This thesis incorporates social history and consultative action research to analyse the development of cross-cultural nutrition services for Indigenous communities in the Northern Territory from 1974-2000 and promote the development of stronger partnerships in 1999-2001.The historical development of nutrition services is analysed against current theory and a model of capacity building for health promotion. Nutrition infrastructure and services have developed systematically, incrementally and substantially. Strengths include the development of enduring and successful inter-cultural partnerships and leadership.Two facilitative narratives which aim to improve inter-cultural knowledge sharing, strengthen capacity and promote participatory action in community based projects were developed, implemented and partially evaluated. Services can be further strengthened by long-term commitments to examining power issues, promoting improved Indigenous control and problem solving and comprehensive bi cultural evaluation that identifies significant indicators to improving outcomes. Participatory action research, facilitative story telling, capacity building, Indigenous education theory and critical social science can inform and guide these efforts in complementary ways. / Master of Arts (Hons) (Critical Social Science)

To date, there has been only limited research investigating the musculoskeletal health of Indigenous Australians. Nevertheless, the pain and disability associated with musculoskeletal conditions are thought to be high. This thesis reports on the outcomes of a cross-sectional survey and clinical assessment designed to measure the prevalence of musculoskeletal conditions, and uses them to inform the development of a community-based musculoskeletal training program for Indigenous Australians living in one of the largest rural Indigenous communities in Australia. There were three separate community-based studies comprising this thesis: The first describes the development of measures for assessing the prevalence of musculoskeletal conditions and the associated risk factors and barriers to managing these conditions for people living in this Community. The development of a screening survey and clinical assessment protocol was based on a literature search, existing validated measures, feedback from Indigenous focus groups and pilot testing with Indigenous people in order to achieve cultural appropriateness. The second study piloted the research tools, then measured and assessed the prevalence of musculoskeletal conditions, associated risk factors and barriers to managing these conditions in the Community. The third study describes the development and implementation of a preliminary community-based intervention delivered by AHWs that responded to the outcomes of the prevalence study. It assessed the cultural acceptability of a musculoskeletal training program (MTP), as well as piloting an approach to assessing changes in skills and knowledge of Aboriginal Health Workers (AHWs) who participated in the MTP. The conduct of these studies reiterates the difficulties associated with conducting studies in Indigenous Communities according to mainstream concepts, which rely on randomly selecting participants in order to achieve generalisability to the larger population. Beyond empowering Indigenous people through sustainable, community-based training initiatives, lies the immediate need to improve access to musculoskeletal health services and to remove this current and considerable barrier to improving the musculoskeletal health of Indigenous Australians. The conclusions of this thesis highlight the importance of giving consideration to cultural sensitivity and collaboration in planning health service delivery to Indigenous people. The application of the community-based model used in this study may have the potential to be seeded in Communities throughout the country as a step towards promoting the musculoskeletal health of Indigenous people living in rural Australia and beyond. / PhD Doctorate

The potential role of local government in NSW to address public health nutrition issues has received encouraging reports. This treatise deals with the question of whether intersectoral collaboration theory is useful to assist development of a relationship with local government to develop food and nutrition policy. Intersectoral collaboration theory describes six conditions necessary for successful action: necessity, opportunity, capacity, relationships, planned action, and sustained outcomes. The project was a feasibility study carried out in a densely populated and multicultural local government area in Sydney�s southwest during April 1998. Eight Council employees and one elected representative were interviewed using the semi-structured questionnaire to collect a range of opinions and knowledge about Council�s involvement in a food and nutrition policy. Conceptual frameworks for the study included the Ottawa Charter and the food and nutrition system. Theoretical underpinning�s were provided by intersectoral collaboration theory and organisational change theory. Using intersectoral collaboration theory, analysis of the interviews revealed that participants were very concerned with conditions of necessity, opportunity and capacity to develop food and nutrition policy. Intersectoral collaboration theory correctly predicted that the action proposed would have to assist Council to achieve their core business, gain social and political support and be possible within the current economic environment and level of other resources available. Participants were not able to identify how a food and nutrition policy would meet these conditions and be feasible within the current capacity of the organisation, and therefore did not become fully engaged in the feasibility study. The health sector needs to develop arguments for local government involvement from their perspective. Organisational change within the heath sector is required to develop capacity for intersectoral partnerships, as an effective strategy to address public health nutrition issues.

<p>Physical activity (PA) is likely to constitute an important aspect of health-related behaviour in growing children. However, the knowledge on levels and patterns of PA in children is limited, due to the difficulty of precisely measuring this complex behaviour in normal daily living. Information on variables that significantly contributes to the variability in PA patterns is warranted as it may inform strategies for promoting physically active lifestyles in school-age youth. The overall purpose of the present studies was to increase the knowledge about the use of accelerometry when assessing PA in children, and examine sources of variability in objectively assessed PA behaviour in children. The study samples included 1954 nine- and 15-year-old children from four geographical locations in Europe (Norway, Denmark, Estonia and Portugal), and additionally 16 Swedish seven-year-old boys and girls. PA was assessed by the MTI accelerometer during free-living conditions, including both weekdays and weekend days. A part of the PA assessment was conducted using different time sampling intervals (epochs). Predictions of estimates of daily energy expenditure from accelerometer output were calculated using previously published equations. Potential correlates of PA behaviour were assessed by self-report. The main findings were; a) the epoch setting had a significant effect when interpreting time spent at higher intensities of PA in young children, b) predicted energy expenditure differed substantially between equations, c) between- and within-day differences in overall levels of PA, time spent at moderate-to-vigorous intensity physical activity and time spent sedentary differed between age, gender and geographical location, d) outdoor play and sports participation were differentially associated with objectively measured PA in 9- and 15-year-old children. It is concluded that the sporadic nature of children’s physical activity require very short epoch settings for detecting high intensity PA, and that different published equations for estimations of daily energy expenditure cannot be used interchangeably. The interpretations of average energy expenditure from available equations should be made with caution. Based on a large sample of children of different ages, weekend days and leisure time during weekdays seem appropriate targets when promoting PA in order to increase the proportion of children achieving current recommendations on health enhancing PA. Further, significant correlates of PA behaviour dependent on age group are presented, which should be considered when planning interventions for promoting PA in school-age youth.</p>

Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2007.

The purpose of this research was to examine and describe the relationships among health status, marital status, income level, education level, age, and body mass index (BMI) with the added influence of spirituality on the health promotion behaviors of African American women, living in South Florida. The sample consisted of 137 women, 18 to 64 years of age, who were born in the United States and whose parents were born in the United States. Each participant completed a demographic questionnaire, the Health-Promoting Lifestyle Profile II (HPLP II), the Short Form-36 Health survey (SF-36), and the Spiritual Well-Being Scale (SWBS). Descriptive and inferential statistics with an alpha level of .05 were used for data analysis. Statistically significant findings were (1) a positive relationship between health promotion behaviors and formal education, (2) a positive relationship between health promotion behaviors and spirituality (existential well-being), and (3) a negative relationship between health promotion behaviors and number of children. In the regression model, the five sets of variables together accounted for 25.5% of the variance in overall health promotion behaviors of African American women F (15, 121) = 2.768, p < .01. The health promotion behaviors of African American women were not significantly affected by health status, marital status or BMI. Of the five demographic variables entered in the model, only number of children and education made statistically significant, unique contributions to health promotion behaviors. A sense of life satisfaction and purpose (existential well-being) made an additional, statistically significant, unique contribution to health promotion behaviors among African American women. The unique contribution of religious well-being was trivial. Therefore, formal education, number of children, and spirituality (existential well-being) may be used as predictors of health promotion behaviors among African American women, based on the results of this study. Culturally appropriate and relevant interventions used to encourage and educate African American women to increase physical activity, and decrease caloric intake are critical to mitigate the high rate of morbidity and mortality that African American women experience from CVD.

With the number of people living longer and with more chronic problems, it is important that health educators examine who they are educating as well as the methods and circumstances of the education. The purpose of this study was to identify the relationship between self-directedness and health promotion in the elderly. A convenience sample of 108 elders who use Senior Centers in rural East Tennessee comprised the study group. The sample was asked to complete the Self-Directed Learning Readiness Scale, the Health Promoting Lifestyle Profile II, and a demographic information survey at a regular meeting of a Senior Center. A positive relationship (r=.394; p<.005) was found between self-directedness as a measure of intrinsic motivation with participation in health promoting behaviors. Demographic information was used to describe the sample and was also used to determine if there was a relationship between any of the demographic items and health promotion practices or self-directed learning readiness. Participation in religious/spiritual activities was significant for both self-directed learning readiness and health promotion practices. Pender’s Revised Health Promotion Model and the Personal Responsibility Orientation Model provided an excellent basis for this study. The study confirmed the need for personal motivation in the elderly to accomplish increased participation in health promotion practices. Both self-directed learning readiness and health promoting behaviors were reviewed for consideration of previous research in the area, and theoretical perspectives. The key implication for practice is that health educators need to understand the motivation of their client prior to educating them regarding an aspect of health promotion. Recommendations for research include more qualitative studies. Almost all the studies available at present are quantitative and the reason for participation needs further investigation. Qualitative studies would enhance the information regarding the reasons for participation in health promotion.

<p>Chronic diseases pose public health concerns globally with an increasing trend in developing countries. The development of interventions to minimize or prevent the burden associated with chronic diseases has therefore become a necessity. In 2002 the School of Public Health of the University of the Western Cape developed a health club intervention in Khayelitsha. This intervention focused on promoting healthy lifestyles, particularly improved diet and physical activity. The objectives of this study was to determine whether members were more physically active than non-members and to determine whether members made healthier dietary choices than non-members.</p>

Introduction The interest in relations between arts and workplace related health has increased. The focus has mostly been on the work of arts and health from a disease perspective and to the best of our knowledge the research focusing on relation between the artists and workplace related health from a salutogenic perspective is rare. In 2007 a project called the Contemporary Artists in Contemporary Society (CACS) Scania project was implemented and evaluated. The project consisted of twelve visual artists being positioned at eight workplaces on half time for a period of six months. The idea of the project was that unprejudiced meetings between the artists and the staff could result in workplace related health promoting processes. This study will try to unravel some of the mystery of how artists’ presence can result in workplace related promotion of health.    Aim The aim was to identify success factors for visual artists functioning as health promoters at a workplace.   Procedure The search for success criterion started with going through the project descriptions and the evaluation reports from the CACS Scania project. This exposition led to the selection of one project that was considered a particularly successful case. Two artists had been placed at the office for management of regional development in Scania. The employees consisted mainly of civil servants and administrators. The evaluation material belonging to this particular project was studied, searching for possible explanations to the success of the project. The material consisted of digital recordings from a focus group interview with five of the participating staff, an interview with the manager, an interview with the two artists as well as stories written by the two artists throughout the project and finally the project description as well as the folder that the two artists produced as a summary of the project. The analysis of the material was influenced by qualitative content analysis and three categories of success factors were found.   Results The experience of the participating staff The result showed that the staff mainly had had positive project related experiences. The staffs’ experiences could be linked to the salutogenic factors comprehensibility, manageability and meaningfulness. The various project related activities were found to be meaningful and the different activities were considered a pleasant reflective break from an everyday routine based and hectic practice. Some of the staff reported having problems managing the openness and indistinctiveness of the project, but the frequent communication with the artists, as well as support from the manager made the indistinctiveness manageable. The presence of the artists and the different project related activities were often found to be amusing, with adherent facilitation of wellbeing among the staff. At other occasions the presence of the artists could be considered disturbing. The artists brought new perspectives into the workplace that sometimes challenged the staffs’ customary way of thinking and acting, opening up possibilities for creativity and reflective processes of work related learning. It seemed as if the positive health related experiences of the staff relied on communication and mutual construction of intellectual fellowship and project related meaning (intersubjectivity).   A framework for the work of the artists Four criteria were considered a useful framework for a description of the artists successful work at the workplace. 1. Presence - The artists were often present at the workplace. 2. Inspiration – The artists were inspired by the workplace. 3. Activity - The artists were constantly presenting things and activated the staff through out the project 4. Communication – The artists communicated with the staff during the development, implementation and completion process of the project.   Organisational climate It seemed as if the organisational climate was suitable for using artists as health promoters. The staff and the manager were for instance describing them as willing to try new and innovative strategies for the development of their work in general and their work related health in particular.   Conclusion To conclude there is a health promoting potential when involving artists as health promoters at a workplace. For this potential to be realised we found three categories of success factors. The experience of the participating staff were considered important since positive experiences, with adherent positive feelings, form the base for psychological and biological processes that generally have a positive impact on health. These experiences are on the other hand dependent on other facilitating factors, that here can be linked to for instance the artists as well as the organisational climate.

Bakgrund: Övervikt hos barn och ungdomar är ett internationellt folkhälsoproblem. Skolsköterskan har en viktig roll i det hälsofrämjande arbetet med överviktiga elever för att kunna främja goda levnadsvanor. Syfte: Syftet var att beskriva skolsköterskors erfarenheter av arbetet med övervikt hos elever inom skolhälsovården. Metod: Studien genomfördes med en kvalitativ ansats. Åtta skolsköterskor intervjuades med semistrukturerade frågor utifrån en intervjuguide. Intervjuerna analyserades med en kvalitativ manifest innehållsanalys. Resultat: Studiens resultat presenterades utifrån fyra kategorier och 12 underkategorier. Kategorin ”Mötet i fokus” visade att skolsköterskorna använde sig av ett individuellt och professionellt förhållningssätt i mötet med elev och föräldrar. De arbetade för att främja en god relation och använde sig av olika metoder i arbetet med de överviktiga eleverna. Kategorin ”Samverka med olika professioner” visade att skolsköterskorna samverkade med både interna och externa aktörer. Kategorin ”Betydande faktorer för att nå framgång” belyste skolsköterskornas möjligheter att arbeta med motiverade elever och föräldrar, samt att skolsköterskorna var tillgängliga och arbetade förebyggande. Kategorin ”Utmaningar i arbetet” lyfte fram ämnets känslighet, svårigheter att förändra samt skolsköterskornas brist på tid och kompetensutveckling. Slutsats: Skolsköterskans arbete med överviktiga elever kräver ett professionellt förhållningssätt och en varsamhet i samtalet på grund av ämnets känslighet. En god relation med elev och föräldrar är en förutsättning för att skolsköterskan skall nå framgång i sitt arbete. Skolsköterskan är beroende av föräldrarnas motivation och vilja att förändra för att kunna stödja eleven. / Background: Overweight among children and adolescents is a worldwide public health problem. The school nurse has an important role in promoting the health of overweight students in order to encourage them to lead a healthy lifestyle. Aim: The purpose of the study was to describe school nurses' experiences working with overweight students. Method: The study was conducted using a qualitative approach. Eight school nurses were interviewed with semi-structured questions based on a set of interview guidelines. The interviews were analyzed using manifest content analysis. Results: Study results were presented from four categories and 12 subcategories. The category ”Meeting in focus” showed that while meeting with parents and students school nurses were able to evaluate students as individuals simultanously maintaining a professional approach. They used various methods to promote good relationships with overweight students. The category ”Collaborate with different professions” showed that school nurses collaborate with both internal and external professions. The category of ”Significant factors for success” highlighted school nurses opportunities to work with motivated students and parents, and showed that not only were school nurses available for students but they also practiced prevention. The category ”Challenges in the work” included the sensitivity of discussing weight problems, difficulties in changing behavior and school nurses' lack of time and further education. Conclusion: The school nurse’s work with overweight students requires a professional approach and care in conversation, because of the sensitivity of the subject. A good relationship with students and parents is a prerequisite for the school nurse to achieve success in their work. The school nurse is dependent on the parents' motivation and willingness to change in order to support the student.