Digitala Vetenskapliga Arkivet

Change search
Refine search result
1 - 24 of 24
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1. Bergman, David
    et al.
    Savage, Carl
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sandahl, Christer
    Teaching group dynamics - do we know what we are doing?: An approach to evaluation2008In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 30, no 1, p. 55-61Article in journal (Refereed)
    Abstract [en]

    Background: Research into the efficacy of programs of leadership and group dynamics in undergraduate medical education is sparse. Aims: The aim of this study was to apply and test a pre-post evaluation design of a one-week experiential learning based course of group dynamics. Methods: Two questionnaires were sent to 160 medical students, before and after the course. The response rate was acceptable (73%). Results: While there was a small change in attitudes towards openness in their professional role and group dynamics, there was a major change in two subgroups of students to these topics. The students who were least interested in collaborative constructivist learning and those students who mainly looked for practical value were the students who changed their attitudes most towards openness in their professional role. Conclusions: It appears that those students who would be least likely to voluntarily attend such a course were the ones who learned the most. This study does not allow for any generalizations regarding the outcome of experiential learning of group dynamics, but it is an argument for the use of systematic evaluations in order to identify students who can benefit from courses aimed at improving profound knowledge.

  • 2. Charandabi, Sakineh Mohammad-Alizadeh
    et al.
    Vahidi, Rezagoli
    Marions, Lena
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Effect of a peer-educational intervention on provider knowledge and reported performance in family planning services: a cluster randomized trial2010In: BMC Medical Education, E-ISSN 1472-6920, Vol. 10Article in journal (Refereed)
    Abstract [en]

    Background: Peer education is an interactive method of teaching or learning which is widely used for educating school and college students, in a variety of different forms. However, there are few studies on its effectiveness for in-service education. The aim of this study was to evaluate the effect of an educational programme including peer discussions, based on a needs assessment, on the providers' knowledge and reported performance in family planning services. Methods: An educational programme was designed and applied in a random selection of half of in-charges of the 74 family health units (intervention group) in Tabriz at a regular monthly meeting. The other half constituted the control group. The programme included eight pages of written material and a two-hour, face-to-face discussion session with emphasis on the weak areas identified through a needs assessment questionnaire. The educated incharges were requested to carry out a similar kind of programme with all peers at their health facilities within one month. All in-charges received one self-administered questionnaire containing knowledge questions one month after the in-charge education (follow-up I: 61 responses), and another one containing knowledge and self-reported performance questions 26 months later (follow-up II: 61 responses). Also, such tests were done for the peers facilitated by the in-charges one (105 responses) and 27 months (114 responses) after the peer discussions. Multiple linear regression was used for comparing mean total scores, and Chi square for comparing proportions between control and intervention groups, after defining facility as the unit of randomization. Results: The mean total percentage scores of knowledge (percent of maximal possible score) in the intervention group were significantly higher than in the control group, both at follow-up I (63%) and at follow-up II (57%); with a difference of 16 (95% CI: 11, 22) and 5 (95% CI: 0.4, 11) percentage units, respectively. Only two of the nine reported performance items were significantly different among the non in-charges in the intervention group at follow-up II. Conclusions: The educational programme including peer discussions using existing opportunities with no need for additional absence from the workplace might be a useful complement to formal large group education for the providers.

  • 3.
    Daivadanam, Meena
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Sree Chitra Tirunal Inst Med Sci & Technol, Achutha Menon Ctr Hlth Sci Studies, Thiruvananthapuram 695011, Kerala, India.;Karolinska Inst, Dept Publ Hlth Sci Global Hlth, Tomtebodavagen 18A, S-17177 Stockholm, Sweden..
    Ravindran, T. K. Sundari
    Sree Chitra Tirunal Inst Med Sci & Technol, Achutha Menon Ctr Hlth Sci Studies, Thiruvananthapuram 695011, Kerala, India..
    Thankappan, K. R.
    Sree Chitra Tirunal Inst Med Sci & Technol, Achutha Menon Ctr Hlth Sci Studies, Thiruvananthapuram 695011, Kerala, India..
    Sarma, P. S.
    Sree Chitra Tirunal Inst Med Sci & Technol, Achutha Menon Ctr Hlth Sci Studies, Thiruvananthapuram 695011, Kerala, India..
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Karolinska Inst, Dept Publ Hlth Sci Global Hlth, Tomtebodavagen 18A, S-17177 Stockholm, Sweden..
    Development of a Tool to Stage Households' Readiness to Change Dietary Behaviours in Kerala, India2016In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 11, article id e0165599Article in journal (Refereed)
    Abstract [en]

    Dietary interventions and existing health behaviour theories are centred on individuals; therefore, none of the available tools are applicable to households for changing dietary behaviour. The objective of this pilot study was to develop a practical tool that could be administered by community volunteers to stage households in rural Kerala based on readiness to change dietary behaviour. Such a staging tool, comprising a questionnaire and its algorithm, focusing five dietary components (fruits, vegetables, salt, sugar and oil) and households (rather than individuals), was finalised through three consecutive pilot validation sessions, conducted over a four-month period. Each revised version was tested with a total of 80 households (n = 30, 35 and 15 respectively in the three sessions). The tool and its comparator, Motivational Interviewing (MI), assessed the stage-of-change for a household pertaining to their: 1) fruit and vegetable consumption behaviour; 2) salt, sugar and oil consumption behaviour; 3) overall readiness to change. The level of agreement between the two was tested using Kappa statistics to assess concurrent validity. A value of 0.7 or above was considered as good agreement. The final version was found to have good face and content validity, and also a high level of agreement with MI (87%; weighted kappa statistic: 0.85). Internal consistency testing was performed using Cronbach's Alpha, with a value between 0.80 and 0.90 considered to be good. The instrument had good correlation between the items in each section (Cronbach's Alpha: 0.84 (fruit and vegetables), 0.85 (salt, sugar and oil) and 0.83 (Overall)). Pre-contemplation was the most difficult stage to identify; for which efficacy and perceived cooperation at the household level were important. To the best of our knowledge, this is the first staging tool for households. This tool represents a new concept in community-based dietary interventions. The tool can be easily administered by lay community workers and can therefore be used in large population-based studies. A more robust validation process with a larger sample is needed before it can be widely used.

    Download full text (pdf)
    fulltext
  • 4.
    Daivadanam, Meena
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Dept Publ Hlth Sci Global Hlth, Stockholm, Sweden; Sree Chitra Tirunal Inst Med Sci & Technol, Achutha Menon Ctr Hlth Sci Studies, Trivandrum, Kerala, India.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Karolinska Inst, Dept Publ Hlth Sci Global Hlth, Stockholm, Sweden.
    Ravindran, T. K. Sundari
    Sarma, P. Sankara
    Sivasankaran, S.
    Thankappan, K. R.
    Changing household dietary behaviours through community-based networks: A pragmatic cluster randomized controlled trial in rural Kerala, India2018In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 8, article id e0201877Article in journal (Refereed)
    Abstract [en]

    Trial design: With the rise in prevalence of non-communicable diseases in India and Kerala in particular, efforts to develop lifestyle interventions have increased. However, contextualised interventions are limited. We developed and implemented contextualised behavioural intervention strategies focusing on household dietary behaviours in selected rural areas in Kerala and conducted a community-based pragmatic cluster randomized controlled trial to assess its effectiveness to increase the intake of fruits and vegetables at individual level, and the procurement of fruits and vegetables at the household level and reduce the consumption of salt, sugar and oil at the household level.

    Methods: Six out of 22 administrative units in the northern part of Thiruvananthapuram district of Kerala state were selected as geographic boundaries and randomized to either intervention or control arms. Stratified sampling was carried out and 30 clusters comprising 6-11 households were selected in each arm. A cluster was defined as a neighbourhood group functioning in rural areas under a state-sponsored community-based network (Kudumbasree). We screened 1237 households and recruited 479 (intervention: 240; control: 239) households and individuals (male or female aged 25-45 years) across the 60 clusters. 471 households and individuals completed the intervention and end-line survey and one was excluded due to pregnancy. Interventions were delivered for a period of one-year at household level at 0, 6, and 12 months, including counselling sessions, telephonic reminders, home visits and general awareness sessions through the respective neighbourhood groups in the intervention arm. Households in the control arm received general dietary information leaflets. Data from 478 households (239 in each arm) were included in the intention-to-treat analysis, with the household as the unit of analysis.

    Results: There was significant, modest increase in fruit intake from baseline in the intervention arm (12.5%); but no significant impact of the intervention on vegetable intake over the control arm. There was a significant increase in vegetable procurement in the intervention arm compared to the control arm with the actual effect size showing an overall increase by 19%; 34% of all households in the intervention arm had increased their procurement by at least 20%, compared to 17% in the control arm. Monthly household consumption of salt, sugar and oil was greatly reduced in the intervention arm compared to the control arm with the actual effect sizes showing an overall reduction by 45%, 40% and 48% respectively.

    Conclusions: The intervention enabled significant reduction in salt, sugar and oil consumption and improvement in fruit and vegetable procurement at the household level in the intervention arm. However, there was a disconnect between the demonstrated increase in FV procurement and the lack of increase in FV intake. We need to explore fruit and vegetable intake behaviour further to identify strategies or components that would have made a difference. We can take forward the lessons learned from this study to improve our understanding of human dietary behaviour and how that can be changed to improve health within this context.

    Download full text (pdf)
    fulltext
  • 5.
    Daivadanam, Meena
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Thankappan, K. R.
    Ravindran, T. K. Sundari
    Balancing expectations amidst limitations: the dynamics of food decision-making in rural Kerala2015In: BMC Public Health, E-ISSN 1471-2458, Vol. 15, article id 644Article in journal (Refereed)
    Abstract [en]

    Background: Food decision-making is a complex process and varies according to the setting, based on cultural and contextual factors. The study aimed to understand the process of food decision-making in households in rural Kerala, India, to inform the design of a dietary behaviour change intervention. Methods: Three focus group discussions (FGDs) and 17 individual interviews were conducted from September 2010 to January 2011 among 13 men and 40 women, between 23 and 75 years of age. An interview guide facilitated the process to understand: 1) food choices and decision-making in households, with particular reference to access; and 2) beliefs about foods, particularly fruits, vegetables, salt, sugar and oil. The interviews and FGDs were transcribed verbatim and analysed using qualitative content analysis. Results: The analysis revealed one main theme: 'Balancing expectations amidst limitations' with two sub-themes: 'Counting and meeting the costs'; and 'Finding the balance'. Food decisions were made at the household level, with money, time and effort costs weighed against the benefits, estimated in terms of household needs, satisfaction and expectations. The most crucial decisional point was affordability in terms of money costs, followed by food preferences of husband and children. Health and the risk of acquiring chronic diseases was not a major consideration in the decision-making process. Foods perceived as essential for children were purchased irrespective of cost, reportedly owing to the influence of food advertisements. The role of the woman as the homemaker has gendered implications, as the women disproportionately bore the burden of balancing the needs and expectations of all the household members within the available means. Conclusions: The food decision-making process occurred at household level, and within the household, by the preferences of spouse and children, and cost considerations. The socio-economic status of households was identified as limiting their ability to manoeuvre this fine balance. The study has important policy implications in terms of the need to raise public awareness of the strong link between diet and chronic non-communicable diseases.

    Download full text (pdf)
    fulltext
  • 6. Elliott, James A.
    et al.
    Abdulhadi, Nadia Noor
    Al-Maniri, Abdullah A.
    Al-Shafaee, Mohammed A.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Diabetes Self-Management and Education of People Living with Diabetes: A Survey in Primary Health Care in Muscat Oman2013In: PLOS ONE, E-ISSN 1932-6203, Vol. 8, no 2, p. e57400-Article in journal (Refereed)
    Abstract [en]

    Background: Although the prevalence of type 2 diabetes in Oman is high and rising, information on how people were self-managing their disease has been lacking. The objective of this study was therefore to assess diabetes self-management and education (DSME) among people living with type 2 diabetes in Oman. Methods: A questionnaire survey was conducted in public primary health care centres in Muscat. Diabetes self-management and education was assessed by asking how patients recognized and responded to hypo- and hyperglycaemia, and if they had developed strategies to maintain stable blood glucose levels. Patients' demographic information, self-treatment behaviours, awareness of potential long-term complications, and attitudes concerning diabetes management were also recorded. Associations between these factors and diabetes self-management and education were analysed. Results: In total, 309 patients were surveyed. A quarter (26%, n = 83) were unaware how to recognize hypoglycaemia or respond to it (26%, n = 81). Around half (49%, n = 151), could not recognize hyperglycaemia and more than half could not respond to it (60%, n = 184). Twelve percent (n = 37) of the patients did not have any strategies to stabilize their blood glucose levels. Patients with formal education generally had more diabetes self-management and education than those without (p<0.001), as had patients with longer durations of diabetes (p<0.01). Self-monitoring of blood glucose was practiced by 38% (n = 117) of the patients, and insulin was used by 22% (n = 67), of which about one third independently adjusted dosages. Patients were most often aware of complications concerning loss of vision, renal failure and cardiac problems. Many patients desired further health education. Conclusions: Many patients displayed dangerous diabetes self-management and education knowledge gaps. The findings suggest a need for improving knowledge transfer to people living with diabetes in the Omani clinical setting.

    Download full text (pdf)
    fulltext
  • 7.
    Eriksson, Hans-G.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    von Celsing, Anna-Sophia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Janson, Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Zander, Viktoria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Sickness absence and self-reported health a population-based study of 43,600 individuals in central Sweden2008In: BMC Public Health, E-ISSN 1471-2458, Vol. 8, p. 426-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Sickness absence is very high in Sweden. The reasons for this phenomenon are not well known. The aim of this study was to investigate the association between degree of self-reported sickness absence and health. The hypothesis was that individuals with long-term sickness absence would report more symptoms and lower self-rated health. Another hypothesis was that women are more likely to self-rate psychiatric diagnoses compared to men, who are more likely to self-rate musculoskeletal diagnoses.

    METHODS

    The data was obtained with a postal survey questionnaire answered by 43,589 individuals, a Swedish random population sample of men and women aged 18-84 years. The response rate was 65%. This study included 19,826 individuals aged 18-64 years old and still at work. They were divided into four groups, based on the number of reported days of sickness absence during the past year.

    RESULTS

    Approximately 40% of the individuals at work mentioned that they had been absent due to illness sometime during the past year. Of those who had been absent 90 days or more, two thirds were women. There was a significant difference between the groups in self-rated health (p < 0.05). Every fifth woman (19.4%) and every fourth man (25.9%) in the group with a sickness absence of more than 89 days rated their health as poor or very poor, but a large proportion, 43.5% of the women and 31.6% of the men, rated their health as good. Long-term illnesses and complaints differed between the groups. The correlations between the groups and illness were mostly significant (p < 0.01). Two thirds of the subjects had both psychiatric and musculoskeletal symptoms. There was a significant difference among them, as men more often had musculoskeletal diagnoses. One third had only psychiatric or musculoskeletal symptoms and in those groups there were no significant diagnosis differences between the sexes.

    CONCLUSION

    Individuals with long-term sickness absence reported more symptoms and lower self-rated health than did those who had not been absent at all, and than those who had been ill 1-28 days. Men and women sick-listed 29 days or more generally reported more illness and complaints. No sex differences among psychiatric and musculoskeletal diagnoses were found, but when reported both psychiatric and musculoskeletal symptoms the musculoskeletal diagnoses were significant among men.

  • 8. Ghadimi, Hadi
    et al.
    Esmaily, Hamideh M.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    General practitioners' prescribing patterns for the elderly in a province of Iran2011In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 20, no 5, p. 482-487Article in journal (Refereed)
    Abstract [en]

    Purpose To determine prescribing patterns by general physicians working in primary care (GPs) in Iran for the elderly and the prevalence of inappropriate prescribing. Methods We collected information about prescribed medicines for 10% of patients in primary care aged 65 years or above in six cities in one province during two separate months 1 year apart. Inappropriate prescribing was determined using Beers criteria, excluding diagnosis-related medications. The WHO indicators for appropriateness of prescribing in general practice and drug-drug interactions (DDIs) were also assessed. Results A total of 2041 patients were studied (mean age 73 years, 56% were women). Drugs for the alimentary system (20%), nervous system (15%), cardiovascular system (14%), and anti-infectives (12%) were most frequently prescribed. Almost all drugs (96%) were prescribed by generic names. Thirty percent of patients received at least one inappropriate drug (27% for men; 33% for women), whereof 94% were categorized as high risk for adverse effects. Indomethacin, diphenhydramine, and methocarbamol were the most common inappropriate medications. The average number of drugs per patient was 4.4 (4.2 for men; 4.5 for women). Forty-four percent of patients received five or more drugs. Antibiotics and injections were prescribed in 39 and 55% of all patients, respectively. Clinically relevant DDIs were observed for 14% of the patients. Conclusion Our findings call for further interventions aiming at educating GPs to reduce potential errors. National drug policies and prescribing guidelines should be implemented to address the problem of inappropriate drug usage among the elderly.

  • 9. Gusdal, Annelie K
    et al.
    Beckman, Christel
    Wahlström, Rolf
    Department of Public Health Sciences, Division of Global Health (IHCAR), Stockholm, Sweden.
    Törnkvist, Lena
    District nurses' use for an assessment tool in their daily work with elderly patients' medication management2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 4, p. 354-360Article in journal (Refereed)
    Abstract [en]

    AIM: To explore the capability of the Safe Medication Assessment (SMA) tool in identifying factors highly related to unsafe medication management among elderly patients and to investigate the district nurses' (DNs) opinions of the SMA's usefulness as a tool in their daily primary healthcare practice. Introduction: Elderly patients who experience many medical conditions often use multiple drugs. As well as the combined decline in physical and cognitive functions, the elderly are at high risk for medication-related problems. It is essential to develop a screening procedure to distinguish elderly at risk of an unsafe medication management.

    METHODS: An explorative study. During a 3-6-month period, 25 voluntary DNs used SMA with 160 patients (consecutively chosen and meeting four specified criteria) in their daily practice. Furthermore, DNs responded to questions regarding SMA's usefulness.

    RESULTS: The result showed that SMA had the capability to identify factors highly related to unsafe medication management among the elderly included in the study. In 64% of assessments DNs identified areas of new information and in 23% of the assessments DNs intervened. They found SMA to be satisfactory regarding its level of simplicity, relevance, completeness, intelligibility, and time for implementation.

    CONCLUSIONS: SMA alerted the DNs to patients' attitudes about medication and empowered them in identifying elderly patients who had unsafe medication management. SMA was also perceived as a useful assessment tool by the DNs.

  • 10. Gusdal, Annelie K
    et al.
    Obua, Celestino
    Andualem, Tenaw
    Wahlstrom, Rolf
    Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Chalker, John
    Fochsen, Grethe
    Peer counselors' role in supporting patients' adherence to ART in Ethiopia and Uganda2011In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 23, no 6, p. 657-662Article in journal (Refereed)
    Abstract [en]

    Our aim was to explore peer counselors' work and their role in supporting patients' adherence to antiretroviral treatment (ART) in resource-limited settings in Ethiopia and Uganda. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Two main categories with related subcategories emerged from the analysis. The first main category, peer counselors as facilitators of adherence, describes how peer counselors played an important role by acting as role models, raising awareness, and being visible in the community. They were also recognized for being close to the patients while acting as a bridge to the health system. They provided patients with an opportunity to individually talk to someone who was also living with HIV, who had a positive and life-affirming attitude about their situation, and were willing to share personal stories of hope when educating and counseling their patients. The second main category, benefits and challenges of peer counseling, deals with how peer counselors found reward in helping others while at the same time acknowledging their limitations and need of support and remuneration. Their role and function were not clearly defined within the health system and they received negligible financial and organizational support. While peer counseling is acknowledged as an essential vehicle for treatment success in ART support in sub-Saharan Africa, a formal recognition and regulation of their role should be defined. The issue of strategies for disclosure to support adherence, while avoiding or reducing stigma, also requires specific attention. We argue that the development and implementation of support to peer counselors are crucial in existing and future ART programs, but more research is needed to further explore factors that are important to sustain and strengthen the work of peer counselors.

  • 11. Kindblom-Rising, Kristina
    et al.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Ekman, Sirkka-Liisa
    Buer, Nina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Nilsson-Wikmar, Lena
    Nursing staff's communication modes in patient transfer before and after an educational intervention2010In: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 53, no 10, p. 1217-1227Article in journal (Refereed)
    Abstract [en]

    The objective was to explore and describe nursing staff's body awareness and communication in patient transfers and evaluate any changes made after an educational intervention to promote staff competence in guiding patients to move independently. In total, 63 nursing staff from two hospitals wrote weekly notes before and after the intervention. The topics were: A) reflect on a transfer during the last week that you consider was good and one that was poor; B) reflect on how your body felt during a good and a poor transfer. The notes were analysed with content analysis. The results showed five different communication modes connected with nursing staff's physical and verbal communication. These communication modes changed after 1 year to a more verbal communication, focusing on the patient's mobility. The use of instructions indicated a new or different understanding of patient transfer, which may contribute to a development of nursing staff's competence. Statement of Relevance: The present findings indicate that patient transfer consists of communication. Therefore, verbal and bodily communication can have an integral part of training in patient transfer; furthermore, the educational design of such programmes is important to reach the goal of developing new understanding and enhancing nursing staff's competence in patient transfer.

  • 12. Kindblom-Rising, Kristina
    et al.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Nilsson-Wikmar, Lena
    Buer, Nina
    Nursing staff's movement awareness, attitudes and reported behaviour in patient transfer before and after an educational intervention2011In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 42, no 3, p. 455-463Article in journal (Refereed)
    Abstract [en]

    The objective was to evaluate changes after a two half-day patient transfer course regarding nursing staffs movement and body awareness, attitudes, reported behaviour, strain, disorder and sick leave. The course aimed at increasing staffs self-awareness of movements and body, and their communication competence, with the intention to promote the patient's independent mobility. Ninety-nine staff in an intervention group and 77 staff in two control groups answered a questionnaire before and after the intervention. After one year there was a significant increase in the number of instructions given and nursing staff's movement awareness in the intervention group compared to the control group. Reported physical disorders decreased significantly in the intervention group compared with both control groups. Increased movement awareness and frequent use of instructions during transfers may encourage patients to move independently and thereby reduce the strain in nursing staff.

  • 13. Manithip, Chanthanom
    et al.
    Edin, Kerstin
    Sihavong, Amphoy
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wessel, Hans
    Poor quality of antenatal care services-Is lack of competence and support the reason?: An observational and interview study in rural areas of Lao PDR2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 3, p. 195-202Article in journal (Refereed)
    Abstract [en]

    Objective: to explore the health-care providers' performance and their own perceptions of the ANC services they provide. Design, setting and participants: this cross-sectional exploratory survey was carried out in 2009 at four district hospitals and 18 health centres in Khammouane and Champasack provinces in rural areas of Laos. Measurements and findings: combinations of quantitative and qualitative methods were used: (i) 59 observations of ANC sessions (components performed and equipment used); (ii) 26 semi-structured interviews with health-care providers engaged in ANC services, interpreted through content analysis. The findings indicated an overall poor quality and performance of ANC services in rural health facilities with lack of routines, scarce or insufficient equipment and limited skills among providers. The health-care providers gave an often pessimistic picture of their competence and motivation to work with ANC. Some articulated a resignation due to lack of feedback from the patients and they expressed a need for support from health-care superiors. Compared to the district hospitals, the health centres were less well-equipped and supplied, and the providers had a heavier workload, because all activities including ANC were carried out by the same provider. The average consultation time for each woman was 5 mins. Conclusions: the quality of ANC services in rural health facilities in Laos was poor due to lack of resources, the providers' limited skills concurrent with inadequate routines and insufficient backup from superiors. Implications for practice: to comply with national and international recommendations for ANC services, our suggestion is to improve the quality of the rural health facilities in Laos by providing basic equipment, support from experienced superiors and in-service training.

  • 14.
    Noor Abdulhadi, Nadia M
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, Div Global Hlth IHCAR, SE-17177 Stockholm, Sweden.; Minist Hlth, Dept Hlth Affairs, Muscat, Oman.
    Al-Shafaee, Mohammed Ali
    Sultan Qaboos Univ, Coll Med & Hlth Sci, Dept Family Med & Publ Hlth, Muscat, Oman.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Karolinska Inst, Dept Publ Hlth Sci, Div Global Hlth IHCAR, SE-17177 Stockholm, Sweden.
    Hjelm, Katarina
    Linnaeus Univ, Sch Hlth & Caring Sci, Vaxjo, Sweden.
    Doctors' and nurses' views on patient care for type 2 diabetes: an interview study in primary health care in Oman.2013In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 14, no 3, p. 258-69Article in journal (Refereed)
    Abstract [en]

    AIM: This study aimed at exploring the experiences of primary health-care providers of their encounters with patients with type 2 diabetes, and their preferences and suggestions for future improvement of diabetes care.

    BACKGROUND: Barriers to good diabetes care could be related to problems from health-care providers' side, patients' side or the health-care system of the country. Treatment of patients with type 2 diabetes has become a huge challenge in Oman, where the prevalence has increased to high levels.

    METHOD: Semi-structured interviews were conducted with 26 health-care professionals, 19 doctors and seven nurses, who worked in primary health care in Oman. Qualitative content analysis was applied. Findings Organizational barriers and barriers related to patients and health-care providers were identified. These included workload and lack of teamwork approach. Poor patients' management adherence and influence of culture on their attitudes towards illness were identified. From the providers' side, language barriers, providers' frustration and aggressive attitudes towards the patients were reflected. Decreasing the workload, availability of competent teams with diabetes specialist nurses and continuity of care were suggested. Furthermore, changing professional behaviours towards a more patient-centred approach and need for health education to the patients, especially on self-management, were addressed. Appropriate training for health-care providers in communication skills with emphasis on self-care education and individualization of care according to each patient's needs are important for improvement of diabetes care in Oman.

    Download full text (pdf)
    fulltext
  • 15. Shirazi, Mandana
    et al.
    Lonka, Kirsti
    Parikh, Sagar V.
    Ristner, Gunilla
    Alaeddini, Farshid
    Sadeghi, Majid
    Wahlstrom, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    A tailored educational intervention improves doctor's performance in managing depression: a randomized controlled trial2013In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 1, p. 16-24Article in journal (Refereed)
    Abstract [en]

    Rational and objectives To assess the effects of a tailored and activating educational intervention, based on a three-stage modified Prochaska model of readiness-to-change, on the performance of general physicians in primary care (GPs) regarding management of depressive disorders. Methods Parallel group, randomized control trial. Primary hypothesis was that performance would improve by 20 percentage units in the intervention arm. The setting was primary care in southern Tehran. The participants were 192 GPs stratified on stage of readiness-to-change, sex, age and work experience. The intervention was a 2-day interactive workshop for a small group of GPs' at a higher stage of readiness-to-change (intention) and a 2-day interactive large group meeting for those with lower propensity to change (attitude) at the pre-assessment. GPs in the control arm participated in a standard educational programme on the same topic. The main outcome measures were validated tools to assess GPs' performance by unannounced standardized patients, regarding diagnosis and treatment of depressive disorders. The assessments were made 2 months before and 2 months after the intervention. Results GPs in the intervention arm significantly improved their overall mean scores for performance regarding both diagnosis, with an intervention effect of 14 percentage units (P = 0.007), and treatment and referral, with an intervention effect of 20 percentage units (P < 0.0001). The largest improvement after the intervention appeared in the small group: 30 percentage units for diagnosis (P = 0.027) and 29 percentage units for treatment and referral (P < 0.0001). Conclusions Activating learning methods, tailored according to the participants' readiness to change, improved clinical performance of GPs in continuing medical education and can be recommended for continuing professional development.

  • 16. Silwer, Louise
    et al.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Lundborg, Cecilia Stålsby
    Views on primary prevention of cardiovascular disease: an interview study with Swedish GPs2010In: BMC Family Practice, E-ISSN 1471-2296, Vol. 11, p. 44-Article in journal (Refereed)
    Abstract [en]

    Background: General practitioners (GPs) have gradually become more involved in the prevention of cardiovascular disease (CVD), both through more frequent prescribing of pharmaceuticals and by giving advice regarding lifestyle factors. Most general practitioners are now faced with decisions about pharmaceutical or non-pharmaceutical treatment for primary prevention every day. The aim of this study was to explore, structure and describe the views on primary prevention of cardiovascular disease in clinical practice among Swedish GPs. Methods: Individual interviews were conducted with 21 GPs in southern Sweden. The interview transcripts were analysed using a qualitative approach, inspired by phenomenography. Results: Two main categories of description emerged during the analysis. One was the degree of reliance on research data regarding the predictability of real risk and the opportunities for primary prevention of CVD. The other was the allocation of responsibility between the patient and the doctor. The GPs showed different views, from being convinced of an actual and predictable risk for the individual to strongly doubting it; from relying firmly on protection from disease by pharmaceutical treatment to strongly questioning its effectiveness in individual cases; and from reliance on prevention of disease by non-pharmaceutical interventions to a total lack of reliance on such measures. Conclusions: The GPs' different views, regarding the rationale for and practical management of primary prevention of CVD, can be interpreted as a reflection of the complexity of patient counselling in primary prevention in clinical practice. The findings have implications for development and implementation of standard treatment guidelines, regarding long-time primary preventive treatment.

  • 17. Sparring, V.
    et al.
    Nystrom, L.
    Ostman, J.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Burstrom, K.
    Jonsson, P. M.
    Changing healthcare utilization patterns in diabetes mellitus: case-control studies 1 year and 8 years after diagnosis2012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 6, p. 784-791Article in journal (Refereed)
    Abstract [en]

    Aims To describe healthcare utilization patterns in young and middle-aged patients with diabetes 1 year and 8 years after diagnosis and to compare with the general population at two time points, 16 years apart.

    Methods Four cohorts with disease duration of 1 year or 8 years were selected from the Diabetes Incidence Study in Sweden, which registers all incident cases of diabetes in the 15- to 34-year age group. Control subjects were selected from the population register matched by age, sex and county of residence. A postal questionnaire was sent to the 1983 and 1992 cohorts in 1991 and 1993, and to the 1999 and 2008 cohorts in 2007 and 2009. Nine hundred and thirteen patients with diabetes and 1679 control subjects responded.

    Results One year after diagnosis, 49% of patients with diabetes in the 1992 cohort compared with 4.2% in the 2008 cohort reported visits to departments of internal medicine and endocrinology. A similar pattern was seen 8 years after diagnosis. The use of day care was 45 times higher among patients with diabetes compared with control subjects. Utilization of outpatient hospital care was higher among patients with diabetes compared with control subjects, even when excluding visits to diabetes clinics.

    Conclusions Excess use of health care among patients with diabetes remained 16 years after the first follow-up. Utilization patterns were stable, except for a major decrease in inpatient care 1 year after diagnosis and an increase in day care 8 years after diagnosis. Observed changes probably reflect successive reforming of diabetes care in Sweden.

  • 18. Sparring, Vibeke
    et al.
    Nystrom, Lennarth
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Jonsson, Pia Maria
    Ostman, Jan
    Burstrom, Kristina
    Diabetes duration and health-related quality of life in individuals with onset of diabetes in the age group 15-34 years - a Swedish population-based study using EQ-5D2013In: BMC Public Health, E-ISSN 1471-2458, Vol. 13, p. 377-Article in journal (Refereed)
    Abstract [en]

    Background: Diabetes with onset in younger ages affects both length of life and health status due to debilitating and life-threatening long-term complications. In addition, episodes and fear of hypoglycaemia and of long-term consequences may have a substantial impact on health status. This study aims to describe and analyse health-related quality of life (HRQoL) in individuals with onset of diabetes at the age of 15-34 years and with a disease duration of 1, 8, 15 and 24 years compared with control individuals matched for age, sex and county of residence. Methods: Cross-sectional study of 839 individuals with diabetes and 1564 control individuals. Data on socioeconomic status and HRQoL using EQ-5D were collected by a postal questionnaire. Insulin treatment was self-reported by 94% of the patients, the majority most likely being type 1. Results: Individuals with diabetes reported lower HRQoL, with a significantly lower mean EQ VAS score in all cohorts of disease duration compared with control individuals for both men and women, and with a significantly lower EQ-5D(index) for women, but not for men, 15 years (0.76, p = 0.022) and 24 years (0.77, p = 0.016) after diagnosis compared with corresponding control individuals. Newly diagnosed individuals with diabetes reported significantly more problems compared with the control individuals in the dimension usual activities (women: 13.2% vs. 4.0%, p = 0.048; men: 11.4% vs. 4.1%, p = 0.033). In the other dimensions, differences between individuals with diabetes and control individuals were found 15 and 24 years after diagnosis: for women in the dimensions mobility, self-care, usual activities and pain/discomfort and for men in the dimension mobility. Multivariable regression analysis showed that diabetes duration, being a woman, having a lower education and not being married or cohabiting had a negative impact on HRQoL. Conclusions: Our study confirms the negative impact of diabetes on HRQoL and that the difference to control individuals increased by disease duration for women with diabetes. The small difference one year after diagnosis could imply a good management of diabetes care and a relatively quick adaptation. Our results also indicate that gender differences still exist in Sweden, despite modern diabetes treatment and management in Sweden.

    Download full text (pdf)
    fulltext
  • 19. Syhakhang, Lamphone
    et al.
    Soukaloun, Douangdao
    Tomson, Göran
    Petzold, Max
    Rehnberg, Clas
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Provider performance in treating poor patients - factors influencing prescribing practices in lao PDR: a cross-sectional study2011In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 11, p. 3-Article in journal (Refereed)
    Abstract [en]

    Background: Out-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs) have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors. Methods: Cross-sectional study using four tracer conditions. Structured interviews with 828 in-patients at twelve provincial and district hospitals on the subject of insurance protection, income and expenditures for treatment, including informal payment. Evaluation of each patient's medical record for appropriateness of drug use using a checklist of treatment guidelines (maximum score = 10). Results: No significant difference in appropriateness of care for patients at different income levels, but higher expenditures for patients with the highest income level. The score for appropriate drug use in insured patients was significantly higher than uninsured patients (5.9 vs. 4.9), and the length of stay in days significantly shorter (2.7 vs. 3.7). Insured patients paid significantly less than uninsured patients, both for medicines (USD 14.8 vs. 43.9) and diagnostic tests (USD 5.9 vs. 9.2). On the contrary the score for appropriateness of drug use in patients making informal payments was significantly lower than patients not making informal payments (3.5 vs. 5.1), and the length of stay significantly longer (6.8 vs. 3.2), while expenditures were significantly higher both for medicines (USD 124.5 vs. 28.8) and diagnostic tests (USD 14.1 vs. 7.7). Conclusions: The lower expenditure for insured patients can help reduce the number of households experiencing catastrophic health expenditure. The positive effects of insurance schemes on expenditure and appropriate use of medicines may be associated with the long-term effects of promoting rational use of drugs, including support to active DTC work.

  • 20. Taha, Hana
    et al.
    Al-Qutob, Raeda
    Nystorm, Lennarth
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Berggren, Vanja
    "Would a man smell a rose then throw it away?" Jordanian men's perspectives on women's breast cancer and breast health2013In: BMC Women's Health, E-ISSN 1472-6874, Vol. 13, p. 41-Article in journal (Refereed)
    Abstract [en]

    Background: Breast cancer is the most common malignancy afflicting women, and the most common cancer overall in Jordan. A woman's decision to go for screening is influenced by her social support network. This study aims to explore Jordanian men's individual and contextual perspectives on women's breast cancer and their own role in the breast health of the females within their families. Methods: An explorative qualitative design was used to purposively recruit 24 married men aged 27 to 65 years (median 43 years) from four governorates in Jordan. Data in the form of interviews transcriptions was subjected to qualitative content analysis. Results: Three themes were identified: a) Supporting one's wife; b) Marital needs and obligations; c) Constrained by a culture of destiny and shame. The first theme was built on men's feelings of responsibility for the family's health and well-being, their experiences of encouraging their wives to seek health care and their providing counselling and instrumental support. The second theme emerged from men's views about other men's rejection of a wife inflicted by breast cancer, their own perceptions of diminished femininity due to mastectomy and their own concerns about protecting the family from the hereditary risk of breast cancer. The third theme was seen in men's perception of breast cancer as an inevitable act of God that is far away from one's own family, in associating breast cancer with improper behaviour and in their readiness to face the culture of Eib (shame). Conclusions: Jordanian men perceive themselves as having a vital role in supporting, guiding and encouraging their wives to follow breast cancer early detection recommendations. Breast health awareness campaigns could involve husbands to capitalize on family support.

    Download full text (pdf)
    fulltext
  • 21. Taha, Hana
    et al.
    Al-Qutob, Raeda
    Nystrom, Lennarth
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Berggren, Vanja
    "Voices of Fear and Safety" Women's ambivalence towards breast cancer and breast health: a qualitative study from Jordan2012In: BMC Women's Health, E-ISSN 1472-6874, Vol. 12, p. 21-Article in journal (Refereed)
    Abstract [en]

    Background: Breast cancer is the leading cause of cancer mortality among Jordanian women. Breast malignancies are detected at late stages as a result of deferred breast health-seeking behaviour. The aim of this study was to explore Jordanian women's views and perceptions about breast cancer and breast health. Methods: We performed an explorative qualitative study with purposive sampling. Ten focus groups were conducted consisting of 64 women (aged 20 to 65 years) with no previous history and no symptoms of breast cancer from four governorates in Jordan. The transcribed data was analysed using latent content analysis. Results: Three themes were constructed from the group discussions: a) Ambivalence in prioritizing own health; b) Feeling fear of breast cancer; and c) Feeling safe from breast cancer. The first theme was seen in women's prioritizing children and family needs and in their experiencing family and social support towards seeking breast health care. The second theme was building on women's perception of breast cancer as an incurable disease associated with suffering and death, their fear of the risk of diminished femininity, husband's rejection and social stigmatization, adding to their apprehensions about breast health examinations. The third theme emerged from the women's perceiving themselves as not being in the risk zone for breast cancer and in their accepting breast cancer as a test from God. In contrast, women also experienced comfort in acquiring breast health knowledge that soothed their fears and motivated them to seek early detection examinations. Conclusions: Women's ambivalence in prioritizing their own health and feelings of fear and safety could be better addressed by designing breast health interventions that emphasize the good prognosis for breast cancer when detected early, involve breast cancer survivors in breast health awareness campaigns and catalyse family support to encourage women to seek breast health care.

    Download full text (pdf)
    fulltext
  • 22. Taha, Hana
    et al.
    Halabi, Yara
    Berggren, Vanja
    Jaouni, Salma
    Nyström, Lennarth
    Al-Qutob, Raeda
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Educational Intervention to Improve Breast Health Knowledge among Women in Jordan2010In: Asian Pacific Journal of Cancer Prevention, ISSN 1513-7368, Vol. 11, no 5, p. 1167-1173Article in journal (Refereed)
    Abstract [en]

    Background: Breast cancer is the most common cancer among women in Jordan and on average 70% of the cases present at advanced stages. The aim of this study was to assess the effectiveness of a public educational campaign conducted by the Jordan Breast Cancer Program to improve breast health knowledge among Jordanian women and to relate their knowledge to breast health practices. Methods: The campaign was conducted in five governorates in Jordan with a total of 105 public group lectures about breast cancer focusing on early detection. The total number of participants was 2,554 women with a median age of 37 years (range: 15-73 years). Median number of women per lecture was 24 (range: 9-38). Before the lectures, the women answered a structured questionnaire about their knowledge and practices. After the intervention 2,418 of them filled a post-test questionnaire with the same content. Correct answers on the 15 knowledge questions yielded a maximum score of 15. Determinants of breast health practices were identified using multivariable logistic regression analysis. Results: The mean knowledge score increased significantly from 10.9 in the pre-test to 13.5 in the post-test (p < 0.001). The percentage with a minimum of 14 correct answers to the 15 questions increased from 18 to 63% (p < 0.001). Adequate breast health practices were generally low but increased significantly with increasing age and attendance at a previous lecture on breast cancer. Breast health practices were also higher among married women and housewives, and significantly associated with older age and greater breast health knowledge (p < 0.001). Conclusions: Group educational lectures appeared effective for improving breast health knowledge among Jordanian women. However, even with the noticeable level of knowledge at the baseline, there were low breast health practices among the study participants. This necessitates further in-depth research to explore womens experiences and socio-cultural barriers to breast health seeking behaviour in Jordan.

  • 23. Taha, Hana
    et al.
    Nyström, Lennarth
    Al-Qutob, Raeda
    Berggren, Vanja
    Esmaily, Hamideh
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Home visits to improve breast health knowledge and screening practices in a less privileged area in Jordan2014In: BMC Public Health, E-ISSN 1471-2458, Vol. 14, article id 428Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breast cancer is the most common cancer afflicting women in Jordan. This study aimed to assess the effects of an educational intervention through home visits, including offering free mammography screening vouchers, on changing women's breast health knowledge and screening practices for early detection of breast cancer in a less privileged area in Jordan.

    METHODS: Two thousand four hundred breast health awareness home visits were conducted and 2363 women aged 20-79 years (median: 41) answered a pre-test interview-administrated questionnaire to assess their breast health knowledge and practices at the baseline. After a home-based educational session, 625 women aged 40 years or older were referred to free mammography screening. Five hundred and ninety six homes were revisited six months later and out of these 593 women participated in a post-test. The women's retained breast health knowledge, the changes in their reported breast health practices and their usage of the free mammography voucher, were assessed.

    RESULTS: The mean knowledge score increased significantly (p < 0.001) from 11.4 in the pre-test to 15.7 in the post-test (maximum score: 16). At the six month follow-up the post-test showed significant (p < 0.001) improvement in women's perceived breast self-examination (BSE) knowledge, reported BSE practice and mammography screening. Out of 625 women that received a voucher for free mammography screening 73% attended the mammography unit, while only two women without a voucher went for mammography screening at the assigned unit. Women who received a follow-up visit were more likely to use the free mammography voucher compared to those who were not followed-up (83% vs. 67%; p < 0.001).

    CONCLUSIONS: Home visits by local community outreach workers that incorporated education about breast cancer and breast health in addition to offering free mammography screening vouchers were effective in improving women's breast health knowledge and practices in a less privileged area in Jordan.

  • 24.
    Vægter, Keld
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    General practitioners' awareness of their own drug prescribing profiles after postal feedback and outreach visits2012In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 4, p. 439-444Article in journal (Refereed)
    Abstract [en]

    Background. General practice accounts for the vast majority of drug prescribing in the Nordic countries. Various methods have been used to promote rational drug prescribing. Awareness of own prescribing profile may be a first crucial step in the quality assessment and improvement process. Aim of the study. To analyse awareness among general practitioners of their drug prescribing profile during two outreach visits one year apart. Methods. All 94 practices with a total of 166 general practitioners in the former Storstrom County, Denmark, were invited to participate in a project launching outreach visits led by a general practitioner; 88 practices with 160 general practitioners agreed to participate. Results. During the first round of outreach visits the general practitioners were asked to rate their own prescribing level of 13 major drug groups as being in the lowest 25%, the middle 26%74%, or the highest 25% of the distribution across all 88 practices. The result was better than chance (chi-square 337, 4 df, r 0.37, both P < 0.0001). After the assessment a one-hour discussion on rational drug prescribing was held. One year later a new round of outreach visits was held. This time the assessment accuracy was generally greatly improved (chi-square 724, 4 df, r 0.48, both P < 0.0001). The main determinants for the improved accuracy during the second round were high accuracy during the first round, and the number of general practitioners in the practice. Conclusions. General practitioners' awareness of their prescribing volumes was substantially improved by a single outreach visit with discussion on rational drug prescribing.

1 - 24 of 24
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf