The findings of this PhD provide a significant contribution to early intervention research. The ability to detect those at ultra-high risk for psychosis (UHR) has been made possible in recent years. It is well known that people with serious mental illness have poor physical health, yet prior to this PhD little was known about the physical health of UHR individuals. This PhD explores the physical health and lifestyle of the UHR group, and makes recommendations for the development of a physical health intervention. A range of methods have been used including quantitative and qualitative methods, systematic reviews and meta-analyses, and a clinical audit. Therefore, a multifaceted approach to investigate the physical health and lifestyle of UHR individuals has been taken. Papers 1-3 suggest UHR individuals are more likely to live an unhealthy lifestyle than their peers. This includes lower levels of physical activity, and higher levels of substance use (generally cannabis, tobacco and alcohol). Paper 4 contains a clinical audit showing physical health and lifestyle factors are not monitored routinely in early detection services, despite the UHR phase being an ideal opportunity to intervene. Living an unhealthy lifestyle can have a detrimental effect on physical and mental health. Papers 1-4 emphasise the need to intervene to promote a healthy lifestyle for the UHR group. In line with the Medical Research Guidelines for the development of complex interventions, a theoretical model is applied in Paper 5. The final paper presents a qualitative study with UHR individuals, their parents and clinicians to explore barriers and facilitators to living a healthy lifestyle and inform the development of a physical health intervention. A final evidence synthesis includes recommendations for future work and the clinical implications of this thesis. The findings of this PhD provide an important and timely contribution to early intervention research. Prior to this work, the physical health of UHR individuals had been largely under researched. For the first time, this PhD presents evidence to suggest individuals at ultra-high risk for psychosis experience cardiovascular risk, and there is an opportunity to intervene to promote physical health. Although not all UHR individuals will develop psychosis, many will continue to experience difficulties with their mental health. Given that this group are also more likely to live an unhealthy lifestyle, it is important to take a holistic approach to treating those at imminent risk for psychosis, considering both mental and physical health.

The oil and gas industry is a vital contributor to the global economy and a key source of employment within oil-producing countries. Oil production is largely dependent on a skilled population who are adept in coping with the demands of an offshore environment. Due to the high risk nature of work offshore, it is a requisite that personnel engage in health promoting behaviours. The research aimed to identify aspects of offshore workers self care which required behaviour change and the behavioural determinants which were associated with engagement in self care. A mixed methods design was utilised to generate novel data and original findings. Phase 1 used a quantitative cross-sectional online survey to assess offshore workers’ (n=352, 53.6% response rate) health, quality of life, mental wellbeing and self care status. The findings highlighted key areas of concern, as indicated by negative scoring across measures, relating to: overweight/obesity; medication adherence; absenteeism (with regard to travelling offshore); medical evacuation; lack of adherence to 5-a-day fruit and vegetable guidelines; physical activity; smoking; hazardous alcohol use, and insomnia. Phase 2 used qualitative theory-based telephone interviews to explore self care behaviours from the perspective of offshore workers (n=16). Offshore workers who had completed a survey and indicated they would like to receive further information on the interviews were invited to participate. Both the interview schedule and data analysis were informed by the Theoretical Domains Framework (TDF). Healthy eating and physical activity were the behaviours most frequently discussed by offshore workers and identified as areas requiring behaviour change. TDF domains representing both behaviours included: beliefs about capabilities; beliefs about consequences; intentions; goals; memory, attention and decision processes; environmental context and resources; social influences; emotion, and behavioural regulation. Phase 3 used qualitative theory-based telephone interviews to explore offshore workers’ (n=13) self care behaviours from the perspective of remote healthcare practitioners. Both the interview schedule and data analysis were informed by TDF. Healthy eating and harmful/hazardous alcohol use were the behaviours most frequently discussed by remote healthcare practitioners and identified as areas requiring behaviour change. TDF domains representing both behaviours included: knowledge; environmental context and resources; social influences; emotion, and behavioural regulation. The findings, when triangulated suggest that offshore workers may benefit from the implementation of a self care intervention which targets healthy eating, physical activity and alcohol consumption. It is advised that the intervention target multiple self care behaviours and that development is underpinned by behaviour change theory to ensure effectiveness. The intervention may be tailored in accordance with the TDF domains identified in this research as determinants of healthy eating, physical activity and alcohol use behaviours.

Friskvård inom företag och dess effekter är väldokumenterat inom forskningen, och organisationer har under de senaste åren satsat mycket pengar på att upprätthålla friskvårdsarbetet. Ett universellt argument verkar vara att detta gör att lönsamheten i verksamheten ökar. I denna studie undersöktes hur friskvården ser ut i en kommunal verksamhet sett ur ett diskursanalytiskt och självstyrningsperspektiv. Detta var intressant eftersom den kommunala verksamheten styrs av politiska riktlinjer, samtidigt som den är skattefinansierad. En ytterligare anledning att studera detta var att kommunal sektor generellt sett hade fler sjukskrivningar än privat sektor. Mer specifikt syftade studien till att förstå hur avdelningschefer uppfattar friskvård i den egna verksamheten, hur processer ser ut för chefers arbete med detta, samt hur de skulle vilja att den framtida utvecklingen ser ut. Detta åstadkoms genom kvalitativa intervjuer med nio kommunala avdelningschefer. Några viktiga resultat var att organisationen använde friskvårdsförmåner för att locka och behålla medarbetare, samt för att respondenterna uppfattade en extern press från samhället att ta ett visst ansvar över sina medarbetares hälsa. Hur cheferna arbetade med att motivera sina anställda var något av en balansgång. De flesta tyckte det var viktigt att motivera och skapa goda förutsättningar för medarbetarna, medan de ansåg att det inte var möjligt att styra dem för mycket eftersom friskvården bedrivs på fritiden. Därför var ett av utvecklingsförslagen som uppkom att integrera friskvården på arbetstid. På detta sätt skulle cheferna få bättre kontroll och kunna ställa högre krav på sina medarbetare att faktiskt använda sig av friskvårdsförmånerna.

Using United States Behavioral Risk Factor Surveillance Survey (BRFSS) and Census data, this study replicated and extended previous research conducted using the Canadian Community Health Survey (CCHS) by Statistics Canada. It examines the associations among both lifestyle and social determinants predictors and a criterion of perceived health. Results were also compared cross-culturally (United States and Canada). The study used secondary data analysis of 2000 and 2001 United States and Census data. In particular, multiple linear regression (MLR) and hierarchical linear modeling (HLM) were used to analyze state and individual-level data. Unlike data at the aggregate level (Canadian health regions and states of the United States), results at the individual-level were consistent across the United States and Canada. Social determinants of health (socioeconomics) were better predictors of health than lifestyle (behaviors). Individual-level socioeconomic characteristics and lifestyle were better predictors than higher level contexts (i.e., characteristics of a state or health regions). The findings of this study suggest that health educators should further research, and increase the focus in teaching and service on, social determinants of health in addition to efforts emphasizing lifestyles (health behaviors). This recommendation aligns with the soon to be released Healthy People 2020 that will add social determinants of health as a priority area for public health.

Background: Cardiovascular disease (CVD) is an important health concern in prison populations as they have an increased risk of the disease compared to the general population. However, there is a lack of interventions to reduce prisoners’ cardiovascular risk, and little is known about the knowledge and risk perceptions of the disease in prison. This study aims to explore the knowledge and risk perceptions of CVD from the perspectives of prisoners and staff to guide the development of a cardiovascular risk reduction intervention for prisoners. Methods: This was a qualitative, exploratory study. Semi-structured interviews were conducted with 16 prisoners and 11 staff, who were purposively recruited from a private prison in Scotland. Framework analysis was used to analyse the data. Findings: The prisoners and staff had limited, non-expert knowledge of CVD. Common behavioural risk factors and cardiovascular events were identified, but gaps in knowledge were evidenced. There were similarities and differences in perceptions of prisoners’ risk of the disease; risk was primarily assessed by judgements about the prisoners’ current health status rather than their risk factor status. Prisoners’ risk of CVD was attributed to negative health behaviours such as smoking and physical inactivity, and these were influenced by multiple factors that interacted across three levels of influence. Individual factors included self-efficacy and mental health problems, social factors included the prison culture and social interactions, and institutional factors included the prison regime and healthcare barriers. An ecological framework was designed to guide a cardiovascular risk reduction intervention that focuses on the multi-level influences of prisoners’ cardiovascular risk. Conclusion: Prisoners have limited knowledge and misconceptions of CVD, and engage in several risky behaviours. There are multi-level influences on prisoners’ CVD risk and cardiovascular health. An ecological approach is recommended to address these influences to reduce the prisoners’ risk of CVD.

Whereas sleep is often thought of as a common health issue among college students, few, if any, researchers have comprehensively evaluated correlates and predictors of sleep quality and quantity within this population. Most often, studies of this type are used by researchers to assess particular categories of correlates and predictors (e.g., emotional and mental health, student employment, substance abuse, etc.). The present study was conducted to determine correlates and predictors of sleep quantity and quality using among randomly selected college students at a Midwestern four-year research university with high research activity. A classroom survey comprised of the Pittsburgh Sleep Quality Index, the Medical Outcomes Study - Short Form 36, a sleep journal, and demographic questions was administered to students enrolled in 18 University Core Curriculum classes during the spring 2011 semester. Four hundred and sixty student surveys were used for data analysis. Average weekday sleep length was found to be statistically significantly correlated only with mental wellbeing. No statistically significant correlations were found between any of the potential predictor variables and the dependent variables of average weekend day sleep length. Overall sleep quality was found to be statistically significantly correlated with mental and physical wellbeing. Using path analysis, three reduced models, one for each of the three dependent variables (weekday sleep length, weekend day sleep length, and overall sleep quality, were produced. Through ×2 testing, reduced models for all three models fit the full model's data; deleted paths did not contribute to the model. As a whole, students are getting adequate sleep length, but possess poor sleep quality. Sleep quality and sleep quantity, are influenced by different factors, creating challenges for those wishing to provide education, prevention and intervention services.

Bakgrund: Idag lever personer med Downs syndrom längre än vad de tidigare har gjort. De tenderar att ha ett stillasittande liv vilket genererar olika komplikationer och följdsjukdomar. Fysisk aktivitet förebygger och behandlar folksjukdomar hos den generella populationen. För att främja hälsa ska sjuksköterskan utföra hälsofrämjande omvårdnad. Syfte: Syftet var att belysa betydelsen av hälsofrämjande fysisk aktivitet hos personer med Downs syndrom. Metod: Studien är utformad som en allmän litteraturstudie. Resultat: Datamaterialet analyserades och tre huvudteman framkom: Hälsofrämjande fysisk aktivitet ger positiva fysiska effekter, Hälsofrämjande fysisk aktivitet ger ökat välbefinnande samt Hälsofrämjande fysisk aktivitet främjar socialt samspel. Fysisk aktivitet förebygger många av de sjukdomar som personer med Downs syndrom riskerar att drabbas av. Fysisk aktivitet förbättrade hälsan hos personer med Downs syndrom. Resultaten som kunde läsas ur litteraturen var minskat kroppsfett, lägre blodtryck, ökad muskelstyrka samt bättre rörlighet och balans. Fysisk aktivitet genererade dessutom ett ökat socialt samspel vilket gav ökad glädje och ökat välbefinnande. Konklusion: Fysisk aktivitet var hälsofrämjande för personer med Downs syndrom. Vid regelbunden fysisk aktivitet skapades bättre förutsättningar för ett hälsosamt liv. / Background: People with Down ́s Syndrome live longer today than they have done previously. But they tend to have a sedentary life which causes different complications and secondary diseases. Physical activity prevents and treats national diseases in the general population. To promote health, nurses should give health- promoting care. Purpose: The aim was to illustrate the importance of health-promoting physical activity in persons with Down’s Syndrome. Method: The study is constructed as a general literature study. Results: The data was analysed and three main themes emerged: Health-promoting physical activity produces positive physical effects, Health-promoting physical activity produces improved well-being and Health- promoting physical activity encourages social interactions. Physical activity preventsmany of the diseases that people with Down’s Syndrome are at risk of contracting. Physical activity improved the health of persons with Down’s Syndrome. Conclusion: Physical activity promoted better health for persons with Down’sSyndrome. Regular physical activity improved the prerequisites needed for increased quality of life.

Bakgrund: Det finns en mängd forskning som visar på positiva effekter av fysisk aktivitet och vilka hälsorisker som finns vid fysisk inaktivitet. Trots detta så ökar stillasittandet och många individer i samhället idag har hälsoproblem. Syfte: Syftet med denna undersökning är att se hur tre veckors hälsocoaching kan påverka människors mående och motivation. Metod: En kvalitativ interventionsstudie med semistrukturerade intervjuer genomfördes med sex personer med olika mål och startlägen. Resultat: Utifrån intervjuerna gick det att tyda att tre veckors hälsocoaching förändrade respondenternas motivation till fysisk aktivitet. Samtliga respondenter är på väg mot en mer aktiv livsstil. En slutsats som dras i denna undersökning är att många faktiskt kan behöva ta hjälp av en hälsocoach för att komma igång med sin livsstilsförändring. / Background: There is a lot of research showing positive effects of physical activity and the health risks associated with physical inactivity. Despite this, sedentary is increasing and many individuals in society today have health problems. Purpose: The purpose of this study is to see how three weeks health coaching can affect people's well-being and motivation. Method: A qualitative intervention study with semistructured interviews was conducted with six individuals with different goals and starting positions. Result: Based on the interviews, it could be read that three weeks of health coaching changed the respondents' motivation for physical activity. All respondents are on their way to a more active lifestyle. A conclusion drawn in this study is that many may actually need to use a health coach to get started with their lifestyle change.

[pt] A presente tese tem como propósito geral analisar, no contexto da Promoção da Saúde, as concepções das categorias de empowerment, participação e dialogicidade a partir da Teoria Educacional Crítica (TEC). Como objetivos específicos, estabeleceram-se: identificar nas Cartas e Declarações sobre Promoção da Saúde, produzidas no período compreendido entre 1986 a 2005, as concepções apresentadas de empowerment, participação e dialogicidade; e, caracterizar as temáticas e os sentidos que estas concepções expressam, respectivamente em cada um destes documentos, a partir da discussão fundamentada na Teoria Educacional Crítica. Trata-se de uma análise documental essencialmente qualitativa, cujo corpus de texto foi composto por sete fontes documentais. Como ferramental de análise elegeu-se um conjunto de técnica e procedimentos da Análise de Conteúdo Temática visando sua interpretação. Tem como corpus de análise Conferências de âmbito internacional sobre Promoção da Saúde, divulgadas pela Organização Mundial da Saúde e pela Organização Pan- Americana da Saúde. Os resultados obtidos apontam que os sentidos do empowerment, nos documentos oficiais de Promoção da Saúde, focalizam a transferência do conhecimento e o desenvolvimento de potencialidades, enquanto que a participação apresenta-se predominantemente com o sentido de controle social, poder de decisão e poder. Merece destaque que a concepção de dialogicidade não se faz presente nos documentos. Entende-se assim que estas concepções e sentidos, tal qual apresentados, não contemplam a práxis transformadora, um dos princípios essenciais tanto da Promoção da Saúde como da Teoria Educacional Crítica. Sugere-se que, para que sujeitos e coletivos na área da saúde concretizem as propostas contidas nas Cartas e Declarações de Promoção da Saúde, faz-se necessário as contribuições da Teoria Educacional Critica. / [en] The general aim of this thesis is to analyse, in the context of health promotion, the conceptions of empowerment, participation and dialogicity to be found in the Declarations and Letters on Health Promotion produced in the period 1986 - 2005, from the perspective of Critical Educational Theory. Specific objectives were: to identify the conceptions of empowerment, participation and dialogicity present in the Declarations; characterise the themes and meanings that these conceptions express in each of the documents, from the perspective of critical educational theory. The bulk of the thesis is a qualitative document analysis, the corpos of which was composed of seven documents. The analytical tools used were a set of techniques and procedures from Content Analysis, utilized with the intention of interpreting the documents. The corpos comprises Declarations resulting from international conferences on Health Promotion, published by the World Health Organization and the Pan-American Health Organization. The results obtained indicate that the meanings of empowerment, contained in these oficial documents on Health Promotion, focus on the transfer of knowledge and the development of abilities, while participation presents itself predominately with the meaning of social control, power and power of decision. An important result was the complete lack of any conception of dialogicity in the documents analysed. These results show that these conceptions and meanings, as interpreted in this analysis, do not contemplate a transformatory práxis, one of the essential principles of Health Promotion and Critical Educational Theory. It is suggested that the possibility of realising the proposals for Health Promotion contained in these Letters and Declarations, by both individuals and colectives, necessitates the contributions of Critical Educational Theory.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2018-02-27T18:23:49Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) michely_rodrigues_alves.pdf: 932143 bytes, checksum: 1b1370ebbb2630bb7c9084f075af5672 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2018-03-09T19:08:46Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) michely_rodrigues_alves.pdf: 932143 bytes, checksum: 1b1370ebbb2630bb7c9084f075af5672 (MD5) / Made available in DSpace on 2018-03-09T19:08:46Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) michely_rodrigues_alves.pdf: 932143 bytes, checksum: 1b1370ebbb2630bb7c9084f075af5672 (MD5) Previous issue date: 2017 / A educa??o popular em sa?de (EPS), mesmo sendo um referencial pol?tico, te?rico e metodol?gico, consolidado como estrat?gia pol?tica, ? um assunto que exige ampla reflex?o e conhecimento para sua efetividade. De acordo com o eixo norteador institu?do pela Pol?tica Nacional de Educa??o Popular em Sa?de no Sistema ?nico de Sa?de (PNEPS-SUS) em 2013, por meio de uma pr?tica pol?tico-pedag?gica, os saberes populares s?o reconhecidos a partir da constru??o compartilhada do conhecimento, com potencial de instrumento auxiliar para reorienta??o das pr?ticas em sa?de. O objetivo deste estudo foi estimular um processo de educa??o e constru??o de conhecimentos, junto aos atores sociais do grupo HIPERDIA, norteado pelo referencial da EPS. A pesquisa foi desenvolvida a partir do problema: a EPS pode contribuir com melhorias na qualidade de vida dos usu?rios no munic?pio de Senhora do Porto/MG?O trabalho foi desenvolvido por meio da metodologia da pesquisa-a??o, com a aplica??o da t?cnica de observa??o participante para a coleta dos dados, car?ter descritivo e com abordagem qualitativa. Os demais atores participantes foram os integrantes do grupo de hipertensos e diab?ticos (HIPERDIA) adscritos no munic?pio de Senhora do Porto-MG. A an?lise dos dados foi feita atrav?s do referencial te?rico da Educa??o Popular, trabalhado dentro da pr?tica pedag?gica das ?rodas de conversa?, sistematizadas por Paulo Freire. O estudo do resultado foi realizado por meio da an?lise do discurso, referenciado pelas teorias de Foucault. Os resultados revelam que a EPS n?o ? um desafio para os atores sociais envolvidos, pois atrav?s das observa??es foram percebidas a??es de mobiliza??o, autonomia e di?logo entre eles, nos momentos que tiveram oportunidade de se expressar. Seria ent?o um impasse para os profissionais de sa?de desconstruir pr?ticas norteadas pela cultura medicamentosa, aos gestores que deveriam apoiar a educa??o permanente dos trabalhadores, adicionando os princ?pios e as pr?ticas de EPS, e ainda, responsabilidade do Minist?rio da Sa?de em auxiliar nas estrat?gias de comunica??o e divulga??o da potencialidade das pr?ticas articuladas ?s culturas populares. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / Popular education in health (EPS), even though it is a political, theoretical and methodological framework consolidated as a political strategy, is a subject that requires wide reflection and knowledge for its effectiveness. According to the guiding axis established by the National Policy on Popular Health Education in the Unified Health System (PNEPS-SUS) in 2013, through a political-pedagogical practice, popular knowledge is recognized through the shared construction of knowledge with potential of an auxiliary instrument to reorient health practices. The objective of this study was to stimulate a process of education and knowledge construction together with the social actors of the HIPERDIA group, guided by the EPS framework. The research was developed from the problem: the EPS can contribute with improvements in the quality of life of the users in the municipality of Senhora do Porto / MG? The work was developed through the action research methodology with the application of the participant observation technique for the data collection, descriptive character and qualitative approach. The other participants were members of the hypertensive and diabetic group (HIPERDIA) enrolled in the municipality of Senhora do Porto-MG. The analysis of the data was done through the theoretical reference of Popular Education, worked within the pedagogical practice of the "round of conversation" systematized by Paulo Freire. The study of the result was carried out through discourse analysis, referenced by Foucault's theories. The results show that EPS is not a challenge for the social actors involved because through the observations it was noticed actions of mobilization, autonomy and dialogue between them, in moments that they had the opportunity to express themselves. It would than be a challenge for health professionals to deconstruct practices guided by the drug culture, to managers who should support the permanent education of workers by adding the principles and practices of EPS and also the responsibility of the Health Ministry to assist in the strategies of communication and dissemination of potentiality practices articulated by popular cultures.