Thesis (M.A.)--University of Missouri-Columbia, 2008. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on August 19, 2009) Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [56]-59).

Thesis (M. A.)--University of British Columbia, 2006. / Includes bibliographical references (leaves 101-104). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Background: Respiratory disease has been one of the top three causes of deaths in Macau in the past decade. As one of the chronic respiratory diseases, chronic obstructive pulmonary disease (COPD) is incurable, but is preventable and treatable. COPD patients suffer from recurrent and progressive respiratory symptoms, and this impacts the health and well-being of patients. Self-management education programmes (SMEP) provide teaching and learning guidance for understanding COPD, emotional support and behaviour change needed to carry out disease-specific care in chronic patients. Evidence has demonstrated that SMEP can mediate a change in health-related behaviours, improve symptom control and the quality of life of COPD patients, with an associated reduction in health care utilization. However, SMEP has never been conducted in Macau, and experiences of providing any form of chronic care for COPD patients in this place is lacking. Aims: This study aimed to explore the effects of a specifically designed self-management education programme on Stage II to IV COPD patients in Macau. Design: The study was conducted as an exploratory randomized controlled trial in a mixed methods approach. Both illness perception and self-efficacy beliefs were adopted to formulate the theoretical framework. In the quantitative strand, the assessment of primary outcomes included illness perception, self-efficacy and inhaler technique. The secondary outcomes included pulmonary function, healthcare utilization and health-related quality of life. In the qualitative strand, focus groups were conducted to explore the subjective perception and experiences of self-management of COPD patients. Fifty one eligible COPD patients were recruited and allocated to experimental (26 patients) and control group (25 patients) by block randomization. A SMEP for COPD patients was developed and validated according to Medical Research Council (MRC) framework. Results: Quantitative results indicated that the primary outcomes (illness perception, self-efficacy and inhaler technique) improved in the experimental group after the SMEP. In relating to the secondary outcomes, days of hospitalization were reduced and symptom dimension of disease-specific health related quality of life (St. George Respiratory Questionnaire) improved. Qualitative findings identified the emergence of a core theme ‘Essentiality’ and five sub-themes ‘Helplessness’, ‘Mutual involvement’, ‘Support’, ‘Control’ and ‘Beneficial’, indicating perception and experiences of participants for self-management. These findings indicate a potential relationship of illness perception and self-efficacy in guiding COPD patients to adapt to health-related behaviour. Discussion and Conclusion: This study has obtained evidence for supporting the proposed theoretical framework and expected experimental effect through employing the MRC guidelines. The study also confirms the estimates of recruitment for a definitive RCT, demonstrated readiness and positive impact in Macau COPD patients to receive self-management intervention, and SMEP as an acceptable and preferable mode of chronic care for COPD for the healthcare system of Macau.

Background: The majority of adults in the UK are overweight or obese, and many embark on weight loss attempts, often without professional support. This dissertation set out to hone in on the cognitive and behavioural strategies used by adults with overweight and obesity attempting to lose weight, particularly in self-guided attempts, and to test the relationship between use of these strategies and weight loss success. Methods: A new taxonomy and questionnaire were developed to provide a framework to identify the cognitive and behavioural strategies used by individuals during weight loss attempts. The taxonomy was used in a systematic review and meta-analysis of self-help interventions for weight loss and in a systematic review of qualitative studies of self-directed weight loss. The questionnaire was used in an observational cohort study in adults with overweight and obesity trying to lose weight. Results: The taxonomy and questionnaire consist of 117 strategies. The qualitative review illuminated a range of attitudes and beliefs towards these strategies and highlighted the centrality of interpretation of self-monitored data. The quantitative review found that self-help interventions led to greater weight loss than unsupported attempts to lose weight at six months. In the cohort study, despite heterogeneity in the strategies employed, coherent patterns of behaviours emerged for individual participants. Strategies related to motivational support, dietary impulse control, and weight loss planning and monitoring were associated with greater weight loss. Conclusion: This dissertation demonstrates that self-help interventions can lead to significant weight loss and provides results to guide the content of such interventions. It maps out a previously uncharted area and provides a set of tools for further research and intervention development.

Na tentativa de compreender como ocorre um processo de autogestão no cotidiano, este estudo parte da abordagem metodológica da Teoria Ator-Rede para acompanhar as atividades de uma cooperativa de trabalho. Sem definições prévias, nem quadro teórico pré-estabelecido, descreve como a autogestão se constrói e é construída nas práticas do dia-a-dia e como é enactada através da articulação de diversos elementos heterogêneos. Considerando humanos e não-humanos como actantes na apresentação de uma experiência autogestionária em que movimentações, relações, tensões, híbridos estão em um constante organizando. Para a Teoria Ator-Rede realidades são enactadas no limite da noção de rede, sendo assim, pode-se questionar: qual a participação da Administração nessa construção? / In order to understand how the process of autogestion happens, this research, in agreement with the methodological approach of the Actor-Network Theory, follows the activities of a work cooperative. Without previous definitions neither a predetermined theory framework, the research describes how the autogestion is constructs and is constructed within day-to-day practices and how is enacted through the articulation of different heterogeneous elements. Considering humans and nohumans as actants in an autogestionary experience in which movements, relations, tensions and hybrids are in constantly organizing. Actor-Network Theory suggests that realities are enacted in the bound of network concept, so, it is possible to ask: what is the participation of the Management in this construction?

The primary purpose of this research study was to provide an in-depth analysis of a pre-diabetes self-management education program located in a Midwest health care center and to evaluate the effectiveness of the program. The study was designed to answer the following research questions: (1) How was the DSME program developed and how is it being implemented? (2) To what extent do the program's elements align with the National Standards for Diabetes Self-Management Education? (3) What factors affect completion of the entire program by participants? (4) What factors affect non-completion of the entire program by participants? (5) How do participants perceive their experience in the program? (6) What are the immediate effects of the program in terms of weight loss and exercise adoption? (7) What are the long-term effects of the program in terms of maintenance of weight loss, maintenance of physical activity, and prevention of T2D? (8) To what extent are the AADE Standards for Outcome Measurement of DSME being met? Effective DSME programs are typically those that meet nationally recognized guidelines and outcomes measures. Data were collected to determine the effectiveness of this program using the following methods: interviews, document reviews, observations, and a survey. Descriptive statistics in the form of frequencies and percentages were used to describe the results. Analysis of the qualitative data was conducted and themes emerged. Recommendations were provided as to how the program can be improved upon to make it more effective.

A recuperação de fábricas falidas pelos próprios trabalhadores, que assumem de alguma maneira os meios de produção e retomam as atividades da empresa, é um fenômeno que se tornou recorrente no Brasil a partir década de 90, no contexto de abertura do mercado e crise econômica. Esta investigação parte da experiência da FACIT, em Juiz de Fora/MG, considerando-a no decorrer de sua história, antes e depois da autogestão, em busca dos significados atribuídos pelos trabalhadores à experiência que vivenciaram e suas trajetórias profissionais e de grupo. A compreensão dessa experiência referencia-se na história mais geral do trabalho e de suas transformações no capitalismo contemporâneo, bem como das experiências de autogestão e autonomia dos trabalhadores no interior desse modo de produção. Considera-se o trabalho categoria central na estruturação das trajetórias e identidade dos trabalhadores, sendo a iniciativa de retomarem a produção de empresas falidas uma saída que se impôs com a crise da sociedade salarial, enquanto tentativa de conquista coletiva dos meios de vida. Nesta nova situação, quando se veem proprietários das instalações e reiniciam a produção sem os antigos patrões ou seus representantes imediatos, os trabalhadores trazem consigo suas trajetórias pretéritas forjadas no reino da heterogestão, dificultando a compreensão precisa do que representa a autogestão da empresa. Habituados ao chão-da-fábrica, lugar que até então podiam ocupar na divisão do trabalho da empresa, encontram-se frente à tarefa de assumirem também a gestão da empresa. Entre o chão e a gestão da fábrica, uma nova trajetória se ensaia, com suas contradições e ambiguidades. / The recovery of the bankrupted factories by their workers that take over the means of production and restarted the company activities is a phenomenon, which has become recurring throughout the nineties while the opening of the market and economic crisis. This study departed from the FACIT situation in Juiz de Fora/MG and analyzed it throughout its history before and after the self management process always aiming at finding the meaningful professional experiences the workers had. The understanding of such experience is shown in the general history of labour and its transformation processes in the contemporary capitalism as well as the self-management and autonomy experiences of the workers in the core of the means of production. The work is considered as the central activity in the development of the workers journey and identity and the initiative of restarting the production in the bankrupted companies was the way the workers found in the salary crises scenario as well as a group attempt for the means of life. In the new situation in which the workers are the facilities owners and the production is restarted without the previous bosses or their representatives, the workers own experiences from the hetero management context make the understanding of what self-management is more difficult. The workers who were used to be on the ground of the factory, the place they were allowed to be according to the company organization, are now supposed to run it. Between the ground and the office, a new history is built with its contradictions and ambiguities.

Na tentativa de compreender como ocorre um processo de autogestão no cotidiano, este estudo parte da abordagem metodológica da Teoria Ator-Rede para acompanhar as atividades de uma cooperativa de trabalho. Sem definições prévias, nem quadro teórico pré-estabelecido, descreve como a autogestão se constrói e é construída nas práticas do dia-a-dia e como é enactada através da articulação de diversos elementos heterogêneos. Considerando humanos e não-humanos como actantes na apresentação de uma experiência autogestionária em que movimentações, relações, tensões, híbridos estão em um constante organizando. Para a Teoria Ator-Rede realidades são enactadas no limite da noção de rede, sendo assim, pode-se questionar: qual a participação da Administração nessa construção? / In order to understand how the process of autogestion happens, this research, in agreement with the methodological approach of the Actor-Network Theory, follows the activities of a work cooperative. Without previous definitions neither a predetermined theory framework, the research describes how the autogestion is constructs and is constructed within day-to-day practices and how is enacted through the articulation of different heterogeneous elements. Considering humans and nohumans as actants in an autogestionary experience in which movements, relations, tensions and hybrids are in constantly organizing. Actor-Network Theory suggests that realities are enacted in the bound of network concept, so, it is possible to ask: what is the participation of the Management in this construction?

A recuperação de fábricas falidas pelos próprios trabalhadores, que assumem de alguma maneira os meios de produção e retomam as atividades da empresa, é um fenômeno que se tornou recorrente no Brasil a partir década de 90, no contexto de abertura do mercado e crise econômica. Esta investigação parte da experiência da FACIT, em Juiz de Fora/MG, considerando-a no decorrer de sua história, antes e depois da autogestão, em busca dos significados atribuídos pelos trabalhadores à experiência que vivenciaram e suas trajetórias profissionais e de grupo. A compreensão dessa experiência referencia-se na história mais geral do trabalho e de suas transformações no capitalismo contemporâneo, bem como das experiências de autogestão e autonomia dos trabalhadores no interior desse modo de produção. Considera-se o trabalho categoria central na estruturação das trajetórias e identidade dos trabalhadores, sendo a iniciativa de retomarem a produção de empresas falidas uma saída que se impôs com a crise da sociedade salarial, enquanto tentativa de conquista coletiva dos meios de vida. Nesta nova situação, quando se veem proprietários das instalações e reiniciam a produção sem os antigos patrões ou seus representantes imediatos, os trabalhadores trazem consigo suas trajetórias pretéritas forjadas no reino da heterogestão, dificultando a compreensão precisa do que representa a autogestão da empresa. Habituados ao chão-da-fábrica, lugar que até então podiam ocupar na divisão do trabalho da empresa, encontram-se frente à tarefa de assumirem também a gestão da empresa. Entre o chão e a gestão da fábrica, uma nova trajetória se ensaia, com suas contradições e ambiguidades. / The recovery of the bankrupted factories by their workers that take over the means of production and restarted the company activities is a phenomenon, which has become recurring throughout the nineties while the opening of the market and economic crisis. This study departed from the FACIT situation in Juiz de Fora/MG and analyzed it throughout its history before and after the self management process always aiming at finding the meaningful professional experiences the workers had. The understanding of such experience is shown in the general history of labour and its transformation processes in the contemporary capitalism as well as the self-management and autonomy experiences of the workers in the core of the means of production. The work is considered as the central activity in the development of the workers journey and identity and the initiative of restarting the production in the bankrupted companies was the way the workers found in the salary crises scenario as well as a group attempt for the means of life. In the new situation in which the workers are the facilities owners and the production is restarted without the previous bosses or their representatives, the workers own experiences from the hetero management context make the understanding of what self-management is more difficult. The workers who were used to be on the ground of the factory, the place they were allowed to be according to the company organization, are now supposed to run it. Between the ground and the office, a new history is built with its contradictions and ambiguities.