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The purpose of this exploratory study was to examine differences between dropouts and completers in a domestic violence focused couples treatment (DVFCT) program. Fifty-eight men met the criteria of participating in at least one couples session for domestic violence. Data was analyzed with t-test and chi-squares. The dropout rate was 36 percent. Three variables — age, race, and marital status — were significant predictors of dropping out from the program. White men who were over 30 and married were found significantly more likely to complete treatment than were nonwhite single men younger than 30. Other variables that approached significance were employment, parental status, living arrangement and prior treatment. That is, employed men who lived with their partners, had children with their partners, and had prior treatment tended to stay in treatment. Stages of Change using the URICA and the URICA-DV measures and level of violence at intake using the Revised Conflict Tactics Scale were not found to differentiate between dropouts and completers in this sample. Other variables examined but not found as significant discriminators between completers and dropouts of DVFCT were education and referral source. A literature review of dropouts in therapy, marriage and family therapy, batterer programs and DVFCT; as well as literature on stages of change, is included. Further discussion and recommendations for further research and for improving domestic violence focused couples treatment is included. / Master of Science

<p><strong>Syfte: </strong>Att kartlägga patientgruppen som förskrevs Fysisk aktivitet på Recept, FaR® och hänvisades till friskvårdslots i Uppsala läns landsting under perioden 090701-091231 samt att undersöka eventuell skillnad i fördelningen av kön beträffande förändringsbenägenhet för fysisk aktivitet vid första kontakt med friskvårdslots. Vidare var syftet att se om de patienter som avslutade kontakten med friskvårdslots visade ökad förändringsbenägenhet för fysisk aktivitet. <strong>Metod: </strong>Patientdata tillhörande patientgruppen (<em>n = </em>193) sammanställdes och kartlades efter insamling av friskvårdslotsar i Uppsala läns landsting. Patienternas förändringsbenägenhet för fysisk aktivitet bedömdes av friskvårdslotsen, enligt Stages of change-modellen, i samband med telefonkontakt. Förändringsbenägenheten för fysisk aktivitet vid första och avslutande telefonkontakt undersöktes hos de patienter (<em>n </em>= 39) som inom tidsramen för detta uppsatsarbete hann avsluta sin kontakt med friskvårdslotsen. <strong>Resultat: </strong>Majoriteten av patienterna i gruppen (<em>n = </em>193<em>) </em>var kvinnor (75,6 %). De flesta var hemmahörande i Uppsala kommun (75,6 %) och primärvården var den enhet som i störst utsträckning hänvisade patienter (63,7 %) till friskvårdslots via FaR®. Träning på gym var den träningsform som flest patienter (30,6 %) föredrog. Av patienterna vars förändringsbenägenhet för fysisk aktivitet bedömdes (<em>n </em>= 167) befann sig störst andel i förberedelsestadiet (46,7 %) följt av begrundandestadiet (39,5 %) vid första kontakt med friskvårdslots. Det förelåg ingen statistiskt signifikant skillnad beträffande könsfördelningen i de olika stadierna vid första kontakten. De patienter (<em>n </em>= 39) som avslutades av friskvårdslotsen visade ökad förändringsbenägenhet för fysisk aktivitet (<em>P </em>= 0,004). <strong>Konklusion: </strong>Patienter som hänvisades till friskvårdslots via FaR® var till största delen kvinnor och flest patienter förskrevs från primärvården. Förskrivning av FaR® med hänvisning till friskvårdlots ökade förändringsbenägenheten för fysisk aktivitet.</p>

Syfte: Att kartlägga patientgruppen som förskrevs Fysisk aktivitet på Recept, FaR® och hänvisades till friskvårdslots i Uppsala läns landsting under perioden 090701-091231 samt att undersöka eventuell skillnad i fördelningen av kön beträffande förändringsbenägenhet för fysisk aktivitet vid första kontakt med friskvårdslots. Vidare var syftet att se om de patienter som avslutade kontakten med friskvårdslots visade ökad förändringsbenägenhet för fysisk aktivitet. Metod: Patientdata tillhörande patientgruppen (n = 193) sammanställdes och kartlades efter insamling av friskvårdslotsar i Uppsala läns landsting. Patienternas förändringsbenägenhet för fysisk aktivitet bedömdes av friskvårdslotsen, enligt Stages of change-modellen, i samband med telefonkontakt. Förändringsbenägenheten för fysisk aktivitet vid första och avslutande telefonkontakt undersöktes hos de patienter (n = 39) som inom tidsramen för detta uppsatsarbete hann avsluta sin kontakt med friskvårdslotsen. Resultat: Majoriteten av patienterna i gruppen (n = 193) var kvinnor (75,6 %). De flesta var hemmahörande i Uppsala kommun (75,6 %) och primärvården var den enhet som i störst utsträckning hänvisade patienter (63,7 %) till friskvårdslots via FaR®. Träning på gym var den träningsform som flest patienter (30,6 %) föredrog. Av patienterna vars förändringsbenägenhet för fysisk aktivitet bedömdes (n = 167) befann sig störst andel i förberedelsestadiet (46,7 %) följt av begrundandestadiet (39,5 %) vid första kontakt med friskvårdslots. Det förelåg ingen statistiskt signifikant skillnad beträffande könsfördelningen i de olika stadierna vid första kontakten. De patienter (n = 39) som avslutades av friskvårdslotsen visade ökad förändringsbenägenhet för fysisk aktivitet (P = 0,004). Konklusion: Patienter som hänvisades till friskvårdslots via FaR® var till största delen kvinnor och flest patienter förskrevs från primärvården. Förskrivning av FaR® med hänvisning till friskvårdlots ökade förändringsbenägenheten för fysisk aktivitet.

<p>Tinnitus is common, and some individuals with tinnitus display high levels of distress. Cognitive behavioural therapy (CBT) is effective in reducing tinnitus distress, but is rarely available. CBT-based self-help, with or without guidance, has yielded positive results in other problem areas, and one initial randomized controlled trial (RCT) has shown promising results for tinnitus.</p><p>This thesis is based on four studies;</p><p>Study I showed that Internet-based self-help treatment with e-mail guidance alleviated tinnitus distress among consecutive patients and was rated as credible as traditional treatments. Active participation in treatment predicted outcome.</p><p>Study II, an RCT, showed that an extended and more interactive version of the Internet-based self-help treatment with e-mail therapist support appeared to be equally effective as a group treatment. In study III, another RCT, a self-help book with weekly telephone support was superior to a wait-list control group. No strong evidence for the importance of telephone contact on outcome was found. In both study II and III, the positive outcome remained after one year and self-help approaches appeared more therapist time-effective compared to group treatment. Also, the received treatment-dose for patients in guided self-help was not lower than in the group treatment.</p><p>Study IV found that the ‘Stages of Change’, from the transtheoretical model, are probably not the right theoretical framework to use with tinnitus patients. Predictors of outcome were found, but they were not in line with the theory behind the Stages of Change. The predictors were better understood when conceptualized as coping, showing that helplessness and less coping before treatment correlated with better outcome.</p><p>In sum, guided cognitive behavioural self-help can decrease tinnitus distress. It appears to be therapist time-effective and shows effects comparable to or slightly below traditional CBT for tinnitus. Effects remain one year after treatment and generalize to a routine clinical setting.</p>

Introdução: Durante o processo de modificação de comportamentos de saúde, os indivíduos passam por diferentes fases, denominadas estágios de mudança de comportamento. O desenvolvimento de intervenções nutricionais específicas para cada estágio pode contribuir para a adoção de práticas alimentares saudáveis na adolescência. Objetivo: avaliar os estágios de mudança de comportamento e verificar sua relação com o consumo alimentar de adolescentes. Métodos: Trata-se de um estudo observacional transversal com adolescentes de escolas públicas de Piracicaba. Foram coletados dados demográficos, antropométricos, de maturação sexual e de consumo alimentar (questionário de freqüência). Realizou-se uma avaliação da percepção alimentar, por meio da comparação entre o consumo alimentar e a classificação individual do aspecto saudável da dieta. Os participantes foram classificados nos estágios de mudança de comportamento (pré-contemplação, contemplação, decisão, ação e manutenção) por meio de algoritmo específico. Resultados: Foram avaliados 390 adolescentes: média de idade de 12,4 anos, 46,4% meninos, 78,7% púberes e 21,1% com excesso de peso. Observou-se consumo médio de 3645kcal, sendo que 36,7% da amostra apresentou alto teor de lipídios na dieta. O consumo médio de frutas, hortaliças e doces foi de 2,3, 2,4 e 4,5 porções diárias, respectivamente. Mais de 44% dos adolescentes mostrou percepção errônea da dieta e não manifestou motivação para modificá-la. Cerca de 40% da amostra foi classificada no estágio de manutenção. Observou-se relação significativa entre os estágios de mudança e o consumo alimentar. Foi realizada uma reclassificação dos adolescentes nos estágios de mudança para identificar indivíduos com características semelhantes segundo o consumo e a percepção alimentares. Conclusão: A classificação dos adolescentes nos estágios de mudança, em associação com os dados de consumo e percepção alimentares, permitiram a identificação de grupos de risco por suas práticas alimentares inadequadas e pelo não-reconhecimento destas. Destaca-se a necessidade do desenvolvimento de intervenções nutricionais futuras direcionadas à população estudada. / Introduction: Over the process of health-related behavior change, people move through different steps called stages of change. The development of nutritional intervention tailored to each stage of change can contribute to the adoption of healthy dietary practices among adolescents. Objective: to evaluate the stages of change and their relationship with dietary intake among adolescents. Methods: Observational cross-sectional study with adolescents from public schools of Piracicaba. Demographic and anthropometric data, sexual maturation and dietary intake (food frequency questionnaire) were examined. Food perception was evaluated comparing dietary intake with self-rated diet. Stages of change classification (precontemplation, contemplation, preparation, action, maintenance) was assessed by a specific algorithm. Results: The sample included 390 adolescents: mean age of 12.4 years, 46.4% boys, 78.7% pubescents and 21,1% overweight. Mean daily energy intake was 3645kcal and 36,7% of adolescents had excessive intake of dietary fat. Average intake of fruits, vegetables and sweets were respectively 2.3, 2.4 and 4.5 portions per day. More than 44% of adolescents were unaware of their unfavourable dietary intake and were not interested in change it. About 40% of adolescents were assigned in maintenance stage. A significant relationship was observed between stages of change and dietary intake. Adolescents were re-classified into stages of change to identify individuals with similar characteristics according to their dietary intake and their food perception. Conclusion: The stage of change assignment, in association with dietary intake and food perception data, allowed the identification of risk groups, considering their inadequate dietary practices and the lack of awareness about them. It should be emphasize the necessity of the development of future nutritional intervention tailored to this population.

The degradation of the environment and climate change represent some of the most important environmental issues affecting our society today, and we need to better understand what can be done in order to mitigate the negative effects of human activity on the environment. The present program of research proposes to examine, through three studies, how the frequency of pro-environmental behaviours (PEB) and harmful-environmental behaviours (HEB) are related to self-determined (SDM) and non-self-determined motivation (NSDM), stages of change (SOC), the satisfaction versus the frustration of basic psychological needs as defined by Self-Determination Theory, and nature relatedness. In Study 1 (N = 377), a scale was created to measure two distinct types of environmental behaviours, PEB and HEB, and the relationships between these types of environmental behaviours and SDM and NSDM were examined. Results demonstrated that both types of behaviours loaded on two distinct factors when conducting an exploratory factor analysis, that they were associated differently with environmental motivation, and that levels of motivation were different according to the reported frequency of adoption of PEB and HEB. In Study 2a (N = 266) and 2b (N = 529), the role of stages of change (SOC) was introduced to determine whether environmental motivation and behaviours were different across SOC and to examine whether SOC played a mediating or moderating role in the relationship between environmental motivation and behaviours. Results indicated that people in the later SOC displayed higher levels of SDM and PEB while people in the earlier stages reported higher levels of NSDM and HEB. It was also observed that SOC partially mediated the relationship between environmental motivation and behaviours. In Study 3 (N = 507) nature relatedness was compared to the satisfaction and frustration of basic psychological needs proposed by SDT to examine their respective roles in the association of motivation, SOC, PEB and HEB. Results revealed that nature relatedness was incremental to need satisfaction and frustration with regard to levels of SDM. Also, nature relatedness was an important determinant of SOC and both types of environmental behaviours. As for the proposed model, it was demonstrated that high levels of nature relatedness were associated with higher PEB and lower HEB through partial mediation by SDM and SOC, while need frustration was linked to a higher reported frequency of HEB through mediation by NSDM. Overall this thesis expands on SDT research by highlighting the importance of including HEB in conjunction with PEB and by demonstrating the prominent roles that SOC and nature relatedness could play in the motivational process associated with environmental action.

The rate of obesity is increasing in the United States. In Florida, almost 60% of the population will be obese by 2030. This increase is expected to contribute to millions of cases of preventable chronic diseases costing the state an estimated $34 billion dollars. Employer-sponsored health programs can positively influence employees' lifestyle choices and support weight loss programs to reduce health-related costs to the employee and the employer. Guided by the transtheoretical model, the purpose of the project was to conduct an employee assessment to determine the need for, interest in, and readiness for a lifestyle intervention weight loss program. One-hundred sixteen employees from a participant pool of 1,500 employees of a community hospital completed an online survey by providing information on age, weight, gender, body mass index, and exercise patterns. They also answered the 36-item University of Rhode Island Change Assessment Scale to determine readiness for participating in the workplace-based Group Lifestyle Balance program. Data were summarized using descriptive statistics; 52% of respondents were between 26 and 55 years of age and 44% of respondents were obese. Scores on the Change Assessment Scale revealed that 46.4% (n = 54) of the respondents were thinking about making a lifestyle change within the next 6 months. The findings indicated that many hospital employees were in the contemplation stage of readiness for change and they were receptive to additional information about the weight loss program. The needs assessment was the first step toward establishing community-level social change, starting with hospital employees, to decrease obesity and improve population health.