Poorly controlled diabetes is common among the majority of youth with type 1 diabetes and can lead to adverse health outcomes at an early age. There is a need to change this to minimise the risk of negative long-term consequences. The onset of complications from diabetes can be prevented or delayed with good management as demonstrated by blood glucose being kept close to or within the normal range. Diabetes control is challenging for young people due to a combination of physiological and psychological factors. Diabetes control needs to be monitored both at an individual level and also at a population level, in order to optimise health outcomes and provide important information for health service provision. There are gaps in knowledge relating to the current level of diabetes control at a population level and of the epidemiological characteristics of youth with type 1 diabetes in the Canterbury region in New Zealand. There has been no research of this nature in the Canterbury region since 2003. There are also gaps in knowledge and a lack of national and international research that investigates psychosocial characteristics of youth with type 1 diabetes and the impact these may have on diabetes control. There is a potentially promising intervention, namely, Motivational Interviewing (MI), that although previous research investigating it with diabetes has shown some promise, methodological problems have limited the conclusions that can be drawn. This thesis, within the New Zealand context, addresses some of these gaps and adds to the body of knowledge of research concerning diabetes control and youth with type 1 diabetes, and investigates MI intervention for youth with poorly controlled diabetes. The thesis encompasses three studies. The first study is an audit that provides up-to-date information on epidemiological characteristics and clinical outcomes for the youth population with type 1 diabetes residing in the Canterbury region. The second study is a cross-sectional study that investigates the relationship between glycaemic control and key psychosocial characteristics: illness beliefs, self-efficacy, and quality of life in youth with type 1 diabetes in Canterbury. The third study is a longitudinal study that investigates the efficacy of MI as an intervention for youth with poorly controlled type 1 diabetes, and explores its impact on diabetes outcomes using statistical and clinical analyses. The first study showed that from 2003 to 2010 the prevalence of adolescents and young adults with type 1 diabetes in Canterbury has increased; there is therefore an increased demand on health resources. In addition, in 2010 glycaemic control at a population level was in the poorly controlled diabetes range and this had remained unchanged since 2003. This suggests the need for more intensive interventions. The second study found that poor diabetes control in youth with type 1 diabetes is influenced by a number of factors, including negative views on diabetes, lower perceived personal control, higher diabetes-related concerns, and lower levels of worry about complications. These findings provide a new understanding of the importance of balancing worries about diabetes complications and the perception of diabetes as a threatening condition. The third study showed that the MI intervention was generally successful in improving diabetes outcomes – clinical, psychosocial, and behavioural changes were observed. Statistically and clinically significant positive changes were found across multiple variables: glycated haemoglobin (HbA1c), glycaemic variability, adherence, and psychosocial functioning. Taken together, the findings of the three studies indicate that majority of youth with type 1 diabetes in the Canterbury region had poor glycaemic control, which suggests that additional interventions may be required to improve management of their condition, especially interventions targeting psychosocial functioning (e.g., illness perceptions) and diabetes self-management. Motivational Interviewing may be a viable option, and therefore further research into this approach is recommended.

Pour les personnes vivant avec le VIH (PVVIH), leur maladie constitue une expérience subjective susceptible d’influer sur leur qualité de vie (QV). Cette thèse explore l’influence de la perception que les PVVIH ont de leur maladie, ainsi que des stratégies de coping, l’auto-efficacité, les stratégies de contrôle en matière de santé, le soutien social et l’ajustement des buts sur la QV et troubles anxio-dépressifs. Une approche comparative entre des personnes françaises avec et sans VIH d’une part et avec des PVVIH françaises et brésiliennes d’autre part a été entreprise. Les participants (France : PVVIH n=206 et sans VIH n=220 ; Brésil : PVVIH n=128) ont répondu à un ensemble de questionnaires évaluant chacune de ces variables. Tout d’abord les résultats ont conforté la plus faible QV et des troubles anxio-dépressifs plus élevés chez les PVVIH comparativement aux personnes sans VIH, mesurés ici à l’aide d’odds ratio. Par ailleurs, les modèles d’équations structurelles ont permis de vérifier l’influence de la perception de la maladie, de l’auto-efficacité et de l’ajustement aux buts des PVVIH françaises sur la QV. Enfin, les régressions hiérarchiques ont montré que la perception de la maladie, l’auto-efficacité et le soutien social étaient des variables prédictives de la QV tant en France qu’au Brésil. La discussion souligne la nécessité de prendre en considération la perception de la maladie dans la compréhension de l’ajustement des PVVIH / For people living with HIV/AIDS (PLWHA), their illness is a subjective experience that may affect their quality of life (QOL). This thesis explores the influence of the perception that PLWHA have of their illness, as well as coping strategies, self-efficacy, health engagement control strategies, social support and goal adjustment on QV and anxiety/depression. A comparative approach between French with/without HIV and PLWHA in France and Brazil was undertaken. Participants (France: PLWHA n=206, without HIV n=220; Brazil: PLWHA n=128) completed questionnaires assessing each of these variables. The results confirm, with the use of odds ratios, that PLWHA have a lower QOL and more anxiety/depression when compared to people without HIV. Moreover, structural equation models were used to verify the influence of illness perception, self-efficacy and goal adjustment on QOL of French PLWHA. Finally, hierarchical regressions showed that illness perception, self-efficacy and social support were predictive of QOL both in France and Brazil. The discussion highlights the need to take into account illness perception to understand the adjustment of PLWHA

Background The district nurse has a key role in caring and supporting patients with different kinds of health problems. A personcentered approach in the patient education facilitates for the patient to participate in self-care and management of the illness. Aim The aim of the study was to examine patients’ illness perceptions and management of their illness. Method Nine patients who has either hypertention, type 2 diabetes or chronic obstructive pulmonary disease were interviewed. The interviews were analyzed by qualitative content analysis with an inductive and deductive approach. Results The results were presented from Leventhal´s five dimensions in The Common Sense Model of Self-Regulation: identity, time-line, consequence, cause and control. The Participants´ describings were formulated into ten categories: the illness is present, mental image, cognitive coping, illness duration, daily impact, behavioral coping, thoughts about cause, coping strategy, meaning of the treatment and coping - seeking social support. Conclusion This study showed that there are different coping strategies to manage illness: The participants used distancing, accepting responsibility, planful problem solving, positive reappraisal and/or seeking social support

Perceptions can be influenced by the media concerning different groups of people. As a result of the importance of the media in how individuals obtain information and formulate opinions, how different groups are presented whether negatively or positively is important. This research examines the portrayal of mental illness in films and the impact that such portrayals have on the perceptions of mental illness of the viewers. Mental illness representations can be found quite prevalently among film and the way in which it is represented can be important as to how populations perceive those with mental disorders. This thesis looks to explore perceptions of mental illness and beliefs from those who have viewed films that portray characters with mental disorders. Through the use of an online survey, one hundred and ninety five participants provided data for this study. Based on previous research, it was hypothesized that individuals who had seen more films portraying mental illness would have more knowledge and sympathy regarding mental illness compared those who had seen less films portraying mental illness. It was also hypothesized that social stereotypes surrounding mental disorders would be present in the knowledge that individuals had more so than factual data about mental disorders. Women were predicted to express more sympathy than men. A statistical analysis program was used to analyze the resulting data including the use of correlations and t-tests. Evidence indicated that the amount of films viewed portraying mental illness did not have an impact on knowledge or sympathy regarding mental illness. Perceptions of mental illness are still a relevant topic and the awareness of facts surrounding mental disorders should continue to be spread.

The overall aim of the thesis was to investigate the experience of having an acute myocardial infarction in newly afflicted persons living in sparsely populated counties, and whether an intervention with peer mentors would provide support by affecting the perception of illness, health related quality of life and everyday life. The aim was also to describe the support of peer mentors from their perspective and what the mentoring meant to them. The thesis was based on four empirical studies (I-IV) and had a prospective, longitudinal, quasi-experimental, comparative design. A suitable sample was recruited, comprising 72 individuals who were newly afflicted with an acute myocardial infarction (AMI) for the first time; 34 of them were offered contact with a peer mentor, while 38 were not. Furthermore, 34 peer mentors participated in the project. The results were based on data collected from 28 individuals with mentors, 33 individuals without and 22 peer mentors. In studies I and III, qualitative approaches were used based on individual interviews with 20 newly afflicted individuals with (n=11) and without (n=9) mentors one year after AMI. The aims were to describe individuals’ perceptions of the psychosocial consequences of an acute myocardial infarction (AMI) and of their access to support one year after the event (I) and to describe individual perceptions of their lifestyle and support, 1 year after an AMI with or without mentorship (III). Study II was quantitative, consisting of data from questionnaires IPQ-R and SF-36 answered by 61 newly afflicted individuals with (n=28) and without (n=33) mentors. It aimed to investigate whether changes in illness perception and health-related quality of life occur over time after an intervention with peer mentors 1, 6 and 12 months after an AMI. Study IV had a mixed design and included peer mentors with the purpose to describing the personal meaning of being a peer mentor, for a person recovering from an acute myocardial infarction. Data consisted of individual interviews (n=15) and some data from IPQ-R and SF-36 that were provided on two occasions (n=22). All of the interviews (I, III, IV) were digitally recorded and analysed by qualitative content analysis, while the quantitative studies included descriptive data and were further compared using analysis of variance (ANOVA) (II) and the paired-sample t-test (IV).   The results from all four studies are interpreted and presented together, and they show differences and similarities between the newly afflicted with or without peer mentors and the peer mentors. The results comprise six main areas; the meaning of becoming a person with an AMI (I, II, III) pointed toward an awareness of the situation expressed both in positive and negative terms, as being thankful or of being afraid of having a second AMI. View at health care (I) indicated that follow-up after discharge was sometimes a positive experience but more often resulted in dissatisfaction with this part of the health-care system. Consequences (II) showed significant effects between groups in the dimensions ‘consequences’ and ‘timeline acute/chronic’ (IPQ-R), with higher mean values for those without mentors and a significant effect of time in both dimensions. There were also physical consequences for many of the participants (I, II, III, IV) as well as psychological consequences (I, II, IV). Everyday life (I, III) was affected by AMI that sometimes limited activities. There were demands to change areas of life-style that were perceived as both positive and negative. Health (II, III, IV) showed that health increased for most individuals during the year, as confirmed by significant values for time for those newly afflicted. The peer mentors showed a decrease in mean values but expressed that they felt healthier after compared with before their commitment. Meaning of support (I, IV) indicated that families and relatives had an important, supportive role for newly afflicted participants. The mentorship showed that the relationship was, in some cases and for different reasons, unsuccessful. However, most of them were satisfied, and new friendships arose. More of the mentors felt pride and were thankful because their experience was shown to be valuable to others in addition to themselves.  The results were synthesised using the Human Becoming nursing theory, which confirmed that recovery after an AMI is a process that occurs over time in which that those afflicted must accept and be comfortable being a person who is afflicted by an AMI. Some tendencies indicated an advantage for the newly afflicted participants who had received contact with a peer mentor. Conclusion: Because the mentor had experienced the same event, the relationship contributed to the security of the mentee. The peer mentors matured with the task because they felt that their experience was valuable and they felt unique. / Övergripande syfte i avhandlingen var att studera erfarenheter av att drabbas av en akut hjärtinfarkt (AHI) för nyinsjuknade personer, boende i glesbygdslän, och om en intervention med kamratstöd i form av mentorer skulle kunna innebära ett stöd, genom att påverka deras sjukdomsuppfattning, hälsorelaterade livskvalitet och deras vardagsliv. Syftet var även att beskriva mentorernas stöd utifrån deras perspektiv, och vad mentorskapet har betytt för dem.   Avhandlingen är baserad på fyra studier (I-IV) och har en prospektiv, longitudinell och kvasiexperimentell, jämförande design. Ett lämpligt urval utgjordes av 72 personer som nyligen hade drabbats av AHI första gången. Av dessa erbjöds 34 att få kontakt med en mentor medan 38 inte erbjöds detta. Dessutom deltog 34 mentorer. Det slutgiltiga resultatet i avhandlingen baserades på data som samlats från 28 personer med mentor, 33 utan mentor samt av 22 mentorer. Studie I och III utgick från kvalitativ metod, baserat på individuella intervjuer med 20 av de nyinsjuknade med mentor (n11), och utan mentor (n9) ett år efter deras AHI. Syftet var att beskriva individuella erfarenheter av psykosociala konsekvenser i samband med en AHI, och deras tillgång till stöd ett år efter händelsen (I), samt att beskriva individuella uppfattningar om deras livsstil och stöd ett år efter AHI, med eller utan mentorskap (III). Studie II var kvantitativ och utgjordes av data från enkäter; IPQ-R och SF-36, som besvarades av 61 nyinsjuknade, varav 28 med mentor och 33 utan mentor, i syfte att undersöka om förändringar i sjukdomsuppfattning och hälsorelaterad livskvalitet förekommer över tid, efter en intervention med mentorer 1, 6 och 12 månader efter AHI. Studie IV hade en mixad design och inkluderade mentorer med syfte att beskriva den personliga betydelsen av att vara mentor, under loppet av ett år, för en person under återhämtningen efter AHI. Data bestod av individuella intervjuer (n15) samt en del data från IPQ-R och SF-36, besvarat vid två tillfällen. Samtliga intervjuer (I, III, IV) spelades in digitalt och analyserades med kvalitativ innehållsanalys, medan de kvantitativa studierna innefattade beskrivande data, samt dessutom analyserades med variansanalys (ANOVA) (II) samt parvisa t-test (IV).   Resultat från samtliga fyra studier är tolkade och presenterade gemensamt, och visar på skillnader och likheter mellan de nyinsjuknade med eller utan mentor, samt mentorerna. Resultaten utgörs av sex huvudområden: Innebörden av att bli en person med en AHI (I, II, III) tyder på en medvetenhet om sin situation, och som uttrycks i både positiva och negativa ordalag, som att vara tacksam eller att vara rädd för att få en ny AHI. Syn på sjukvården (I) antyder att uppföljningen efter utskrivning i vissa fall var en positiv upplevelse, men flera av dem var missnöjda med den delen av vården. Konsekvenser (II) visade  signifikant effekt mellan grupperna för dimensionerna ’konsekvenser’ och ’tidslinje akut/kronisk’ (IPQ-R) med högre medelvärden för dem utan mentor. Dessutom var det signifikant effekt för tid i båda dimensionerna. Det förekom även fysiska konsekvenser för flera av deltagarna (I, II, III, IV) liksom psykologiska konsekvenser (I, II, IV). Vardagslivet (I, III) påverkades av AHI genom att den i vissa fall hindrade dem från fysiska aktiviteter.  Det fanns krav på dem att förändra delar i deras livsstil, vilket kunde uppfattas som både positivt och negativt.  Hälsa (II, III, IV) visade att de flestas hälsa hade förbättrats under året, vilket bekräftades med signifikanta värden för tid hos de nyinsjuknade. Mentorerna hade däremot sjunkande medelvärden men uttryckte att de mådde bättre efter sitt uppdrag, än innan. Betydelsen av stöd (I, IV) visade att familjer och närstående hade en betydelsefull roll för de nyinsjuknade. Mentorskapet för dem med mentor samt mentorerna visade att relationen i vissa inte hade fungerat, av olika anledningar. Trots allt var ändå de flesta tillfreds, och nya vänskapsförhållanden hade uppstått. Flera mentorer kände sig stolta och var tacksamma för att deras erfarenheter hade visat sig värdefulla för andra, men även för dem själva.   Resultaten syntetiserades med omvårdnadsteorin Human Becoming, som bekräftade att återhämtningen efter en AHI är en process som förekommer över tid, och innebär att acceptera och känna sig bekväm med att vara en person som drabbats av AHI. Det fanns vissa tendenser till att det var en fördel för de nyinsjuknade att ha kontakt med en mentor. Slutsatsen var att eftersom mentorerna hade genomgått samma händelse, bidrog det till trygghet. Mentorerna hade växt med uppgiften, eftersom de kände att deras erfarenheter var värdefulla, och att de var unika. / <p>Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 2 inskickat, delarbete 4 inskickat.</p><p>At the time of the doctoral defence the following papers were unpublished: paper 2 submitted, paper 4 submitted.</p>

Submitted by Fabricia Fialho Reginato (fabriciar) on 2015-08-28T22:49:03Z No. of bitstreams: 1 RenataZancan.pdf: 353007 bytes, checksum: 31a58b0044f4158aacaf13e5e91683cb (MD5) / Made available in DSpace on 2015-08-28T22:49:03Z (GMT). No. of bitstreams: 1 RenataZancan.pdf: 353007 bytes, checksum: 31a58b0044f4158aacaf13e5e91683cb (MD5) Previous issue date: 2013-02 / Nenhuma / O câncer infantil é um conjunto de doenças caracterizadas pela proliferação descontrolada de células anormais. Apesar dos avanços da ciência e da medicina, fazendo com que a taxa de sobrevida chegue em média a 80%, a doença ainda é considerada ameaçadora e os tratamentos são dolorosos e invasivos. Esta experiência pode acarretar consequências psicológicas, dentre elas, o Transtorno de Estresse Pós-traumático (TEPT) ou a presença de sintomatologia do mesmo. Dessa forma, o objetivo dessa dissertação foi investigar a presença de TEPT em jovens sobreviventes de câncer infantil através de dois estudos, um de revisão sistemática e outro empírico. O estudo de revisão sistemática, apresentado na sessão 1, buscou investigar a presença e a prevalência de sintomas de TEPT em sobreviventes de câncer infantil, fatores associados ao transtorno e implicações clínicas. Identificaram-se índices de sintomas de TEPT mais altos nos sobreviventes quando comparados à população em geral. Variáveis como idade, idade no diagnóstico, sintomas de TEPT nos pais e crenças sobre saúde e doença foram associadas ao TEPT. Destacou-se a necessidade de intervenções clínicas específicas para esta população. O estudo empírico, apresentado na sessão 2, foi realizado com 65 adultos e adolescentes, com idade média de 19 anos, que haviam concluído o tratamento há pelo menos um ano em um hospital público de Porto Alegre. O principal objetivo foi investigar a presença de sintomas de estresse pós-traumático e sua relação com a percepção sobre a doença nesses pacientes sobreviventes. Examinou-se também a relação dos sintomas de TEPT com variáveis clínicas e sociodemográficas. Foram aplicados os questionários IPQR-H – Revised Illness Perception Questionaire for Healthy People , para avaliar a percepção sobre a doença, o PCL-C- PTSK Checklist – Civilian Version e SPTSS-Screen for Post -traumatic stress symptoms, para transtorno de estresse pós-traumático e um questionário de dados clínicos e sociodemográficos. Os índices de sintomatologia de TEPT variaram de 9,2% a 18,5% na amostra, não havendo diferenças significativas entre homens e mulheres. Correlações significativas foram encontradas entre sintomas de TEPT e algumas dimensões da percepção sobre a doença. Não foram encontradas associações significativas entre variáveis clínicas e sociodemográficas e sintomas de TEPT. A percepção sobre a doença foi preditora de sintomatologia de TEPT em sobreviventes de câncer infantil. Assim, identificou-se que a percepção sobre a doença deve ser investigada em sobreviventes de câncer infantil para atuar na prevenção e no tratamento de sintomas de TEPT nesses pacientes. Destaca-se a importância do acompanhamento psicológico durante todo o tratamento e após o término do tratamento, durante o período necessário para readaptação desses pacientes a vida social. / Childhood cancer is a group of diseases characterized by uncontrolled proliferation of abnormal cells. Despite advances in science and medicine, making the survival rate reaches 80% on average, the disease is still considered threatening, and the treatments are painful and invasive. This experience can lead to psychological consequences, among them Post Traumatic Stress Disorder (PTSD) or the presence of its symptoms. Thus, the aim of this thesis was to investigate the presence of PTSD symptoms in young survivors of childhood cancer through two studies, one systematic review and one empirical. The systematic review study, presented in session 1, attempted to investigate the presence and prevalence of PTSD symptoms in childhood cancer survivors, factors associated with the disorder and clinical implications. Higher indices of PTSD symptoms were identified when compared to general population. Variables as age, age at diagnosis, PTSD symptoms in parents and beliefs about health and illness were associated with PTSD. We pointed out the need for specific clinical interventions for this population. The empirical study presented in session 2 was conducted with 65 adults and adolescents with the mean age of 19, who had completed the treatment, at least one year before, in a public hospital in Porto Alegre. The main objective was to investigate the presence of PTSD symptoms and its relation to illness perception in these survivor patients. It also examined the relationship between the PTSD symptoms and the clinical and sociodemographic variables. Questionnaires were IPQR-H – Revised Illnes Perception Questionnaire for Healthy People, to assess the perception of the disease, the PCL-C-PTSK checklist – Civilian Version and SPTSS- Screen for Post-Traumatic Stress Symptoms for Posttraumatic Stress Disorder and a questionnaire of clinical and sociodemographic date. The rates of PTSD symptoms ranged 9.2% to 18.5% in the sample, with no significant differences between men and women. Significant correlations were found between PTSD symptoms and some dimensions of illness perception. No significant associations were found between clinical and sociodemographic variables and PTSD symptoms. The illness perception was a predictor of PTSD symptoms in survivors of childhood cancer. Thus, we identified that the illness perception should be investigated in childhood cancer survivors in order to act in the prevention and treatment of PTSD symptoms in these patients. We highlight the importance of psychological counseling throughout the treatment and after the treatment during the period required for rehabilitation of these patients social life.

Tyrimo tikslas – nustatyti galimas sąsajas tarp kiekvieno asmenybės stiliaus aukštesnio išreikštumo ir ligos suvokimo ypatumų, lyginant su kiekvieno asmenybės stiliaus žemesnio išreikštumo grupės ligos suvokimo ypatumais. Tyrime dalyvavo 190 VšĮ Ukmergės ligoninės Fizinės medicinos ir reabilitacijos skyriuje besigydančių pacientų (vyrų ir moterų). Siekiant įvertinti tiriamųjų asmenybės stiliaus išreikštumo bei ligos suvokimo sąsajas, tiriamiesiems išdalinti klausimynai, kuriuos jie pildė namuose ir grąžino tyrėjui. Tyrime naudoti du klausimynai: Ligos suvokimo klausimyno (Illness Perception Questionare, IPQ; Weinman ir kt., 1996) atnaujinta versija (IPQ-R) ir pagal DSM-IV-R klasifikaciją sudarytas klausimynas asmenybės stilių išreikštumui nustatyti. Tyrimo rezultatai parodė, kad aukštesnio išreikštumo vengiančiam, priklausomam, šizoidiniam, paranoidiniam, histrioniniam, ribiniam asmenybės stiliams būdingas didesnis tapatinimasis su liga, lyginant su žemesnio išreikštumo asmenybės stilių tapatinimusi su liga; aukštesnio išreikštumo vengiančio, priklausomo, paranoidinio, histrioninio, obsesinio-kompulsinio asmenybės stilių požiūris į ligą negatyvesnis, lyginant su žemesnio išreikštumo asmenybės stilių požiūriu į ligą; aukštesnio išreikštumo vengiantis, priklausomas, paranoidinis, histrioninis, ribinis, obsesinis-kompulsinis asmenybės stiliai patiria daugiau nuo ligos suvokimo skirtumų priklausančių neigiamų emocijų, kurios turi įtakos su sveikata susijusio elgesio... [toliau žr. visą tekstą] / The aim of the study was to examine the relations between every highly expressed personality style and illness perception peculiarity comparing with lower expressed personality style and illness perception peculiarity. 190 patients from Ukmerge Hospitals Physical Medicine and Rehabilitation centre were examined in this experiment (both men and women). In order to examine relations between expressed personality style and illness perception, every patient had to complete the questionnaire at home and bring it back researcher. Two questionnaires were used in this experiment: Illness Perception Questionnaire, IPQ (Weinman ir kt., 1996) new version IPQ – R and questionnaire to identify expressed personality style which was created based on DSM – IV – R. The results showed that: patients with higher expressed personality style (avoiding, depending, paranoid, schizoid, borderline personalities) have higher identification with illness, comparing with lower expressed personality style patients; patients with higher expressed personality style (avoiding, depending, paranoid, histrionic, anancastic personalities) have more negative attitude towards illness, comparing with lower expressed personality style patients; patients with higher expressed personality style (avoiding, depending, paranoid, histrionic, borderline and anancastic personalities) experience more negative emotions related to illness perception which influence health related behavior, comparing with lower expressed... [to full text]

Tyrimo tikslas – nustatyti ir palyginti sveikatos kontrolės lokuso, savo ligos suvokimo ir pykčio ryšius hemodialize gydomų ir hemodializei besirengiančiųjų pacientų grupėse. Tyrime dalyvavo 74 hemodialize gydomi ir 53 hemodializei besirengiantieji. Hemodialize gydomi pacientai sudarė 58,3%, o hemodializei besiruošiantieji pacientai 41,7% tiriamųjų. Pacientų amžius svyravo nuo 21 iki 86 metų, amžiaus vidurkis – 59,03.Tyrimas buvo atliekamas Lietuvos sveikatos mokslų universiteto klinikų nefrologijos skyriuje, Šiaulų dializės centre UAB B. Braun Avitum ir Šiaulių Respublikinės ligoninės nefrologijos skyriuje. Šiame tyrime buvo naudojamas kiekybinis tyrimas, kurio metu buvo pateikta anketa. Ją sudarė: sveikatos kontrolės lokuso klausimynas ( MHLC), ligos suvokimo klausimyno atnaujinta versija ( IPQ – R), klinikinio pykčio klausimynas ( CAS) ir pateikti 5 papildomi klausimai nesusiję su minėtais klausimynais. Tyrimo rezultatai parodė, kad sveikatos kontrolės lokusas, savo ligos suvokimas ir pyktis turi tarpusavio sąsajų. Hemodializei besirengiančių ir hemodialize gydomų pacientų kitų įtakos sveikatos kontrolės lokuso ryšiai su pykčiu ir savo ligos suvokimo dimensijomis priklauso nuo sociodemografinių charakteristikų: amžiaus, lyties, išsilavinimo ir šeiminės padėties. Pagrindinės išvados parodė, kad hemodializei besirengiančių kitų įtakos sveikatos kontrolės lokusas yra susijęs su labiau išreikštu pykčiu ir pozityvesniu... [toliau žr. visą tekstą] / The aim of the study was to find and compare the links between health locus of control, illness perception and anger in hemodialysis and pre – hemodialysis groups . The study included 74 hemodialysis patients and 53 pre – hemodialysis patients. There were 58,3,% of hemodialysis patients and 41,7% of pre – hemodialysis patients. Age of patients was between 21 and 86, average age - 57,03 years old.The study was carried out in Lithuanian University of Health Sciences nephrology clinic, Šiauliai hemodialysis center UAB “B. Braun Avitum” and Šiauliai hospital nephrology clinic. It was used a quantitative survey – a questionnaire. It consisted of: Multidimensional Health Locus of Control Scale ( MHLC), Illness Perception Questionnaire ( IPQ – R), Clinical Anger Scale ( CAS) and there have been given 5 additional questions unrelated to these questionnaires. The results of search showed links between health locus of control, illness perception and anger. Health locus of control links with illness perception and anger in hemodialysis and pre – hemodialysis groups depended on sex, age, education, family status. The main consclusion demonstraits, that other influence health locus of control have links with much anger and much positive perception of illness according to treatment control dimension, but much negative perception of illness according to personal control, illness coherence and emotional representations dimensions in pre... [to full text]

Adherence to medication in asthma and attention deficit hyperactivity disorder (ADHD) is important because medication may prevent serious consequences, possibly with lifelong effects. Several factors have been identified that influence adherence to medication in these disorders, but the importance of personality traits, beliefs about medication and illness perception has been insufficiently explored. The overall aim of this thesis was to study adherence to medication in asthma and ADHD, and in particular factors associated with adherence. The participants (n=268) in Study I were recruited epidemiologically and consisted of young adults with asthma, aged 22 years (±1 year). Impulsivity and, in men Antagonism and Alexithymia were associated with low adherence among respondents with regular asthma medication (n=109). The participants (n=35) in Study II were recruited from primary care clinics and consisted of adults (mean age 53 years). In men, Neuroticism was associated with low adherence, but Conscientiousness with high adherence. Beliefs about the necessity of medication were positively associated with adherence behaviour in women. In the total sample, a positive necessity-concern differential of beliefs predicted higher adherence. The participants in Study III, IV (n=101) and V (n=99) were recruited from Child and Adolescent Psychiatric clinics and consisted of adolescents with ADHD on long-term ADHD medication. Study IV assessed the reliability and validity of Swedish translations of the Beliefs about Medicines Questionnaire-specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with ADHD. Exploratory Principal Component Analysis (PCA) loadings of the BMQ-Specific items confirmed the original components, the specific-necessity and specific-concerns. The exploratory PCA for B-IPQ revealed two components; the first one, B-IPQ Consequences, captured questions regarding perceptions of the implication of having ADHD (items 1, 2, 5, 6 and 8) and the second one, B-IPQ-Control, the perceptions of the ability to manage the ADHD disorder (items 3, 4 and 7). Adherence correlated positively with BMQ-necessity-concern differential but negatively with beliefs about medication regarding concerns and side effects as well as Antagonism. Adolescents with more beliefs in the necessity, but with less concerns and side effects were less intentionally non-adherent. Adolescents with more perceptions that ADHD affected life showed less unintentional non-adherence. Negative Affectivity was associated with beliefs in the necessity of medication, but also with concern about medication and side effects. Negative Affectivity was positively associated with perceived consequences in life caused by ADHD and less control over ADHD. Hedonic Capacity was associated with less concerns about medication. In conclusion: In asthma and ADHD, adherence was associated with personality and beliefs about medications treatment. The personality traits showed numerous associations with perception about ADHD and beliefs about asthma and ADHD medication. This thesis increases our understanding of these person-related underlying factors of non-adherence, which may enable targeted actions intended to turn non-adherence into adherence as well as to identify individuals at risk for non-adherence. The Swedish translation of BMQ-Specific and B-IPQ proved to be valid and reliable, suggesting that the scales are useful in clinical work to identify risks of low adherence and to increase knowledge about how adolescents perceive ADHD. / Följsamhet till läkemedelsbehandling vid astma och ADHD (attention deficit hyperactivity disorder) är viktigt eftersom optimal behandling kan förebygga allvarliga och livslånga konsekvenser. Flera faktorer som påverkar följsamhetsbeteendet har tidigare identifierats exempelvis ekonomiska faktorer, men vikten av personlighetsdrag, uppfattning om läkemedel och sjukdomsuppfattning har tidigare inte undersökts tillräckligt. Det övergripande syftet för avhandlingen var att studera följsamhet till läkemedel hos personer med astma och ADHD och i synnerhet påverkande faktorer. Avhandlingen utgörs av fem delstudier. Personlighet kan beskrivas som grundläggande egenskaper som kännetecknar likheter och skillnader mellan individer, den så kallade egenskapsteorin. Personlighet kan beskrivas utifrån fem grundläggande personlighetsdrag: känslomässig instabilitet, utåtriktning, öppenhet, vänlighet och målmedvetenhet, den så kallade fem-faktor modellen. När det gäller uppfattning om läkemedel så vägs uppfattningen om nödvändigheten av läkemedelsbehandlingen för att kontrollera sjukdomen mot oron för läkemedlens negativa effekter-biverkningar. Följsamhetsbeteendet beror på vilken uppfattning som dominerar. Uppfattning om sjukdom påverkas bland annat av personens uppfattning om hur mycket sjukdomen påverkar personens liv och sjukdomens varaktighet. Resultaten av denna avhandling visar att följsamheten var högre hos tonåringar med ADHD än hos vuxna med astma. Följsamheten till astma- och ADHD-medicinering var signifikant associerad med uppfattning att läkemedel var nödvändigt såväl som personlighetsdragen, särskilt antagonism. Följsamheten var inte associerad med ålder eller kön. Med anledning av att kön är relaterad till andra faktorer bör det beaktas i utredning av följsamhet till läkemedel. Personlighetsdraget känslomässig instabilitet, var relaterat till många uppfattningar om läkemedlen och sjukdomsuppfattningar. Avhandlingen visar på sambandet mellan vissa personrelaterade faktorer och följsamhet till läkemedel, hos personer med astma och ADHD. Den svenska översättningen av frågeformulären: Uppfattning om läkemedel (BMQ-Specific) och Uppfattning om ADHD (B-IPQ) visade sig ha god kvalitet för användning i kliniska utvärderingar och forskning som involverar ungdomar med ADHD.

Hypertension is defined as an asymptomatic disease which means that the disease is not related to the experience of physical symptoms. This illness is mainly managed by means of oral drug therapies, but research shows that many patients fail to take their medication as they should. Non-compliance is the main problem associated with drug-related treatments, specifically amongst patients diagnosed with chronic conditions, such as hypertension. Past research has focused on many different factors accounting for the high occurrence of non-compliance. Psychological factors relate to patients’ beliefs about their diagnosed illness and their prescribed treatment regimen. These beliefs are conceptualized in terms of the self-regulation model as constituting 5 main dimensions: identity or symptoms of their illness, the consequences of their illness, timeline or specifically referring to the course of the illness (chronic or acute), causes of the illness and controllability. Compliance is vital in the treatment and management of hypertension and research attempting to understand the relation between compliance and patients’ illness cognitions are thus important. The already high prevalence of this condition coupled with an increase in the number of people reporting low compliance suggests the need for intervention. The research question informing the present study was based on the role that psychological factors play in impacting patients’ medication-taking patterns. The medication adherence model describes medication compliance in terms of purposeful action, patterned behaviour and feedback. Purposeful action concerns patients’ intentional decisions to take their medication while patterned behaviour relates to the medication-taking patterns that patients develop. The feedback dimension guides the medication-taking patterns, providing feedback about blood pressure for example. The theory informing the present study involved social cognitive theory, which highlights the role of self-efficacy and outcome expectancies. Self-efficacy is linked with feelings of personal control and specifically refers to people’s belief in their ability to perform certain actions that will produce desired outcomes. Outcome expectancies are described as people’s ability to consider the consequences of their actions and using this information to direct their behaviour. Bearing in mind these two aspects of social cognitive theory, patients’ belief in their ability to conform to their medication instructions together with their expectations that it will improve their health will direct their medication-taking behaviour (i.e. their compliance). The illness-perception questionnaire-revised and the medication-taking questionnaire were used to obtain information about patients’ illness cognitions and their medication compliance. The correlational findings as well as the results produced by regression analysis revealed that, although illness cognitions can play a determining role in patients’ compliance, the present findings found no relation between how patients take their medication and psychological factors, defined in terms of the self-regulation model. Only one of the factors used during factor analysis revealed to significantly predict medication. Limitations associated with the present study might account for this finding and it is recommended that future research should focus on a larger sample and also use supplementary assessment measures in conjunction with self-report measures. Copyright / Dissertation (MA)--University of Pretoria, 2012. / Psychology / unrestricted