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published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The purpose of this longitudinal repeated measures experimental study was to determine the effects of bone health testing using dual energy X-ray absorptiometry (DXA) on outcomes of intentions toward and actual engagement in bone health behaviors (calcium intake, vitamin D intake, physical activity) among perimenopausal women. The Perimenopausal Bone Health Behaviors Model was developed based on the Theory of Planned Behavior and guided this study to determine how perimenopausal women respond to DXA and bone health information compared to bone health information only.One hundred fifty community-based perimenopausal women (ages 35-55) were randomly assigned to an intervention group (n=75 DXA and bone health information) or to a comparison group (n=75 bone health information). Baseline demographic data were collected. The Prevention Intentions Questionnaire and Behaviors Questionnaire were administered at baseline, at two weeks, and at two months after both groups received assigned interventions.Results showed 32% (n = 24) of intervention group women had low bone density. The intervention of DXA and bone health information showed near-significance (p = .068) over the intervention of bone health information alone in affecting women's intentions, and showed near-significance in affecting calcium intake (p = .052). Lower bone density test scores were related to higher intentions (r(74) = -.23, p = .046) at two weeks after DXA and bone health information, and were related to improved vitamin D intake (r(73) = -.25, p = .03) at two months after DXA and bone health information. At study end, Attitudes contributed 27.0% of the variance in Intentions among women who received DXA and bone health information; Attitudes, Subjective Norms, and Perceived Behavioral Control contributed 62.0% of the variance in Intentions among women who received bone health information only.Nursing interventions focusing on perimenopausal women should include providing bone health information to all perimenopausal women. Interventions targeting attitudes toward bone health behaviors may motivate some perimenopausal women to participate in behaviors that contribute to decreased risk of osteoporosis. Early detection and intervention in perimenopausal bone loss may reduce osteoporosis morbidity and may impact women's quality of life, reduce financial consequences to individuals, families, communities, and the nation.

This study explored the effectiveness of Handle With Care, a mental health promotion training program for child care practitioners working with children between birth to age 6. Handle With Care program content is based on research evidence. Training units are intended to deepen practitioners’ understanding of how children’s social-emotional development, centre and family connections and positive workplace activities link to children’s well-being and practitioners’ roles in these areas. Fifty-seven front-line practitioners from three different regional groups (Rural, Suburban, Urban) completed Handle With Care workshops and were compared to 56 comparison participants, matched according to region, who were not exposed to training. The evaluation utilized a time series repeated measures design and consisted of mixed quantitative and qualitative measures to determine training outcomes related to practitioner’s mental health promotion knowledge and practices. Findings indicated that child care practitioners who participated in Handle With Care training demonstrated increased mental health promotion knowledge. In particular, they acquired better comprehension of issues concerning practitioner and child attachment relationships, children’s self-esteem, emotion expression and regulation and peer relationships. Training participants significantly differed from comparison participants in their knowledge of these topics. In terms of practices, training participants also evidenced significantly improved practices relative to comparison participants. These gains were especially observed in relation to practitioners building trusting relationships with children, fostering children’s sense of self and competence, positive peer interactions and practitioners promoting their own mental health. In contrast, Handle With Care training did not show the intended consistent outcomes with respect to practitioners helping children with emotional communication, dealing with diversity, changes and transitions and practitioners building relationships with children’s parents. Results tended to be discrepant across regional groups, and in some instances, gains in mental health promotion and knowledge were not sustained over time. Overall, the study suggests that Handle With Care is a useful way to augment child care practitioners’ capacity to consider the mental health of all children in their care and flexibly implement strategies to help children reach their optimal potential. The study also provides important information concerning regional differences and areas of training content that may benefit from revision.

Infection control practices are a critical element in home-based care for people living with HIV/AIDS. It involves principles and procedures used to minimize the risk of spreading infections in home-based care. Infection control practices help to prevent morbidity, mortality rates and improve health for the volunteer caregivers and the patients. However, most previous studies on home-based care have focused on burdens of care, perceptions of rewards, quality of care and challenges faced by caregivers. Therefore, it is not clear how and to what extent infection control practices are carried out in home-based care. The purpose of this study is to explore the experiences of home-based care coordinators and volunteer caregivers regarding infection control practices in home-based care. Qualitative interviews were conducted with ten home-based care coordinators/project managers and ten focus group discussions were conducted with volunteer caregivers. An interview guide and a focus group schedule with open ended questions were used. Volunteer caregivers in home-based care organizations were faced with practical challenges regarding infection control practices that posed a threat to their work and health. The received insufficient infection control material resources such as gloves, masks and sanitizers. They also mentioned to have received poor quality gloves that easily broke, poor quality aprons that were not tight; easily blown by the wind and also thin masks that could not filter the bad odour. Other challenges that they faced included, insufficient water supply; insufficient knowledge on infection control and lack of cooperation from some patients and some family members regarding the use of protective clothing especially gloves and masks. Most volunteer caregivers were ridiculed by some family, community members and friends. Sometimes they could not access some patient due to HIV related stigma and discrimination. However, volunteers developed various strategies of dealing with these challenges such as replacing the torn gloves with plastics, carrying 2.5 litres of water, educating patients and family members about the importance of wearing gloves and practicing infection control. These findings require the government, NGOs, funders and donors to form a forum with volunteer caregivers to discuss the supply of materials. They need to establish a central administration that will be responsible for allocating adequate and quality materials for infection control practices. This central administration should also be responsible for supervising HBCOs including monitoring and evaluating infection control practices. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Background: There is global concern about the impact of lifestyle related diseases which have been on a steady increase in recent years. Poor nutrition, reduced physical activity and cigarette smoking have been documented as the main lifestyle behaviors that result in an increase in prevalence of the three most common occurring chronic diseases of lifestyle namely: diabetes, hypertension and cardiac diseases. Healthcare workers are frontline personnel and are seen as role models by their family, friends and the community they serve. It is therefore important that positive healthy lifestyle behaviors are practiced and encouraged by healthcare workers themselves. Objectives: To develop an initial descriptive profile of hospital employees with regards to their general knowledge, attitudes and practices about healthy lifestyles and to make appropriate recommendations to the hospital management on how the workplace can support the adoption of healthy lifestyles. Methods: The study was conducted at one health institution using the permanently employed staff as the study population. An exploratory descriptive study design was used in context of the precede-proceed planning framework. Self-administered questionnaires and consent forms were distributed in English and isiZulu. Collection boxes were placed in all wards and departments. Data was captured using the SPSS version 13 statistical package. Results: The response rate was 42%. Respondents were classified into the administrative, general staff and health professional categories. There was a significant difference (p=0.03) between the staff body mass index and their weight perception. Knowledge and attitude had mean indices of greater than 70% and the practice indices were lower for all three categories at less than 45%. A significant difference was found between certain staff categories in the knowledge and attitude indices but no significant difference existed in their practices. Conclusion: All categories of staff possessed adequate knowledge and attitudes but this is not transferred into positive health promoting practices. The possibility of workplace health promoting interventions was well supported by staff especially with regards to healthier meal choices at the staff dining room and an onsite gym facility. The main limitations of the study were the non-standardized data collection tool, and the poor response rate, which make the generalization of the study findings difficult. / Thesis (M.PH.)-University of KwaZulu-Natal, 2008.

Health and social policies identify empowerment as a guiding ideal for health promotion, yet there is little theoretical understanding of youth empowerment. The need for theory to guide practice and research in working with youth in a health promotion context led to this grounded theory study to develop a theory of youth empowerment. A community health nurse acting on BC Ministry of Health's adaptation of the World Health Organisation's Healthy Cities Initiative initiated a community organising project in an inner city community of Vancouver, which merged with the Vancouver Board of Parks and Recreation Blueprint for Youth Services policy. The study was based on 32 months of participant observation where the researcher was a co-facilitator of a community organising effort aimed at engaging youth in identifying their quality-of-life issues, and developing and implementing their solutions. Of the ,123 youth entering the process, 66 attended at least three meetings of which 18 demonstrated ongoing commitment to the community action process. Partnering between adults and youth as the process of empowering youth emerged as the core category in the analysis, comprised of two sub-processes, Creating an Empowering Environment for Youth and Becoming Empowered. An empowering environment allowed youth to take responsibility in a welcoming social climate with enabling support from adults. The adults demonstrated their belief in the capacity of youth to act in the community, expected youth to take responsibility, cared for youth, and offered encouragement through acting-with interactions with young people. Youth felt welcome and participated in the process, taking responsibility for voicing, decision making and action on their qualityof- life issues. The adults transferred the power to youth by giving up their responsibility for voicing, decision making and taking action. By taking responsibility and acting in the community with enabling support, the youth became empowered by controlling the process and incrementally developing their competence, self-esteem, confidence and understanding, which cultivated their belonging to the community. Participating in an empowering process enhanced their development and set in motion a social change process that raised the consciousness of adults and influenced organisational practice. The theory identifies youth empowerment as an ecological construct and a capacity-building process.

Högt blodtryck är en global välfärdssjukdom som ökar i frekvens. Levnadsvanor har stor betydelse för att en individ skall utveckla högt blodtryck. Livsstilsförändringar skall vara den inledande behandlingen, vid högt blodtryck. För att förändra livsstilen behövs utbildning och rådgivning samt motiverande samtal. Ansvaret för sin sjukdomsbild och sitt liv har genom samhällsutvecklingen mer och mer blivit individens ansvar. Omvårdnadsteoretiker Dorthea Orem menar att patienten behöver stärka sin förmåga till egenvårdskapacitet. Trots kunskaper om hjärtkärlsjukdomar råder det en bristande följsamhet hos individer till att genomföra livsstilsförändringar, därför finns det intresse av att studera problemet. Syftet med studien var att belysa distriktssköterskans erfarenheter av vad som främjar följsamhet till livsstilsförändringar hos patienter med högt blodtryck. Studien genomfördes med konventionell innehållsanalys med induktiv ansats som utgångspunkt. Resultatet i studien belyser vikten av att utgå från patienten och skapa individanpassad behandling för följsamhet till livsstilsförändring. I mötet med distriktssköterskan är det viktigt att patienten känner delaktighet och blir medveten om sitt ansvar i förändringen. För vidmakthållande av livsstilen krävs lång och regelbunden uppföljning där distriktssköterska och patient strävar mot samma mål. Ytterligare kunskap och forskning krävs i olika redskap såsom beteendemodeller som kan användas vid arbete kring patienter med högt blodtryck och livsstilsförändringar. Av betydelse för fortsatt forskning är att även ge patienternas syn på vad det innebär när förändringen utgår från patienten. / High blood pressure is a worldwide welfare disease and it increases. Lifestyle habits play a major part in how people develop high blood pressure. The initial treatment should therefore be lifestyle changes. Changes in lifestyle requires education, counselling and motivational interviewing. The illness responsibility has shifted from a societal level into an individual level. Nursing theorist Dorthea Orem believes that the patient needs to strengthen its ability for self-care capacity. Despite knowledge about cardiovascular disease there is a lack of compliance amongst individuals to implement lifestyle changes, and therefore it´s of interest to study. The purpose of this study was to illuminate district nurses experiences of compliance to lifestyle changes in patients with hypertension. The study was conducted with conventional content analysis with an inductive approach. The results of the study illuminated the importance that the patient is the starting point and then create individual treatment for better compliance to lifestyle changes. It´s of importance, that the patient are empowered and become aware of their own responsibility in their lifestyle changes. . It´s necessary to have regular and long-term follow up, to maintain the new lifestyle and make it a habit. It is important that the district nurse and the patient are striving towards the same goal. . Additional knowledge and research required in various tools such as behavioral models that can be used when working on patients with high blood pressure and lifestyle changes. Continued research is needed from the patients perspective. It should be clarified what it means to make lifestyle changes from patients point of departure.

This thesis examines the evolution of HIV/ AIDS education for women in metro- Vancouver. The research focuses on two questions, "What AIDS education programs for women currently exist in Vancouver?" and "How effective has AIDS prevention education for women been?" Since the reported incidence of HIV/ AIDS continues to rise, the latter question leads to a further issue, "Why have some women been excluded from the HIV/ AIDS discourse? I chose to investigate these issues from a socialist feminist perspective. This perspective, which focuses on women's position within the economy, society, and family, guided my analysis of information I gathered from a variety of sources. These included both primary and secondary sources, namely: brochures; magazines; newspapers; television reports; journals; books; presentations; and interviews. The findings of the research reveal that, at the onset, preventative educational strategies did not exist for metro-Vancouver women because the gendering of the AIDS epidemic rendered women invisible. Since subsequent AIDS education focussed on "risk groups" rather than risk behaviors, many women who do not belong to a "risk group" still believe that they are not at risk. Consequently, gender appropriate strategies for AIDS prevention education need to be further developed. As well, these strategies are only one part of the solution. Belief systems, social scripting, and perceptions of one's self and others are the more challenging and difficult pieces to change, as are the underlying root causes of drug addiction and promiscuity.