Background: The last two decades have witnessed Rwanda’s rapid industrialization and technology development due to its successful governmental policy. Almost 75% of the population currently has access to the internet due to the increasing availability of smartphones in the country. Despite these advances, diabetes literacy and coping mechanisms were found to be lacking in some Rwandan communities. And although several studies have demonstrated smartphone applications to improve diabetes patients’ self-management capacity, until the introduction of this research project in April 2019, there was no diabetes self-management application available in Rwanda. Objectives: The main aim of this research project was to develop “Kir’App”; the first Rwandan diabetes self-management smartphone application. Two goals were processed to achieve this. First, the needs and expectations of Rwandan diabetics of the potential app were assessed. Following the results of that assessment, the first prototype of Kir’App was developed. The app was presented to the participants of the previous study for use, and then a second study was conducted to evaluate the users’ experiences after a period of 3 months of use. Methods: Both studies in this research project used the same research methodology. Study participants were recruited using convenience sampling at the Rwanda Diabetes Association. Data was collected using semi-structured, in-depth, face-to-face interviews. Findings were thematically analyzed using Mayring’s method of qualitative content analysis. For the second study, both deductive and inductive approaches were used to analyze the transcripts according to the original categories and sub-categories of the previous study. Results: The first study included 21 participants with both type 1 (female = 5, male = 6) and type 2 (female = 6, male = 4) diabetes. Participants’ age ranged from 18 - 69 years, with a mean age of 35.2 years. The second study included 14 people from the previous study. Their age ranged from 19 - 70 years, with a mean age of 34.4 years. The findings of the first study identified eight main themes: (1) diabetes education and desired information provision; (2) lack of diabetes knowledge and awareness; (3) need for information in crisis situations; (4) required monitoring and reminder functions; (5) information on nutrition and alcohol consumption; (6) information on physical activity; (7) coping with the burden of disease, through social support and network; and (8) app features. The results of the second study evidenced seven among the eight themes of the previous study and added one new theme: (1) diabetes education and desired information provision, (2) increased diabetes knowledge and awareness, (3) monitoring and reminder functions, (4) nutrition, (5) physical activity, (6) coping with the burden of disease, (7) app features, and (8) user behavior and usability. Generally, participants stated that the app increased their diabetes knowledge and assisted them with their diabetes self-management. Conclusion: This research project first provided recommendations that were used to design the features of the first Rwandan diabetes self-management smartphone application (Kir’App). Then the first prototype of Kir’App was developed and proved to meet the overall needs and expectations of the diabetics that participated in this research project. The qualitative insights that were discovered from the strict user-centered design process were used in this research project and will be followed for further improvement of the app. The next steps of this research project will focus on the evaluation of the impact of Kir’App on the Rwandan diabetics’ self-management capacity and quality of life.:List of figures 7 List of abbreviations 8 1. Introduction 9 1.1. Background of the Study 9 1.2. Problem Statement 12 1.3. Study Aim 12 1.4. Research Objectives 13 1.5. Research and theoretical approaches used 14 1.6. Structure of the thesis 19 2. Publication 1: The Assessment of the Rwandan diabetics’ needs and expectations to develop their first diabetes self-management Smartphone Application (Kir’App) 20 3. Kir’App, the first Rwandan diabetes self-management smartphone application 42 3.1. Kir’App description and development process 42 3.2. Functionalities (pages) of Kir’App 43 3.3. Some of Kir’App features in screenshots 45 4. Publication 2: A qualitative study of users’ experiences after 3 months: the first Rwandan diabetes self-management Smartphone application “Kir’App” 49 5. Discussion 62 6. Conclusion and recommendations 67 6.1. Research objectives achievement 67 6.2. Limitations of the research project 68 6.3. Contribution to research fields and implication for practice of Kir’App 70 6.4. Recommendations 71 7. Summary 72 7.1. English version 72 7.2. German version 74 Bibliography 76 APPENDIXES 82 A. Appendix of study 1: Assessment of the Rwandan diabetics’ needs and expectations to develop the first diabetes self-management smartphone application (Kir’App) A.1. Interview guide 83 A.2. Summary of recurrent themes and sub-categories with examples 85 B. Appendix of study 2: A qualitative study of users’ experiences after 3 months: the first Rwandan diabetes self-management Smartphone application “Kir’App” 101 B.1. Comparison of themes 101 C. Autobiographic reflection 120 D.Acknowledgement 121 E.Dedication 121 F. Impact factor of journal with InCites Journal Citation Reports 122 Anlage 1 : Erklärungen zur Eröffnung des Promotionsverfahrens 123 Anlage 2: Einhaltung der gesetzlichen Vorgaben im Rahmen meiner Dissertation 124 Anlage 3: Ethical clearance to conduct the research project in Rwanda 125 / Hintergrund: In den letzten zwei Jahrzehnten erlebte Ruanda aufgrund seiner erfolgreichen Regierungspolitik eine rasche Industrialisierung und technologische Entwicklung. Fast 75% der Bevölkerung hat derzeit, aufgrund der zunehmenden Verfügbarkeit von Smartphones im Land, Zugang zum Internet. Trotz dieser Fortschritte wurde festgestellt, dass insbesondere die Diabetes-Aufklärung und Versorgung in einigen Teilen Ruandas nicht erfolgreich verliefen. Obwohl mehrere Studien gezeigt haben, dass Smartphone-Anwendungen das Selbstmanagement von Diabetes-Patienten verbessern können, war bis zum Start dieses Forschungsprojekts im April 2019 in Ruanda keine Anwendung zum Selbstmanagement von Diabetes verfügbar. Ziele: Das Hauptziel dieser Studie war die Entwicklung von Kir’App, die erste Smartphone Selbstmanagement Anwendung von Diabetes in Ruanda. Zwei Schritte waren nötig um dieses Ziel zu erreichen: Im Forschungsteam haben wir zunächst die Bedürfnisse und Erwartungen ruandischer Diabetiker gegenüber einer potenziellen App erfragt. Nach den Ergebnissen dieser Bewertung wurde der erste Prototyp der Kir’App entwickelt. Die App wurde den Teilnehmern der vorherigen Studie für 3 Monate zur Verfügung gestellt, woraufhin eine zweite Studie durchgeführt wurde, um die Erfahrungen der Benutzer nach 3 Monaten zu erfragen. Methoden: Beide Studien dieses Forschungsprojekts verwendeten die gleiche Forschungsmethode. Die Studienteilnehmer wurden anhand von willkürlichen Stichproben bei der Rwanda Diabetes Association rekrutiert. Die Daten wurden mithilfe von halbstrukturierten persönlichen Interviews gesammelt. Die Ergebnisse wurden unter Verwendung von Mayrings Methode der qualitativen Inhaltsanalyse nach grundlegenden Themen untersucht. Für die zweite Studie wurden sowohl deduktive als auch induktive Ansätze verwendet um die Transkripte gemäß den ursprünglichen Kategorien und Unterkategorien der vorherigen Studie zu analysieren. Ergebnisse: Die erste Studie umfasste 21 Teilnehmer mit Diabetes Typ 1 (weiblich = 5, männlich = 6) und Typ 2 (weiblich = 6, männlich = 4). Das Alter der Teilnehmer lag zwischen 18 und 69 Jahren, bei einem Durchschnittsalter von 35,2 Jahren. Die zweite Studie umfasste 14 Personen aus der vorherigen Studie. Ihr Alter lag zwischen 19 und 70 Jahren mit einem Durchschnittsalter von 34,4 Jahren. Die Ergebnisse der ersten Studie identifizierten acht Hauptthemen: (1) Aufklärung zum Krankheitsbild des Diabetes und gewünschte Informationsbereitstellung, (2) Mangel an Wissen und Verständnis für Diabetes, (3) Informationsbedarf in Krisensituationen, (4) Erforderliche Überwachungs- und Erinnerungsfunktionen, (5) Informationen zur Ernährung und Alkoholkonsum, (6) Informationen zur körperlichen Aktivität, (7) Bewältigung der Krankheitslast durch soziale Unterstützung und Netzwerke; (8) App-Funktionen. Die Ergebnisse der zweiten Studie zeigten sieben der acht Themen der vorherigen Studie und fügten ein neues Thema hinzu. (1) Aufklärung zum Krankheitsbild des Diabetes und Informationsbereitstellung; (2) Erhöhtes Wissen und Verständnis für Diabetes; (3) Überwachungs- und Erinnerungsfunktionen; (4) Ernährung; (5) körperliche Aktivität; (6) Bewältigung der Krankheitslast; (7) App-Funktionen; (8) Nutzungsverhalten und Benutzerfreundlichkeit. Im Allgemeinen gaben die Teilnehmer an, dass die App ihr Diabeteswissen erweitert hat und sie bei ihrem Diabetes-Selbstmanagement unterstützt hat. Fazit: Dieses Forschungsprojekt lieferte zunächst Empfehlungen, anhand derer die Funktionen der ersten ruandischen Smartphone Anwendung für das Diabetes-Selbstmanagement (Kir’App) entwickelt wurden (siehe 1. Studie). Dann wurde der erste Prototyp von Kir’App entwickelt, der die allgemeine Bedürfnisse und Erwartungen der Diabetiker, die an diesem Forschungsprojekt teilgenommen haben erfüllte (siehe 2. Studie). Die qualitative Erkenntnisse, die wir aus dem benutzerzentrierten Designprozess erhalten haben, werden zur weiteren Verbesserung der App verwendet. Die nächste Schritte dieses Forschungsprojekts konzentrieren sich auf die Bewertung der Effekten von Kir’App auf die Fähigkeit zum Diabetes-Selbstmanagement und die Lebensqualität der ruandischen Diabetiker.:List of figures 7 List of abbreviations 8 1. Introduction 9 1.1. Background of the Study 9 1.2. Problem Statement 12 1.3. Study Aim 12 1.4. Research Objectives 13 1.5. Research and theoretical approaches used 14 1.6. Structure of the thesis 19 2. Publication 1: The Assessment of the Rwandan diabetics’ needs and expectations to develop their first diabetes self-management Smartphone Application (Kir’App) 20 3. Kir’App, the first Rwandan diabetes self-management smartphone application 42 3.1. Kir’App description and development process 42 3.2. Functionalities (pages) of Kir’App 43 3.3. Some of Kir’App features in screenshots 45 4. Publication 2: A qualitative study of users’ experiences after 3 months: the first Rwandan diabetes self-management Smartphone application “Kir’App” 49 5. Discussion 62 6. Conclusion and recommendations 67 6.1. Research objectives achievement 67 6.2. Limitations of the research project 68 6.3. Contribution to research fields and implication for practice of Kir’App 70 6.4. Recommendations 71 7. Summary 72 7.1. English version 72 7.2. German version 74 Bibliography 76 APPENDIXES 82 A. Appendix of study 1: Assessment of the Rwandan diabetics’ needs and expectations to develop the first diabetes self-management smartphone application (Kir’App) A.1. Interview guide 83 A.2. Summary of recurrent themes and sub-categories with examples 85 B. Appendix of study 2: A qualitative study of users’ experiences after 3 months: the first Rwandan diabetes self-management Smartphone application “Kir’App” 101 B.1. Comparison of themes 101 C. Autobiographic reflection 120 D.Acknowledgement 121 E.Dedication 121 F. Impact factor of journal with InCites Journal Citation Reports 122 Anlage 1 : Erklärungen zur Eröffnung des Promotionsverfahrens 123 Anlage 2: Einhaltung der gesetzlichen Vorgaben im Rahmen meiner Dissertation 124 Anlage 3: Ethical clearance to conduct the research project in Rwanda 125

Abstract Background Diabetes mellitus type 2 is a chronic and progressive disease that affects people in different ages. Lack of physical activity and overweight are examples of factors that increase the risk of developing the disease. It is of great importance that our offering advice on how to handle the patient's self-care nag leads to an increased understanding of self-care and minimizes the risk of diabetes-related complications.   Aim The purpose of this literature study is to describe patients' experience of self-management in relation to type 2 diabetes mellitus. Method A descriptive literature study based on 10 qualitative science articles searched using the PubMed database.   Main Result From our research, we found that there was a conjunction of both facilitating and hindering factors that affected self-management associated with type 2 diabetes mellitus in daily life. Experiences of self-management vary in patients. Patients experienced both negative and positive experiences. Many patients showed that they had achieved a form of balance in their self-control. Interestingly, the majority of patients had difficulty managing their self-control as well as unique experiences and strong feelings of the disease that manifested as anxiety, fear, loneliness. Patients wanted more structured and tailored advice from healthcare professionals that could aid those with diabetes in making decisions with regards to self-management. This allows patients to make important life changes surrounding health decisions.   Conclusion To conclude, patients with type 2 diabetes mellitus gain an increased understanding of lifestyle changes such as self-management with the help of health literacy capacity, counselling and information & support from the family, so that patients can use self-management techniques in a better way.

Uganda endorsed school-based management (SBM) through the enactment of the Education Act (2008), which provided for the establishment of the School Management Committees (SMCs) in public primary schools to be in charge of managing schools on behalf of the government. The Act states that SMCs are specifically in charge of Universal Primary Education (UPE) in Uganda and are responsible for the successful implementation of the policy. The purpose of this study was to investigate the roles of SMCs in the accountability for the UPE achievements. This study is rooted in the interpretivist constructionist research paradigm. The researcher utilised semi-structured interviews and observations to generate data to answer the research questions. The qualitative approach enabled the researcher to interact with the participants in order to harness their primary voice while sharing their lived experiences in the real world. Data obtained from the interviews and observations were corroborated with document analysis data related to SBM and accountability for universal basic primary education achievement. The researcher used multiple research sites and participants to generate data, a case study approach which is more robust in comparative data. The sampling for the participants was purposive and four SMCs from four regions of Uganda and four participants from each of the SMCs were selected. The findings of the study indicate that the voluntary SMCs did implement the roles and responsibilities for UPE accountability, though there were diverse degrees of success. The differing measures of SMC effectiveness were as a result of factors such as: member capacity and perceptions; lack of policy implementation; other stakeholder actions: and inadequate resources. The importance of a volunteerism strategy as a cornerstone of UPE implementation was eminent in this study since the schools were poorly resourced partly due to high poverty levels in the community. The researcher concludes that the effectiveness of the SMC in monitoring the implementation of UPE is based on the relationship they have with other stakeholders and, thus, a model was developed to emphasise the importance of the relationships. / Thesis (PhD)--University of Pretoria, 2017. / Education Management and Policy Studies / PhD / Unrestricted

Bakgrund: Kronisk njursjukdom drabbar mer än var 10:e människa världen över. Sjukdomen är komplex och kan ses i samband med andra sjukdomar. Individer behöver utföra en livslång och krävande egenvård av denna progressiva sjukdom. I dagens hälso- och sjukvård vårdas vanligtvis en sjukdom i taget vilket kan få vården att brista i individanpassat egenvårdsstöd. Syfte: Syftet med litteraturstudien är att beskriva erfarenheter av egenvård för individer med kronisk njursjukdom. Metod: En kvalitativ litteraturstudie baserad på åtta empiriska studier. Artiklarna hämtades från databaserna PubMed och Cinahl. Innehållsanalysen gjordes utifrån Fribergs femstegsmodell. Resultat: Två kategorier och sju underkategorier skapades utifrån resultatet. Kategorierna; 1) Hälsorelaterade värderingar och upplevelser påverkar egenvården 2) Behov av stöd för att utföra egenvård. Konklusion: Litteraturstudien visar att individer kan uppleva ångest och oro över sitt hälsotillstånd vilket försvårar utförandet av egenvård. Hälso- och sjukvården behöver ha ett personcentrerat bemötande och beakta individens beteenden och värderingar för att kunna ge en individanpassad information och ett kontinuerligt egenvårdsstöd. Därefter kan individen få en god förutsättning att ta till sig kunskap om sin hälsa. Sjuksköterskan har ett ansvar i att möta det egenvårdsbehov individen har genom att ge egenvårdsstöd för att leva ett mer hälsosamt liv. / Background: Chronic kidney disease affects more than every 10th person worldwide. The disease is complex and can be seen with other diseases. Individs need to perform a lifelong and demanding self-management of this progressive disease. In today's health care, one illness is usually cared for at a time, which can cause the care to fail in individualized self-management support. Aim: The aim of this study was to describe experiences of self-management for individs with chronic kidney disease. Methods: A qualitative literature study based on eight empirical articles. The articles were retrieved from the databases PubMed and Cinahl. The content analysis was based on Friberg's five-step model. Results: Two categories and seven subcategories were created based on the result. The two categories were: 1) Health-related values and experiences affect self-management 2) Need for support to perform self-management. Conclusion: The study shows that participants may experience anxiety about their state of health, which makes it difficult to perform self-management. Healthcare needs to have a person-centered approach and take into account the individ's behaviors and values in order to be able to provide individualized information and continuous self-management support. After that, individs can have a good chance of absorbing knowledge about their health. The nurse has a responsibility to meet the individs self-management needs by providing support to live a healthier life.

No description available.

Bakgrund Diabetes typ 2 är en folksjukdom som ökar globalt. Hanteringen av diabetes typ 2 innebär ett stort ansvar för individen för att inte utveckla allvarliga komplikationer. Sjuksköterskan har ett ansvar att utbilda och motivera individer med diabetes typ 2 för att förenkla utförandet av olika livsstilsförändringar. Syfte Syftet var att belysa erfarenheter av motivation till genomförandet av livsstilsförändringar hos vuxna individer med diabetes typ 2. Metod Studien utfördes utifrån en icke-systematisk design och för att kunna besvara syftet sammanställdes 15 vetenskapliga artiklar. Artiklarna inhämtades från databaserna PubMed och CINAHL med hjälp av relevanta sökord. Artiklarna kvalitetsgranskades sedan utifrån Sophiahemmet Högskolas bedömningsunderlag, vidare utfördes en integrerad dataanalys för att identifiera olika kategorier. Resultatartiklarna indelades i två huvudkategorier med tillhörande underkategorier. Resultat De två huvudkategorierna som identifierades var inre motivation och yttre motivation. Sammanfattningsvis avhandlar den inre motivationen bland annat om hur känslor kring att leva med diabetes typ 2 och hur rädslan för komplikationer bidrog till att individer gjorde livsstilsförändringar. Den yttre motivationen handlar om stödet omgivningen bidrog med samt hur den kulturella och socioekonomiska faktorn hade en betydande roll för hur individer kunde hantera diabetes typ 2. Individerna ansåg att kost och fysisk aktivitet utgjorde hinder för att genomföra livsstilsförändringar, till exempel att kroppsliga besvär var ett hinder till att utöva fysisk aktivitet. Slutsats De motiverande faktorerna skilde sig åt mellan individerna. Av sjuksköterskan krävs ett personcentrerat förhållningssätt som utgår från patientens nuvarande livssituation för att på bästa sätt ge anpassad information och råd som betraktas vara rimliga i förhållande till individens förutsättningar. / Background Diabetes mellitus type 2 is a public health disease that is increasing globally. The management of diabetes mellitus type 2 requires a great responsibility for the individual, in order to not develop serious complications. The nurse has a responsibility to educate and motivate individuals with diabetes mellitus type 2 to simplify the implementation of different lifestyle changes. Aim The study aimed to explore experiences of motivation for the implementation of lifestyle changes in adults with diabetes mellitus type 2. Method The design of the study was a non-systematic review where 15 scientific articles were used to answer the aim. The articles were gathered using relevant keywords in the databases PubMed and CINAHL. The articles were quality reviewed by using Sophiahemmet University´s assessment form. An integrated analysis was used to identify categories. The result articles were divided into two main categories with associated subcategories. Results Two main categories were identified in the result, those were internal motivation and external motivation. In summary, the internal motivation refers to the feelings of living with diabetes mellitus type 2. Further, it includes how the fear of complications contributed to making certain lifestyle changes to avoid complications. Support from the surroundings is important to manage diabetes mellitus type 2, which can be referred to external motivation. Cultural and socioeconomic factors were also important in how individuals manage their diabetes mellitus type 2. Individuals considered that diet and physical activity were barriers and therefore had difficulties implementing changes. For example, that physical problems were a barrier to practice physical activity. Conclusions There were differences in which factors that were considered motivating for the individuals. The nurse requires to have a person-centered approach based on the patient´s current life situation, to provide adjusted information and advice that is considered reasonable in relation to the individual’s capability.

Bakgrund: Diabetes är en kronisk som ökar i omfattning i världen. Behandlingsalternativen är insulin och läkemedel samt egenvård. Egenvård är nödvändig för att minska risk för framtida komplikationer till följd av sjukdomen och innebär framförallt förändrade kost-och motionsvanor. Metod: En kvalitativ litteraturöversikt. Vetenskapliga artiklar med kvalitativ ansats har analyserats. Syfte: Belysa patienters upplevelser av egenvård vid diabetes typ-2. Resultat: I analysen framkom fyra teman 1) Att få en sjukdomsdiagnos, 2) utmaningar gällande kost-och motionsvanor och 3) det professionella stödet 4) stöd från anhöriga. Konklusion:Egenvård är en process som kräver mycket stöd från anhöriga och sjuksköterskan. Stödet från sjuksköterskan i form av stöttning och vägledning i sjukdomen och stöd från anhöriga genom uppmuntran och motivation. Bristande stöd från dessa leder till bristande egenvård. / Background: Diabetes is a chronic disease that is increasing in the world. The treatment options are insulin and medication as well as self management. Self management is necessary to reduce the risk of future complications as a result of the disease and primarily involves changes in diet and exercise habits. Method: A qualitative literature review. Scientific articles with a qualitative approach have been analyzed. Aim: To shed light on patients' experiences of self management in type 2 diabetes. Findings: The analysis revealed three themes 1) Being diagnosed with a disease, 2) Struggles regarding food and exercise habits 3) the professional support and 4) support from relatives. Conclusion: : Self management is a process that requires a lot of support from relatives and the nurse. The support from the nurse in the form of guidance within the disease and support from relatives through encouragement and motivation. Lack of support from these leads to lack of self management

Bakgrund  Hjärtsvikt är en folksjukdom som orsakar lidande hos de drabbade och medför dessutom ett stort ansvar för den egna hälsan. Egenvård är för personer med hjärtsvikt en viktig del för att förhindra försämringar då snabba förändringar av sjukdomstillståndet kan ske. Om den drabbade saknar den motivation eller kunskap som krävs kan det följaktligen medföra komplikationer. Sjuksköterskan har därför ett stort ansvar att utbilda och stödja den drabbade för att förhindra detta. E-hälsa kan därför vara ett bra stöd för att underlätta både för den drabbade och sjuksköterskan.  Syfte  Syftet med arbetet var att kartlägga förväntningar och upplevelser på E-hälsa som stöd till egenvård, hos personer med hjärtsvikt.  Metod  För att besvara syftet genomfördes en icke-systematisk litteraturöversikt som baserades på 15 vetenskapliga artiklar. Både kvalitativa och kvantitativa artiklar inkluderades. Artiklarna inhämtades med hjälp av relevanta sökord i databaserna PubMed och CINAHL. För att säkerställa att artiklarna var av god kvalitet användes Sophiahemmet Högskolas bedömningsunderlag, vidare utfördes en integrerad analys där två huvudkategorier och sju subkategorier identifierades.  Resultat  Resultatet delades in i förväntningar av kommunikation och förståelsesamt upplevelser av påverkad sjukdomsförståelse som huvudkategorier. I resultatet framkom det att patienter med hjärtsvikt förväntade sig en förbättrad vårdrelation, förbättrad egenvård och ökad förståelse för sin sjukdom. Vidare upplevde patienterna ökade kunskaper om egenvård vid hjärtsvikt vilket medförde förbättrad egenvård. Dessutom upplevdes en förbättrad kontakt med sjukvårdspersonal och ökad motivation till att fortsätta med goda rutiner. Problem med tekniken var en vanlig komplikation.  Slutsats  I den aktuella litteraturöversikten framkom det att många ansåg E-hälsotjänster som ett bra stöd till egenvård då de fick en ökad förståelse för sin sjukdom. Fynden anses därför vara ett stöd för att finna egenvårdsbalans. Vidare forskning av ämnet anses dock vara nödvändigt för att resultatet ska kunna betraktas som överförbart. / Background  Heart failure is a widespread disease that causes suffering for those who are affected and brings a great deal of responsibility of their own health. Self-care plays a crucial part in preventing deterioration for people with heart failure, since rapid changes of the medical condition can occur. If the affected lacks the required motivation or knowledge, it can consequently lead to complications. Therefore, the nurse has a great deal of responsibility to educate and aid the affected to prevent this. E-health is for that reason believed to be a good support to facilitate for both the affected and the nurse.  Aim  The aim was to describe expectations and experiences of E-health as a support for self- care, among people with heart failure.  Method  A non-systematic literature review based on 15 scientific articles was made to answer the purpose. Both qualitative and quantitative articles were included. The articles were collected using relevant keywords in the data bases PubMed and CINAHL. To ensure that the articles were of good quality, the assessment basis of Sophiahemmet University were used. Furthermore, an integrated analysis was performed where two main categories and seven subcategories were identified.  Results  The result was divided into the two main categories expectations of communication and understanding and experiences of affected understanding of the disease. It emerged in the result that patients with heart failure expected improved care relationship, improved self- care and improved understanding of one’s disease were expected. Furthermore, increased knowledge about self-care in heart failure was experienced, which led to improved self- care. Additionally, there was an improved contact with healthcare staff and an increased motivation to proceed with good practices. The most common complication were problems with the E-health technology.  Conclusions  The current literature review emerged that many considered E-health as a good support for self-care as they gained an increased understanding of one’s disease. The findings are therefore considered to be a support to find self-care balance. However, further research of the subject is considered necessary for the result to be considered transferable.

Objective: The purpose of the current study was improving the measurement precision of the Transition Readiness Assessment Questionnaire (TRAQ 5.0–20 item) in order to gain better decimation of transition readiness skills across the 5 Stages of Change–from Precontemplation to Mastery. Methods: In stage 1, starting with the TRAQ 5.0 20-item, 5 domain subscale questionnaire, we eliminated the five lowest discriminating items using Item response theory (IRT) in MPlus v7.4,which eliminated the domain subscale Managing Daily Activities, and we e added 15 more difficult and better discriminating items. We added items to both to the remaining 4 domain subscales and created a new domain subscale entitled Future Planning. The revised 30-item TRAQ was piloted among 386 youth between 16 and 24 years old (mean = 20 years; 54% female; 87% White). Results: After examining the model fit, discrimination and difficulty coefficients, and modification indices, we eliminated 10 items and the new Future Planning domain subscale we eliminated. The resulting questionnaire has 4 domain subscales and 20 items. It exhibited good to excellent fit to the data, χ2(164) = 887.239, p <.001, CFI = 0.943, TLI = 0.93, RMSEA = 0.0942 (90% CI: 0.090, 0.114), WRMR = 1.111. All items have acceptable discrimination coefficients. Each of the 4 domain subscales have improved reliability as compared with the original TRAQ 5.0 20 item scale. Conclusions: The revised 20-itemTRAQ 6.0 has 4 domains subscales; Managing medications, keeping appointment, tracking health issues, and Talking with providers and has good construct validity as demonstrated by model fit. By adding more difficult items to the 4 resulting domain subscales, we have demonstrated improved item discrimination and difficulty, and therefore can better measure acquisition of transition readiness skills across the five stages of change from pre-contemplation to contemplation to initiation to action and finally to mastery.

Background: India's growing economy has led to radical lifestyle changes and one of the consequences is an unexpected explosion of non-communicable diseases, such as Type 2 Diabetes. The prevalence of Type 2 Diabetes has more than doubled since 1980 from four to over eight percent in 2016. India has today the second largest adult population affected by Type 2 Diabetes in the world. 72.9 million adults had diabetes in India 2017 and by year 2035 this number is predicted to rise to 109 million. To cope with this epidemic, patients will need to perform adequate self-management. Nurses’ may have a major part in providing the support and knowledge patients require to be able to perform this.  Aim: The aim of the study is to describe nurses’ experience of good self-management among patients diagnosed with T2D. Method: The study has a descriptive and qualitative design. Semi structured interviews with open-ended questions were carried out at a hospital setting in Kerala, India. Results: The analysis from the interviews resulted in three sub-themes and one main theme. The three sub-themes are Support from the family is fundamental for the patient's well-being, The importance of individualized care and The importance of teaching patients how to manage their condition. The three sub-themes resulted in the main theme Three Cornerstones for good self-management. Discussion: The result demonstrates that the nurses’ finds individualized care as an important matter. The participants declare that patients have different knowledge regarding Type 2 Diabetes, and how individualized care is a way to provide what the patient requires in order to perform self-management. The nurses also express how they always involve the patients' family, since their experience is that the absence of the family impairs the patient's condition.