The prevalence of low back pain has assumed an upsurge trend in the last five decades despite the many interventional strategies. One interventional strategy that has been unsuccessful has been patient education. Lack of positive results from many of the existing patient education programmes is probably due to the type of health information that has been presented and the method that has been used. Many of the health education programmes have been planned according to what the medical professionals assumed the individuals needed to know, assumptions that could have ignored some crucial aspects. This study explored the perceived health education needs of individuals with low back pain at the Nairobi Hospital Rehabilitation Unit in Kenya, the method used to educate the individuals, the appropriateness of the method according to the individuals in addition to identifying the source of the health education that the individuals had.

<p>This thesis investigated the potential role of indigenous healers in life skills education in South African schools. The main focus of this study was to explore how indigenous knowledge of traditional healers can contribute to the development of life skills education in South African schools. The research also sought to strengthen Education Support Services in the South African education system, in order to address barriers to learning. These barriers to learning are linked to health challenges such as substance abuse, violence, malnutrition and HIV/AIDS and many other health-related issues in school-going age learners.</p>

Deeper understanding of family health and support after childbirth from the perspective of first-time parents and their informal support network is needed. Postpartum experiences and health concerns of first-time mothers and fathers and, discourses on sexuality and informal support after childbirth were explored in low-income, suburban areas in Ilala, Dar es Salaam, Tanzania. Individual qualitative interviews with first-time mothers (n=10) and fathers (n=10), and 14 focus group discussions with first-time parents (n=40) and informal support persons (n=42) provided the data, which were analyzed through qualitative content and discourse analysis. First-time parents’ areas of concern were newborn care and hygiene, infant feeding, handling crying infant, maternal nutrition and hygiene, uncertain body changes for the mother and, sexuality. The mothers were burdened with caring responsibilities and fathers felt neglected and excluded from the care of the mother and infant after childbirth, both by the families and the health care system. Sexuality after childbirth created tension between new parents due to the understanding that abstinence would protect child health during the breastfeeding period, which could be several years. Women’s adherence to sexual abstinence was more emphasized compared to men’s. Men’s engagement with other sex partners and the risk of contraction HIV was a threat to family health. First-time parents drew on support from both informal and formal sources. Informal support networks played a major role in providing information, materials, guidance and supervision while conveying stereotypic gender norms. Contradictions in the messages to parents within and between the support systems created uncertainties that might have negative implications for family health. Poor parents and those who did not adherence to the social norms were less likely to get informal support than others were. There is a need for information and practical guidance on basic aspects of care for the mother and infant, male involvement, and the importance of social support to first-time parents, as new parents face physical, social and relational challenges after childbirth. The link between the health care system and informal networks need to be strengthened to enable them to complement each other in promoting family health after child health.

Over the past 100 years the average life span of humans has increased in developed countries. Mortality rates have changed because of the virtual eradication of infectious diseases, such as polio and smallpox, and the increase in chronic diseases. Chronic diseases, such as coronary heart disease, are related to lifestyle behaviour, a factor over which the individual has some control. Matarazazo (1984) believes that 'behavioural pathogens are the key to understanding health behaviours of the individual and subsequently designing more effective methods of dealing with chronic disease and illness. Fries (1980) suggests another approach to dealing with chronic disease, through the strategy of 'compressed morbidity'. This refers to the postponement of chronic infirmity relative to average life duration. By achieving compressed morbidity, it is expected that health costs will decrease and improvement of quality of life will occur. This may be possible in at least two ways: firstly, by self-empowerment of the individual and secondly by the development of health self-efficacy. Thus giving the individual the power to act upon certain health-damaging behaviours as well as the confidence to influence behavioural change and persistence to cope with difficulties whilst the process of change is occurring. Thirdly, as a result of this, behaviour changes will occur and this would lead to a reduction in health cost which would be of overall benefit to the community. One method of reducing these health care costs is through health promotion and health education. Improvements in health knowledge and skills through health education and health promotion has been shown to facilitate changes in lifestyle and so reduce the incidence of various diseases. This study examined the effectiveness of two types of self-care models, health self-care and medical self-care. Health self-care refers to individuals assuming more responsibility for prevention, detection and the treatment of health problems using self-care information. Medical self-care involves the use of General Practitioners (GP) offering advice to their patients and subsequently patients making informed decisions about their health. The health self-care model Healthtrac, attempts to provide an effective use of the Australian health care system. Healthtrac is an information and skills based mail delivery program designed to assist individuals in elevating their perceptions of health self-efficacy and improve their lifestyle behaviours. Better Health is the medical self-care model which is designed with the perspective that GP's are the best suited as the initiators of change in individual health self-care. Participants (N = 864) are adult males and females. The methodology for this study involved 864 high risk of chronic disease participants who have been identified using the Healthtrac Health Risk Assessment (HRA) instrument. There were (n = 343) participants in the health self-care group, (n =66) in the medical self-care group and (n = 455) in the control group. This instrument was designed to identify individuals who have or are at high risk of developing chronic disease. These participants were part of the Better Health promotion program of a Health Insurance company. All the participants received a letter of advice detailing the presence of certain risk factors as determined by their health risk appraisal. They were requested to visit their local GP who recommended the necessary behavioural changes and medical support required for medically satisfactory outcomes. They were encouraged to follow the advice of the GP and received a second HRA after 6 months and again12 months after the start of the project. The Healthtrac component of the study involved 343 subjects who completed the HRA instrument. Participants in this group were matched with the Better Health subjects for variables such as age, gender, employment, disease or lifestyle and educational level. Baseline impact variables were calculated and compared with the same variables at 6 monthly intervals during the 12 month period of the study. Process variables such as user satisfaction were determined by a questionnaire. Investigation of the Health Benefits Organisation records were used to gather data on the number of claims for hospitalisation and other medical costs. A control group of 455 participants were matched with the same variables as those participants in the health self-care model and medical self-care groups. The analysis of results indicate that variables such as number of doctor's visits, days spent in hospital and total risks scores for the health self-care model were lower than the Medical model scores. The variable, cost of disease findings indicate that there were no significant differences between the two experimental groups, from the baseline data (Q1) to the 12 month period (Q3). The cost of diseases for heart disease was able to be lowered more by participants in the health self-care than the medical self-care model. The opposite occurred for the blood pressure condition. The health self-efficacy questionnaire results indicate that the health self-care group participants reported higher self-efficacy scores, therefore they were more confident about the self-management of their health behaviours than the members of the medical self-care group. No significant differences occurred among the experimental and control groups on such variables as achievement of outcomes and management of disease on self-efficacy scores. Both experimental groups, health self-care and the medical self-care model philosophies have strengths and weaknesses. Health self-care provides health information and support through printed materials whereas the medical self-care model provides health information through GP's. Both health promotion programs are important in making the individual aware of methods needed to improve health and in developing the knowledge necessary to modify clients health behaviours. This in turn is an important factor in the reduction of medical costs and the prevention of some diseases.

Objective: To examine the impact on dental utilisation following the introduction of a participating provider scheme (Regional and Rural Oral Health Program {RROHP)). In this model dentists receive higher third party payments from a private health insurance fund for delivering an agreed range of preventive and diagnostic benefits at no out-ofpocket cost to insured patients. Data source/Study setting: Hospitals Contribution Fund of Australia (HCF) dental claims for all members resident in New South Wales over the six financial years from l99811999 to 200312004. Study design: This cohort study involves before and after analyses of dental claims experience over a six year period for approximately 81,000 individuals in the intervention group (HCF members resident in regional and rural New South Wales, Australia) and 267,000 in the control group (HCF members resident in the Sydney area). Only claims for individuals who were members of HCF at 31 December 1997 were included. The analysis groups claims into the three years prior to the establishment of the RROHP and the three years subsequent to implementation. Data collection/Extraction methods: The analysis is based on all claims submitted by users of services for visits between 1 July 1988 and 30 June 2004. In these data approximately 1,000,000 services were provided to the intervention group and approximately 4,900,000 in the control group. Principal findings: Using Statistical Process Control (SPC) charts, special cause variation was identified in total utilisation rate of private dental services in the intervention group post implementation. No such variation was present in the control group. On average in the three years after implementation of the program the utilisation rate of dental services by regional and rural residents of New South Wales who where members of HCF grew by 12.6%, over eight times the growth rate of 1.5% observed in the control group (HCF members who were Sydney residents). The differences were even more pronounced in the areas of service that were the focus of the program: diagnostic and preventive services. Conclusion: The implementation of a benefit design change, a participating provider scheme, that involved the removal of CO-payments on a defined range of preventive and diagnostic dental services combined with the establishment and promotion of a network of dentists, appears to have had a marked impact on HCF members' utilisation of dental services in regional and rural New South Wales, Australia.

The aim of this thesis is to demonstrate the importance of walking to public health. The first part is characterized by epidemiological research. First, a typology for the measurement of walking is developed. A systematic review is conducted of observational studies to determine the health benefits of walking in its own right. Studies consistently confirm that 30 minutes walking on most days of the week is sufficient to reduce the risk of cardiovascular diseases and non-communicable disease risk. Then, a series of epidemiological analyses describes the prevalence and correlates of walking, using multiple health and non-health surveillance data sets. Surveillance data indicate that the prevalence of walking at the above recommended levels is low across all domains. Between 1991 and 2001 an increase in walking occurred, and was the main contributor to reductions in leisure time physical inactivity; however, the proportion of the population who achieved the recommended amount of physical activity by walking did not change in leisure and transport domains. The next part of the thesis is characterized by health promotion research examining the impact of three population-based approaches to increasing walking among Australian adults. The first was an evaluation of a conversion of rail to trail, as an environmental change intervention; the second was a mass media campaign promoting walking to work, and the third was a targeted print media walking program. Providing environmental supports with minimal promotion had no effect on walking. A nation-wide mass media campaign promoting walking to work increased walking and other moderate intensity physical activity, but process evaluation indicated other promotional efforts contributed as well. The targeted print media randomised trial had the greatest effect on walking, but the increases were not greater than spontaneous change in the control. Increases in total physical activity were achieved only when the intervention was supplemented by the use of a pedometer. The expectation that broader approaches to the promotion of walking will bring about changes at the population level, were not corroborated by these case studies. There is a need for enhancement of walking-specific interventions to influence total PA at the population levels.

Includes bibliographical references (leaves 310-325). / xvi, 325 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / A study which investigates in a South Australian context: 1. What are the physical activity gaps between social groups and how do these gaps relate to health and the other benefits of physical activity? 2. What are the contraints on choices and what needs to be done to make the choices of people to increase moderate physical activity easier? 3. What is the role of the social environment in relation to moderate physical activity choices and what needs to be done to ensure supportive environments? The results show that physical activity frequently becomes the province of differents sectors of society at different times. Recent case studies demonstrate that policies about how governments organise their services lead to more fundamental changes than specific health policies. / Thesis (Ph.D.)--Adelaide University, Dept. of Public Health, 2001

This research was undertaken approximately 20 months after the introduction of alcohol brand advertising on New Zealand television, which resulted in a fourfold increase in televised alcohol advertising and a 42% increase in overall alcohol advertising. The primary aim of the research was to examine the nature of the relationships between young people's responses to televised alcohol advertising and drinking-related behaviours. The research was based on two surveys, one with l0 to 17 year olds and one with 18 to 29 year olds. The l0 to 17 survey involved 500 randomly selected face-to-face interviews in New Zealand's three largest urban areas. The 18 to 29 survey involved 1012 interviews. Respondents were randomly selected from throughout New Zealand and interviewed using a computer-assisted telephone interviewing (CATI) system. Both surveys asked about responses to specific alcohol advertisements, which were ones these age groups had been more exposed to. One of the two key response measures identified how frequently they recalled having seen the advertisement; this was labelled recalled exposure. Positive response to the advertising was measured by liking of the advertisement. Structural equation modelling (SEM) was used for the analyses, but this was preceded by correlation and regression analyses. On the basis of factor analyses that preceded the structural equation modelling, most of the modelling was based on the responses to the three beer advertisements in each study. 10 to 17 year old survey: The findings from the structural equation modelling were consistent with the hypothesis that positive responses to beer advertising (as measured by liking) were contributing to an increase in expected frequency of future drinking. The data were also consistent with the beer advertising contributing to an increased frequency of current drinking, although the relationship was just under the 0.05 level of significance. There was some limited evidence that recalled exposure may be associated with the drinking status of 10 to 13 year olds but, because of the small number of drinkers in this age group, this result needs to be interpreted with caution. The regression analyses indicated that recalled exposure was a predictor of 10 to 17 year olds' perceptions of how often their age/gender group drank and how accepting their friends were of drinking and occasional drunkenness. Other survey responses were also indicative of an influence of alcohol advertising on young people. Alcohol advertising was an important source of information about drinking, particularly for the 10 to 13 year old males. Almost half of these younger males accepted the portrayals in alcohol advertising as realistic and almost two thirds of them felt that alcohol advertising does encourage teenagers to drink. 18 to 29 year old survey: This study provided support for the hypothesis that more positive responses to televised beer advertisements resulted in larger quantities of alcohol being consumed on typical drinking occasions by 18 to 29 year old New Zealanders. It did not provide support for the hypothesis that drinking larger quantities of alcohol led to more positive responses to beer advertisements. The model showed that positive responses to beer advertisements had both a direct influence on quantity and an indirect influence, via its influence on positive beliefs. This study also provided support for the hypothesis that more positive responses to beer advertising were associated with increased alcohol-related problems. As with the 10 to 17 year olds, recalled exposure was related to perceptions of peer influence and behaviour. It was a significant predictor for female perceptions of peer quantities consumed and male and female perceptions relating to peer approval of drunkenness. The regression analyses also identified that recalled exposure was a predictor of males saying they were drinking more than the year before, however a SEM that specified reciprocal paths between these two variables found neither path to be significant. Discussion and implications This research has identified the importance of examining positive responses to alcohol advertisements. This acknowledges the active recipient of advertising who responds positively to advertising that offers valued outcomes. It also emphasises the importance of considering emotional/affective responses to advertising. However, the study also indicates that the weight of advertising is important, as reflected in the cognitive measure of recalled exposure. This appears to be having most influence on perceptions of what is normative behaviour. The results of the SEMs must be viewed as tentative, given the exploratory nature of the analyses and the limitations of cross-sectional surveys. However, as for all the previous studies, relationships have been identified between measures relating to alcohol advertising and those relating to alcohol consumption. While it is not possible to make definitive statements about directions of influence between these variables, these studies have all provided data that are consistent with the theory-based hypothesis that alcohol advertising does have an influence on alcohol consumption by young people.

This research was undertaken approximately 20 months after the introduction of alcohol brand advertising on New Zealand television, which resulted in a fourfold increase in televised alcohol advertising and a 42% increase in overall alcohol advertising. The primary aim of the research was to examine the nature of the relationships between young people's responses to televised alcohol advertising and drinking-related behaviours. The research was based on two surveys, one with l0 to 17 year olds and one with 18 to 29 year olds. The l0 to 17 survey involved 500 randomly selected face-to-face interviews in New Zealand's three largest urban areas. The 18 to 29 survey involved 1012 interviews. Respondents were randomly selected from throughout New Zealand and interviewed using a computer-assisted telephone interviewing (CATI) system. Both surveys asked about responses to specific alcohol advertisements, which were ones these age groups had been more exposed to. One of the two key response measures identified how frequently they recalled having seen the advertisement; this was labelled recalled exposure. Positive response to the advertising was measured by liking of the advertisement. Structural equation modelling (SEM) was used for the analyses, but this was preceded by correlation and regression analyses. On the basis of factor analyses that preceded the structural equation modelling, most of the modelling was based on the responses to the three beer advertisements in each study. 10 to 17 year old survey: The findings from the structural equation modelling were consistent with the hypothesis that positive responses to beer advertising (as measured by liking) were contributing to an increase in expected frequency of future drinking. The data were also consistent with the beer advertising contributing to an increased frequency of current drinking, although the relationship was just under the 0.05 level of significance. There was some limited evidence that recalled exposure may be associated with the drinking status of 10 to 13 year olds but, because of the small number of drinkers in this age group, this result needs to be interpreted with caution. The regression analyses indicated that recalled exposure was a predictor of 10 to 17 year olds' perceptions of how often their age/gender group drank and how accepting their friends were of drinking and occasional drunkenness. Other survey responses were also indicative of an influence of alcohol advertising on young people. Alcohol advertising was an important source of information about drinking, particularly for the 10 to 13 year old males. Almost half of these younger males accepted the portrayals in alcohol advertising as realistic and almost two thirds of them felt that alcohol advertising does encourage teenagers to drink. 18 to 29 year old survey: This study provided support for the hypothesis that more positive responses to televised beer advertisements resulted in larger quantities of alcohol being consumed on typical drinking occasions by 18 to 29 year old New Zealanders. It did not provide support for the hypothesis that drinking larger quantities of alcohol led to more positive responses to beer advertisements. The model showed that positive responses to beer advertisements had both a direct influence on quantity and an indirect influence, via its influence on positive beliefs. This study also provided support for the hypothesis that more positive responses to beer advertising were associated with increased alcohol-related problems. As with the 10 to 17 year olds, recalled exposure was related to perceptions of peer influence and behaviour. It was a significant predictor for female perceptions of peer quantities consumed and male and female perceptions relating to peer approval of drunkenness. The regression analyses also identified that recalled exposure was a predictor of males saying they were drinking more than the year before, however a SEM that specified reciprocal paths between these two variables found neither path to be significant. Discussion and implications This research has identified the importance of examining positive responses to alcohol advertisements. This acknowledges the active recipient of advertising who responds positively to advertising that offers valued outcomes. It also emphasises the importance of considering emotional/affective responses to advertising. However, the study also indicates that the weight of advertising is important, as reflected in the cognitive measure of recalled exposure. This appears to be having most influence on perceptions of what is normative behaviour. The results of the SEMs must be viewed as tentative, given the exploratory nature of the analyses and the limitations of cross-sectional surveys. However, as for all the previous studies, relationships have been identified between measures relating to alcohol advertising and those relating to alcohol consumption. While it is not possible to make definitive statements about directions of influence between these variables, these studies have all provided data that are consistent with the theory-based hypothesis that alcohol advertising does have an influence on alcohol consumption by young people.

Thesis aim: This thesis aims to analyse and critically evaluate the Children Activity Scanning Tool (CAST), which measures children’s physical activity (PA) engagement levels in school playgrounds and similar environments, focusing on CAST reliability and validity using data from four health promotion projects in the Northern Rivers (Move it Groove it (MIGI) project), Illawarra, Central Coast and Dubbo areas in NSW, Australia.The overall research question is whether physical activity engagement levels of large numbers of children can be validly and reliably measured in school playgrounds and similar environments using CAST.Methodology: CAST was used to scan school playgrounds and similar environments, in which unstructured rest, play and other physical activities take place. Scanning was undertaken by a team of trained observers who concurrently scanned a pre-defined area of the playground and recorded the number of children engaged in assigned physical activity intensity categories.Criterion validity was measured in three projects comparing the total number of children counted in separate physical activity categories to an independent count of the number of children in the playground using Pearson correlation coefficients. Data obtained during instrument development were used to determine criterion validity in two projects when compared to videotapes using Pearson correlation, Cronbach alphas and 95% CI around mean engagement levels.Data obtained during development and training, as well as project field data were used for reliability testing. Cronbach alpha, Pearson correlation, factor analysis and 95% CI around mean engagement levels were used to measure inter-rater reliability.Data from multi-level regression models obtained in three projects were used to calculate intra class correlation (ICC) and composite reliabilities of scan and break level physical activity engagement.Results: Criterion validity measures comparing sums of categories counts to independent counts of all children yielded Pearson correlation coefficients of 0.97, 0.81 and 0.96 in the Illawarra, Central Coast and Dubbo projects respectively. Criterion validity measures comparing field and video scores yielded Pearson correlation coefficients of 0.47, 0.52 and 0.56 respectively in the Move it Groove it (MIGI) project, and in the Illawarra study Cronbach alphas of 0.98 and 0.85, and a Pearson correlation of 0.93. There were no significant differences between the mean numbers of children who were engaged in a physical activity level when 95% CI were used except for one category in the MIGI study.Inter-rater reliability estimates in all projects were high or very high. There were no significant differences between the mean numbers of children engaged in a physical activity level when 95% CI were used. Almost 86% (12/14) of the standardised Cronbach alpha estimates were equal to or greater than 0.93. Principal component analysis values ranged from 76%-98%. ICCs obtained from field data yielded composite reliabilities of 0.77-0.94.Conclusion: It was concluded that CAST was a valid and reliable instrument to measure physical activity engagement levels of children in school playgrounds.Recommendations: The two or three categories versions CAST should be used as they produced the highest quality data when used to observe large groups in well-defined playgrounds. Further research is needed to validate other variables (eg equipment), validate a one observer CAST version, and test the feasibility of using children as observers.