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Bakgrund: Under 1980-2020 ökade andelen människor med övervikt i Sverige. Fortsätter utvecklingen i samma takt kommer det att innebära att hälften av världens befolkning är överviktig år 2030. Övervikt är en riskfaktor för många sjukdomar såsom diabetes, hjärt-och kärlsjukdomar och cancer. Stigmatiseringen av överviktiga innebär att de anses vara lata, okunniga och viljesvaga. När stigmatisering sker inom vården förstärks känslor av skuld och skam hos patienter med övervikt vilket kan leda till allvarliga konsekvenser, exempelvis att patienter inte söker nödvändig vård. Syfte: Att belysa hur sjuksköterskor upplever interaktionen med patienter med övervikt. Metod: Litteraturstudie med kvalitativ ansats. Använda databaser var Pubmed, CINAHL och Psycinfo som resulterade i 12 kvalitativa studier till litteraturstudiens resultat. Alla studier kvalitetsgranskades och analyserades sedan med hjälp av metasyntes. Resultat: Resultatet som framkom presenteras i tre teman; Organisation och utbildning, attityder och bemötande samt sjuksköterskans arbetsmiljö med tillhörande subteman. Faktorer som tidsbrist, sjuksköterskans attityd och behov av utbildning var återkommande. Det mest oväntade fyndet var att sjuksköterskor drar sig för att samtala om övervikt med patienter och dessutom känner de att de inte har tillräcklig kunskap. Konklusion: Det framkom att sjuksköterskor ansåg att det var deras ansvar att initiera samtalet om övervikt, både i preventivt syfte och vid redan befintlig grundsjukdom. Sjuksköterskors upplevelser är värdefulla och ger insyn i hur förbättringsarbete kan ske organisatoriskt, det saknas utbildning, träning, resurser och tid. Litteraturstudien gav ett innehållsrikt resultat gällande vad som påverkade sjuksköterskors interaktion med patienter med övervikt. Slutligen behövs det både utbildning och redskap för att sjuksköterskor ska kunna erbjuda en god personcentrerad omvårdnad. / Background: The amount of people with overweight increased during 1980-2020 in Sweden. If this development continues this will entail that half of the world’s population will be overweight by the year 2030. Being overweight is considered a higher risk of contracting diseases such as diabetes, heart diseases and cancer. The stigma of being overweight is that they are considered being lazy, ignorant and weak willed. When stigma occurs in health care, feelings of guilt and shame are increased in patients with overweight which can lead to serious consequences such as patients not seeking necessery care. Aim: To illustrate how nurses perceive the interaction with patients with overweight. Method: Literature Study with qualitative approach. The used databases were Pubmed, CINAHL and Psycinfo that resulted in 12 qualitative studies for the literature studies results. All studies were quality reviewed and analyzed using metasynthesis. Result: The results that emerged were presented in three themes; Organisation and education, attitudes and interaction & nurses work environment with associated subthemes. Factors such as lack of time, nurses attitude and need for education were recurrent. The most unexpected find was that nurses are reluctant to discuss overweight and felt that they did not have enough knowledge. Conclusion: The results show that nurses considered it their responsibility to initiate the conversation about overweight, both in a preventative way but also when a preexisting condition was apparent. Nurses' experiences are valuable and give an insight into how improvements can be made organizationally, there is a lack of education, training, resources and time. The literature study gave an inclusive result regarding what influenced nurses' interaction with patients with overweight. Finally there is a need for education and tools for nurses to be able to give good patient centered care.

Purpose: Unhealthy behaviors and bad habits are some of the major problems modern healthcare is facing and cause serious consequences in both oral health and health in general. Therefore one important aspect of modern dental and medical training is training in health behavior change. In this field, a counseling method and technique called Motivational Interviewing (MI) has shown quite promising results. MI training is introduced and applied as a part of the students training in various dental and medical educational centers. The purpose of this systematic literature review was to study the effects of MI training on dental and medical students’ counseling skills and their confidence in health behavior change communication with the patients. Method: The study was a systematic literature review, conducted from December 2010 to May 2011. Identification of relevant individual studies for this review was made by analyzing data collected through searches in seven different databases: PubMed; Cohrane Central; Trip; PubMed Clinical Queries; Cinhal; Medline and Health Information Resources. Results: Seven relevant articles were found. Six articles showed that MI training seem to have an altering effect on the counseling skills of the students. Five articles showed improvement in the students’ confidence in using MI and behavior change communication. Conclusion: Training in MI seems to have a positive influence on the communication skills of the students leading to improved counseling techniques and better ability to counsel patients on health behavior change.

There have been a host of studies performed documenting that college students engage in alcohol consumption to a degree that is dangerous to their health and well-being (Brenner, Metz, & Brenner, 2009; Harris et al., 2010; Leichleiter et al., 1998; Martens, O'Connor-Dams, & Paiement-Duffy, 2006). Many other studies indicate that college athletes indulge in a higher level of alcohol consumption than their non-athletic peers (NCAA, 2006; Williams, Jr. et al., 2008). There is a continuing culture of excessive consumption of alcohol by college athletes. When reading the headlines about a collegiate athlete who dies because of misusing alcohol, one might ask how the issue continues to be such a problem, and what can be done about it. As a result of data from a study (Nolt et al., 2013) highlighting head coaches' confidence and self-efficacy regarding the issue of alcohol consumption by athletes, an interventional study was developed to address what appears to be a lack of confidence and self-efficacy on the part of collegiate head coaches to address and intervene with athletes who misuse alcohol. Presented in this dissertation are data, which quantified a lack of confidence and self-efficacy of collegiate head coaches to address the issue of athletes who consume alcohol to the detriment of their health and well-being, as well as data from the resulting training which is the subject of this current study. Results affirm that an interventional training which includes alcohol use education combined with motivational interviewing technique successfully increases head coach confidence and ability to conduct a brief intervention with an athlete who drinks. / Kinesiology

The degree to which patients and their therapists align over time on their perceptions of therapeutic processes and intermediary outcomes has generally been regarded as an important element of effective psychotherapy; however, few studies have examined empirically the influence of such dyadic convergences on ultimate treatment outcomes. This study examined (a) whether early treatment convergences in patient-therapist alliance and session progress ratings were associated with subsequent worry and distress reduction (and final posttreatment level) in psychotherapy for generalized anxiety disorder (GAD), and (b) whether treatment type and the initial (session 1) levels of perceived alliance and session progress moderated these associations. Data derived from a clinical trial in which patients with severe GAD were randomly assigned to receive either 15 sessions of cognitive-behavioral therapy (CBT; n = 43) or 4 sessions of motivational interviewing (MI) followed by 11 integrative CBT-MI sessions (n = 42). Patients and therapists rated the alliance and session progress after each session. Patients rated their worry and distress multiple times throughout treatment. Dyadic multilevel modeling revealed, as predicted, that alliance convergence over the first half of therapy was associated with greater subsequent worry (p = .03) and distress (p = .01) reduction. Additionally, the combination of low initial patient-rated alliance and early divergence was associated with the worst trajectory for the distress outcome (p = .04). Unexpectedly, session progress divergence had a near significant association with lower posttreatment worry (p = .05) and was significantly associated with more accelerated subsequent distress reduction (p = .03). Additionally, for patients who perceived their initial progress more positively, whether dyads converged or diverged in early session progress ratings affected the trajectories (though not the ultimate amount) of distress change (p = .02). These findings suggest that divergence of early patient-therapist alliance perspectives, especially when coupled with lower initial patient-rated alliance quality, may be an important marker for patient nonresponse and therapist responsiveness (e.g., use of alliance repair strategies). The findings on patient-therapist session progress convergence are less straightforward, though several possible implications are discussed.

Bakgrund:  Motiverande samtal (MI) fokuserar på att främja patienters egen motivation och har visats vara gynnsam i syfte att främja beteendeförändringar. Diabetes är en snabbt växande folkhälsosjukdom och livsstilsförändringar har en positiv påverkan på sjukdomsförloppet. Trots befintlig kunskap om livsstilsförändringar finns svårigheter att uppfylla rekommendationerna och förändringarna upplevs ofta svåra att bibehålla över en längre tid. Syfte:  Beskriva patienters upplevelser av motiverande samtal för att främja livsstilsförändringar vid diabetes.  Metod:  Litteraturstudien inkluderade åtta kvalitativa studier från databaserna Cinahl, PubMed, PsycInfo och Scopus. Därefter kvalitetsgranskades valda studier utifrån Olsson & Sörensens bedömningsmall för kvalitativa studier och analysen utfördes utifrån Fribergs femstegsmodell.  Resultat:  Litteraturstudien resulterade i fyra kategorier med två subkategorier vardera. Följande kategorier identifierades; ”utveckla en vårdrelation som främjar livsstilsförändringar”, ”stöd att genomföra livsstilsförändringar”, ”hjälp att balansera livet vid livsstilsförändringar” och ”stärka det egna ansvaret vid livsstilsförändringar”. Konklusion:  Patienterna upplevde att MI var en metod som främjade och underlättade genomförandet av livsstilsförändringar. Mer forskning och utbildning inom området kan bidra till att MI används i större utsträckning i den kliniska verksamheten. / Background:  Motivational interviewing (MI) has the focus to promote patients own motivation and has been proven successful in promoting behavior changes. Diabetes are diseases growing fast in the society and lifestyle changes are considered to have a positive impact on the development of the disease. Regardless of existing knowledge about the positive effects of lifestyle change, the majority of people with the diagnosis do not meet the recommended goal and changes are often hard to maintain over a longer period.  Aim:  To describe patients experience of motivational interviewing to promote lifestyle changes in diabetes.  Methods:  A qualitative literature study was made with eight qualitative studies. The studies included was found through the databases Cinahl, PubMed, PsycInfo and Scopus. The studies was quality reviewed from Olssens and Sörensens model for qualitative studies and the analysis was made from Fribergs five step model.  Results: The literature study resulted in four categories with two subcategories each. Following categories where identified; ”developing a nursing relationship that promotes lifestyle changes”, ”support in the lifestyle changes”, ”help to balance the everyday life in the lifestyle changes” and ”reinforces the responsibility in the lifestyle changes”. Conclusion:  The patients experienced that MI was a method that promoted and facilitated the implementation of lifestyle changes. More research and education in the area could lead to an increased use of MI in the clinical situation.

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

Bakgrund: Diabetesprevalensen i världen ökar ständigt, en förklaring kan vara försämrade levnadsvanor vilka ofta leder till övervikt och fetma, kända riskfaktorer för diabetes typ 2. Diabetes typ 2 kan ofta regleras med livsstilsförändringar. En samtalsmetod som visat positiva effekter på förändring av levnadsvanor är motiverande samtal (MI). Behandling som involverar korta interventioner har visat positiva effekter vilket kan vara användbart inom den ofta tidspressade hälso och sjukvården. Syfte: Att kartlägga och beskriva effekter av interventioner baserade på motiverande samtal (MI) vid vård av personer med diabetes typ 2. Metod: Litteraturöversikt, där nio vetenskapliga artiklar med kvantitativ ansats granskades. Databaserna Cinahl with full text, MEDLINE, PubMed, PsycINFO, Scopus och Google Scholar användes. Resultat: Fysiologiska effekter, kost, psykologiska effekter och egenvård var de områden som framkom. Viss effekt av MI kunde visas över tid i flera områden, som bland annat HbA1c, vikt, kunskap och förståelse om diabetes, följsamhet till fysisk aktivitet, känsla av kontroll och egenvård. Dock saknades signifikanta skillnader mellan grupperna i flera av studierna. Konklusion: Resultaten i litteraturöversikten är inte entydiga. Motiverande samtal kan vara en möjlig samtalsmetod att använda i sjuksköterskans möte med personer med diabetes typ 2 för att öka möjligheten att sköta om sin egen hälsa för att minska komplikationsrisker. Ytterligare forskning av hög kvalitet behövs inom området. / Background: The prevalence of diabetes continues to rise worldwide, and oneexplanation being the decrease in positive lifestyle habits which often lead to weight gain and obesity, well known risk factors for diabetes type 2. Diabetes type 2 can be more easily managed by lifestyle changes. One counselling approach which has been found to have positive effect on lifestyle changes is Motivational Interviewing (MI).Treatment that involve short interventions have shown to have positive effects and may be useful in an often time poor environment such as the healthcare system. Objective: To map out and describe the effects of interventions based on motivational interviewing (MI) done in treatment of people with diabetes type 2. Methodology: Literature review of nine quantitative scientific articles. The databases Cinahl with full text, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar was used. Results: Physiological effects, diet, psychological effects and personal care were addressed. An effect of MI over time was found on several areas such as HbA1c, weight, knowledge about and understanding of diabetes type 2, compliance to physical activity, locus of control as well as personal self-care. However a lack of significant differences were found between groups in several studies. Conclusion: The results of the literature review are inconsistent. Motivational interviewing may be a possible counselling approach to apply in the nursing setting together with people with diabetes type 2, as a way to improve health behaviours such and decrease the risk of complications.

Background: Diseases partly depending on lifestyle is a global problem. Lifestyle changes with in the areas of tobacco, physical activity, diet and alcohol can reduce the risk of developing this diseases. To change habits and lifestyle is often difficult and takes time. Strengthening a person's belief in their ability to change can facilitate change. Motivational Interviewing (MI) is a counseling method that aims to provide support for lifestyle change. The person's own perspective is in focus. The counselor is trying to explore and understand it through empathically listening, and find the person's own motivation. Aim: To compile research of the usability of Motivational Interviewing at lifestyle change in the areas of tobacco, physical activity, diet and alcohol. Method: A literature study based on 13 articles of quantitative and qualitative approaches. Result: MI was useful at lifestyle change related to the areas of tobacco, physical activity, diet and alcohol, the highest usability was found at smoking cessation. No effect was found for diabetes and physical activity. MI improved the belief to commit lifestyle change. Emphatically listening facilitated lifestyle change. Conclusion: MI was useful at lifestyle change related to the areas of tobacco, physical activity, diet and alcohol, the highest usability was found at smoking cessation. MI improved the belief to commit lifestyle change and made persons more ready to change. Follow up improved the outcome. / Bakgrund: Sjukdomar som till viss del beror på levnadsvanor är ett globalt problem. Livsstilsförändringar inom områdena tobak, fysisk aktivitet, kost samt alkohol kan minska risken utveckla dessa sjukdomar. Förändring av levnadsvanor är ofta svårt och tidskrävande. Att stärka en människas tro på att hon/han kan förändras underlättar för att genomföra en förändring. Motiverande samtal (MI) är en samtalsmetod som syftar till att ge stöd till livsstilsförändring. Personens egna perspektiv är i fokus. Genom empatiskt lyssnande försöker rådgivaren utforska och förstå det, samt finna individens egen motivation till förändring. Syfte: Att sammanställa forskning om användbarheten av motiverande samtal vid livsstilsförändringar inom områdena tobak, fysisk aktivitet, kostvanor samt alkohol Metod: En litteraturstudie gjord på 13 artiklar, ansatser av kvantitativa och kvalitativa. Resultat: MI var användbart vid livsstilsförändringar relaterat till områdena, mest användbart vid rökstopp. Ingen effekt fanns vid diabetes och fysisk aktivitet. MI ökade tilltron till att kunna genomföra livsstilsförändringar. Empatiskt lyssnande av behandlaren underlättade för förändring. Slutsats: MI var användbart vid livsstilsförändringar relaterat till områdena tobak, fysisk aktivitet, kost samt alkohol, mest användbart vid rökning. MI ökade tilltron att kunna genomföra en livsstilsförändring, samt gjorde människor mer redo för den. Upplevelsen av att inte bli tillrättavisad underlättade för förändring. Uppföljning förbättrade utkomsten