This research project is an examination of the role of voluntary sports clubs (VSCs), within a modernised political and policy process, in creating and sustaining forms of social capital. From 1997 onwards, consecutive New Labour administrations concerned with social inclusion and civic renewal have established a pivotal position for social capital in many areas of social policy. In this context increasing political expectations and policy demands are being made of VS Cs to contribute to this broader social regeneration agenda. Social capital is a contested term between the democratic, rational and critical strains of the concept, not least because each of which has its own conceptual framework. In order to tease out the distinct differences between the competing strains of social capital, and inform on its potential formation or destruction in VSCs, the concept of the political opportunity structure (POS) has been employed as an analytical tool. A qualitative case-study research method, within a critical realist methodology, was chosen for primary data collection. This was based on a two-phase approach to capture the perceptions of both VSC members and external stakeholders in relation to the meaning, value and output of VSCs. Based on semi-structured qualitative interviews: thirty-one for phase one and twenty-six for phase two, three case studies were generated. This study shows that social capital is a powerful comparative and reflexive concept that can facilitate a critical picture of how social relations operate at the micro level of the VSC, and how these inform on a range of other social processes and conditions. New Labour's modernisation programme was clearly indicated as a key structural process that highlights the importance of structure and top-down processes in developing social capital in VSCs at grass roots level. This research project shows how implicit tensions between modemisation and mutual aid, when embedded in a voluntary based organisation and serviced by a simplistic interpretation of social capital, tend to lead to policy misdirection at best and at worst the entrenching of contradictory processes that may destroy the very edifice that is targeted by much social policy.

The interdependencies within the health care system are seldom taken into account prior to implementation of e-health projects, and there tends to be little change management as part of the plan. Our proposal offers a systems analysis model that gives e-health a framework to consider and manage the introduction, changes and outcomes. This research describes the use of a modified Patient Care Pathway as a method to design and implement e-health projects, presenting as a case study the pre-implementation phase of a teleradiology project in rural Thailand. The proposal is that a modified version of Patient Care Pathways can be used as a prospective design model for e-health services. The method adopts systems engineering principles and applies a ―whole systems approach‖ thereby providing a much richer schematic representation of the patient care pathway illustrating both the patient‘s journey through the system and also the information flow. Our method was applied to the design of a new teleradiology service that was to be established in Thailand, to connect GP‘s in a rural hospital to the radiology department in a tertiary hospital with a further connection to a specialist radiologist in a medical school in Bangkok. By comparing the pre-implementation Patient Care Pathway with the proposed pathway using the teleradiology, a systems analysis model was developed to identify critical points in the system and identify and anticipate how the system would support the changes in clinical practices. The method produced a valuable framework to better understand and thereby manage the implications of change prior to implementation of an e-health project.

Electronic government (e-government) has established as an effective mechanism for increasing government productivity and efficiency and a key enabler of citizen-centric services. However, e-government implementation is surrounded by organisational, technological, political and social issues, which have to be considered and treated carefully in order to facilitate this change. Conversely, from an adoption perspective, e-government services are yet to be universally accepted as a medium for accessing online public services since its inception more than a decade ago. In terms of prior research into understanding the implementation challenges and adoption factors, most existing literature focus into either the implementation context or adoption context separately and no research studies were found that take a holistic viewpoint of both implementation and adoption. Furthermore, only a few researchers have explored and reflected on the important factors that can impact e-government implementation using well founded theoretical models or frameworks. Besides, there is no universal model for e-government implementation and adoption that is applicable for all countries to ensure success, especially for developing and Gulf Cooperation Countries (GCC). Therefore, this thesis attempts to explore and investigate the key challenges that influence e-government implementation and the factors influencing citizen adoption in the state of Qatar. By simultaneously analysing and aligning the implementation issues of e-government with the adoption aspects, this study aimed to develop a better understanding of the gaps that exists between implementation and adoption. Through combining the implementation and adoption aspects of e-government, this thesis proposes a unified conceptual model which could be used as a frame of reference by government institutions that seek to implement and diffuse e-government systems in Qatar. To do so, the research draws from two well established theoretical models, Institutional Theory (for understanding implementation) and the Unified Theory of Acceptance and Use of Technology (UTAUT) model (for understanding adoption). The research adopted a multi-method approach [combining qualitative (interviews) and quantitative (survey) methods] to explore practices and experiences of implementing and adopting e-government systems in the State of Qatar.

Background: Informed consent is a concept that is fundamental to the ethical inclusion of individuals in medical research projects. Theoretical and ethical analyses of consent has focused on important criteria including voluntariness, competence, provision of information, recommendation, understanding, decision making al!d authorisation. Study aims: (l) To explore the meaning of the concept of informed consent to parents who are contemplating including their sons in research projects, which are designed to develop and trial novel genetic treatments; (2) To assess the ways in which these parents engage in the consent process. Discussion: This thesis draws on qualitative interview data on the process ofconsent as experienced by parents of children with Duchenne muscular dystrophy. The results from an interpretative phenomenological analysis ofthe interviews indicate that there is significant dissociation between how parents are expected to think and choose, and how they actually behave in real life when ml)king consent decisions for their children. Many ofthe criteria which are used'for assessing adequacy of consent appear unrealistic, impossible or irrelevant to parents. This incongruence seems to result from a model, based on a principle-led form ofrational reasoning, which tends to abstract the process of consent from its clinical and social setting. There is a risk that a strict focus on a narrow analysis of consent, concentrating on elements such as competence, voluntariness, etc., can lead to consent becoming devoid ofmeaning to individuals. In tum, this threatens parents' participation in decision-making and provides some explanation for why many patients, parents, clinicians and researchers feel cynical, irritated, or despondent about consent. A more sophisticated understanding of how these decisions are made is important to ensure that ethical decisions about paediatric research participation can be made.

Background Quality of diabetes care is variable and sub-optimal worldwide. Few studies have been undertaken in the developing world to identify factors that influence care. Objectives To identify, explore and test the patient, health professional and organisational factors associated with the quality of care of patients with diabetes in primary care in Tunisia. Methods A multi-method study within an ethnographic framework. Qualitative methods include participant observation, semi-structured interviews and focus groups with health professionals and patients with diabetes. Content and ethnographic analyses were undertaken. Quantitative data were collected from a random sample of medical records of patients with diabetes from a nationwide sample of 48 randomly-selected health centres. Multivariate regression analyses were undertaken to identify associations with fifteen quality indicators and 57 potential explanatory factors. Results The mean age of the study population (n=2160) was 62.4years, mean duration of diabetes 8.4years, 62% were female and 94% had type 2 diabetes. The standard of care varied but some improvements were apparent since 2000. The three most important factors to emerge from the qualitative data were also significantly and independently associated with higher quality of care: availability of medication, clinician motivation and chronic disease clinics. Other important factors were financial, gender and adherence issues. The predominant theme that emerged from the ethnographic analysis was the perception that access to medication at the health centre is "the only thing that matters". Conclusion This study has provided a detailed, unique picture of diabetes care in primary care from a low/middle income country. Important themes that need to be addressed in order to successfully implement culturally-appropriate, quality improvement interventions are accessibility to medications, clinician motivation, patients' health beliefs and gender issues. It is recommended that strategies, such as the development of the role of paramedical staff, be implemented within the context of culturally-adaptable national programs.

Research on the trafficking of women in Taiwan has hitherto largely explored the perceptions and roles of governmental officials and non governmental organisations. Very rarely has research focused on the lived experiences of women who have experienced sex trafficking, as reported by the women themselves. This thesis considers how sex trafficking operates in Taiwan through analysis of the current policy context and empirical data from semi structured interviews carried out with trafficked women and a number of key professionals working on combating sex trafficking in Taiwan. It outlines the processes of recruitment, transportation and coercion deployed in the trafficking process, and examines the similarities, as well as some differences, in the experiences of women who were smuggled into Taiwan or who came through `fake marriage', as well as those who came for `true marriage' or tourism. Mechanisms of control and regulation have been identified through analysis of the accounts of these women's experiences which provide a context for understanding their involvement in prostitution. The accounts of the women were contrasted with government policy and the ways professionals defined sex trafficked women. Based on this analysis, I recommend that the mechanisms through which women said they were controlled, forced and/or deceived have not been sufficiently acknowledged by policy makers, and that an important consequence of this under-acknowledgement is that law enforcement officials can fail to investigate the whole range of the trafficking process, which may lead to some women not being identified as being trafficked and not being given access to appropriate services and support as a result. This prompts a broader consideration of definitions of and policy frameworks on sexual trafficking in Taiwan and, related to this, the implications for relevant professionals, in particular the need to explore more fully the background of women who present themselves as having been trafficked.

Reflection-in-action is a complex concept, proposed by Schon (1983) to describe practitioners’ tacit knowing and ability to work with uncertainty and value conflicts in the midst of action. Its existence is widely accepted in the nursing literature and is a requirement of many healthcare professions. Yet it remains underexplored, especially in the context of the hospital ward. This inquiry used poetry to support a collaborative action research approach, to explore the tensions and possibilities of reflecting during care giving in a hospital ward. Three levels of inquiry: personal, relational and organisational informed the multi-stranded design that involved a co-inquiry group of practising nurses, participant observation in a ward and action learning sets with senior nursing staff. Bourdieu’s concepts of habitus and fields of practice, wider fields of power and various capitals were used with feminist and systemic inquiry perspectives to explore nurses’ ability to use reflection to influence their workplace. The text uses stories, images, metaphors and poetry to generate powerful new insights into the conscious and unconscious ward learning culture and nurses’ embodied dispositions that enable and inhibit reflecting. This thesis presents the reality of reflecting by highlighting some unconscious games, paradoxes and contradictions present in the ward resulting in reflecting inaction. These included: we do it all the time, the paradox of the busy syndrome, the waiting game, whinging creating an emotional orgy, feeling unsupported by managers and talking behind your back. Nurses, who embodied reflexivity, reflected spontaneously which sometimes appeared as gossip. They developed systemic and political agency, noticed their body and used relational processes in the midst of action. They influenced change systemically gaining resources, demonstrating effective leadership and challenging policies. Relationally, they created improved collegial working relationships with managers and staff overcoming collective negativity in the ward. Personally, they managed the complexity of emotions in the ward, encouraging patient centred care, reducing job stresses and improving job satisfaction.

No description available.

No description available.

This thesis explores the barriers to accessing primary care health service provision for Gypsies and Travellers in England. Research took place 'in two phases. The first was a qualitative study of Gypsies' and Travellers' cultural beliefs, attitudes, perceptions of and access to health care. Findings included low expectations and poor experience of services, as well as many examples of communication barriers between Gypsies and Travellers and health staff. The second phase built on these findings, by adopting participatory action research (PAR) methods, to explore communication processes from both staff and Gypsy and Traveller perspectives. The aim was to elicit understanding with a view to exploring how barriers might be overcome. Both phases ofresearch show how Gypsy and Traveller experiences of discrimination and racism contribute to a sense ofdevalued identity, characterised by feelings of shame and humiliation. Shame and attempts to ward off shame are central features of relationships and encounters with health staff as personal reactions to these experiences can produce mutual mistrust and poor relations between staff and the Gypsy and Traveller patients. At the same time, health staff reactions are shaped by pressures related to role, status and setting. By focusing on processes of coconstructed communication, I identify specific patterns of tension and mistrust. In conclusion, I argue that a reflective and collaborative staff approach in primary care, based on effective leadership and a shared team ethos, can provide the empathic focus needed as a starting-point for trust and effective communication. I also argue that acquisition of good communication skills and development of experiential cultural awareness, whilst essential, are insufficient to guarantee cultural competence. A reflexive approach, focussing on personal qualities, values, beliefs and attitudes, is also essential for cultural safety. I outline the specific staff training implications of these findings, in terms of ensuring culturally safe health care for Gypsies and Travellers.