Wellness educators have faced a great challenge to develop strategies to move people toward the adoption of positive lifestyle behaviours. This research explores concepts of self and the impact of Thai culture on the motivation of young college women to engage in health-promoting lifestyle behaviours (HPLBs) in the context of northeastern Thailand. A sequential mixed methods design enables an exploration of the relationships among sense of coherence, identity status, and HPLBs in the first phase, and an inductive analysis of the impact of Thai cultural context in the second phase. In study A, three instruments: the Health-Promoting Lifestyle Behaviors Profile II (HPLP II), the Extended Version of the Objective Measure of Ego Identity Status (EOM-EIS), and the Orientation to Life Questionnaire (SOC-29), were used with 350 senior college women. Sense of Coherence was significantly correlated with achieving a sense of identity, lessening diffusion identity and engaging in health-promoting behaviours. Although a considerable proportion of the variance (26.7 %) for engaging in HPLBs was accounted for by SOC, identity achievement, and identity moratorium, the magnitude of the unexplained variance was considerable. This led to inductive exploration of other variables influencing HPLBs in Study B. By data-driven thematic analysis, the Model of the Mindful Self emerged from in-depth interviews with 25 college women. The model describes three main themes: (a) the cultural background and the surrounding ongoing influences which impact on the development of Thai women's sense of self and their health-related behaviours, (b) the sense of self and identity formation in the Thai context, and (c) the health-related behaviours that stem from the sense of self. Sense of self and its behaviours are socially constructed within the specific culture in which individuals are embedded. The social phenomena and research outcomes are interpreted under the lens of social constructionism. The knowledge generated by this study provides guidance for teaching about health promotion in Thai undergraduate nursing programmes and also provides a basis for initiating health-promoting programmes based on the individual's sense of self for female adolescents in Thailand.

Magister Public Health - MPH / The global problem of overweight and obesity is disturbing judging by the World Health Organization 2008 statistics which estimate that 1.4 billion and 500 million adults are overweight and obese. Thus, as a major risk for non-communicable diseases (NCDs) which are the foremost cause of disability and death, the problem of obesity needs to be addressed not only globally but in South Africa as well. South Africa’s burden of disease includes NCDs and causes of death of diseases such as diabetes (3%), cardiovascular diseases (CVDs) (11%), cancer (7%) and chronic respiratory diseases (3%). The HealthKick study is a school-based nutrition and physical activity intervention programme in the Western Cape, S.A., aimed to promote healthy behaviours such as healthful eating and physical activity in children, parents and teachers to reduce the risk of non-communicable diseases. During the formative phase of the study it emerged that educators were at high risk for NCDs because of their high levels of obesity. This study therefore aimed to describe primary school educators’ perceptions regarding body weight, related health risks and barriers to weight management. A qualitative approach was used to collect data and included focus group discussions (FGDs), and in-depth individual interviews (IDIs). In addition anthropometric measurements were taken. Four schools were purposively selected and a total of thirty one male and female educators participated in the seven focus group discussions and four in-depth interviews from the four schools. Male FGDs and IDIs and female FGDs and IDIs were conducted separately. The focus group discussions and in-depth interviews were digitally recorded and transcribed verbatim. Thematic data analysis was conducted with the use of ATLAS ti 6.1 computer software.The results of the study indicate that educator perceptions regarding their own body weight varied slightly from the actual. Positive and negative weight loss experiences and feelings regarding their own body weight were expressed. Educators appeared knowledgeable about overweight/obesity and its health risks for particular NCDs. Several personal barriers were identified by the educators; however, of particular interest were the barriers relating to the school environment, identified barriers included lack of time, heavy workloads and school responsibilities. Several factors for consideration emerged relating to implementing an educator weight management programme in the schools. These included: the involvement of the department of education (DOE), the type of activities planned and the time of implementation.

Trust for health care professionals (interpersonal trust) and the health care system (institutional trust) is imperative for the performance of health care systems. However, at the same time, contemporary societies today are characterised by decreasing levels of trust and citizens today are increasingly inclined to seek health information from sources beyond health care professionals. Sociologists have argued that societal institutions, such as the health care system, are subject to individuals’ increasing mistrust, which has created a “critical distance” between lay citizens and modern medicine. In this critical distance, the health care system and its representatives are continually questioned why citizens’ trust for the medical institution can not be taken for granted. Because individuals living in the modern society are more inclined to take control over their health by engaging in health information seeking behaviour, the present study aims to examine whether there exists an association between interpersonal and institutional trust and differences in health information seeking behaviour. This study focuses on the Swedish context, where decreasing levels of trust for societal institutions - including the health care system, have been reported. Multivariate logistic regression analysis using data from European Social Survey (2004) was utilised to answer the research questions “Is the degree of trust for the health care system in Sweden associated with individuals' health information seeking behaviours?” and “Is the degree of trust for health care professionals in Sweden associated with individuals' health information seeking behaviours?”. The majority of the results from this study were not statistically significant, why the null hypothesis can not be ruled out. More recently collected data and more representative operationalisations of variables might generate more valid results. The study topic provides a potentially fruitful and valuable route for future scientific research, why it is considered important to further investigate whether mistrust for the healthcare system and its experts motivates individuals to consult alternative sources rather than health care professionals when seeking health information.

In 2003 a WHO treaty presented the use of cigarettes and tobacco as an international tobacco epidemic: a public health concern that needed to be diminished. Decreasing smoking prevalence can be an effect of individual choice, the social context or of governmental interventions. This master thesis originated in an interest in governmental measures aimed at decreasing the population´s smoking prevalence. The data used in this thesis include records of parliamentary and governmental bills as well as the parliamentary debates in the Swedish Parliament 1971 and 2011. Discourse analysis was used to analyse how the hazards of cigarette smoking in a public health perspective were of any interest to the national political arena of the Swedish Parliament. Fivethemes developed from the documents. The essence of the themes evolved to vision, society structure and tools for policy making. To conclude: forty years of policy making resulted in legislation; a smoking ban was put into place and shift of societal norms.The agenda of tobacco policy making expanded, what was politically acceptable and possible to add to the agenda during forty years varied. There were changes in discourse as well as development of new discourse.

Type 2 diabetes is a life-threatening condition, and it is rapidly growing in the world. If patients receive adequate education and support, they can manage their diabetes-related tasks effectively and reduce the severe complications of this disease. However, traditional self-management education and practices were not very effective in stimulating behaviour change and addressing patients’ diversified needs and expectations. Mobile text messaging is a promising method for type 2 diabetes self-management as it can provide continuous and customized support to these patients. However, there is a lack of knowledge about the optimal approach to designing and delivering mobile text messages. Hence, this dissertation aimed to define effective message strategies for mobile text messaging interventions targeting type 2 diabetes self-management. This manuscript-based dissertation consists of three complementary studies. The first manuscript includes a systematic review and a meta-analysis of tailored mobile text messaging interventions on type 2 diabetes self-management. It examines the tailoring strategies, message content, and structure and identifies the moderators of effectiveness in these interventions. The second manuscript includes a systematic review and a meta-synthesis of qualitative evidence on patients’ experiences and perspectives of mobile text messaging studies. The third manuscript consists of a prospective qualitative study to explore the text messaging design and delivery preferences of patients. In the first and second studies, the comprehensive search strategy included major electronic databases, key journal searches, and hand searches of the reference lists of related systematic reviews and meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Collaboration's guidelines and recommended tools were used for data extraction, risk of bias and critical appraisal assessments, data analysis and reporting. Within a social marketing framework, the third study included semi-structured interviews and a thematic analysis of the main findings. In the first manuscript, 13 eligible trials were included for the systematic review and 11 eligible trials were further analyzed in the meta-analysis. This study concluded that tailored mobile text messaging interventions could improve glycemic control in patients with type 2 diabetes. The subgroup analyses revealed the importance of some moderators such as message delivery, message direction, message frequency, and using multi-modalities. In the second manuscript, the systematic review included 14 eligible studies, and the thematic synthesis included 13 eligible studies. Patients emphasized the importance of tailored text message design and delivery. They felt “supported” by using text messaging and improved their communication with family/friends and care providers. Mobile text messaging increased patients’ self-awareness, knowledge and control of diabetes. The third study explored that mobile text messages could be more effective if they are gain-framed and written in a standard format. Patients favoured the text messages that included simple and direct tone and provided statistical evidence. The findings demonstrated patients’ needs and expectations for advanced tailoring strategies in both message content and delivery. Together, the manuscripts fill a significant gap and inform research and practice for the development of more effective message strategies that could lead to reducing the spread of type 2 diabetes worldwide. / Graduate / 2022-05-12

Med en socialkonstruktivistisk och sociokulturell ansats, studeras skolkuratorers uppfattning om och erfarenhet av grundskoleelevers psykiska hälsostatus samt skolkuratorernas definieringar av psykisk hälsa/ohälsa. Studien problematiserar att det rapporteras från återkommande enkätstudier att mer än varannan grundskolelev uppger sig ha återkommande psykosomatiska symptom vid minst två tillfällen i veckan, samtidigt som knappt nio av tio grundskoleelever uppger sig ha gott eller mycket gott psykiskt välbefinnande. Mer än varannan grundskolelev lider av psykisk ohälsa är utgångspunkten i den offentliga debatten. Empirin består av intervjuer med skolkuratorer vilka inte delar den bild av grundskolelevers psykiska hälsostatus som utmålas i den offentliga debatten. Allmängiltiga definitioner av psykisk hälsa/ohälsa finns inte, vilket bidrar till delade meningar råder bland forskare, myndigheter, politiker, media, etcetera om vad begreppen innebär. Utifrån studien kan slutsatser dras att definitionsförvirring, otillräckliga mätinstrument och brist på hänsyn till samhällsutvecklingen bidrar till en missvisande bild av grundskolelevers psykiska hälsostatus.

No / The aim of this research was to evaluate the effectiveness of a school-based intervention designed to enhance young people's motivations to breastfeed. A cluster randomized controlled trial was conducted involving 50 post-primary schools from across Northern Ireland. However, dropout and exclusion criteria utilized for the current study resulted in an effective sample size of 42 schools. The intervention was delivered in two 35-min classroom sessions targeting those beliefs identified by the theory of planned behaviour (TPB) as significant in predicting motivation to breastfeed. Questionnaires incorporating the key components of the TPB were administered to all intervention and control schools at baseline, 1 and 6 months post-intervention. Multi-level modelling was used to analyse the data. Findings suggest that the intervention was effective in that it increased females' intentions to breastfeed, expanded their knowledge and led to more favourable attitudes and perceptions of subjective norms. Notably, females' knowledge increased more in secondary schools than in grammar schools irrespective of whether they were control or intervention schools. The research has provided evidence to support the use of the TPB in the design and evaluation of an intervention to increase females' intentions to breastfeed.

<strong>Background:</strong> Cardiovascular disease (CVD) can have its beginnings in childhood, especially if the child is overweight. Without intervention, increased risk factors in childhood track in adulthood, putting the individual at increased risk for early cardiovascular morbidity and mortality. As a result, childhood health outcomes are an increasingly popular area for health research. However, little progress has been made on the most effective way to enable children to lead healthy lives. <strong>Methods:</strong> This thesis incorporated five studies. Firstly, a systematic review and meta-analysis of 63 papers involving nearly 50,000 school children examined the relationship between body mass index (BMI) categories and CVD risk factors. Secondly, a focus group study with 46 students to discuss their knowledge and attitudes towards health, health behaviours and health education. Thirdly, a focus group study with six mothers to discuss screening weight in childhood, and their perceptions of childhood health and health education. Fourthly, a component analysis to establish the characteristics of nine successful educational interventions on children’s health. Finally, a pilot intervention and feasibility study involving 314 students. <strong>Results:</strong> Overweight and obese BMI categories were associated with substantial increases in CVD risk factors measured and that the association with obesity was greater than that with being overweight. The focus group studies found that the depth of knowledge and the perceived depth of knowledge that participants had about CVD risk factors affected their attitudes and behaviours, although not in the same way. The pilot intervention was deemed feasible. A significant change was brought about in the students’ knowledge of cardiovascular disease and raised their self-efficacy towards ensuring the health of their hearts. <strong>Conclusion:</strong> The effect of obesity on cardiovascular risk factors is greater than that of being overweight. Additionally, studies in this area are hindered by inconsistent measurements and definitions of the BMI categories. Secondly, both parents and children need to be equipped with deep knowledge and understanding to facilitate attitude and behaviour change towards healthy living. Finally, the pilot intervention should be trialled in a randomised, controlled trial.

Background: The prevalence of disability increases with age; therefore with an aging population, interventions to reduce disability are crucial. This thesis adopts a behavioural conceptualisation of disability. The theoretical frameworks of the International Classification of Functioning, Disability and Health (ICF), the Theory of Planned Behaviour (TPB) and the integrated ICF/TPB model are applied to investigate disability and physical activity (PA) behaviours. The thesis aims to: (1) identify the factors involved in the prioritisation of patients for total joint replacement; (2) classify patient pre-operative expectations of total hip replacement (THR) and investigate the relationship between expectations and recovery after surgery, and; (3) test whether the TPB and theory-based interventions can predict and explain PA within individuals. Method: Five studies were conducted. In the first study, health professionals judged whether the items from two prioritisation tools measured each of the ICF constructs. In the second study, surgeons ranked patient vignettes, which differed by constructs from the integrated model, in order of priority for THR. In the third study, a large cohort of THR patients reported expectations of surgery pre-operatively. Health and functioning were also reported pre-operatively and 1-year post-operatively. The fourth and fifth studies were a series of experimental n-of-1 studies using diary methods assessing TPB cognitions and PA behaviours. Results: There is a lack of agreement between judges in relation to the content of many of the items from prioritisation tools. Behavioural and psychological factors can influence prioritisation for THR. The majority of patient expectations of THR addressed activities and social participation; however, the evidence for a relationship between expectations and recovery was limited. The TPB can predict PA within some individuals but the evidence in support of interventions to increase PA was limited. Discussion: The findings provide important clinical and theoretical implications for understanding disability and physical activity behaviours.

What’s God got to do with Sex? Exploring the relationship between Spiritual engagement and the sexual health activities of Samoan youth. Improving the health and social wellbeing of Pacific youth is a key priority for the New Zealand Government. When the Pacific youth population’s sexual health is compared with that of other ethnic groups in New Zealand there are clear disparities. At the same time, spiritual engagement is frequently noted as protecting young people from engaging in health-risk taking behaviours. Objectives: This study determines whether a relationship exists between patterns of spiritual engagement and the sexual health activities of Samoan attending secondary schools in New Zealand. Does going to church or rating spiritual beliefs as important influence the sexual health activities of Samoan youth? Method: This research analyses data from ‘Youth 2000’, a youth health and wellbeing survey conducted in 2001. The survey was conducted with approximately 10,000 New Zealand secondary school students which included 646 Samoan and 5219 New Zealand Europeans. Nine sexual health activities were explored. Data relating to spiritual engagement and the sexual health activities of Samoan and New Zealand European students were extracted from the survey, measured and compared. Results: A significant proportion of Samoan youth have not had sexual intercourse. Just under a third of Samoan students (32.1%) have had sexual intercourse, with the average age of first sexual intercourse around 14 years. Findings reveal that the spiritual engagement variables: church attendance and the importance of spiritual beliefs have mixed influences on the different sexual health activities of Samoan youth. Conclusions: This study reinforces the central importance of spiritual engagement in the lives of many Samoan secondary school students. Government policies and interventions require an understanding of key health behaviours and their related risk and protective factors specific to New Zealand youth.