Patient education to support self-management of patients with mental illness

This study explores areas which need to be improved to develop the quality of patient education to support self-management of patients with mental illness in psychiatric hospitals. The study was conducted in five phases during the period 2000 – 2007. First, patients‘ (n = 313) satisfaction with patient education were investigated. Second, patients' (n = 51) experiences of patient education were explored. Third, a national survey was conducted to investigate realisation of patient education from the staff (n = 55) viewpoint. Fourth, outcomes of patient education were investigated by evaluating the impacts of different patient education methods on patients‘ (n = 311) attitudes towards medication, knowledge level and importance of information. Fifth, patients‘ (n = 16) perceptions of different patient education methods were explored. Patients reported poor satisfaction with patient education (Phase I), and they have considerable need to receive information during their hospital stay (Phase II). Described by staff, the content of patient education covered almost all informational areas investigated. However, discrepancies related to the realisation of patient education were found. (Phase III.) Evaluation of different patient education methods indicate that patients derived benefits from structured patient education with supportive methods (Phase IV) and patients also perceived that these methods supported their information receiving (Phase V). In order to improve the quality of patient education to support self-management of patients with mental illness patient education should be systematically and individually provided to all patients by using different educational methods. Realisation of this should be ensured by providing written instructions, improving nurses‘ knowledge and skills as well ensuring operating conditions.

Internet-based breast cancer patient’s pathway as an empowering patient educational tool

This three-phase study was conducted to examine the effect of the Breast Cancer Patient’s Pathway program (BCPP) on breast cancer patients’ empowering process from the viewpoint of the difference between knowledge expectations and perceptions of received knowledge, knowledge level, quality of life, anxiety and treatment-related side effects during the breast cancer treatment process. The BCPP is an Internet-based patient education tool describing a flow chart of the patient pathway during the breast treatment process, from breast cancer diagnostic tests to the follow-up after treatments. The ultimate goal of this study was to evaluate the effect of the BCPP to the breast cancer patient’s empowerment by using the patient pathway as a patient education tool. In phase I, a systematic literature review was carried out to chart the solutions and outcomes of Internet-based educational programs for breast cancer patients. In phase II, a Delphi study was conducted to evaluate the usability of web pages and adequacy of their content. In phase III, the BCPP program was piloted with 10 patients and patients were randomised to an intervention group (n=50) and control group (n=48). According to the results of this study, the Internet is an effective patient education tool for increasing knowledge, and BCPP can be used as a patient education method supporting other education methods. However, breast cancer patients’ perceptions of received knowledge were not fulfilled; their knowledge expectations exceed the perceived amount of received knowledge. Although control group patients’ knowledge expectations were met better with the knowledge they received in hospital compared to the patients in the intervention group, no statistical differences were found between the groups in terms of quality of life, anxiety and treatment-related side effects. However, anxiety decreased faster in the intervention group when looking at internal differences between the groups at different measurement times. In the intervention group the relationship between the difference between knowledge expectations and perceptions of received knowledge correlated significantly with quality of life and anxiety. Their knowledge level was also significant higher than in the control group. These results support the theory that the empowering process requires patient’s awareness of knowledge expectations and perceptions of received knowledge. There is a need to develop patient education to meet patients’ perceptions of received knowledge, including oral and written education and BCPP, to fulfil patient’s knowledge expectations and facilitate the empowering process. Further research is needed on the process of cognitive empowerment with breast cancer patients. There is a need for new patient education methods to increase breast cancer patients’ awareness of knowing.

Implementation of educational change in Finland: The case of the undivided basic education reform

For the past decades, educational large-scale reforms have been elaborated and implemented in many countries and often resulted in partial or complete failure. These results brought researchers to study policy processes in order to address this particular challenge. Studies on implementation processes brought to light an existing causal relationship between the implementation process and the effectiveness of a reform. This study aims to describe the implementation process of educational change in Finland, who produced efficient educational reforms over the last 50 years. The case study used for the purpose of this study is the national reform of undivided basic education (yhtenäinen peruskoulu) implemented in the end of the 1990s. Therefore, this research aims to describe how the Finnish undivided basic education reform was implemented. This research was carried out using a pluralist and structuralist approach of policy process and was analyzed according to the hybrid model of implementation process. The data were collected using a triangulation of methods, i.e. documentary research, interviews and questionnaires. The data were qualitative and were analyzed using content analysis methods. This study concludes that the undivided basic education reform was applied in a very decentralized manner, which is a reflection of the decentralized system present in Finland. Central authorities provided a clear vision of the purpose of the reform, but did not control the implementation process. They rather provided extensive support in the form of transmission of information and development of collaborative networks. Local authorities had complete autonomy in terms of decision-making and implementation process. Discussions, debates and decisions regarding implementation processes took place at the local level and included the participation of all actors present on the field. Implementation methods differ from a region to another, with is the consequence of the variation of the level of commitment of local actors but also the diversity of local realities. The reform was implemented according to existing structures and values, which means that it was in cohesion with the context in which it was implemented. These results cannot be generalized to all implementation processes of educational change in Finland but give a great insight of what could be the model used in Finland. Future studies could intent to confirm the model described here by studying other reforms that took place in Finland.

Implementation of educational change in Finland: The case of the undivided basic education reform

For the past decades, educational large-scale reforms have been elaborated and implemented in many countries and often resulted in partial or complete failure. These results brought researchers to study policy processes in order to address this particular challenge. Studies on implementation processes brought to light an existing causal relationship between the implementation process and the effectiveness of a reform. This study aims to describe the implementation process of educational change in Finland, who produced efficient educational reforms over the last 50 years. The case study used for the purpose of this study is the national reform of undivided basic education (yhtenäinen peruskoulu) implemented in the end of the 1990s. Therefore, this research aims to describe how the Finnish undivided basic education reform was implemented. This research was carried out using a pluralist and structuralist approach of policy process and was analyzed according to the hybrid model of implementation process. The data were collected using a triangulation of methods, i.e. documentary research, interviews and questionnaires. The data were qualitative and were analyzed using content analysis methods. This study concludes that the undivided basic education reform was applied in a very decentralized manner, which is a reflection of the decentralized system present in Finland. Central authorities provided a clear vision of the purpose of the reform, but did not control the implementation process. They rather provided extensive support in the form of transmission of information and development of collaborative networks. Local authorities had complete autonomy in terms of decision-making and implementation process. Discussions, debates and decisions regarding implementation processes took place at the local level and included the participation of all actors present on the field. Implementation methods differ from a region to another, with is the consequence of the variation of the level of commitment of local actors but also the diversity of local realities. The reform was implemented according to existing structures and values, which means that it was in cohesion with the context in which it was implemented. These results cannot be generalized to all implementation processes of educational change in Finland but give a great insight of what could be the model used in Finland. Future studies could intent to confirm the model described here by studying other reforms that took place in Finland.

Parental influences and mothers’ experiences on infant and young child feeding practices

The objective of this thesis was to better understand how parental factors influence feeding practices, how mothers experience feeding and what factors mothers perceive influencing feeding in different contexts. This study is largely based on STEPS Study (Steps to Healthy Development of Children), which is a longitudinal cohort of 1797 families. In addition, qualitative data was collected among mothers in Finland and Solomon Islands. The results of this study show that different parental determinants associate with infant and young child feeding behavior and practices. Mothers with high cognitive restraint of eating introduced complementary foods earlier and neophobic mothers’ breastfed exclusively for a shorter time than mothers who ranked lower in these behaviors. Fathers’ poor diet quality associated with shorter total breastfeeding duration. Mothers’ postnatal depressive symptoms associated with shorter duration of exclusive breastfeeding, earlier introduction of complementary foods and lower compliance of feeding recommendations. The higher amount of marital distress associated with longer duration of exclusive breastfeeding and better compliance with feeding recommendations. Mothers, who participated in qualitative interviews, described how complex interplay of individual perceptions, significant others and socio-cultural environment influenced feeding practices and behavior. This study showed that several parental factors influence infant and young child feeding practices as well as compliance with the feeding recommendations. Maternal experiences and perceptions on child feeding relate to the context where mother-infant pair lives in. These results highlight the importance of targeting feeding support and, if needed, specific interventions to mothers and families who are in risk of poor feeding practices.