Nurses as health care workers are at risk of biological agents such as bacteria, viruses and others. At health care settings exposure to bloodborne pathogens can cause infections through needlestick injuries. The objectives of this research were to determine factors surrounding recapping needles in hospital nurses and to implement an educational strategy to reduce the recapping practices. It was a descriptive and exploratory approach where the PRECEDE component of the PRECEDE/PROCEDE Model was used as the framework to systematize and analyze the information obtained from the focus group sessions. A total of 120 nurses participated from four different departments. The study was conducted in three phases: diagnosis, implementation and evaluation of the educational strategy. The results obtained from the focus group sessions revealed that predisposing, reinforcing, enabling and environment factors were related to the practice of recapping and needlestick injuries. Most of this information represented the essential basis for the implementation of the educational strategy. During the diagnostic phase, the percentage of needles without recapping was 24% contrasting with 40% found after the educational strategy. The percentage difference (16%) was statistically significant (p < 0.001). The odds ratios calculation in the departments studied showed that the educational strategy was a protective factor to avoid the recapping of used needles. An important conclusion is that the educational strategy, which focused on the practice and habit of what should be done (e.g., NOT recapping used needles), contributed to the decrease in recapping practice. However, nurses perceived did it not provide a safe working environment. The implications are focused on: nurses and hospital management have to engage in an active role to promote a safety work environment where nurses and other health care workers can be protected. The incorporation of educational strategies, continuous and updated training, as well as the evaluation and monitoring process can play a determinant role in the control of hazard exposures. It is imperative that a safe and healthy workplace for the personnel be provided; not less important is the acquisition of equipment and devices for sharp handling and disposal, to complement the prevention of accidents related to needlestick injuries.

Problématique: Devant les recommandations de concevoir des interventions éducatives en santébucco-dentaire intégrées dans des modèles de promotion de la santé (Petersen, 2010), le constat est fait, aprèsune recension qualitative des écrits en s’adossant au modèle Precede-Proceed (Green et Kreuter, 1991) qu’ilexiste peu d’études sur les représentations cognitives en santé bucco-dentaire des personnes âgées autonomes enparticulier sur la maladie carieuse, la gingivite, la mobilité dentaire, la sécheresse buccale et le bruxisme.Objectif : Identifier les représentations cognitives, selon Meunier (2002), exprimées dans le comportement desanté bucco-dentaire. Méthode: Suivant la méthode qualitative de la théorisation ancrée, l’analyse des verbatimest réalisée de l’étape de codification à l’étape de mise en relation (Paillé,1994). L’échantillon, non représentatif,repose sur 12 répondants volontaires (5 hommes et 7 femmes, de 66 ans à 90 ans). Les entretiens semi-directifssont menés à l’aide d’un guide d’entretien, préalablement testé, qui s’appuie sur plusieurs concepts dont leHealth Belief Model. Il comprend : un état de santé déclaré, une description de sa propre santé bucco-dentaire etune description du répondant et de ses ressources. Résultats : Les représentations cognitives, favorables ou non,sont proportionnellement plus présentes au niveau de l’attribution causale et du mécanisme d’apparition desmaladies bucco-dentaires. Les répondants expriment une proportion importante de « je ne sais pas» concernantles maladies en santé orale sauf pour la maladie carieuse. Ils ne se perçoivent pas comme malade. La notion debonne santé orale est difficile à définir autrement que par opposition à une mauvaise santé orale. Enfin, alors queles thèmes ne sont pas questionnés dans le guide d’entretien, l’esthétique et les préoccupations financièresoccupent une place importante dans les discours. Discussion : Ces résultats font émerger des obstaclesreprésentationnels vis-à-vis de la santé orale et mettent en exergue les différentes caractéristiques d’uncomportement en santé orale. Ils semblent confirmer que l’étape du diagnostic éducatif est incontournable dansla conception d’un programme d’éducation en santé orale car elle permet, entre autre, de faire émerger lesreprésentations cognitives, les connaissances déjà acquises et les nombreuses incertitudes. Il est à noter que touteintervention en éducation doit prévoir une définition positive de la santé orale. Conclusion : La poursuite derecherche s’avère nécessaire afin de répondre aux objectifs d’une intervention éducative. Un des principauxenjeux est l’adoption par l’individu d’un raisonnement basé sur l’acquisition de connaissances et de savoir luipermettant de prendre des décisions plus favorables à sa santé. / Premise: Given the need to develop educational programmes integrated into more generalmodels to promote oral health (Petersen, 2010), we observe that there are few studies on the cognitiverepresentations of the independent elderly on oral health. This observation is made after an qualitative review ofthe literature drawing on the Precede-Proceed model (Green et Kreuter, 1991). The lack of studies on this topicis especially apparent regarding tooth decay, gingivitis, dental mobility, dry mouth and bruxism. Aims: Toidentify the cognitive representations, defined by Meunier (2002), present in oral health behaviour. Method:According to the qualitative method of Grounded theory, the verbatim’s analysis is realized from the codingstage up to the integrating stage (Paillé, 1994). The sample, non-representative, is based on 12 voluntaryrespondents (5 men and 7 women, aged from 66 years to 90 years). The semi-directive interviews are led with aninterview guide based on the reference design of the Health Belief Model. Data includes reported health status,reported description of the respondent and their resources and reported description of their own oral health.Results: The categories of causal attribution and mechanism of appearance include most of cognitiverepresentations, either positive or negative. The respondents express an important proportion of “ I don’t know”regarding diseases in oral health, with the exception of cavities. They do not perceive themselves as sick persons.They define a good oral health only as opposed to poor oral health. Finally, while these topics are not addressedin the interview guide, aesthetics and financial concerns occupy an important place in the discourses.Discussion: These results reveal the representational barriers to improved oral health behaviour and stress thevarious characteristics of it. The results contribute to structuring a relevant educational diagnosis that isnecessary to prior in an education programme. Every health educational programme must include a positive oralhealth definition. Conclusion: There is a need for further research to address the objectives of educationalprogrammes. The main stake is to bring people to adopting knowledge based on reasoning yielding improvedoral health decisions.

The thesis presents a method of the delimiter based syntax analysis. There is introduced a definition, an algoritm of the computation and analysis of the delimiters in the thesis. Farther the thesis presents an algorithm creating a distributed parser based on the input grammar with the analysed delimiter symbols. Then there is introduced an implementation of the distributed parser created by the introduced method.

The study reviewed the provision of childbirth and parenting education in the ACT for indicators of effectiveness and needs. Users (n = 207) and providers (n = 7) were surveyed for information on educational and administrative aspects of the service. An original design questionnaire was based on the PRECEDE framework (predisposing, reinforcing and enabling factors in educational diagnosis and evaluation) and the social model of health. Items were drawn from the relevant literature, concerning individual, social and service delivery elements of the health fields concept interpreted for pregnancy, childbirth and parenting. Individual factors were related to Maslow's hierarchy and the valuing approach to health education. The provider survey covered information on organisational elements, comprising inputs, processes, products, outputs and outcomes of childbirth education. The study comprised a literature review, cross-sectional non-experimental surveys of users and providers, and a needs assessment combining information from each of the three sources. Descriptive statistical techniques, analysis of variance and valuing analysis were used to extract information on effectiveness indicators and needs from the user data. Comparisons were made between present and past users, and between women of different ages, experience of pregnancy and preferences for public or private methods of education for childbirth. No evidence was found of individual differences in the women's attitudes, beliefs and values that could be attributed to education. However, users expressed strong approval and positive views of the service and its providers. The level of personal health skills, confidence and emotional preparatiqn they achieved through childbirth and parenting education did not fully meet their expectations. The survey also found that the organisation of childbirth and parenting education has not developed professionally like other health services. Service goals and objectives are ill-defined; planning and coordinating are inadequate for an integrated maternal health care system. The service's main resources are its highly motivated and dedicated teachers and clients. Several recommendations are made for educational and administrative measures to enhance service effectiveness within present organisational constraints, based on the needs identified by the study.

Needlestick injuries (NSIs) are a recognized risk for occupationally-related transmission of bloodborne pathogens (BBP). The occurrence of NSIs and BBP exposures among firefighters (FFs) and emergency medical services (EMS) personnel has been documented. The purposes of this study were: 1) to define the problem of NSI among FFs and EMS personnel in a suburban fire department (FD) and identify practices and factors that influence sharps use and safety; 2) design and implement and intervention to promote safer sharps device usage; and 3) to measure the effectiveness of the intervention among FFs and EMS personnel. A multi-phase, mixed methods approach was used that included a diagnosis phase that utilized a mixed methods exploratory design, an intervention period, and a quantitative evaluation phase that used a before and after evaluation design. In the diagnosis phase, data regarding sharps device practices were obtained through a count of discarded sharps devices. Qualitative data regarding sharps practices and factors which influenced those practice were obtained via focus groups. The PRECEDE/PROCEED model (PPM) was used as the theoretical framework for assessment, planning, implementation, and evaluation of an intervention to increase the occurrence of safer sharps device behaviors and decrease the frequency of riskier sharps device behaviors. The evaluation phase included a post-intervention sharps count and a post-intervention survey to assess changes in sharps practices and the impact of the intervention. During the baseline sharps count, 2743 sharps devices were counted and classified according to pre-established categories of safer or risky behaviors for NSI. Altered safety devices on IV stylets were the highest count for unsafe behaviors (n=105), followed by recapped traditional needles (n= 53). A statistically significant increase in risky behaviors was observed in discarded sharps from engines, as opposed to ambulances, among all sharps devices combined (p=0.000) and IV stylets (p=0.000). When comparing advanced life support (ALS) medications to all other medications, a statistically significant increase in unsafe behaviors occurred among all sharps devices combined (p=0.000) and prefilled syringes (p=0.000). Input from eight focus groups of firefighters allowed for identification of multiple themes which guided the development of an intervention. The intervention included distribution of a hands-on training kit and booklet, expansion of an existing required BBP training, and posters to increase awareness regarding NSI prevention. In the evaluation phase, a total of 2178 sharps devices were counted and classified in a post-intervention sharps count. Altered safety devices on IV stylets were the highest count of unsafe behaviors (n=50). Recapped traditional needles were the second highest count of unsafe behaviors (n=27), but experienced an 18.7% drop in frequency when compared to baseline. When comparing riskier behaviors to the pre-intervention baseline sharps count, statistically significant decreases in risky behaviors were observed in all sharps devices combined ( 2=25.71, p=0.000), IV stylets (2=16.87, p=0.000), and traditional needles (=5.07, p=0.024). A post-intervention survey, consisting of 15 Likert scale questions, was returned by 165 out of 383 active field personnel (41.3%). Results indicated high frequencies of strongly agree and somewhat agree responses regarding risk perception; the importance of using safer needle devices; the impact of the intervention on safer needle practices and sharps safety awareness. Critical predisposing, reinforcing, enabling, and environmental factors which influenced sharps device practices were identified. This study identified factors and practices which influenced unsafe sharps device behaviors. Due to the statistically significant decreases in risky behavior in the post-intervention sharps count and the positive responses in the post-intervention survey, it can be concluded that the intervention did positively impact sharps device behavior and reduced the risk of NSI. The implications of the study are numerous and include a need to explore these practices and factors at other fire departments and EMS agencies, address gaps in regulations; promote research targeting FFs and EMS personnel in regard to NSI, and promote a nationwide effort to prevent NSI among emergency responders.

In the United States, the rates of unplanned pregnancies and sexually transmitted diseases, including HIV infection, caused by unprotected sex is alarmingly high. Adverse outcomes of unprotected sexual intercourse continue to be a burden, not only for affected adolescents but for the community at large. Using data from the National Longitudinal Study of Adolescent Health, this study applied the PRECEDE model as a means to identify those salient risk factors and risk conditions of sex initiation and engagement in unprotected sex among adolescent students. Results showed that 52.6% of the students have had sexual intercourse and 54.5% of sexually experienced students reported inconsistent condom use during sexual intercourse. Logistic regression analysis showed that risks factors for having had sexual intercourse differ from those for having engaged in unprotected sex in sexually experienced students. Furthermore, these factors also differed between male and female students. Only students’ age and perceived hardships related to pregnancy were found to be common risk factors for both outcomes in both sex groups. Results suggest that the PRECEDE is a practical tool to aid program planners identify the intervention priorities most relevant to their target populations.

Handwashing is a well known practice to prevent the hospital-acquired infections, and it is also a basic procedure of the nosocomial infection control programs. This research is conducted to use PRECEDE model to investigate the factors affecting nurses¡¦ performance in handwashing practices. We conducted a cross-sectional study to investigate 212 nurses working patients` heaithcare from a medical center of north Taiwan, and a quota sampling method was used to analyze nurses¡¦ handwashing practices. The results of this research includes (1) the major causes affect nursing staffs¡¦ performance in handwashing practices include attitudes (enthusiastic and passive), encouragements from colleagues, and feedback of the nosocomial infection rate or density. (2) different perfessional department and different ward type also affect the performance of nurses¡¦ handwashing practices. (3) nurses washed their hands often after contacting patients¡¦ body substances, and they usually forget to wash their hands after checking patients¡¦ medicine charts. (4) seif-reported factors for poor adherence with handwashing are heavy work loading and taking patients¡¦ needs priority. The suggestions of this research are (1) providing nurses the routine feedback information regarding the changes in nosocomial infection rate versus their performance in handwashing practices. (2) making nursing supervisors and their colleagues to understand the importance of handwashing practice as well as encouragement, reminding, and supporting. (3) the above two suggestions should be executed continually. From the positive feedback, it shall enhance nursing staffs` attitudes to improve their handwashing practices, and then, nursing staffs will be willing to keep excellent performance in handwashing practices.

Background: Healthcare workers’ hand hygiene remains a key pillar because it prevents and controls healthcare associated infections. Healthcare Workers’ hand hygiene compliance is suboptimal. Aim: The study developed contextualised guidelines for Healthcare Workers’ hand hygiene and infection control in patient care. Methods: The Precede-Proceed model with Theory of Planned Behaviour guided the study. The study was conducted following the mixed methodology approach, observational survey, exploratory, descriptive and contextual in nature study with mixed thematic analyses in a research wheel process. Data were collected through direct participant observation of hand hygiene opportunities through observing (n=95 Healthcare Workers; n=570 practices). Self-administered questionnaires were used to collect data from Healthcare workers (n=189) regarding challenges they faced in achieving hand hygiene. Structured interviews were conducted with patients (n=574). Retrospective reviews of healthcare associated infections and their associated mortalities were carried out from mortality records. Data were analysed retrospectively. Partly the data were statistically and mixed thematically analysed. Guidelines were developed using intervention alignment throughout, mapping, matching, pooling, patching and validation corroborated with Precede-Proceed models’ best practices. The study was ethically reviewed and approved by University of South Africa and the Medical Research Council of Zimbabwe project numbers, 6067662 and MRCZ/B/208. Results: Hand hygiene non-compliances were mostly found in the following contexts, after touching patients’ surroundings, and before doing an aseptic procedure. A non-hand hygiene compliance of Healthcare workers 167(29.3%) and compliance 403(70.7%) in context was suboptimal with sad patients and challenges faced by Healthcare workers. Conclusion: Healthcare Workers had gaps in hand hygiene compliance and availability of required resources. Gaps were also noted in ongoing hand hygiene promotion educational strategies and guidelines to comply and prevent. Guidelines to enhance hand hygiene included, attend to hand hygiene strictly after touching patient surroundings, bed linen, lockers and curtains to prevent gastroenteritis; follow standard precautions against HCAIs from spreading to patients' environments; and comply with hand hygiene guidelines, policies and regulations for best practice with patients. The study contributes generalisable knowledge. / Health Studies / D. Litt et Phil. (Health Studies)