The shortage of healthcare workers and doctors in the developing world compared to the developed world is a problem, and will continue to be so, due to the continual migration of qualified professionals and the inability of the state to remedy these shortfalls. A shortage of healthcare workers and specialist doctors will seriously hamper the Government’s National Health Insurance (NHI) plan, as well as the sustainability of the private health care sector. In addition, the duration of medical training in South Africa is exceptionally long. The three major hospital groups and other private corporates have over the last number of years taken limited initiative to fund education projects in conjunction with the academic institutions. However, these projects have been poorly focused and have been managed in an unstructured and detached manner. There is a desire from the private sector to get involved in these projects on a much larger scale through more formalised structures. Given this background, the primary objective of this research is to develop a business model for medical subspecialty training to complement the current academic subspecialty training in South Africa. A trial model for training subspecialists in reproductive medicine was developed as a first attempt to address the threatening shortages and training duration. This trial programme is the basis of this research. A two-phased process was used in collecting data. In Phase 1 data was collected from stakeholder groups. The results of this survey assisted in generating variables to include in the measuring instrument for the survey in Phase 2. In Phase 2 the perceptions and expectations of sub-specialists (reproductive subspecialists and cardiologists) regarding sub-specialty training was collected. The results of the demographic variables confirm the aging profile of subspecialist and the need to ensure succession. The results further showed that cardiologists and reproductive subspecialist expectations of the training of subspecialists are very similar except for their expectations on the training duration. Reproductive subspecialist respondents agreed more than cardiology subspecialist respondents that the training duration is too long. The biggest gap between perceptions and expectations is also with the factor training. The results showed that the expectations of subspecialists are not met for training. From these results a business model for the training of medical subspecialists is proposed. This proposed business model can play a complementary role to the existing state controlled system and form the bases of Public Private Partnerships (PPP) in medical training. This proposed business model will fit a developing country were the focus is on primary healthcare, with financial and capacity constraints. The proposed model would require role players to bring about change to accommodate a larger scale Public Private Partnership (PPP) to ensure the implementation of the model. The proposed decentralised business model for training subspecialists would allow the trainee subspecialist to practise as a specialist thus maintaining an acceptable income, and enable an expedited completion and lead to a wider dissemination of medical expertise that can be delivered in a wider national foot print. It further will provide for a structured Public Private Partnership.

This inquiry explored the everyday struggles of several women who worked as coordinators and instructors in three government-funded job-entry programs for women in the non-profit sector. The programs studied included an entry program for native women, a program which trained immigrant women in bookkeeping skills, and a program which trained women on social assistance to enter the construction trades. The work of the staff in these programs was considered in light of a theoretical framework developed by Nancy Fraser. Fraser has called for a different approach -- a more critical discourse-oriented inquiry -- to the study of social-welfare policies and programs. This approach focuses on the political struggle over the interpretation of needs, particularly women's needs, which she sees as central to social-welfare policy-making. In her study of the American system, she has found that "needs talk" is the medium through which inequalities are symbolically elaborated and challenged. She also has found that needs talk is stratified and differentiated by unequal status, power, and access to resources, and organized along lines of class, gender, race, ethnicity and age. For this study, information was collected through interviews with the staff in the three programs, observations of life skills classes, and examination of program proposals. Government and government-related documents were also examined. The analysis revealed that, in the official policy documents at the national level, women’s needs were interpreted within a dominant policy framework which focused on reducing spending, matching workers to the market and privatizing training programs. Programs for women were developed based upon a "thin” understanding of women's needs -- one which focused on women’s lack of training and job experience and ignored the structural inequalities of the labour market and women’s different racial and class struggles. At the local level, analysis of the interviews, observations and documents indicated that the staff struggled to respond to the trainees' diverse and complex needs which the official policy discourse addressed in only a limited way. In their negotiations with the state, the staff employed a plurality of needs discourses, engaging in a process which both challenged and reproduced the dominant policy orientation toward getting women "jobs, any jobs”. There were moments of resistance by the staff to the dominant policy orientation, most notably in the program for native women. The trainees also challenged the narrow interpretation of women's needs, particularly in the program training women to enter the construction trades. Generally speaking, the analysis indicated that the staff played a crucial role in mediating between women and the state and in producing a kind of discourse which tended to construct the trainees as subjects needing to be "fixed". The analysis also revealed that the relationships between staff, trainees and the state were organized around unequal access to resources based on gender, race and class. In order to transcend the limitations outlined in this study, efforts are required to democratize decision-making, collectively organize the non-profit private sector, challenge privatization and the exploitive practices of the state, and bring alternative approaches which support participatory and dialogical processes of need interpretation. The analysis brings to light the importance of studying the implications of state policies on adult education practice, particularly policies which promote privatization. It also reveals the explanatory power of a feminist theoretical framework which provides a more critical, discourse-oriented approach to examining policy and practice, and the usefulness of this framework for further research and political advocacy. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

Individuals who are disadvantaged by low-income and/ or minority status face a number of barriers to experiencing optimal health and eating well. Twenty Aboriginal and 29 non-Aboriginal participants (N = 49) from Ottawa, Canada took part in a cross-sectional, mixed methods study and completed one questionnaire and single in-depth interview that verified: 1) food security status and household eating habits, 2) fruit and vegetable purchase and consumption, and 3) knowledge about or participation in the Good Food Box [GFB] Program. Ottawa GFB staff (n = 5), site coordinators (n = 6) and steering committee members (n = 3) took part in separate discussion groups to identify challenges and strengths related to program coordination, management and delivery. Within an ecological framework, qualitative data is discussed using a social phenomenological and thematic approach. Using χ2 analyses, results suggest a medium effect size and association between food security status and Aboriginal identity (χ2(1) = 8.04, p < 0.01; φ = 0.4) and satisfaction with how stores meet household food needs and gender (χ2(1) = 5.86, p < 0.05; φ = 0.36). A relationship between participation in the GFB Program and food security status (χ2(1) = 11.13, p < 0.01; φ = 0.48) is also shown where estimates suggest that GFB customers are 9.9 times more likely to be food secure compared to non-affiliates. ANOVA results and post-hoc tests demonstrate a significant mean difference in frequency of fruit consumption between GFB customers and non-program users (F(2, 46) = 11.29, p = 0.00) where 29.6% of the variance (ω2 = 0.296) is explained by program participation. Results-based and community-driven recommendations to improve access to healthy food, food security and the GFB Program are discussed as shared responsibilities between different levels of government across sectors and the community since these are public and social health issues, determinants of health and economic concerns. Implications of findings are also discussed.

Women treated for a gynecological cancer report longstanding post-treatment difficulties for which they rarely seek or receive help. Few intervention studies have successfully improved global sexual health within this population. Research in this domain is challenging due to inconsistent measurements of sexuality, low response rates and high attrition rates. The overarching study objectives were: (a) To contribute to the advancement of research on supportive care needs (including sexual health needs), desire for help, and predictors of needs; and, (b) To inform the development of services for gynecological cancer survivors. In Study 1, a qualitative interview study explored the experiences of 15 gynecological cancer survivors. Interviews were conducted and analysed based on the Interpretive Description approach . In Study 2 (for which results were analyzed in two parts), a descriptive, cross-sectional needs assessment was conducted to measure supportive care needs, desire for help, sexual health and vaginal changes, and service format preferences in 113 patients. In Part 1 of Study 2, descriptive and regression analyses explored patient needs, desire for help and potential predictors of these variables. In Part 2, a descriptive analysis explored sexual health needs and vaginal changes, desire for help with sexual health needs, and their associations with sociodemographic and medical variables. Qualitative results from Study 1 suggested that psychological, emotional and relational aspects of sexuality were as important to the participants as physiological sexual response. In the needs assessment, the strongest predictors of greater unmet needs and increased readiness for help were younger age and shorter time since treatment. Moderate to high sexual and social needs were equally prevalent in women recently treated and those treated several years prior to the study, suggesting that sexual and social needs may remain unaddressed over time. Further, many women who reported a need did not desire help, demonstrating the subjectivity of needs and distress, as well as the potential presence of barriers to seeking help. Both studies revealed a common finding, where sexual health needs were a product of the discordance between participants’ current sexual experiences and their perceptions of ideal sexual health. Overall, the two studies indicate that a significant subgroup of patients experience unmet needs in cancer survivorship, most of which are non-physical; also, while some needs were higher following treatment, unmet social and sexual health needs show little relationship with time since treatment. Ambivalence about receiving help with unmet needs is related to beliefs about the role of the health care team in meeting non-physical needs, as well as other perceived barriers. Patient’s perceived sexual health needs and barriers to receiving help should be evaluated within a comprehensive framework of needs and discussed one-on-one. Future research should explore the added predictive value of other groups of medical and psychological variables.

Respite Care programs for the elderly and their families are being recognized and developed within Long Term Care systems. Research on these programs is sparse and focused on outcome studies. Very little work has been published that addresses grounded theory building or exploratory needs assessments in the definition of need and objectives for respite care. This exploratory study addresses the issue of need for respite from two perspectives. Within an urban Canadian center, focused interviews were conducted with a sample of family caregivers in high risk situations. Case scenario questionnaires were distributed and focused interviews conducted with Long Term Care case Managers, content analysis was used to identify themes and issues from all data sources. The themes and categories that emerged from the data are discussed in relation to a system stimulation model and locus of control perspective as applied to understanding need and establishing program objectives and delivery patterns. Implications for needs assessments, program design, intervention, and future research are presented. / Arts, Faculty of / Social Work, School of / Graduate

BISTÅNDSHANDLÄGGARENS RESPEKT FÖR DEN ENSKILDE – ETT ÖNSKETÄNKANDE? Författare: Francisco Mauricio De Leon Gonzalez, Maria Huynh Mälardalens Högskola Akademin för hälsa, vård och välfärd Socionomprogrammet Examensarbete inom socialt arbete, 15 högskolepoäng Vårtermin 2020     Sammanfattning Syftet med studien är att beskriva biståndshandläggarnas handlingsutrymme och uppmärksamma dilemman som kan uppstå under biståndshandläggningen med äldre som har en demenssjukdom samt hur biståndshandläggarna uppfattar sitt handlingsutrymme. Författarna till studien önskade även belysa självbestämmanderättens roll under handläggningsprocessen mellan en biståndshandläggare och en äldre som har en demenssjukdom. För att besvara studiens syfte och frågeställningar använde sig författarna av en kvalitativ metod och genomförde sex semistrukturerade intervjuer. De semistrukturerade intervjuerna genomfördes bland fyra kommuner med sammanlagt sju biståndshandläggare inom äldreomsorgen som arbetar eller tidigare har arbetat med det. Författarna valde dessa informanter via ett målinriktat urval och använde de teoretiska perspektiven gräsrotsbyråkrati och konsekvensetik/utilitarismen. Resultatet visar att biståndshandläggare har skilda uppfattningar angående sitt handlingsutrymme och inställningar gentemot självbestämmanderätten. Olika dilemman kan uppstå i relation till den enskildes självbestämmanderätt och biståndshandläggarens handlingsutrymme, som biståndshandläggarna förhåller sig till på olika sätt. Vissa förhållningssätt riskerar att förbise den enskildes självbestämmanderätt mer än andra, i vilket anhöriga kan användas som stöd under biståndshandläggningen. / BISTÅNDSHANDLÄGGARENS RESPEKT FÖR DEN ENSKILDE – ETT ÖNSKETÄNKANDE? Authors: Francisco Mauricio De Leon Gonzalez, Maria Huynh Mälardalen University School of Health, Care and Social Welfare The Social Work Program Thesis in Social Work, 15 credits Spring term 2020     Abstract The aim of this study has been to describe care managers’ discretion and pay attention to dilemmas that can arise during the need assessment with an elderly who has dementia and how the care managers perceive their discretion. The authors of the study wished to illustrate the role of right to self-determination during the need’s assessment between a care manager and an elderly who has dementia. To answer the aim of this study as well as the research questions, a qualitative method with six semi-structured interviews has been carried out. The semi-structured interviews were held with seven care managers from elderly care who work or have previously worked with it, from four different municipalities. The authors chose the interviewees through a target selection and has used the theoretical perspectives of street-level-bureaucracy and consequence ethics/utilitarianism. The result indicates that the care manager has different perceptions regarding their discretion and attitudes towards the right to self-determination. Different dilemmas can arise in relation to the individuals´ right to self-determination and the care managers´ discretion, which the care managers´ relate to in different ways. Certain approaches risks disregarding the individual’s right to self-determination more than others, in which the individual’s relatives can be utilized as support during the need’s assessment.

<p><strong>Introduction. </strong>Treatment decisions for locally recurrent prostate cancer are difficult due to the number of available treatment options, varied evidence about their effectiveness and differences in side effects. It has been shown that decision aids improve information delivery and patient confidence in treatment decision-making.</p> <p><strong>Purpose.</strong> The purpose of this study was to identify and describe the decisional support needs of men with locally recurrent prostate cancer.</p> <p><strong>Methods.</strong> A two-phase descriptive needs assessment study employing both quantitative and qualitative methods was conducted to identify and describe the treatment decision-making needs of men with recurrent prostate cancer. Through a two-round Delphi process in Phase 1, physician consensus on treatment options for the decision aid was established. Phase 2 involved patient interviews to determine treatment decision-making needs.</p> <p><strong>Results.</strong> Oncologists and patients agreed that the treatment decision-making process took time, and may take several months. Some patients described feelings of regret and/or uncertainty about their treatment decision. Individualized patient needs for information and support were recognized. Key barriers to effective treatment decision-making included information overload and lack of access to unbiased information sources. Establishing a centralized information resource such as nurse-led information sessions was recommended by patients.</p> <p><strong>Conclusions.</strong> Treatment decision-making is time consuming for oncologists and patients. Despite these efforts, patients report unmet information needs and are not always confident in their treatment decision. Time efficient and effective ways of improving patient confidence in treatment decision-making, as well as implications for nursing practice and future research are discussed.</p> / Master of Science in Nursing (MSN)

<p><strong>Purpose</strong></p> <p>Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer death among Canadians. Little is known about the types of supportive care needs (SCNs) that patients with colon cancer experience during the diagnostic phase or whether these needs are met. To inform the development of population specific healthcare services, a needs assessment of patients with newly diagnosed advanced colon cancer was conducted to identify the types, prevalence, severity, and importance of unmet SCNs, as well as to identify any gaps between patient priority needs and their use of supportive care services.</p> <p><strong>Patients and Methods </strong></p> <p>A descriptive cross-sectional survey was conducted. Over one year, all newly diagnosed patients with colon cancer at the Juravinski Cancer Centre were screened for eligibility. Sixty-two of 80 eligible patients completed a self-report written questionnaire prior to starting treatment (response rate = 77.5%). The questionnaire included the Supportive Care Needs Survey-Short Form, Functional Assessment of Cancer Therapy-Colorectal and Health Service Utilization Questionnaire.</p> <p><strong>Results</strong></p> <p>‘Fears about the cancer spreading’ was the most prevalent unmet SCN (n = 52/62 or 84%). Unmet SCNs experienced by 65% or more of participants related to lack of control about treatment outcomes, the uncertain future, and concerns about family member well-being. Patients also rated these needs as being most severe.</p> <p>The two most severe CRC-specific concerns were related to ‘body appearance’ (Mean = 1.77, SD = 1.37) and ‘bowel control’ (Mean = 2.28, SD = 1.37). The most important or priority unmet needs were related to uncertainty about the future (43.5%), fatigue (24.2%), and information (22.6%). Less than 12% of participants had used existing supportive care services in the community.</p> <p><strong>Conclusion </strong></p> <p>Prevalent and priority unmet needs were related to psychosocial support and information. Recommendations for designing colon cancer-specific services are provided along with strategies to improve patient use of existing resources.</p> <p><strong> </strong></p> / Master of Science (MSc)

In our increasingly competitive world, it is critical that college graduates enter the workplace with the appropriate skills to not only survive but also grow their career. Current college graduates have not consistently acquired the skills needed for success in the workplace to learn and thrive continuously in our rapidly changing world. The Virginia Tech College of Agriculture and Life Science must identify the specific strategies that develop best the needed skills for the success of the graduate and society The purpose of the study was to identify a land grant college of agriculture and life sciences' (LGCALS) current programmatic and classroom strategies for developing students' ability to learn and thrive continuously in our rapidly changing world and a (1) explore programmatic strategies for developing students' ability to continuously learn and thrive; (2) explore innovative instructors classroom strategies for developing students' ability to learn and thrive continuously; (3) describe graduates perceptions of career readiness as measured through the bases of competence inventory, and finally; (4) compare programmatic strategies, classroom strategies and graduates' perceptions for career readiness. A mixed methods convergent parallel design guided the research. Qualitative interviews were employed for exploring experiences using an interpretive, constructivist, and naturalistic approach for research objectives 1 and 2. A cross sectional survey design and questionnaire, Making the Match, was used to conduct the quantitative research for objective 3. The mixed methods portion of the convergent parallel design was used to frame and explore research objective 4. Findings of the study detail need for curriculum improvement in problem solving, learning, time management, creativity and change, and personal strengths. / Ph. D.

A total of 58 percent of elderly individuals receiving elderly care report experiencing loneliness, as indicated by the National Board of Health and Welfare's annual survey focused on this demographic. Regardless of the adverse effects of loneliness on health, addressing and acknowledging involuntary loneliness is crucial, given its potential to cause discomfort and diminish the wellbeing of the elderly. The objective of this study is to explore how aid officers, through conversations with the elderly, identify and address loneliness among this population. Additionally, the study aims to understand the actions aid workers take upon recognizing loneliness. The goal is to determine whether aid officers' perceptions of loneliness in the elderly are linked to various interventions provided by social services for this demographic. The research questions focus on how aid officers observe and address feelings of involuntary loneliness in the elderly, the nature of the needs assessment conducted by aid officers regarding these feelings, and the types of interventions offered to address loneliness among the elderly. The study adopts a qualitative approach, involving interviews with four aid officers from the Health Care and Care Administration. These aid officers are responsible for approving interventions, including social care for the elderly. The theoretical framework for interpreting the findings encompasses the activity theory and continuity theory. The results and analysis indicate that aid officers individually recognize and address loneliness in the elderly. However, they operate within common guidelines and templates, particularly in the context of social interventions where loneliness plays a role in the assessment for granting social interventions.