Medication nonadherence is a healthcare problem that costs the United States billions of dollars annually. The purpose of this project was to propose an evidence-based program for healthcare personnel to increase the rate of medication adherence in hypertensive Black adults who require daily, oral medication. The transtheoretical model of change was used to explain the process of change and to identify approaches to changing non-adherent behaviors related to medications. Motivational interviewing was used to explain the process that nurse-educators would use to guide patients through the stages of change. In the initial step of this quality improvement program, a convenience sample of 9 healthcare personnel were given an overview of the proposed program and asked to provide feedback on the relevance and meaningfulness of the proposed program using a program development evaluation form. Numerical data collected from the evaluation form were gathered using a 5-point Likert-type, scale. The data results were analyzed to determine the relevance and meaningfulness of the proposed program. The analyzed data were reported in frequency and percentages. Descriptive statistics were used. According to the findings, all 9 healthcare personnel supported the use of the proposed program and believed that its content was relevant and meaningful to clinical practice. The findings also revealed that 8 out of the 9 healthcare personnel believed that patients who qualified for the proposed program would be likely to participate. Adoption of this evidence-based program would facilitate social change by improving the rate of medication adherence in hypertensive Black adults and potentially improving their overall health.

<p><strong>Background:</strong> The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings.</p><p><strong>Aims:</strong> The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies.</p><p><strong>Methods:</strong> Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective.</p><p><strong>Results:</strong> In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations.</p><p><strong>Conclusions:</strong> Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.</p>

<p>The purpose of this study was to describe how nurses, working in primary health care and responsible for diabetes care, reflected on patient information and education, its’ content and experiences of providing it. The study had a descriptive design and seven nurses from seven health care units in the middle of Sweden participated in the study. Data were analyzed with qualitative content analysis. The results are presented in two main categories; <em>“The information”</em> and<em> “The procedure”.</em> The two subcategories; Adjusting information and Bring about knowledge and to live with the disease<em> </em>emerged from <em>“The information”</em>. The five subcategories; Specific situation information, Increased insight about lifestyle changes, Developed dialogues, Nurses’ and patients’ perspective of responsibility and Supporting and follow ups<em> </em>were formulated from <em>“The procedure”</em>. Individual adjusted information within dialogues was highlighted. The motivational interview technique was considered as contributing to possibilities for more successful treatment and lifestyle changes. The main result showed that nurses responsible for diabetes care in primary health care empathized the need of individual adjusted information and the procedure providing it, in order to support the patients’ daily life.</p>

An estimated 50% of mortality from the 10 leading causes of death is due to behaviour. Individuals can make important contributions to their own health by adopting health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a counselling approach for behavioural change that builds on a patient empowerment perspective by supporting autonomy and self-efficacy. The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on general health care professionals’ learning and practice of MI. Specific aims are; study I was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies; study II was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services; study III was to evaluate the attitudes towards MI and clinical use of MI with children´s weight issues one year after child health care nurses’ participation in MI training; study IV was to systematically review studies that have evaluated the contents and outcomes of MI training for general health care professionals. Participants in study I were 15 community pharmacy pharmacists in Östergötland, Sweden. Participants in study II were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Data for both studies were obtained through focus group interviews. Study III, participants were 76 nurses from child health care centres in Östergötland, Sweden. 1-year after MI training they answered a survey. Study IV, the material was 10 empirical studies that have evaluated different aspects of MI training. MI training for general health care providers is generally of short duration and tends to focus on specific topics such as diabetes, smoking, and alcohol. The training seems to contain more training on phase I elements, such as clients’ inner motivation, than on phase II, which involves strengthening clients’ commitment to change. MI is seen as practical and useful in work with lifestyle and health promotion issues, especially with issues that may be perceived as sensitive, such as alcohol and obesity. General health care providers have positive attitudes to MI and view MI as being compatible with their values and norms about how they want to work. Clients’ resistance reactions are difficult to handle in the first stages of learning MI, and may lead to frustration. Strategies to avoid resistance are including in the final stages of learning MI. Learning and clinical use of MI for general health care providers is influenced by interactions with their environment (colleagues, staff and organization). Unlearning of old knowledge can be a problem for general health care providers in the learning and clinical use of MI.

The purpose of this study was to describe how nurses, working in primary health care and responsible for diabetes care, reflected on patient information and education, its’ content and experiences of providing it. The study had a descriptive design and seven nurses from seven health care units in the middle of Sweden participated in the study. Data were analyzed with qualitative content analysis. The results are presented in two main categories; “The information” and “The procedure”. The two subcategories; Adjusting information and Bring about knowledge and to live with the disease emerged from “The information”. The five subcategories; Specific situation information, Increased insight about lifestyle changes, Developed dialogues, Nurses’ and patients’ perspective of responsibility and Supporting and follow ups were formulated from “The procedure”. Individual adjusted information within dialogues was highlighted. The motivational interview technique was considered as contributing to possibilities for more successful treatment and lifestyle changes. The main result showed that nurses responsible for diabetes care in primary health care empathized the need of individual adjusted information and the procedure providing it, in order to support the patients’ daily life.

No description available.

African Americans carry a disproportionate amount of the health burden for chronic disease in the United States (Center for Disease Control and Prevention, 2007). Diabetes, heart disease and cancer, to name a few, are diseases which prematurely capture the lives of African Americans. While chronic, these diseases are preventable with the advent of behavioral change. Physical activity is a primary contributor to longer life expectancy and fewer health concerns (United States Department of Health and Human Services, 1996). While American society, as a whole, struggles to incorporate more physical activity in their lifestyles, African Americans exhibit higher levels of physical inactivity which correlates to higher instances of preventable and chronic health problems in this subgroup of the population. Thus intervention which addresses the specific needs of this community, the mechanisms by which to prompt behavior change and the most effective means to disseminate this information is needed to affect health behavior change in this population. The African American church provides an ideal vehicle by which to diminish these health issues as existing teaching, support and resource mechanisms can be utilized. The current paper explores the relationship between increasing intrinsic motivation through employing motivational interviewing as a strategy to increase physical activity among African Americans church members.

Inom Kriminalvårdens tre ben häkte, anstalt och frivård, förs samtal med klienter för att försöka åstadkomma förändring. Denna uppsats fokuserar på samtalen med de klienter som inte bara är kriminella, utan även har ett missbruk av narkotika. Detta faktum gör att samtalen försvåras då det finns många underliggande faktorer som påverkar, både utifrån klientperspektiv som myndighetsperspektiv. För att ändå kunna skapa ett gott samtalsklimat som kan leda till förändring, ses detta arbete utifrån samtalsmetoden Motivational Interviewing, MI, vilken förespråkas av Kriminalvården. Den svenska översättningen av MI är Motiverande Samtal. En före detta klient och missbrukare har intervjuats liksom nio professionella med samtal som grundläggande arbetsmetod. Uppsatsen har ett fenomenologiskt perspektiv. Vad som framkommit under intervjuerna och vad som finns att hämta från litteraturen, har sedan analyserats utifrån ett humanistiskt och existentialistiskt samt ur ett kommunikativt perspektiv.                       Det studien tydligast visar på, är att samtal är en förutsättning för att bedriva ett bra arbete med de klienter som är bland de svåraste inom Kriminalvården. Dock visar studien på att det finns faktorer som försvårar samtalen för förändring. En slutsats dras att dessa behöver tas i beaktande för att de professionella inom Kriminalvården ska kunna utföra sitt arbete. Därför kan MI enligt resultatet utgöra en mycket bra grund i samtalen, men att det finns en del kvar som kan förbättras, inte minst utifrån aspekten att samtalen påverkas av flera inre och yttre faktorer, vilka specificeras i studien. Det är flera av de intervjuade som ej använder sig av MI, men det kan tolkas som att metoden i sig är lätt att ta till sig i då den utgår ifrån grundläggande mänskliga värderingar. Detta gör att metoddelarna i MI ändå kan skönjas även bland de intervjuade som inte säger sig ha användning av metoden. Kriminalvårdens personal har, trots många svårigheter att övervinna i arbetet, ett unikt tillfälle att samtala om förändring, oavsett om MI används som metod eller ej. / Within the three ”legs” of the Swedish Prison and Probation system; detention centre, prison and probation office, there are conversations held with the clients, with the purpose of bringing about a change. This essay is focused on the conversations with the clients who are not only criminals, but also have a drug abuse. This fact makes the conversations more difficult because of many underlying factors, both from the perspective of the client and of the authority. To be able to create a good climate for discussion which could lead to change, the method of Motivational Interviewing (MI) is used. MI is the foundation of the prison and probation authority´s everyday work with clients. A former client and drug addict, has been interviewed as well as nine professionals. The essay has a phenomenological perspective. The results of the interviews and what is found in the literature has been analyzed from a humanistic and existentialistic perspective as well as a communicative perspective.                       The most important findings in the study are that use of conversations is a very important and basic method to be able to carry on a good work with the most difficult clients within the Swedish Prison and Probation system. Yet, this essay also shows factors which makes the conversations towards change more difficult. The conclusion is drawn that the professionals within the Prison and Probation system, have to take these factors into consideration, to be able to do their work. Motivational Interviewing as an approach can therefore be, according to the result, a very good foundation in these conversations. The study also shows that there are still things that could be better, especially that the conversations can be influenced by several of inner and outer factors, which are specified in the study. There are many of the interviewed, that are not using the MI technique, though that could mean that the method in it self, is easy to embrace because of its base on fundamental human values. Therefore some of the MI techniques can be seen among the interviewed that stated that they didn´t have any use of the method. The staff of the Prison and Probation system have, despite the many difficulties in the work, a unique opportunity to discuss change, no matter if MI is used as a method or not.

En stor del av dagens sjukskrivningar beror på psykisk ohälsa och fysisk inaktivitet och har blivit ett folkhälsoproblem. Stress beror av relationen mellan individ och miljö, där individens självuppfattning och verklighetsupplevelse är av betydelse för upprätthållandet av välbefinnande. Stress uppkommer av flera olika orsaker, stressorer, vilka skiljer sig människor emellan. Fysisk aktivitet har visat sig ha en positiv inverkan både i att förebygga och behandla stress och företagssköterskan kan genom hälsorådgivning ha en betydande roll för yrkesverksammas fysiska aktivitetsutövande. Syftet med studien var att beskriva den fysiska aktivitetens betydelse för den upplevda stressnivån bland anställda inom ett kommunalt energi- och vattenbolag. Kvantitativ metodik med enkätundersökning användes, där 34 av 39 personer valde att medverka. Resultatet analyserades med beskrivande statistik och det visade sig finnas indikationer på att de äldre arbetstagarna var mest stressade. Yrkesverksamma som ägnade en stor del åt mycket ansträngande fysisk aktivitet upplevde mindre stress. Studien visade även att en majoritet av dem som bedömdes vara stressade var stillasittande. Fysisk aktivitet tycktes också medförda positiva upplevelser som en bättre självkänsla och en mer positiv syn på livet. Det finns behov av ytterligare studier för att säkrare slutsatser ska kunna dras. / Many of today’s sick leaves are caused by psychological illness and lack of physical activity has become a public health problem. Stress is depending on the relation between the person and the environment, where self-perception and experience of reality are important for maintaining well-being. Causes of stress, stressors, can be many and vary from individual to individual.  Physical activity has shown to have a positive effect in both preventing and treating perceived stress and the occupational nurse can, through health counselling, have an important role to play in changing exercising habits among workers. The purpose of the study was to describe the physical activity’s importance for the experienced stress level among the employees of a municipal energy and water company. Quantitative method with questionnaires was used, where 34 of 39 workers chose to participate. The result was analyzed with descriptive statistics and indicated that the older employees were the most stressed. Workers who devoted much time to intense exercising experienced less stress. The study also showed that the vast majority of workers who were stressed were sedentary. Physical activity seemed to give positive experiences like better self-esteem and a more positive way of looking at life. Further studies would be needed for more definitive conclusions.

Bakgrund: Övervikt och fetma är ett ökande problem i Sverige och stora delar av världen, för både vuxna och barn. Övervikt och fetma hos modern innan och under graviditeten ökar risken för övervikt och fetma hos barnet. Risken för fetma hos barn ökar i proportion med föräldrarnas fetma. Fetma vid 4 års ålder ökar riskerna för fetma senare i livet. Ett överviktigt/obest barn har generellt sämre livskvalité och är oftare deprimerade, fetma orsakar också sjukdomar som t.ex. högt blodtryck och diabetes. Att amma sitt barn främjar dess aptitreglering och förebygger övervikt. Syfte: Syftet med denna studie var att undersöka om utökade interventioner inom ramen för ordinarie basprogram under graviditet och småbarnstid hos kvinnor med BMI över 25 påverkade viktutveckling/ISOBMI och amningslängd hos barnet fram till fyra års ålder. Metod: Interventionsstudie omfattande 182 barn indelade i en interventionsgrupp (94) och en jämförelsegrupp (88). Enkäter rörande barnets vikt, längd och matvanor samlades in och analyserades när barnet var 10 månader, 2,5 år och 4 år gammalt Resultat: En signifikant skillnad sågs mellan grupperna vid fyra års ålder, då fler var överviktiga och feta i jämförelsegruppen. Medelvikten skilde ett kg. En trend sågs i alla viktkategorier där jämförelsegruppen vägde mer än interventionsgruppen. Det sågs ingen signifikant skillnad i amningslängd mellan grupperna.Slutsats: Överviktiga/feta kvinnor får i större utsträckning överviktiga/feta barn. Vår studie visar att små interventioner gör skillnad. / Background: Obesity is an increasing problem in Sweden and large parts of the world, for both adults and children. Overweight and obesity in the mother before and during pregnancy increases the risk of overweight and obesity in the child. The risk of childhood obesity is increasing in proportion with parental obesity. Obesity at age four increases the risk of obesity later in life. An overweight / obese child generally have worse quality of life and are more often depressed, obesity also causes diseases such as hypertension, and diabetes. To breastfeed the child promotes its appetite control and prevents obesity. Purpose: The purpose of this study was to investigate whether enhanced interventions within the framework of regular base program during pregnancy and under the children’s first four years in women with a BMI over 25 affects weight gain / ISOBMI and lactation length. Method: The intervention study of 182children divided into an intervention group (94) and a comparison group (88). Surveys regarding the child's weight, height and dietary habits were collected and analyzed when the child was 10 months, 2.5 years and 4 years old Results: A significant difference was seen between the groups at age four, when more were overweight and obese in the comparison group. The average weight differed one kg. A trend was seen in all weight categories in which the control group weighed more than the intervention group. There was no significant difference in breastfeeding duration between the groups. Conclusion: Overweight / obese women have a greater degree of overweight / obese children. Our study shows that small interventions make a difference.