This qualitative exploration takes place within the context of homelessness, oral health and health promotion. The idea for this work was associated with 'An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland', which identified homeless people as a priority group. This led to ‘Something to Smile About’ (STSA), a pilot oral health promotion intervention for homelessness sector practitioners and homeless clients. An evaluation of STSA, which was judged to have failed, highlighted the interplay between intervention design, and the two principal stakeholders: practitioners and homeless clients. The aim of the research was to explore the contextual and experiential elements of homelessness that influence homeless people’s engagement with health promotion. As the research progressed, these two factors were conceptualised as the public and private faces of homelessness. It became apparent that to fully understand the issues surrounding homeless people’s engagement, it would be necessary to explore the private, innermost elements of homelessness. Seventeen homelessness sector practitioners and 34 homeless people took part in a qualitative exploration, in order to examine the engagement process from the perspective of both stakeholders. It emerged that that the homelessness policy context, coupled with work environments and perceptions of clients, shaped practitioners’ interactions and thus influenced client engagement. Practitioners utilised a narrow ‘window of engagement opportunity’ within a wider framework of managing client health problems and preparation for engagement, engaging with clients, and finally, disengaging from clients. From the work with homeless people, a ‘journey’ through homelessness emerged, in the form of a trajectory from ‘deconstruction’ of pre-homeless identity, to ‘construction’ of a homeless identity, and finally, to ‘reconstruction’ of a post-homeless, ‘reclaimed’ life. Appropriate points for engagement on this trajectory were identified. The thesis ends with a set of recommendations to assist practitioners to engage their homeless clients, and from the client perspective, encourage and facilitate engagement with practitioners and health promotion services.

Thesis (Ph.D.)--University of Jyväskylä--[Jyväskylä, Finland], 2006. / Includes bibliographical references (leaves 81-91).

Thesis (M. P. A.)--Texas State University-San Marcos, 2007. / "Summer 2007." Includes bibliographical references (leaves 53-56).

Thesis (M.S.)--Ball State University, 2009. / Title from PDF t.p. (viewed on Mar. 17, 2010). Research paper (M.S.), 3 hrs. Includes bibliographical references (p. 45-47).

Thesis (M.S.)--University of Michigan, 1994. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1996. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1996. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1994. / Includes bibliographical references.

A proposta de Reforma Psiquiátrica vem modificando a assistência ao portador de transtorno mental nas últimas décadas. Com a desinstitucionalização do doente mental, emergem novos paradigmas com grandes desafios a todos os atores sociais envolvidos na construção da cidadania e na busca da reabilitação psicossocial. Surgem novos conceitos do processo saúde-doença, novas redes de assistência, alocação de recursos como também a implantação de Centros de Atenção Psicossocial CAPS e ainda diretrizes do Ministério da Saúde determinando que as ações, no campo da saúde mental, sejam realizadas na atenção básica, ou seja, nas Unidades Básicas de Saúde (UBS) e por meio da Estratégia Saúde da Família (ESF). A ESF passa a ser uma importante ferramenta no processo saúde-doença no que diz respeito ao cuidado integral do ser humano visando à promoção, prevenção, proteção e recuperação tanto das doenças físicas, sociais quanto mentais. Assim, o objetivo deste trabalho é compreender as necessidades da ESF para desenvolver as ações de saúde mental na comunidade e identificar as ações desenvolvidas pelas equipes da ESF frente aos portadores de transtornos mentais e seus familiares. Trata-se de uma pesquisa qualitativa, que foi desenvolvida por meio de entrevista semiestruturada realizada com os membros das equipes da ESF, as entrevistas foram gravadas e transcritas na íntegra para análise. O material foi analisado por meio da Análise Discurso sob a ótica do referencial teórico do materialismo histórico e dialético. Emergiram das entrevistas três categorias: Processo Saúde Doença-Mental; Família; Processo de Trabalho. Os discursos dos informantes revelaram que os profissionais ESF mantêm a prática da psiquiatria tradicional centrado nas consultas, na medicação e nos exames, sendo esse o principal instrumento para a produção de saúde, e exercício das práticas destes profissionais está baseado no diagnóstico psiquiátrico; é incipiente o numero de profissionais que se mobiliza a desenvolver ações voltas ao acolhimento e a escuta; realizam atividades grupais e relatam que existe a necessidade de ampliar seus conhecimentos na área de saúde mental. / The proposed Psychiatric Reform has changed how mental health patients have been assisted in recent decades. With the deinstitutionalization of mental health patients, new paradigms have emerged offering great challenges to all social actors involved in constructing citizenship and to the search for psychosocial rehabilitation. New concepts of the health-disease process have appeared, along with new assistance networks, allocation of resources, as well as the creation of Psychosocial Care Centers CAPS, and Health Ministry guidelines stipulating that actions in the mental health field be undertaken at the basic care level at Basic Health Units (UBS) and through the Family Health Strategy (ESF). ESF has become an important tool in the health-disease process with regard to integral care aiming for the promotion, prevention, protection and recovery of physical, social and mental illness. Thus, the objective of this work is to comprehend the needs of ESF to develop mental health actions in the community and identify the actions developed by ESF teams with regard to mental health patients and their relatives. It is a qualitative research, to be developed through semi-structured interviews with members of the ESF teams; the interviews were recorded and fully transcribed for analysis. O material foi analisado por meio da Análise Discurso sob a ótica do referencial teórico do materialismo histórico e dialético. The material was analyzed through discourse analysis under the theoretical framework of historical and dialectical materialism. Three categories emerged from the interviews: Health-Mental Illness process; Family; Work Process. The discourses of the informants revealed that ESF professionals keep traditional psychiatric practice centered on consultations, medication and exams, making it the main tool for health production, with the exercise of these professionals practice based on psychiatric diagnosis; the number of professionals who mobilize to develop actions focusing on welcoming and listening is still incipient; they perform group activities and report the need to broaden their knowledge on the field of mental health.

Background: There are naturally occurring health events, such as illness diagnosis, that motivate people to spontaneously adopt healthy behaviours. Such events are often re-ferred to as teachable moments. They have the potential to increase the effectiveness of behaviour change interventions, when people are already motivated to change behaviour. However, it is unclear what makes illness diagnosis a teachable moment for some people but not for others. This project aims to identify the factors determining whether and for whom diagnosis of type 2 diabetes is a teachable moment, and to explore the components of a potential intervention to reduce the risk of type 2 diabetes among high-risk groups. Method: A mixed-methods design, divided into two studies, was employed. The first study was a qualitative study and used semi-structured interviews (n=10 patients and n=13 relatives). It explored the changes occurring in people after diagnosis of type 2 diabetes in oneself or a family member in an effort to identify what factors make diagnosis a teachable moment. The study also explored people's suggestions for a potential diabetes prevention intervention. The second study was a quantitative study and used postal questionnaires (n=85 patients and n=55 relatives). It investigated the relationship between potential teachable moment factors and primary outcomes (physical activity, diet, interest in diabe-tes-related information and education course). Results: This mixed-methods study suggests that the factors that may make diagnosis of type 2 diabetes a teachable moment for patients are outcome expectancy, perceived con-trol, severity, self-concept or social role, gender and time since diagnosis; and for relatives: perceived risk, severity, self-concept or social role, and gender. Although there was lack of complete alignment in factors identified through different methods, this study advances understanding of when interventions may be more (or less) successful. The study makes recommendations for potential interventions to capitalise on the teachable moment crite-ria. Conclusion: The current project highlights the complexity of teachable moment criteria and their relationship with behaviour change. Future research is required to further uncov-er these criteria and their utility for health promotion.