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Principles of equity of access to health care of individual citizens in need are internal iuaIl health systems and most developing economies are preoccupied with reforming , their health policies to achieve this. Ghana brought in fee for service, a cost recovery system at the behest of the IMP. .This system it Was later observed, rather perpetuated inequities and inequalities in health care access and outcomes.

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Increased health behaviours among young people could reduce national health costs. Brief cost-effective interventions that can be easily administered and replicated are especially likely to be adopted. Focusing on modifiable cognitive antecedents of behaviour is likely to maximise the effectiveness of behaviour change interventions. The theory ofplanned behaviour (TPB) is the most widely applied model of cognitive antecedents of behaviour but there have been surprising few tests ofthe theory in trials ofTPB-based behaviour change interventions. Three studies tested the utility of the TPB as a basis for the design ofhealth promotion leaflets targeting condom use and regular exercise among young people. Study 1 reports a randomised controlled trial (RCn ofan extended TPB-based leaflet plus quiz and motivational incentive designed to promote condom use and preparatory behaviours amongst young people. The intervention promoted pro-condom use cognitions and preparatory actions, compared to a control condition but did not increase condom use. Study 2 reports the results ofa ReT conducted to evaluate the effect of a TPBbased leaflet designed to encourage young people to exercise. The leaflet was evaluated on its own, in combination with a quiz and motivational incentive and in combination with an implementation intention forrmition activity. Results revealed no significant differences in cognitions or behaviour between the three intervention groups when compared to the control. This is discussed in terms of ceiling effects in the target behaviour (exercise).

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UK healthcare policies emphasise that patients' dignity should be respected. However, studies indicate that hospital patients are vulnerable to a loss of dignity. There is a dearth of research relating to patient dignity generally and little research ~as been undertaken in acute hospital settings specifically. A qualitative case study examined the meaning of patient dignity and how patient, staff and environmental factors affect patients' dignity. The study's setting was a surgical ward, specialising in urology, and ethical approval was obtained. Data were collected from post discharge interviews with patients (n=12); four-hour periods of participant observation (n=12) with follow-up interviews with patients (n=12) and staff (n=13); observation of staff handovers (n=12); interviews with senior nurses (n=6); and examination of Trust documents. Data were analysed using Ritchie and Spencer's (1994) framework approach. A model of patient dignity was presented to portray the definition which developed from the findings: 'Patient dignity is feeling valued and comfortable psychologically with one's physical presentation and behaviour, level of control over the situation, and the behaviour of other people in the environment'. Lack of privacy in hospital threatened dignity, heightened by bodily exposure and a mixed sex environment. A conducive physical environment, a dignity-promoting culture and leadership, and other patients' support promoted patient dignity. Staff being curt, authoritarian and breaching privacy threatened dignity. Staff promoted dignity by providing privacy and interactions which made patients feel comfortable, in control and valued. Patients' impaired health threatened dignity due to loss of function, intimate procedures and psychological impact. Patients promoted their own dignity through their attitudes and developing relationships with staff. A second model was constructed to portray how patients' dignity is threatened or promoted by staff behaviour, the hospital environment and patient factors. The results emphasise that staff behaviour and the hospital environment have an important impact on whether patient dignity is threatened or promoted. However, patient factors can also promote dignity.

Researchers and policymakers have become increasingly aware of the value of talking therapies and service providers are confronted with the need to deliver these cost-effectively. Amongst service providers, social workers are at the front line of rendering these kinds of services to families and people in the community. Yet in the UK theyoften do not have the training or / ., experience to provide interpersonally mediated talking-therapy services to people who specifically need them. This thesis suggests that a therapeutic approach, informed by the narrative and family therapy traditions, might be particularly useful, and its applicability and explores its theoretical development by means of case examples. Narrative therapy is particularly germane to the concerns of social work, in that it takes an ethical stance on people's stories, and addresses issues of oppression and the consequences of being marginalised. There have been few studies exploring the application and outcome of narrative therapy, mainly due to a lack of appropriate developed methodologies. The goal of this study was to develop a methodology that could indicate changes in the stories of families. Boje's (2001) idea of exploring the 'antenarratives' - the speculative precursors to full-fledged narratives - was adopted for this purpose. The present study tried to answer two research questions. These are whether an antenarrative methodology can be used to illustrate changes in the stories of families in order to assess the outcome of narrative family therapy, and whether this methodology can be used to track both grand and micro narratives and the changes that take place in these stories. The study was conducted from a practitioner-researcher perspective, with the researcher applying a model of narrative family therapy with participants from several families. For darity's sake, this thesis restricts itself to a detailed case-study account of the transcripts of a series of sessions with ') two families. A baseline narrative was analysed after the first session and a second base line after the sixth session. After each of the two analyses, changes were suggested to refine th~ approach. The conclusions reached are that the antenarrative approact) helps to track the development and construction of families' stories. Themaps illustrating how different themes deverop and interact in particular were helpful in illustrating both this and the ways in which stories develop rules and strategies to justify their own existence. It was recommended that the methodology be split into three sections depending on the goal of the study. The first part addresses the initial understanding to help sift through large volumes of data, whilst the grand and micro narratives helping to understand what is happening to stories and why this takes place. The latter part, concerned with narrative type, authorship, and comparative questions, is able to show what has changed and how this has occurred. The theoretical contributions made are that stories should not be seen , as two-dimensional and linear, but as multi-dimensional entities in which multiple stories interact with one another. The idea of a 'Tamara' - a play on multiple stages - is helpful in understanding how stories interact with one another and how the point or angle of view will determine the stories we hear and see. It also highlights the idea that families should not be seen as singlestory entities, but as living multiple stories, and formulates the issues so that they can be applied in social work contexts. The concepts of a grand and micro narrative were easily integrated with narrative therapy's idea of developing thick descriptions of people's lives, i and can turn the observer's gaze back upon the professionals to show how social workers police families through the process of providing help, thereby enhancing the profession's reflective capacities.

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No description available.

This thesis is an analysis of interactional practices through which the work of a mental health information line is carried out, utilising discursive psychology and conversation analysis in the analysis of a corpus of calls to MIND Infoline. The aim of MIND Infoline is to provide information on mental illness, and the services in England and Wales which support those affected by mental illness. In negotiating access to the data, the call-takers of the line were encouraged to suggest topics for analysis such that the work of this thesis would be of benefit to them. Three of these topics are the foci of the analytic chapters; how callers are asked what it is they want from the line, how courses of action are proffered to callers, and how crying callers are responded to. In the analysis of these topics, institutional restrictions are discussed as consequential for the actions engaged in by the call-takers, who are encouraged to refrain from giving advice, 'chatting' with callers, and providing emotional support. In the analytic chapters, empirically grounded observations are made about four recurrent practices engaged in by the call-takers; • The use of interrogatives which constrain callers' responses and make relevant a request for information .• The use of modal verbs and' If / Then Constructions' in the proffering of courses of action to callers • The use of ' Yes / No' interrogatives in the proffering of courses of action to callers • Empathetic formulations which are deployed following occurrences of caller crying The reporting of the findings back to the helpline staff and the application of these findings for their work are also discussed. The thesis as a whole contributes to the literature on the analysis of institutional interactions, particularly to the literature on the management of restricted practices in institutional settings.