Dissertations / Theses on the topic 'Primary prevention – methods'

Abstract Although in Finland the incidence of maternal and neonatal mortality in labor is very low, labor carries some risks. This study focused on two major complications in labor: fetal asphyxia and maternal hemorrhage. The roles of fetal electrocardiographic ST-analysis (STAN) and pelvic artery embolization in the prevention and management of these complications were investigated. Intrapartum fetal monitoring aims at a timely detection of fetal hypoxemia. When non-selected parturients were randomly assigned to be monitored during labor either by STAN or conventional cardiotocography, no differences between the groups were detected in terms of neonatal outcome and operative delivery rates. Only the incidence of fetal blood sampling was lower in the STAN group. In the interpretation of the STAN tracings according to the guideline matrix provided by the STAN manufacturer, the interobserver agreement was moderate; in terms of clinical decision -making as to whether to intervene in the labor, this agreement varied from moderate to good among STAN-trained obstetricians. The aim of prophylactic pelvic artery occlusion balloon catheterization, with or without embolization, is to reduce hemorrhage in elective cesarean operations in patients with placenta accreta. Furthermore, pelvic arterial embolization may be performed post partum if bleeding continues after cesarean hysterectomy, or may serve as an alternative to hysterectomy. In the present study, pelvic artery catheterization and embolization did not reduce blood loss during cesarean delivery, nor did it decrease the need to perform hysterectomy in patients with placenta accreta. In the management of massive postpartum hemorrhage, pelvic artery embolization was most successful in patients with uterine atony, with a success rate of 75% in achieving hemostasis. However, the angiographic method included risk of complications, the most hazardous being thromboembolic complications. To conclude, STAN does not provide improvement in intrapartum fetal monitoring when compared to cardiotocography, but the need for fetal blood sampling is reduced. This may relate to the fact that subjective interpretation of STAN data is moderate at best. Prophylactic catheterization and embolization of pelvic arteries does not improve the surgical outcome of patients with placenta accreta. In the management of postpartum hemorrhage, pelvic artery embolization should be considered, especially in cases with uterine atony.

Violence is a leading cause of morbidity and mortality amongst young people. Public health approaches are now being increasingly utilised to reduce the risk of young peoples' involvement in violence. One such programme is Medics Against Violence (MAV), which aims to reduce pro-violent attitudes and enhance empathy in secondary school pupils. This thesis aims to investigate whether this approach can be effective in tackling youth violence in secondary school pupils. A mixed-methods approach was adopted to conduct both an outcome and process evaluation of MAV. Four schools took part in the outcome evaluation, which examined whether there was a change in attitudes towards violence or empathy in pupils receiving the MAV programme. The process evaluation consisted of focus groups with school pupils, and open-ended questionnaires and semi-structured interviews with MAV volunteers. There was a small but significant reduction in pro-violent attitudes immediately post-intervention. However, this was not sustained at three months and there was no significant increase in empathy scores. Pupils generally demonstrated anti-violent attitudes, although were more likely to support the use of reactive violence. The pupils appeared to enjoy and generally engage well with the programme. In particular, the use of real footage, interviews with those affected by violence and the Glasgow setting provided a sense of realism for the pupils. Moreover, pupils valued the opportunity to discuss the issues raised by MAV with the volunteers. Volunteers felt engagement was occasionally an issue in the most affluent areas. However, some volunteers adapted the programme to focus on victimisation prevention in the most affluent schools. Further development is therefore needed in terms of establishing who the programme is aimed at (i.e. potential victims or perpetrators), focusing on reactive violence and increasing the sustainability of its effects.

Introduction In primary care, clinicians are engaged in trying to help patients change their behaviour in order to prevent heart disease. The risk of heart disease is increased by lack of exercise; smoking and eating a high fat diet, all of which are modifiable lifestyle behaviours. The aim of the thesis is to explore the potential for the use of the Transtheoretical Stages of Change CTIM/SOC) model in primary care and consider how the findings can be utilised by clinicians helping patients to change unhealthy behaviour. Method There are three parts to this study; the first is a structured review which examines studies using the TIM/SOC behavioural model in primary care, both when the intervention is tailored to the stage of change and/or when it is used as an outcome/predictor measure. The second part examines the secondary data from a cardiovascular disease study ('Realising the potential of the family history in risk assessment and primary prevention of coronary heart disease in primary care' - ADDFAM) which used the TIM/SOC model, to see what change predictors could be found. The third part comprises a qualitative study using semi-structured interviews to identify the facilitators and barriers of behaviour change as experienced by individuals attempting to change their unhealthy behaviour to see if these could be explained in terms of the TIM/SOC model. Results • There appears to be validity in the basic premise of moving through the stages of change which spanned the three distinct sources of evidence. However, in the interview data, no-one spoke in terms of a timeframe except for a social occasion or in terms of life priorities, which throws some doubt on the time-scales imposed on change process in the TIM/SOC model. • There is mixed evidence for the TIM/SOC model either as an intervention, or an outcome/predictor measure, in particular, there is some doubt that movement through the stages of changes equates to actual behavioural change. • There was evidence to suggest that the TIM/SOC constructs are used in the process of change. However, there were identified differences to the processes as outlined in the model, in particular the helping relationships construct was found to be in use throughout the change process, rather than as the TIM/SOC suggests between the action and maintenance stage. Specific constructs for sustaining behavioural changes are not covered under the TIM/SOC model and their inclusion may be helpful for the maintenance stage of the behaviour change. Additional constructs that may be useful to consider in the model include denial/fatalism; psychological aspects and demographic data. XlI Conclusions By triangulating the structured review with the ADDFAM study database results and findings from the qualitative interviews, this study has highlighted both positive and negative aspects of the TIMjSOC model for use in primary care. Suggestions are made for changes to the model that could be evaluated in future research and these include: comparing the TIMjSOC model against the PAPM (a non-timeframe model); inclusions of additional constructs for denial/fatalism; demographic details and psychological factors. The helping relationships construct should be expanded for use across all stages of change and specific new constructs evaluated for sustaining the change. In addition the similarities and differences between the constructs of self-efficacy and control should be explored and evaluated. The findings identified in the thesis have highlighted some areas that clinicians can focus on in primary care to help patients to change their unhealthy behaviours. Xlll

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
This paper proposes a technological solution using a predictive analysis model to identify and reduce the level of risk for type 2 diabetes mellitus (T2DM) through a wearable device. Our proposal is based on previous models that use the auto-classification algorithm together with the addition of new risk factors, which provide a greater contribution to the results of the presumptive diagnosis of the user who wants to check his level of risk. The purpose is the primary prevention of type 2 diabetes mellitus by a non-invasive method composed of the phases: (1) Capture and storage of risk factors; (2) Predictive analysis model; (3) Presumptive results and recommendations; and (4) Preventive treatment. The main contribution is in the development of the proposed application.
Revisión por pares

Bakgrund: Hjärt- och kärlsjukdomar är ett globalt växande folkhälsoproblem som dessutom är en ekonomisk last på samhället. Forskning har uppskattat att majoriteten av dödsfall kommer att bero på hjärt- och kärlsjukdomar vid år 2030. Några riskfaktorer för att utveckla hjärt- och kärlsjukdom är ett högt BMI, rökning och låg fysisk aktivitet. Forskning har visat att primärpreventivt arbete med livsstilsförändringar är något som minskar riskfaktorerna och är kostnadseffektivt för samhället. Syftet: var att beskriva vilka primärpreventiva metoder sjuksköterskan använder för att uppmuntra till livsstilsförändringar hos patienter med risk för  hjärt- och kärlsjukdom samt att beskriva hur dessa primärpreventiva metoder påverkar riskfaktorerna. Syftet var också att beskriva urvalsgrupperna i de valda vetenskapliga artiklarna. Metod: För att besvara syftet och frågeställningarna hade denna litteraturstudie en beskrivande design där tolv vetenskapliga artiklar har analyserats. Databaserna PubMed och CINAHL användes vid sökningen för att finna de vetenskapliga artiklarna. Resultat: Sjuksköterskor använde olika metoder för att uppmuntra till livsstilsförändring hos hjärt- och kärlsjuka patienter. Dessa metoder innebar att sjuksköterskan antingen fungerar som en informationsgivare eller samarbetspartner gentemot patienten. Effekten av metoderna varierade och enligt vissa studier gav de ej gav någon effekt. Slutsats: Utifrån litteraturstudiens resultatet går det ej med säkerhet att säga vilka metoder som är mest effektiva. Sammanfattningsvis kan sjuksköterskan i sitt kliniska arbete ta hänsyn till båda förhållningssätt i mötet med patienterna och anpassa metoden utifrån ett individuellt perspektiv.
Background: Coronary heart disease is a growing health issue from a global perspective. Research has estimated that coronary heart disease will stand for the majority of deaths by the year 2030.  Risk factors include a high BMI, smoking and low level physical activity. Research has also shown that lifestyle change can decrease the risk factors and is cost-effective for the society. Aim: The aim with the litterature study was to describe which primary prevention methods nurses use to encourage lifestyle change for patients at  risk of developing coronary heart disease, and to describe how these methods affect the risk factors. The purpose was also to describe the sample groups in the chosen articles. Method: To answer the study questions, the literature study had a descriptive design where twelve scientific articles were analysed and categorized. The databases PubMed and CINAHL were used to find the scientific articles. Results: Nurses use an array of different methods to encourage life style change in patients with coronary heart disease. These methods include the nurse either acting as a information giver or a collaboration partner towards the patient. The effect of these methods varied and some of the studies didn’t show any effect whatsoever. Conclusion: On the basis of the literature study, the methods nurses use and their effectiveness are inconclusive. In conclusion, the nurse can consider all of the methods in the work place, and decide which method is adequate based on the individual variations of the patients.

Reducing intimate partner violence levels in southern Africa is a necessary component of an effective HIV primary prevention strategy. A prerequisite to behaviour change is a shift in attitudes. This study sought to identify effective ways of assessing and changing attitudes and behaviours towards IPV to prevent HIV infection in a developing country context. Combining a systematic review of current evidence with advanced statistical analyses of data from a southern Africa regional household survey (n = 20,639), Soul City Regional Evaluation Phase 1, findings indicate that: a gold standard to measure IPV attitudes and behaviours is needed; interventions targeting structural change and based in the community are more effective; the effectiveness of mass media interventions may not be robust; the interaction of different prevention interventions may mediate overall effectiveness. Exploratory factor analysis, multiple imputation, and regression techniques were applied to complex, multileveled, and correlated data with missingness.

Introduction: Obesity is widely regarded as one of the biggest public health problems in the UK today. Policy suggests more can be done in primary care to support adults with obesity, particularly identifying and referring individuals with “high risk” obesity (obesity with co-morbidities) to weight management services. The aims of this thesis were to examine the role of primary care in the management of adults with co-morbid obesity; to understand the barriers facing patients and practitioners in accessing NHS adult weight management services via primary care; and to explore theory-driven, evidence-based interventions targeted at primary care practitioners to improve the management of co-morbid obesity. Methods: This was a mixed methods study, integrating qualitative and quantitative approaches. There were 4 phases of research in this thesis: Phase 1) Semi-structured interviews with 9 senior dietitians involved in planning and delivery of adult weight management in Scotland; Phase 2) A realist review of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity; Phase 3) Analysis of 9,677 GP referrals to the largest NHS weight management service in Scotland, the Glasgow and Clyde Weight Management Service (GCWMS); Phase 4) Analysis of interviews with 20 patients who had been referred to GCWMS, as well as 17 primary care practitioners (GPs and practice nurses) from referring practices. Key results: Phase 1) identified that there is no consensus among key stakeholders (senior dietitians) about the role of primary care in adult weight management, with a number of tensions apparent related to who should be doing what, where, and how. Phase 2) found 12 mechanisms that were characteristic of successful interventions targeting primary care practitioners, many of which could be activated by improving communication between primary care and weight management services. A number of important contextual factors that influence these interventions were also identified, at micro (individual/interpersonal), meso (institutional) and macro (infrastructural) levels. Phase 3) found that roughly a third (n=3250, 33.6%) of 9,677 adults with obesity referred to GCWMS attended at least one session. The likelihood of attendance increased with age, BMI category, and increasing affluence. Practice-level characteristics that were most strongly associated with attendance were being a non-training practice, having a larger list size, and not being in the most deprived areas. Phase 4) helped to explain some of this variation in attendance, related to geographical and structural barriers, particularly for working adults and those from areas of high socio-economic deprivation. An expanded conceptual model of candidacy theory is proposed, advancing our understanding of access to weight management. Conclusion: GPs and practice nurses are well placed to discuss weight and related health issues and to refer patients to further sources of support. This support should ideally be local, familiar, and relatively quick and easy to access, particularly important in areas of high socio-economic deprivation, which have the highest proportion of referrals to GCWMS but the lowest likelihood of attendance. To improve the identification and referral of adults with obesity, future interventions should consider training of practitioners, audit/feedback on referrals, and tools to aid both identification (e.g. automatic BMI calculators, posters in waiting area) and referral. To improve attendance following referral, however, greater emphasis needs to be placed on improved communication between weight management services and primary care, and improved accessibility of services.

Thesis submitted in fulfilment of the requirements for the degree Master of Education in the Faculty of Education and Social Sciences at the Cape Peninsula University of Technology 2014
This study aimed to determine learners' understanding and experiences of the different types of bullying and to examine the extent of bullying and roles they have been exposed to in various types of bullying. The research question was: What are primary school learners. understanding and experiences of bullying? Literature indicates that bullying can be executed in direct and indirect forms (Olweus, 1993:10; Boulton et al., 2002:354; Hunter & Boyle, 2002:324; Piskin, 2003:556; Lee, 2004:9). Direct bullying can be defined as relatively open attacks on a victim (Boulton et al., 2002:354) that are carried out face to face and may include pushing, kicking and fighting (Lee, 2004:10). Indirect bullying can be defined as being more subtle and less direct (Boulton et al., 2002:354) and will include behaviour such as social isolation and exclusion from a group. This study used the Olweus Intervention Method (1995), which offers a theoretical framework that could help the researcher find meaning in respect of the roles of the bully, victim and bystander. Urie Bronfenbrenner.s ecological theory (Bronfenbrenner,1998:993-1027) of human development was used as a lens for understanding bullying. Bronfenbrenner places child development within four different interacting levels, for example, the microsystem, mesosystem, exosystem and macrosystem (Sigelman & Schaffer, 1995:87). The researcher used a mixed-method research design as it could provide a better understanding of how learners understand their experiences of bullying . whether they were the victim, bully or witness. The total sample comprised 296 Intermediate Phase learners. The study began with a quantitative method, testing the understanding of concepts, and using a questionnaire for learners, and thereafter concluded with a qualitative method comprising a small number of learners (interviews with a focus group), exploring their experiences of bullying. The quantitative data was analysed by means of descriptive statistics to present simple summaries about the sample and the measures. The responses were recorded in frequency tables and percentages were calculated to determine general trends. The qualitative data was systematically organised into themes and patterns to bring meaning to the themes by telling a story. Information obtained from respondents was treated as highly confidential and the research findings were presented with integrity. The results indicated that most learners have not been exposed to bullying as victims, although a high number of incidences were reported. Older boys were mostly involved in incidences of physical violence. Of significance is the fact that the main kind of bullying was that of emotional bullying. Table 4.7 shows that mostly boys are teased (37.0%), while Table 4.16 shows teasing others mostly occurs between learners of the same age (30.4%). On the other hand, Table 4.17 reveals that mostly girls are prone to spread rumours about others (17.5%) of the same age as themselves (26%) and fall prey to this type of emotional bullying.

My diploma thesis is about prevention of the most risky behaviour on primary school which is bullying. Prevention is presented through the methods and strategie sof drama education. In the theoretical section acquaints readers with important informations of bullying and substance of drama in education, which are the basis for a comprehensive understanding of this issue. The theoretical part is also the basis for creating bullying prevention project using the methods and strategies of drama education, presented and reflected in the practical part. The practical part is also the result of a questionnaire, which is focused on opinion surveys of teachers of primary schools to prevent bullying and the use of methods and techniques of drama in this issue. KEYWORDS: Drama in Education, methods and strategies, risky behaviour, bullying, prevention, classroom, primary school

School prevention methodist plays a key role in the successful elimination of risky behavior in the school environment. His function has undergone changes since its establishment, as has the context of its operation. This thesis is focused on the process of generating the position of a prevention methodist and the changes that have affected his current position. It also outlines current issues related to the performance of the function of school preventionist. The theoretical part presents the current legislative framework in which the school prevention methodist operates, as well as earlier legislation, and draws attention to the possible pitfalls of some legal norms. It also places the person of the ŠMP in the intra-ministerial system of school prevention and more broadly in the inter-ministerial organization of prevention. For a better understanding of the current situation, the theoretical part of the work opens a look into the history of prevention in the Czech Republic, or ČSFR, respectively. It characterizes the basic concepts associated with the person of the school prevention methodist, ie primary prevention, risk behavior, etc. The essential part is devoted to a broader understanding of the role of school prevention methodist through a look at the development of his function and the...

The implementation of Electronic Medical Records (EMRs) may lead to improved quality of primary health care. To investigate this, we conducted a mixed methods study of eighteen Toronto family physicians who implemented EMRs in 2006 and nine comparison family physicians who continued to use paper records. We used a controlled before-after design and two focus groups. We examined five preventive services with Pay for Performance incentives: Pap smears, screening mammograms, fecal occult blood testing, influenza vaccinations and childhood vaccinations. There was no difference between the two groups: after adjustment, combined preventive services for the EMR group increased by 0.7% less than for the non-EMR group (p=0.55, 95% CI -2.8, 3.9). Physicians felt that EMR implementation was challenging.

RESUMO: A Nigéria tem uma população estimada em cerca de 170 milhões de pessoas. O número de profissionais de saúde mental é muito diminuto, contando apenas com 150 psiquiatras o que perfaz aproximadamente um rácio de psiquiatra: população de mais de 1:1 milhão de pessoas. O Plano Nacional de Saúde Mental de 1991 reconheceu esta insuficiência e recomendou a integração dos serviços de saúde mental nos cuidados de saúde primários (CSP). Depois de mais de duas décadas, essa política não foi ainda implementada. Este estudo teve como objetivos mapear a estrutura organizacional dos serviços de saúde mental da Nigéria, e explorar os desafios e barreiras que impedem a integração bem-sucedida dos serviços de saúde mental nos cuidados de saúde primários, isto segundo a perspectiva dos profissionais dos cuidados de saúde primários. Com este objetivo, desenvolveu-se um estudo exploratório sequencial e utilizou-se um modelo misto para a recolha de dados. A aplicação em simultâneo de abordagens qualitativas e quantitativas permitiram compreender os problemas relacionados com a integração dos serviços de saúde mental nos CSP na Nigéria. No estudo qualitativo inicial, foram realizadas entrevistas com listagens abertas a 30 profissionais dos CSP, seguidas de dois grupos focais com profissionais dos CSP de duas zonas governamentais do estado de Oyo de forma a obter uma visão global das perspectivas destes profissionais locais sobre os desafios e barreiras que impedem uma integração bem-sucedida dos serviços de saúde mental nos CSP. Subsequentemente, foram realizadas entrevistas com quatro pessoas-chave, especificamente coordenadores e especialistas em saúde mental. Os resultados do estudo qualitativo foram utilizados para desenvolver um questionário para análise quantitativa das opiniões de uma amostra maior e mais representativa dos profissionais dos CSP do Estado de Oyo, bem como de duas zonas governamentais locais do Estado de Osun. As barreiras mais comummente identificadas a partir deste estudo incluem o estigma e os preconceitos sobre a doença mental, a formação inadequada dos profissionais dos CPS sobre saúde mental, a perceção pela equipa dos CSP de baixa prioridade de ação do Governo, o medo da agressão e violência pela equipa dos CSP, bem como a falta de disponibilidade de fármacos. As recomendações para superar estes desafios incluem a melhoria sustentada dos esforços da advocacia à saúde mental que vise uma maior valorização e apoio governamental, a formação e treino organizados dos profissionais dos cuidados primários, a criação de redes de referência e de apoio com instituições terciárias adjacentes, e o engajamento da comunidade para melhorar o acesso aos serviços e à reabilitação, pelas pessoas com doença mental. Estes resultados fornecem indicações úteis sobre a perceção das barreiras para a integração bem sucedida dos serviços de saúde mental nos CSP, enquanto se recomenda uma abordagem holística e abrangente. Esta informação pode orientar as futuras tentativas de implementação da integração dos serviços de saúde mental nos cuidados primários na Nigéria.------------ABSTRACT: Nigeria has an estimated population of about 170 million people but the number of mental health professionals is very small, with about 150 psychiatrists. This roughly translates to a psychiatrist:population ratio of more than 1:1 million people. The National Mental Health Policy of 1991 recognized this deficiency and recommended the integration of mental health into primary health care (PHC) delivery system. After more than two decades, this policy has yet to be implemented. This study aimed to map out the organizational structure of the mental health systems in Nigeria, and to explore the challenges and barriers preventing the successful integration of mental health into primary health care, from the perspective of the primary health care workers. A mixed methods exploratory sequential study design was employed, which entails the use of sequential timing in the combined methods of data collection. A combination of qualitative and uantitative approaches in sequence, were utilized to understand the problems of mental health services integration into PHC in Nigeria. The initial qualitative phase utilized free listing interviews with 30 PHC workers, followed by two focus group discussions with primary care workers from two Local Government Areas (LGA) of Oyo State to gain useful insight into the local perspectives of PHC workers about the challenges and barriers preventing successful integration of mental health care services into PHC. Subsequently, 4 key informant interviews with PHC co-ordinators and mental health experts were carried out. The findings from the qualitative study were utilized to develop a quantitative study questionnaire to understand the opinions of a larger and more representative sample of PHC staff in two more LGAs of Oyo State, as well as 2 LGAs from Osun State. The common barriers identified from this study include stigma and misconceptions about mental illness, inadequate training of PHC staff about mental health, low government priority, fear of aggression and violence by the PHC staff, as well as non-availability of medications. Recommendations for overcoming these challenges include improved and sustained efforts at mental health advocacy to gain governmental attention and support, organized training and retraining for primary care staff, establishment of referral and supportive networks with neighbouring tertiary facilities and community engagement to improve service utilization and rehabilitation of mentally ill persons. These findings provide useful insight into the barriers to the successful integration of mental health into PHC, while recommending a holistic and comprehensive approach. This information can guide future attempts to implement the integration of mental health into primary care in Nigeria.

The M.A. thesis "The Prevention of hazardous Behaviour" researches the cooperation and interconnectedness of three professional groups and conducts a describes their experience and opinions in the field of child and youth risk-behaviour. The three (target) respondent groups are: primary school prevention methodists, OSPOD social workers and a group of professional lecturers of primary prevention of risk behaviour. The theoretical part introduces definitions and theoretical concepts of hazardous behaviour and types methods of their prevention. In its conclusion, the theoretical part summarizes of selected primary laws. The practical part of the thesis presents a summary and an analysis of data gathered through a survey among the respondent groups.

La mise en œuvre d’activités de prévention de la consommation de substances psychoactives (SPA) (tabac, alcool et cannabis) en milieu scolaire est une stratégie couramment utilisée pour rejoindre un grand nombre de jeunes. Ces activités s’inspirent, soit de programmes existant, soit d’innovations dictées par le contexte d’implantation ou l’existence de données de recherche. Dans un cas comme dans l’autre, l’évaluation de ces programmes représente la meilleure voie pour mesurer leur efficacité et/ou connaître comment ceux-ci sont implantés. C’est cet impératif qui a motivé une commission scolaire du Québec a recommandé l’évaluation de l’Intervention en Réseau (IR), un programme développé en vue de retarder l’âge d’initiation et de réduire la consommation problématique de SPA chez les élèves. Ce programme adopte une approche novatrice avec pour principal animateur un intervenant pivot (IP) qui assure le suivi des élèves de la 5e année du primaire jusqu’en 3e secondaire. Inspiré des modèles en prévention de la santé et de l’Approche École en santé (AES), le rôle de l’IP ici se démarque de ceux-ci. Certes, il est l’interface entre les différents acteurs impliqués et les élèves mais dans le cadre du programme IR, l’IP est intégré dans les écoles primaires et secondaires qu’il dessert. C’est cet intervenant qui assure la mobilisation des autres acteurs pour la mise en œuvre des activités. Cette thèse vise à rendre compte de ce processus d’évaluation ainsi que des résultats obtenus. L’approche d’évaluation en est une de type participatif et collaboratif avec des données quantitatives et qualitatives recueillies par le biais de questionnaires, d’entrevues, de groupes de discussion, d’un journal de bord et de notes de réunions. Les données ont été analysées dans le cadre de trois articles dont le premier concerne l’étude d’évaluabilité (ÉÉ) du programme. Les participants de cette ÉÉ sont des acteurs-clés du programme (N=13) rencontrés en entrevues. Une analyse documentaire (rapports et journal de bord) a également été effectuée. Cette ÉÉ a permis de clarifier les intentions des initiateurs du programme et les objectifs poursuivis par ces derniers. Elle a également permis de rendre la théorie du programme plus explicite et de développer le modèle logique, deux éléments qui ont facilité les opérations d’évaluation qui ont suivi. Le deuxième article porte sur l’évaluation des processus en utilisant la théorie de l’acteur-réseau (TAR) à travers ses quatre moments du processus de traduction des innovations (la problématisation, l’intéressement, l’enrôlement et la mobilisation des alliés), l’analyse des controverses et du rôle des acteurs humains et non-humains. Après l’analyse des données obtenues par entrevues auprès de 19 informateurs-clés, les résultats montrent que les phases d’implantation du programme passent effectivement par les quatre moments de la TAR, que la gestion des controverses par la négociation et le soutien était nécessaire pour la mobilisation de certains acteurs humains. Cette évaluation des processus a également permis de mettre en évidence le rôle des acteurs non-humains dans le processus d’implantation du programme. Le dernier article concerne une évaluation combinée des effets (volet quantitatif) et des processus (volet qualitatif) du programme. Pour le volet quantitatif, un devis quasi-expérimental a été adopté et les données ont été colligées de façon longitudinale par questionnaires auprès de 901 élèves de 5e et 6e année du primaire et leurs enseignants de 2010 à 2014. L’analyse des données ont montré que le programme n’a pas eu d’effets sur l’accessibilité et les risques perçus, l’usage problématique d’alcool et la polyconsommation (alcool et cannabis) chez les participants. Par contre, les résultats suggèrent que le programme pourrait favoriser la réduction du niveau de consommation et retarder l’âge d’initiation à l’alcool et au cannabis. Ils suggèrent également un effet potentiellement positif du programme sur l’intoxication à l’alcool chez les élèves. Quant au volet qualitatif, il a été réalisé à l’aide d’entrevues avec les intervenants (N=17), de groupes de discussion avec des élèves du secondaire (N=10) et d’une analyse documentaire. Les résultats montrent que le programme bénéficie d’un préjugé favorable de la part des différents acteurs ayant participé à l’évaluation et est bien acceptée par ces derniers. Cependant, le roulement fréquent de personnel et le grand nombre d’écoles à suivre peuvent constituer des obstacles à la bonne marche du programme. En revanche, le leadership et le soutien des directions d’écoles, la collaboration des enseignants, les qualités de l’IP et la flexibilité de la mise en œuvre sont identifiés comme des éléments ayant contribué au succès du programme. Les résultats et leur implication pour les programmes et l’évaluation sont discutés. Enfin, un plan de transfert des connaissances issues de la recherche évaluative est proposé.
Implementation of school-based substance use prevention activities is a widespread strategy to reach out to a significant number of young people. These activities are based either on existing programs or innovations dictated by the context of implantation or the existence of research data. In one case or another, evaluation of these programs is the best way to measure their effectiveness and/or to know how they operate. It is this need that motivated a school board in Quebec to recommend the evaluation of the Intervention Network (IR), a program developed to delay the age of substance use onset and to reduce problematic use of substances among students. This program takes an innovative approach with a patient navigator (PN) as the main implementation actor who keeps track of students from grade 5th to 9th. Inspired by such models in the fields of health prevention and the Healthy Schools Approach (HSA), the role of the PN here differs from those fields. S/he serves as an interface between the various stakeholders and students but in the IR program, the PN is integrated in primary and secondary schools involved in the program. The PN is also the one who ensures mobilization of other actors for the implementation of the program activities. This thesis aims to provide an account of the evaluation process and the results obtained. The evaluation approach is participatory and collaborative and combines both quantitative and qualitative data collected through questionnaires, interviews, focus groups, a logbook and meeting notes. Data were analyzed in the framework of three articles, the first being an evaluability assessment (EA) of the program. Participants of this EA are key-informants involved in the program implementation (n=13). A document review (report, logbook) was also conducted. The EA was helpful to clarify the intentions and objectives of the initiators of the program. It helped provide explicit information on the program theory and develop the logic model, two elements that facilitated subsequent evaluation operations. The second article is a process evaluation that uses Actor-Network Theory (ANT) as analytical framework, through the four moments of innovation translation (problematization, interessment, enrollment and mobilization of allies), controversies analysis, and the role of human and non-human actors. After analysis of the 19 interviews and available documents, results showed that the program implementation phases adequately follow the four moments of the ANT, that management of controversies by negotiation and support was needed for the mobilization of some human actors. This process evaluation also highlighted the role of non-human actors in the implementation process. The last article is a combined evaluation of the effects (quantitative component) and the process (qualitative component) of the program. For the quantitative component, a quasi-experimental design was used and data were collected longitudinally by questionnaires from 901 students of 5th and 6th grades and their teachers from 2010 to 2014. Data analysis indicated that the program had no effect on the accessibility and perceived risk, problematic use of alcohol and use of both alcohol and cannabis among participants. On the other hand, results suggest that the program could help reduce the level of consumption and delay the age of onset of alcohol and cannabis. These results also suggest a potentially positive effect of the program on alcohol intoxication among students. As for the qualitative component, stakeholder interviews (N = 17) and focus groups with high school students (N = 10) were conducted. Program documents were also analyzed. Results of this second process evaluation showed that the program is highly viewed and positively appreciated by the different actors involved in the program. However, frequent staff turnover and the number of schools to follow can be obstacles to the smooth running of the program. Nevertheless, the leadership role and support from the principals, teacher’s collaboration, the quality of the PN and flexibility in the implementation process are identified as factors contributing to the success of the program. All the results and their implication for program implementation and evaluation are discussed. Finally, to ensure greater access to the results, this thesis concludes with a plan for transferring knowledge drawn from the evaluation research.

Text in English
Cervical cancer remains the leading cause of cancer mortality among women worldwide, a burden in the developing countries and commonly detected through symptoms at later invasive stages. The study aimed at establishing knowledge and awareness of the importance of cervical cancer screening in the Makhuduthamaga Sub-district by exploring the perceptions of women and professional nurses and through the review of the National Cervical Cancer Screening Policy (2013). Recommendations to address the gap in knowledge and to inform the National Cervical Cancer Screening Policy were developed based on the study findings. A mixed-method approach was used in this study through a sequential explanatory design, which is quantitatively driven was used. Quantitative data were obtained by using a researcher developed checklist. The checklist was developed from variables stated in the National Cervical Cancer Screening Policy and was used to review its implementation. Qualitative data was obtained through in-depth interviews with individual women and focus group discussions with professional nurses. The study was conducted in ten randomly selected clinics of Makhuduthamaga Sub-district. Purposive sampling was done to obtain qualitative data. An average score of 9.7 was obtained for all ten clinics that participated in the study with regard to the evaluation of the implementation of the National Cervical Cancer Screening Policy. Only 6 (60%) clinics implemented the policy whereas 4 (40%) clinics did not implement the policy. Women and professional nurses perceived cervical cancer screening as important. Lack of knowledge among women regarding cervical cancer screening contributed to the majority of women not screening for cervical cancer. Lack of resources, the 10 year interval of normal cervical cancer screening, the use of disposable vaginal speculums and brushes, lack of standardized cervical cancer screening training, centralization of cytology laboratories came out as factors that negatively influence the uptake of cervical cancer screening. Cervical cancer screening awareness campaigns, availability of resources and standardized in-service trainings on cervical cancer screening were recommended to enhance the cervical cancer screening uptake. Key concepts:
Health Studies
D. Litt. et Phil. (Health Studies)