Many patient-level barriers to more effective post-fracture osteoporosis (OP) management are associated with patients’ perceptions of their bone health and the link between their fracture and OP. These barriers could be addressed by interventions which account for the role of patients’ perceptions, such as those based on theories of behaviour change. This thesis had two objectives: to review the literature and determine whether these theories have been integrated in post-fracture OP management and to examine patients’ awareness of the OP-fracture link. The results showed that theories of behaviour change have not been integrated into post-fracture interventions, that most patients do not perceive the OP-fracture link even after a baseline intervention and that two baseline factors predict who is less likely to make the OP-fracture link at follow up. Based on these findings, modifications to current OP interventions were proposed and guidance that could help create new, patient-centered interventions was provided.

Many patient-level barriers to more effective post-fracture osteoporosis (OP) management are associated with patients’ perceptions of their bone health and the link between their fracture and OP. These barriers could be addressed by interventions which account for the role of patients’ perceptions, such as those based on theories of behaviour change. This thesis had two objectives: to review the literature and determine whether these theories have been integrated in post-fracture OP management and to examine patients’ awareness of the OP-fracture link. The results showed that theories of behaviour change have not been integrated into post-fracture interventions, that most patients do not perceive the OP-fracture link even after a baseline intervention and that two baseline factors predict who is less likely to make the OP-fracture link at follow up. Based on these findings, modifications to current OP interventions were proposed and guidance that could help create new, patient-centered interventions was provided.

This dissertation uses a multi-method approach to examine the role of online communities as a source of peer-to-peer supportive care for breast cancer survivors. A collection of four studies is presented. Study 1) A systematic search of the Internet identified 111 active online communities for breast cancer survivors with extensive archives of personal health experiences (one third had over 100,000 posts each as of 2010-10-26). More than one-third (36.0%) were initiated by breast cancer survivors or loved ones, and more than two-thirds (69.5%) were maintained with little or no professional input. Study 2) An analysis of Facebook (www.Facebook.com) identified 620 public breast cancer groups containing a total of 1,090,397 members as of 2008-11-23. The majority of groups were created for fundraising and awareness purposes (92.6%), rather than supportive care (7.4%). Study 3) One hundred breast cancer survivors, known to provide peer support were surveyed on their supportive care needs and use of online communities. Two-thirds (68.6%) of the 73 respondents reported at least one unmet need, most frequently (30 to 40%) concerning sexual problems, stress, survivor identity, fear of recurrence, and ongoing symptoms or side effects. About one-third (31.5%) used online communities predominantly during and while recovering from treatment. Reasons for non-use included lack of need, self-efficacy, trust and awareness. Study 4) Twelve breast cancer survivors who participated in the previous study were interviewed on how and why they used online communities. Unmet needs drove use, particularly during periods of stress, uncertainty or insufficient local support. Online communities served as a unique supportive care resource due to their quality of information, reassurance from similar others, availability, anonymity, and limited commitment. Social support, technology adoption and health behaviour theories help to explain use. Online communities have the potential to fill gaps in health care services by addressing the supportive care needs of breast cancer survivors in a way that may not be available elsewhere, and survivors may play an increasingly important role as care providers. Future research must focus on overcoming barriers to use, and identifying factors that enhance their effectiveness among diverse groups.

This dissertation uses a multi-method approach to examine the role of online communities as a source of peer-to-peer supportive care for breast cancer survivors. A collection of four studies is presented. Study 1) A systematic search of the Internet identified 111 active online communities for breast cancer survivors with extensive archives of personal health experiences (one third had over 100,000 posts each as of 2010-10-26). More than one-third (36.0%) were initiated by breast cancer survivors or loved ones, and more than two-thirds (69.5%) were maintained with little or no professional input. Study 2) An analysis of Facebook (www.Facebook.com) identified 620 public breast cancer groups containing a total of 1,090,397 members as of 2008-11-23. The majority of groups were created for fundraising and awareness purposes (92.6%), rather than supportive care (7.4%). Study 3) One hundred breast cancer survivors, known to provide peer support were surveyed on their supportive care needs and use of online communities. Two-thirds (68.6%) of the 73 respondents reported at least one unmet need, most frequently (30 to 40%) concerning sexual problems, stress, survivor identity, fear of recurrence, and ongoing symptoms or side effects. About one-third (31.5%) used online communities predominantly during and while recovering from treatment. Reasons for non-use included lack of need, self-efficacy, trust and awareness. Study 4) Twelve breast cancer survivors who participated in the previous study were interviewed on how and why they used online communities. Unmet needs drove use, particularly during periods of stress, uncertainty or insufficient local support. Online communities served as a unique supportive care resource due to their quality of information, reassurance from similar others, availability, anonymity, and limited commitment. Social support, technology adoption and health behaviour theories help to explain use. Online communities have the potential to fill gaps in health care services by addressing the supportive care needs of breast cancer survivors in a way that may not be available elsewhere, and survivors may play an increasingly important role as care providers. Future research must focus on overcoming barriers to use, and identifying factors that enhance their effectiveness among diverse groups.

This thesis aimed at developing and evaluating a tailored behavioural sleep medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome (OSAS) and overweight. Participants with moderate or severe OSAS (apnea-hypopnea index ≥15) and obesity (Studies I-II) or overweight (Studies III-IV), treated with continuous positive airway pressure (CPAP) (Studies I-II) or admitted to CPAP treatment (Studies III-IV), were recruited from the sleep clinic at Uppsala University Hospital, Sweden. Semi-structured individual interviews were analysed using qualitative content analysis (Study I). Data on moderate-to-vigorous physical activity (MVPA) and sedentary time were collected with three measurement methods and analysed regarding the level of measurement agreement (Study II). Potential disease-related and psychological correlates for the amount of MVPA, daily steps and sedentary time were explored using multiple linear regression (Study III). Physical activity and eating behaviour changes were examined after a six month behaviour change trial (Study IV). A tailored behavioural sleep medicine intervention targeting physical activity and healthy eating in combination with first- time CPAP treatment was compared with CPAP treatment and advice on the association between weight and OSAS. According to participants’ conceptions, a strong incentive is needed for a change in physical activity and bodily symptoms, external circumstances and thoughts and feelings influence physical activity engagement (Study I). Compared with accelerometry, the participants overestimated the level of MVPA and underestimated sedentary time when using self-reports (Study II). The participants spent 11 hours 45 minutes (71.6% of waking hours) while sedentary. Fear of movement contributed to the variation in steps and sedentary time. Body mass index was positively correlated to MVPA (Study III). The experimental group increased intake of fruit and fish and reduced more weight and waist circumference compared with controls. There were no changes in physical activity (Study IV). The novel tailored behavioural sleep medicine intervention combined with first-time CPAP facilitated eating behaviour change, with subsequent effects on anthropometrics, but it had no effects on physical activity and sedentary time. Fear of movement may be a salient determinant of sedentary time, which has to be further explored in this population. The results confirm sedentary being a construct necessary to separate from the lower end of a physical activity continuum and highlight the need of developing interventions targeting sedentary behaviours specifically.

Perceptions of health and illness which include the perceived cause and recourse play an important role in diagnosis and management of illness. Traditional and allopathic medicines are used simultaneously and sometimes without the knowledge of the health professional and this has an impact on clinical outcomes. Overlooking patients’ subjective experience, health providers’ biases and prejudice may pose a negative impact on clinical outcomes. This study explores patients’, traditional healers’ and psychological counselors’ perception of illness by conducting interviews and administering open-ended questionnaires. The data is analyzed both qualitatively and quantitatively through the use of content analysis and non-parametric statistical procedures. The results indicate that the concept of illness is complex and multidimensional with physical and socio-spiritual aspects. Effective management requires a joint approach between indigenous and western health systems. The results further show that traditional healers fully embrace the integrated health approach while there is some skepticism and uncertainty from psychological counselors which could be stemming from their training. There is still work to be done in terms of health planning and policy but also the training of health professionals. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

Introduction: The high prevalence of HIV in South Africa was confirmed by Department of Health (2005) which reported an HIV prevalence rate of 40.7 percent amongst antenatal clinic attendees at public facilities in KwaZulu-Natal in 2004. Abstinence is one of the strategies used by many different cultures where young unmarried people are encouraged to abstain from sex until marriage, to prevent young girls from getting pregnant and acquiring sexually transmitted infections (STIs). Aim: The aim of this study was to investigate African rural high school learners' choice of sexual abstinence and to compare abstinent versus non-abstinent African rural high school learners in order to be able to develop tailored educational messages. Abstinence was defined as not having penetrative sex, since this is the accepted definition of abstinence in Zulu culture. Objectives: a) To investigate the prevalence of abstinence from sexual intercourse amongst African rural high school learners, b) To assess demographic, psychosocial, and economic determinants of abstinence from sexual intercourse, c) To make recommendations about abstinence interventions. Method: A descriptive cross-sectional study was carried out in a rural area (Ugu District in southern KwaZulu-Natal). One class of Grade 9 learners, ages 14-20 years, was selected from each often randomly selected rural high schools. An anonymous selfreporting semi-structured questionnaire used the I-Change model to investigate demographic and economic information, attitudes, social influences, self-efficacy and intentions towards sexual abstinence. Chi square and T-tests were used for bivariate analysis and Logistic regression was used to develop a model for abstinence from sexual intercourse. Results: A total of 454 learners participated with a mean age of 16.76 years (SD 1.41) age range 14-20 years. Of the sample 208 (45.8%) were male and 246 (54.2%) female. The majority were Christian (84.6% (n=384)) and of this population, 28.3% (n=127) reported that they had 'ever had sex'. Furthermore, 24.5% (n=91) of learners reported that they were currently sexually active. Fifty six percent (n=252) of learners reported that they abstained from sex. When comparing learners reporting abstinence (n= 252) with those not abstinent (n= 202), abstinent learners were significantly more often females, who had never had sex (p / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2007.

This thesis is an investigation of the self-reported health behaviour changes made by adults in the Canadian Community Health Survey 2007, categorized by BMI category. Descriptive analyses and forward stepwise regression were performed to determine variables associated with HBC. The final sample n = 111,449. Overall, 58% of individuals had made a HBC in the past year. Increased exercise was the most common HBC (29%), followed by improved eating habits (10%) and losing weight (7%). Only 51% experienced barriers to HBC; lack of will power was most commonly cited. Overweight and obese individuals were more likely to undertake HBC. In the regression model, opinion of own weight was the strongest predictor of HBC, followed by fruit and vegetable consumption, number of consultations with doctor, smoking status, and perceived health.

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There is strong evidence supporting the view that beliefs and attitudes influence health behaviour. Furthermore, cultural and social beliefs also have been shown to influence the way health care facilities are used. Although western medicine plays a dominant role in the mass control of disease, traditional or folk medicine continues to play an important role in the health care of black communities. They therefore, possess unique attitudes, values and beliefs about health and illness which integrally influence their health behaviour. This study aims therefore to: understand phenomenologically the urban African’s perception of illness, disease and health; identify attitudes that directly influence health behaviour: identify “trigger factors” that precipitate health action and isolate factors that contribute to “negative” health behaviour. The sample in this study consisted of 3 groups of urban Africans who were 20 years and older. Group 1 comprised first time attenders to a medical outpatients department Group 2 and Group 3 were sample groups drawn from the Umlazi Township and the Kwa Mashu Township respectively. The Health and Illness Battery in the language of the participants were administered by trained interviewers. This study has demonstrated the following: urban Africans have a personal conception of illness, health and disease that influences their manner of help‐seeking; there are certain attitudes and beliefs that directly influence both positive and negative health behaviour;. there are several health beliefs which interact in a complex way and may lead to medical help‐seeking. Health action was found to be influenced by significant individuals in the subject's environment; demographic variables, such as, age, sex, education and urbanisation strongly influence the health and illness beliefs; these results validated some of the fundamental aspects of the common western health and illness models; the use of services and facilities are determined by the location, accessibility and the quality of services; financial costs, time, transport, lack of community supports, negatively affected helpseeking; symptoms have been identified as a “trigger factor” of help‐seeking. Individuals use other forms of treatments independent of medical treatments. A model of help‐seeking for urban Africans is proposed. / Thesis (Ph.D.)-University of Natal, 1993.