Communication in Smoking Cessation and Self-management : a study at Nurse-led COPD-clinics in Primary Health Care

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

Consumer reactions to different forms of CSR communication

Aim Companies around the world are making sizeable investments into CSR initiatives, but ensuring appropriate returns on these investments remains challenging. Therefore, it is of value to study the communication of corporate CSR efforts. The purpose of this study is to investigate how consumers react to rational versus emotional message strategies in CSR communication. Two categories of consumer reactions were considered: trust and purchase intention. Methods Qualitative research with four focus groups was conducted. Participants discussed three texts regarding a CSR project, utilising a rational, emotional and a hybrid rational-emotional message strategy respectively. The conversations focused on trust towards the communication and purchase intention. Results Trust - All of the respondents viewed the rational text over the emotional text as more trustworthy, but they most positively reacted to the combined strategy. Rational information was viewed as more reliable by many participants, with emotional cues adding value by better holding their attention. Purchase intention – Participants more positively reacted to the rational CSR communication strategy, compared to an emotional strategy. For approximately half of respondents, the hybrid strategy targeting both rational and emotional cues was the most successful in terms of purchase intention. Upon further analysis, it was identified that this division in respondents’ opinions may reflect a gender difference, where men portrayed the more task oriented and women the socially sensitive consumers. Conclusions The findings support previous research championing the use of rational strategies over emotional strategies in CSR communication. A number of managerial implications that can be used by companies in order to better communicate their CSR activities and increase returns on CSR-related investments are provided.

Han, hon, höna? : En kvantitativ studie om attityder till det könsneutrala personliga pronomenet hen

Språk både reflekterar och påverkar vår världssyn. Hur mottas då försök från gräsrotsnivå att introducera ett könsneutralt pronomen i ett språk som speglar den i samhället rådande könsdikotomin? Syftet med denna uppsats är att utifrån Hirdmans och Butlers respektive genusteorier undersöka vilken inställning användare på ett stort svenskt internetforum har till det könsneutrala personliga pronomenet hen. Undersökningen genomfördes med hjälp av en internetbaserad enkät som besvarades av cirka 150 personer. För att analysera svaren till de slutna frågorna tog vi hjälp av statistikprogrammet SPSS och för att bearbeta de öppna frågorna har vi använt oss av en tematisk analys. Resultatet visar på starkt polariserade åsikter runt hen, där ungefär lika många personer är för som emot ordet. Bland dem som är emot användandet av hen uppfattar de flesta att syftet med ordet är att skapa ett könslöst samhälle, medan hen-förespråkarna ser det som ett komplement till hon och han. Vi har även kunnat se att det finns ett visst samband mellan individens attityd till hen och dennes syn på kön och genus, vilket bekräftar vår hypotes om att det finns en sådan korrelation.

Lek och empowerment : de alternativa rummens roll i sociala rörelser

Play and empowerment: the role of alternative spaces in social movements The article examines the role played by alternative space in social movements and argues that it plays a crucial role in counter-acting feelings of powerlessness and facilitating the empowerment of subaltern groups. Alternative space is defined – using Benjamin’s notions ofshock, nature and history – as constituted by forms of interaction in which society is made to appear as history. To facilitate empowerment, alternative space must, firstly, provide a place for subaltern groups in which they are no longer subordinated; secondly, instill hope that social change is possible and encourage such change; and, thirdly, expand or consolidate alternative space itself. These tasks can easily enter into conflict with each other, since they sometimes appear to require alternative space to adopt more ”abstract” forms of interaction in which aspects of the social situation are bracketed and sometimes more ”concrete”ones in which such aspects are again given attention. In order to study how movements may relate to this difficulty, the article looks at three contemporary Japanese social movements with NAM, New Start / New Start Kansai and the General Freeter Union as central organizations. Only the third successfully combines the three tasks, in large measure through its skillful use of the play-element.