Cancer is the leading cause of death in Taiwan. Breast cancer has the highest morbidity rate in females. Early detection in Taiwanese women is hampered by their inadequate knowledge of risk factors, their biased perceptions of mammography and by their low intentions to carry out recommended preventative strategies. Although the Internet has become a powerful tool to disseminate health information, health information offered on the web frequently is not theoretically-based or patient-centered. Effken's (2003) Informatics Research Organizing Model (IROM) and the Transtheoretical Model (TTM) (Prochaska & Diclemente, 1982; Rakowski, Dube, & Goldstein, 1996) were used to guide the design and evaluation of a tailored web-based program aimed at improving effective breast cancer detection in Taiwanese women. This study used a pretest-posttest design to examine the impact of a tailored, web-based educational intervention on Taiwanese women's perceptions of and intentions to obtain mammography, as well as their satisfaction with the website. One hundred twenty eight Taiwanese women were randomly assigned to one of two groups: tailored intervention (TI) or standard intervention (SI). The TI group received tailored educational materials (i.e. tailored messages, case studies, personal testimonies, and mammography information). The SI group received an educational brochure developed by the Bureau of Health Promotion, Department of Health (DOH). A Stage of Adoption of Mammography Question (SAMQ) and Decisional Balance of Mammography Inventory (DBMI) were administered before and after the educational intervention. A Website Users Satisfaction (WUS) and Demographics Inventory (DI) were administered after the intervention. All materials and instruments were delivered and assessed via a website. ANCOVAs, Chi-Square tests and t-tests were utilized to test the hypotheses. Results of the study revealed that the TI group differed significantly from the SI group in terms of perceptions of, and intentions to obtain, mammography, as well as in satisfaction with the website. The results of this study contribute to our knowledge of how a health education website can change women's mammography-related perceptions and intentions if theoretically-based and tailored interventions are emphasized.

Background. Lung cancer is the leading cause of cancer deaths worldwide. Low survival rates have been attributed to delays to diagnosis, and some patients report having symptoms for several months before presenting to health services. Strategies are needed to encourage timely help-seeking. The Web is increasingly used as a health information source. Aim. The aim of this thesis is to explore whether the Web plays a role in help-seeking behaviour of people with lung cancer prior to diagnosis, and how the Web can be utilised to encourage earlier presentation to health services for symptomatic people. Systematic review. To begin, I carried out a systematic review of the literature (N=34), which highlighted a scarcity of research on Web use for symptom appraisal among cancer populations. Mixed-methods study. I conducted a survey with recently diagnosed (6 months or less) lung cancer patients (N=113). Based on survey responses, I purposively selected a sub-sample of patients and their family/friends ("proxies") for semi-structured interviews (N=33). In the survey, 20.4% of participants reported they or proxies had researched their condition online before the diagnosis. Interview results suggest perceived impacts of online information on symptom appraisal, forming the decision to seek help, and on interactions with healthcare professionals. Intervention development and evaluation. Based on my findings, I developed a Web-based intervention. The intervention provides tailored information about lung cancer, and uses components based on the Theory of Planned Behaviour ("TPB-components") to encourage earlier help-seeking. This intervention was tested in an online feasibility study (N=130), and subsequently in an online randomised controlled trial (N=212) with a factorial design to test main and interaction effects of tailoring and TPB-components. The feasibility study and first trial helped identify methodological issues which were addressed in a second trial with a mixed factorial design. This trial (N=253) indicated that the self-reported likelihood of visiting a doctor increased significantly by 11.8% from before to after viewing study information (p < 0.001), but no effects of tailoring or TPB-components were found. When examining only those aged ≥50 years, who are at highest risk of lung cancer, those receiving tailored information reported an increase of 13.2% in likelihood of seeking help, compared to 3.2% in the untailored group (p=0.01). Participants aged 50+ receiving the TPB-component reported a larger increase (13.8%) than those who did not receive the TPB-component (5.2%), but this did not meet the significance criterion (p=0.054). Conclusions. According to patients' perceptions, the Web can impact on processes in the appraisal, help-seeking and diagnostic interval leading up to diagnosis. Presentation of information about symptoms and risk factors online can produce significant effects on self-reported likelihood of seeking help. These findings indicate that there is potential for the Web to be utlised in the endeavour to educate the public about symptoms and to promote earlier presentation to health services, but due to small effects and differential dropout in this study, further research is required.

La détection du délirium à l’aide d’outils est importante pour pouvoir intervenir le plus rapidement et efficacement possible. Le but de ce projet de recherche est d’évaluer l’efficacité d’une intervention de transfert de connaissances (TC) sur mesure auprès d’infirmières sur le taux d’utilisation conforme d’un outil de détection du délirium (ODD). L’intervention auprès d’infirmières a été basée sur les barrières et facilitateurs à utiliser un tel ODD identifiés par un questionnaire (n=30) et deux groupes de discussion (n=4). Les barrières identifiées par le questionnaire reflétaient un besoin de connaissances et d’amélioration des compétences infirmières. L’une des barrières identifiée à partir des groupes de discussion était le manque de connaissances sur les causes possibles du délirium et les interventions infirmières à privilégier selon ces causes. Les activités de TC retenues étaient une capsule clinique sur les manifestations du délirium évaluées par un ODD et une carte aide-mémoire sur des interventions infirmières possibles. Les taux d’utilisation de l’ODD ont été évalués en pré et post implantation d’une intervention de TC (devis pré-post test) à partir d’une revue de 242 dossiers médicaux de patients (avant n=121 ; après n=121). Aucune différence significative n’a été notée entre les périodes pré et post intervention de TC (p > .99). Une explication réside dans le taux déjà élevé (> 85%) d’utilisation de l’ODD observé avant l’intervention de TC pour deux des trois quarts de travail. L’intervention de TC basée sur les barrières et les facilitateurs a été appréciée par les infirmières et elle pourrait avoir le potentiel de promouvoir une pratique basée sur les résultats probants. / The use of an assessment tool for delirium detection (ATDD) is important to intervene as quickly and as efficiently as possible. The aim of the study was to evaluate the efficacy of a knowledge transfer tailored intervention (KT-TI) to optimize the conform use of an ATDD by nurses. The intervention was based on barriers and facilitators to the use of an ATDD. The barriers identified with the questionnaire (n=30) revealed a need for knowledge and an improvement of nursing skills. One of the barriers identified in focus groups (n=4) was the lack of knowledge on delirium causes and specific nursing interventions to favour accordingly. The chosen KT activities were a clinical capsule on delirium manifestations as evaluated by the ATDD, and a pocket sized information card on possible nursing interventions. The rate of conform use of an ATDD was evaluated in pre and post KT intervention (pre-post design) with a review of 242 patient’s medical charts (pre n=121; post n=121). No significant difference was noted between pre and post KT-TI (p > 0.99). An explanation for this resides in the fact that the observed rate of use of an ATDD by nurses was already high (> 85%) in pre KT-TI on two work shifts. The KT intervention based on barriers and facilitators to change was appreciated by nurses and it may have the potential to promote evidence-based practice.

The obesity epidemic is a global health concern. In the United States alone, 68.5% of adults are categorized as overweight or obese; of these, 35.1% are considered obese. Obesity is a leading cause of morbidity and mortality from diabetes and cardiovascular disease, two diseases adversely affecting minority groups such as Mexican Americans. Yet, a modest 5% decrease in weight, through changes in diet and physical activity, can help control type 2 diabetes. The current study extracted the dietary data and selected outcome variables from Beyond Sabor, a 12 week intervention conducted in the Lower Rio Grande Valley, Texas, a predominantly Mexican American disadvantaged community. Social Cognitive Theory, guided the design of this culturally tailored intervention. Community resources and natural helpers emerged through the utilization of community based participatory research methods. Study participants (n= 1,273) were recruited from local food bank sites and randomized into treatment and control groups. The treatment group received 12 weekly sessions focusing on healthier eating habits, cooking methods, and physical activity. The control group received 6 nutrition education sessions on similar topics. The study measured changes in several food groups including consumption of soda, fruit juice, and fruit and vegetables. A repeated measures Analysis of Variance was employed to determine changes in treatment and control groups from baseline, post intervention and 40 week follow up. The results showed a significant decrease in soda (F= 8.48, p< .001) and fruit juice (F= 3.12, p= .045) consumption for both groups, with a particular decrease in soda for the treatment group. In addition, there was a significant increase in fruit (F=15.32, p< .001) and vegetable (F=3.16, p= .04) consumption in both groups. The outcome variables selected were weight, body mass index (BMI), and fasting plasma glucose (FPG). There were significant changes for all three variables over time. The intervention resulted in changes in dietary behaviors that ultimately led to changes in weight, BMI, and FPG. It is evident from the current study, that the use of community based helpers facilitated changes in food habits. This study serves as a prognosticator for future interventions.