Browsing by Subject "teoria"

Nonadherence has been a challenge in health care since ancient times, and it is still a major source of poor therapeutic outcomes today. Various theories and theoretical models have been applied to explain adherence. So far no single theory or theoretical model has proved comprehensive, and the effects of various interventions applied have been limited. Theorizing of adherence is still incomplete. The aim of this study was to review the theoretical background of adherence so far, and to find the commonalities in theories and theoretical models, but also to discover possible trends in them. Study material comprised 20 theories and theoretical models. Material was found in reference books and documents with an aspect of adherence. Inclusion criteria involved adult outpatients with chronic diseases, excluding any special groups such as pregnant women. Emphasis was on the relevance of the theory, but comprehensive time span as well as various theory views were also considered. A chronological order was created. A qualitative content analysis was conducted, where phrases describing essential theory contents were categorised into distinctive classes. The incidence of classes and the possible trends of the incidence were analysed. Five classes emerged as commonalities in majority of the theories: Patient factors; sociocultural factors; motivation; phrases that referred to a behavioral view; and cognitive processes. Factors that diminished towards this day were the pivotality of cognitive processes in theory, and the subjective view of the health threat. Several factors were found to increase towards present-day theories and models: phrases that described the individual’s agency, such as self-efficacy or empowerment, concrete expressions of the individual’s abilities, skills and actual opportunity to the desired behavior, phrases that consisted of behavior being a function of its context or environment, and phrases where multifaceted intervention or tailoring the intervention according to the change process phase were considered. The commonalities found in the material reflect its emphasis on psychological behavior theories. The changes reflect the shift in how the patient’s agency is viewed in a patient care relationship. Newer theories also amplify the importance of viewing health behavior change as a series of phases. To achieve patient-centered care, these aspects create an increasing demand to health care professionals’ proficiency in how they encounter their patients. Moreover, there is an important signal for future intervention development in the form of a shift into multifaceted interventions and a system approach. Furthermore, a trend exists from using more general and abstract theories to a more concrete and applied approach. In the future, it is probably more fruitful to pursue knowledge-based and validated models and guidelines that are applicable to practice instead of aiming at developing a comprehensive universal theoretical approach.

In this master’s thesis I examine transdisciplinarity in theory and practice. Transdisciplinarity is seen as an inevitable approach when we strive to understand and solve many of the complex problems of the modern world e.g. the environmental crisis. For this reason it has also quickly increased in popularity in the research funding. With this premise and despite the diverse theory on transdisciplinarity the implementation in practice is often relatively flimsy. This gap between theory and practice has acted as a motivation to the thesis, in which I am interested in how the transdisciplinary expectations based on the theoretical ideals and set on the cross-disciplinary environmental research intersect with the realistic transdisciplinary advancements in the research programs. In addition, I am interested to know why the practice doesn’t meet the expectations. The thesis is solidly theory-oriented. First I shed light on the background, characteristics and motivations of transdisciplinarity as well as disciplines, after which I present an array of the complex challenges of transdisciplinarity. In the results section I examine the manifestations of the challenges on a practical level that is based on three environmental research programs organized over the course of 2011–2014 by HENVI, the Helsinki University Centre for Environment (now HELSUS). In addition to the qualitative analysis based on the interview data, the results section also examines theory on a more practical level of implementing transdisciplinary research programs in general. This presentation thus enables a closer dialogue between the analysis data and practical theory. The primary results of this thesis are five problematics that are the manifestations of theory not meeting the practice properly. They are organized into the themes of funding, knowledge production, administration, socio-culture and education and help to organize and ultimately face the challenges of transdisciplinary research. From a comprehensive set of perspectives the problematics display strongly the highly disciplinary nature of the modern academia. This is the most significant single reason for the difficulties to accomplish transdisciplinarity. In addition, all the five problematics reflect the temporal restrictions that also undermine the potential of an effective transdisciplinary interaction. The essential measures to create solutions and hence also the ideal implementation of transdisciplinarity are mainly beyond the focus of the thesis. However, the problematics provide a problem-based framework that strives to contribute to the further studies focused more profoundly on the actual solutions