellan hur instruktionerna till sjuksköterskan var formulerade och de kriterier som skulle vara uppfyllda för att få poäng. / Background: The prevalence of childhood overweight and obesity has increased worldwide during the last few decades. The Primrose project studies the potential to prevent child obesity by parental consultation at a child health centre. It is critical that the health visitor complies with the instruction manual for any intervention. Aim : Within the framework of the Primrose project, evaluate to what extent health visitors and parents have followed the instructions in the Primrose manual, during a health control at the age of twelve months. Method: The food diary and the goal formulation sheet were studied in order to evaluate whether they had been completed according to the manual. The latter was graded using a recommended point system related to the level of detail the goals were formulated. Result: Nearly 75% of the food diaries were completed in a correct manner. The evaluation of the points derived from the goal formulation sheets indicates that the health visitor, together with the parents, had not been able to formulate the goals in sufficient detail. Conclusion: The instructions for the completion of the food diaries are clear. The authors consider that the unsatisfactory result with the level of detail the goals were formulated is caused by the lack of agreement between the way the instructions were presented and the demands of the criteria that steer the point system.

Magister Chirurgiae Dentium (MChD) / This study was undertaken to examine the preventive dental and medical attendance behaviour of mothers of young children. The 'Theory of Reasoned Action' used to predict intention to visit the dentist and the doctor, failed to account for more than 11% of the variance in dental behaviour and 9t in the variance in medical behaviour in all the subjects. However, on assessing these behaviours for the 2 different age groups, for the younger age group, the prediction improved to 19% for the dental intention in terms of the total attitude and subjective norm score, and to 45% and 34% respectively for the individual attitudes and subjective norms. In the older age group, the prediction improved to 20% for the dental intention in terms of the total attitude and subjective norm score, and to 39% and 30% respectively for the individual attitude and subjective norms. This finding is further supported by factor analysis of the data, whereby using a principal components analysis structure, other patterns to the data were found which indicates that preventive dental and medical behaviour is a complex behavioural category, consisting of more than one action. Two dimensionso of affect accounted for 59% of dental attitudinal data and 57.9% of the dental subjective norm data, whereas three dimensions of affect accounted for 64.5% of the medical attitudinal data and 64.8% of the medical subjective norm data. The mothers had positive attitudes to both the two dental and three medical actions highlighted by the principal components analysis. The younger mothers showed stronger attitudes associated with the treatment outcome action, whereas the older mothers showed a more positive preventive orientation by the dental data. Although two-thirds of the young mothers received dental advice from the health visitors, they were highly selective on what information to accept and put into effect. An indication here is that health messages including dental health are perceived differently by the 2 age groups even though they are from the same social class group. This finding holds in important implications for the method, approach and content of dental heath of education. In terms of the medical data, the three actions highlighted, indicated that while a health directed behaviour, in terms of a healthy outcome e.g. normal growth is important, an expectation as well as a more emotional, love and tender care factor were also implicated. A healthy baby may however not be the only factor of importance to the mother, but also the mechanisms of achieving such a state of health, matters not only in terms of the convenience but also, greatly depend on the love and level of care the mother gives the child. This aspect may even be more accentuated in one parent families, in which especially the young mother is under enormous socia-economic pressure to take up employment, foresaking time she would otherwise have spend with the child. The effect of subjective norms on preventive health behaviour shows evidence of a 'inner cicle' or 'kinship' as reference group to the mother, which mediates between and modifies the influence of the health profession in as far as compliance with health care is expected from the mother. It therefore appears that in the lower social classes, there exists an intricate social network, exercising an important effect on the way of life of the mother, and since this network may be one of the few supports she has, its influence will be exerted in various dimensions of the mothers' life including health. There appears to be a hidden pathway or code of conduct, defined by these social norms and to which the mother feels she owes her allegiance. The level of communality between the social networks and preventive dental behaviour should be further investigated. This study has clearly indicated that some of the dental and medical attitudes and subjective norms under consideration, has a marked independent yet related effect on preventive health behaviour whereas other attitudes and subjective norms acted independently or sometimes not at all. The dental health educator, must therefore determine for each community and individual which action is the most appropiate target for behavioural change. Furthermore, this study has shown that if beliefs are to be modified, referents to support such a behaviour change, must therefore be appropiate to attaining this objective. since preventive medical and dental behaviour consists of various actions, the application of the Azjen and Fishbein model, should be to a specific action of the behaviour, which assumes importance in the target community, important others. associated with Baric (20) has emphasised the role of the family as an important influence on attitude and behaviour, while Boothroyd- Broóks (39) has pointed to the contribution of society as important mediators in secular life. The results from this study would tend to support the views of Suchman(193), Baric(20) and Boothroyd-Brooks(39) that, kinship, family and social norms were important in the development of behaviour but, to sustain such a behaviour, a deeper understanding is required of the social forces operative through the social network, which shapes the mothers' health behaviour into action. be this medical or dental attendance for herself or for that of her children.

La qualité de la relation établie entre le visiteur médical et le médecin prescripteur influence la fidélité du médecin prescripteur envers le visiteur médical et son intention de prescrire un nouveau produit. Le choix de faire référence exclusivement au contenu de la relation par le concept de la relation, est une démarche originale dans le champ de la prescription, il est validé par les résultats de l’enquête. Si pour prescrire le médecin généraliste n’a pas besoin d’éléments autres que son expérience personnelle de ce médicament, l’influence de la fidélité envers le visiteur médical aura une faible importance. A l’inverse, pour une nouveauté médicamenteuse le médecin basera son intention de prescrire sur la qualité de la relation mise en place, mais également sur sa fidélité envers le visiteur médical, représentant d’un laboratoire. En isolant la variable sensibilité à l’innovation du médecin généraliste, nous pouvons démontrer son influence sur l’intention de prescrire un nouveau médicament. Or l’innovation est un enjeu majeur pour l’industrie pharmaceutique mais également pour le médecin, elle concerne à la fois la connaissance et la prescription des médicaments. L’information est complexe par la multiplicité des sources et le médecin devra appuyer sa décision de prescrire un nouveau médicament sur une caractéristique individuelle, sa propre sensibilité à l’innovation. Nos résultats montrent qu’en 2013 en France il est difficile d’élaborer des stratégies de lancement de médicament, en ignorant l’orientation relationnelle des médecins. Nos résultats mettent en évidence l’influence de la qualité de la relation sur l’intention de prescrire. Notre approche permettra, non seulement de mieux comprendre les mécanismes de création et de développement de la qualité de la relation entre le visiteur médical et le médecin généraliste, mais également de mesurer ce concept par l’intermédiaire de ses composants (confiance, satisfaction et engagement dans la relation). De même, la sensibilité à l’innovation est une caractéristique individuelle du médecin généraliste, que les responsables marketing lors des stratégies de ciblage des médecins, doivent prendre en compte avant un lancement. / The quality of the relationship between the pharmaceutical sales representative and the physician, influence the prescribing physician loyalty to the pharmaceutical sales representative, the relationship quality also influences the physician to prescribe a new product. The decision to refer exclusively to the contents of the relationship with the concept of the relationship, is a novel approach in the field of prescription, it is validated by the results of the investigation. If the general practitioner, to prescribe, does not need items other than his personal experience of this drug, the influence of loyalty to the health visitor will have little importance. Conversely, for a new drug the doctor will base its intention to prescribe on the quality of the established relationship, but also on his loyalty to the pharmaceutical representative, Isolating the variable sensitivity to innovation, of the general practitioner, we can demonstrate its influence on his intention to prescribe a new drug. But innovation is a major challenge for the pharmaceutical industry and also for the physician; it involves both knowledge and prescription of drugs. The information appears complex due to the multiplicity of sources and the doctor will base its decision to prescribe a new drug on personal characteristic, its own vision of the novelty, his own sensitivity to innovation. Our results show that in 2013 in France it is difficult to develop strategies to launch drug while ignoring the relational orientation of physicians. Our results highlight the influence of the quality of the relationship on the intention to prescribe. Our approach will not only allow a better understanding of the mechanisms of creation and development of the quality of the relationship between the pharmaceutical sales representative and the general practitioner, but also to measure this concept through its components (trust, satisfaction and commitment in the relationship). Similarly, sensitivity to innovation is an individual characteristic of the general practitioner, as marketers in targeting strategies physicians should consider before launch. Similarly, sensitivity to innovation is an individual characteristic of the general practitioner, as such; it must be taken in account when marketers are targeting strategies to them.

Two key policy documents are having an impact on health visiting practice in Scotland: Getting It Right for Every Child (GIRFEC) (2013), which seeks to promote all children’s wellbeing, and The Healthcare Quality Strategy for NHS Scotland (2010) which promotes person-centred care. ‘Shared decision making’ is integral to ‘person-centred care’; however no research studies to date have linked shared decision making with health visitor practice. This thesis reports on a descriptive, qualitative research study, which was conducted in two health board areas in Scotland, in order to explore the processes that support effective shared decision making in health visiting practice within the context of implementing GIRFEC. The design was in three phases and used Elwyn’s Framework, of ‘Choice, Options and Decision Talk’ as a structure (2012). Phase 1 consisted of audio recordings of 2 x health visitor: parent encounters when decisions were being made; Phase 2 consisted of semi-structured interviews with 9 x health visitors and 9 x parents who had made decisions within the last 6 months; Phase 3 involved 3 x focus groups reviewing the findings to date and reflecting on current issues when implementing GIRFEC. The framework method was used for analysis and two additional themes were identified: ‘Issues’ and ‘Relationships’. The health visitors demonstrated that they built up trusting relationships with parents; however there was lack of understanding and application of decision making theory which supports analysis, and an outcome focused approach to person-centred planning. This thesis identifies areas for health visitor practice development.