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Background. Although research has been carried out within higher education circles little is known about any educational benefits that may result from primary care professionals engaging in networked learning and what strategies may be used to overcome barriers to effective learning. Aim. This research was undertaken to identify specific educational strategies which may inform educators wishing to support continuing professional development for healthcare professionals within communication and information technology. Method. A model of networked learning was developed from the literature and using the experience of working models elsewhere. The model was implemented and evaluated over two case studies, and further refined in a third. The evaluation methodology used action research collecting data from surveys, interviews, observer participation, electronic text generated bye-mail discussions, and project documents. Results. Healthcare professionals were able to usefully communicate over a prolonged period with colleagues about clinical and professional matters, developing a number of process skills; using e-mail, web and on-line database searching. Compared to face -to-face small group learning, the added benefit of using e-mail discussions supported by web based learning resources was being able to use the method at a place, pace and time of their own choosing whilst still remaining committed to a shared educational experience. GPs were able to use the educational material to put to-wards a portfolio (personal learning plan) for accreditation for PGEA. Specific roles for an on-line facilitator in addition to small group learning skills were identified. However networked learning is acknowledged to have many obstacles, eg access, using software, lack of support which will need to be overcome. Managing a learning environment for CPO for healthcare professionals involves an integration of the teaching and learning strategy of the host organisation with a networked learning environment. Conclusion. A networked learning environment has the potential of supporting continuing professional development and its assessment with portfolios. For individual participants much depends on there own learning style, what they feel is relevant to learn at the time and their own preferences for a learning format. Much needs to be done to provide the necessary supporting infrastructure and integration of provision across traditional divides within healthcare education. This research describes a number of recommendations, which can inform action by educational stakeholders interested in healthcare education.

The results of the literature review and survey show that tremendous changes have taken place in the United Arab Emirates both in its economic as well as in the provision of health care, since its independence in 1971.  The country has extensive primary health care services that are easily accessible.  The range of services provided includes health promotion, preventive, curative and maternity and child health services. However, the philosophy of primary health care is not generally accepted and the emphasis remains on providing  a curative service and the use of high technology medicine.  There are many other difficulties with the current system including a shortage of manpower; poor co-ordination between primary care and hospital based services; rising cost of health care provision; inadequate provision of health education programmes; inadequately or inappropriately resourced primary health centres; and the lack of reliable and good quality data on primary health care. Several recommendations are made: 1.  Creating a task force dedicated to primary health care and involving all stakeholders in order to identify gaps and deficiencies, make recommendations for improvement and ensure that the recommendations are being implemented. 2.  Emphasising the importance of primary health care in the overall provision of health care. 3.  Establishing a correct balance and a better co-ordination between primary, secondary and tertiary levels of care.  This should include an improvement in the referral and feedback system between primary care and hospitals. 4.  Ensuring the establishment of an effective health education programme aimed at emphasising the  value of primary health care, simple low-cost technology, health promotion and prevention services so minimising the dependence on the use of hospitals and high technology medicine.  This should take into account the different cultural, religious and social backgrounds of both the expatriate community as well as local inhabitants. 5.  Improving the provision of maternal child health care, screening, health promotion, prevention services and the availability of equipment, facilities and resources to enable primary care health professionals to carry out the assessment and management of most common and treatable conditions. 6.  Producing doctors, nurses and other health professionals who will promote health for all people and meet the needs of the society they serve.  This will require a greater collaboration and partnership between medical schools and the Ministry of Health.  7.  Developing a system of continuing professional development with staff training programmes for health professionals, to ensure the maintenance of their competence. 8.  Forming a professional organisation, such as a College or Institute of general practice, in order to identify the professional needs of general practitioners, to represent the specialty on professional matters and on all relevant medical decision making bodies, and to promote professional development at both national and international levels.

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Background. Implementation research is the scientific study of methods to promote the uptake of research findings in clinical practice. Cluster randomised trials are commonly adopted in implementation research, where interventions are generally targeted at health professionals or policymakers, in order to protect against contamination that would occur if individual patients were randomised. The application of cluster randomisation has important implications for design and analysis of trials evaluating implementation strategies. Case study: The Urological referral guidelines evaluation (URGE) has been used throughout this thesis, to explore the design and analysis issues of adopting a cluster randomised trial design in implementation research. URGE aimed to evaluate the effectiveness and efficiency of a guideline-based open access urological investigation service. This cluster randomised study adopted a 2X2 balanced incomplete block (BIB) design and collected data both prior to and following introduction of the intervention. The unit of randomisation was general practice and patients were recruited upon referral to secondary care. Aim: To investigate the implications of cluster randomisation for the design and analysis of trials evaluating implementation strategies. Objectives: This thesis has four distinct components. 1. A review of published cluster randomised trials in the field of implementation research. The methodological quality of these studies is assessed (Chapter 2). 2. An exploration of clustering within the URGE trial. Estimates of clustering and the imprecision in these estimates are considered for a number of endpoints, including process and outcome of care indicators and costs (Chapters 4 and 7). 3. The application of statistical methods in the analysis of cluster randomised trials. A number of approaches to the analysis of cluster randomised trials are described, applied and compared empirically. Incorporation of the BIB design and pre-intervention performance are also considered (Chapters 5 and 6). 4. Analysis of cost data collected from the economic evaluation conducted within the URGE trial. The analysis of skewed cost data collected within a cluster randomised trial design is considered (Chapter 7).