Good health care delivery is one of the most essential social services and is the lifeline of a country’s infrastructural development. Since most of Nigeria’s disease burden is due to preventable diseases, the emerging ICTs have a significant role to play in a country’s health care delivery industry. This research offers a distinctive perspective on the applications of ICTs in seven university teaching hospitals in Nigeria, with a focus on the University College Hospital, Ibadan. A research model that was proposed with its associations was tested using both qualitative and quantitative data collected from health workers (including those in training) and the clients/patients they serve. For the first time, the perspectives of the beneficiaries of ICTs’ usage in the health sector, apart from the health workers (i.e., the patients/clients), were considered. Hitherto, the few research studies and findings that are available in this area in Nigeria and other developing countries was focused only on the users of the ICTs, i.e., the health workers. The data presented here found evidence that health professionals were highly aware of the on-going trends in the adoption of ICTs and their applications for use in communication in the health sector, but the potential benefits of ICTs in the health sector have not been fully exploited by the Nigerian teaching hospitals that were studied. The study also found that there are many barriers to the implementation of e-health solutions in Nigeria, and that these barriers cause delays or hinder their use. The Nigerian health sector is compromised with a lack of infrastructure, services and expertise, limited resources, low literacy levels and professional associations. In addition to these inherent problems, shortcomings in the knowledge and skills of patients and health professionals in using ICT solutions present other challenges. Some of these obstacles pertain to ICT itself and, with time, they will be alleviated, while others relate to the challenges that ICT poses for health care organizations. This calls on different stakeholders to fully implement and mainstream ICT applications in the health sector so as to make them a reality, and not a myth, in promoting the access to, and the quality of, health services. ICTs and their applications offer the foundation for information sharing and exchange. In Nigeria, the journey is likely to be a lengthy one, with numerous obstacles, many of which are unique to health care settings that must be surmounted. However, policy makers should realize that ICTs are not only necessary in the health sector for a well-adjusted society, but the lack thereof may render such a society obsolete. The study also notes that the adoption of ICTs in an organization and/or in a society can be driven by many factors. Since the diffusion of innovation requires an understanding of people, hardware, software, communication networks and data resources that collect, transform and disseminate information, it has been suggested that theories from information systems are well suited to explain such aspects of the diffusion and adoption phenomena. This work has therefore proposed a hybrid of Rogers’ (1995) Diffusion of Innovation Model and Venkatash et al.’s (2003) Unified Theory of Acceptance and Use of Technology (UTAUT). Both theories provide important insights into the factors influencing technology transfer in developing countries, and this has been demonstrated by the findings of this research study.

The present PhD thesis develops and applies an evaluative methodology suited to the evaluation of policy and governance in complex policy areas. While extensive literatures exist on the topic of policy evaluation, governance evaluation has received less attention. At the level of governance, policymakers confront choices between different policy tools and governance arrangements in their attempts to solve policy problems, including variants of hierarchy, networks and markets. There is a need for theoretically-informed empirical research to inform decision-making at this level. To that end, the PhD develops an approach to evaluation by combining postpositivist policy analysis with heterodox political economy. Postpositivist policy analysis recognises that policy problems are often contested, that choices between policy options can involve significant trade-offs and that knowledge of policy options is itself dispersed and fragmented. Similarly, heterodox economics combines a concept of incommensurable values with an appreciation of the strengths and weaknesses of different institutional arrangements to realise them. A central concept of the field is coordination, which orientates policy analysis to the interactions of stakeholders in policy processes. The challenge of governance is to select the appropriate policy tools and arrangements which facilitate coordination. Via a postpositivist exploration of stakeholder ‘frames’, it is possible to ascertain whether coordination is occurring and to identify problems if it is not. Evaluative claims of governance can be made where arrangements can be shown to frustrate the realisation of shared values and objectives. The research makes a contribution to knowledge in a number of ways a) a distinctive evaluative approach that could be applied to other areas of health and public policy b) greater appreciation of the strengths and weaknesses of different forms of evidence in public policy and in particular health policy and c) concrete policy proposals for the governance and organisation of diabetes services, with implications for the NHS more broadly.

Prevention of disease is a key strategy in the NHS, contributing to cost-effective health care and lower morbidity and mortality through early identification and management of risk factors in large populations. However, effects of increased prescribing, in the form of a growing burden of treatment for patients and challenges associated with polypharmacy, have prompted criticism from medical practitioners as well as scholars from the biomedical and social scientific fields. Whilst a growing evidence base guides prescribing, factors in the social world also influence how medicines are used. Patients’ views on medicines are recognised as important for a good outcome of treatment, but they are not very well known with regards to risk management prescribing and polypharmacy. The research presented in this thesis draws on critical examinations of societal influences on large-scale prescribing, and focuses on cardiovascular (CVD) risk management in primary care. This approach allowed me to explore the use of medicines in a setting where prescribing is common but also involves challenges in terms of the balancing of beneficial and harmful effects for populations and individuals. General influences on patients’ expectations of prescribed medicines were addressed in a review and synthesis of medical and social scientific literature describing beliefs, views and experiences. An update of the national clinical guidance on CVD risk assessment and modification of blood lipids offered an opportunity to review how CVD risk and the benefit and harm from statins were represented in a lay context; UK newspapers. In the empirical part of the research, I explored patients’ understanding of their own use of medicines in CVD risk management. My findings produced a thematic structure describing how patients conceptualise a diagnosed CVD risk and make sense of the recommended risk management treatments. Central influences on patients’ views are a simplified representation of CVD risk as a distinct condition with particular consequences for the individual, anticipation of defined effects from medicines, and a personalised understanding of health information which leads to individual responsibility for engaging with risk management. To propose implications of my findings, I discuss them in relation to three current policy reports on disease prevention and prescribing. My study adds knowledge about a central part of modern primary care, based on suggestions of how the currently dominating approach in CVD prevention might shape people’s perspective of medicines.

For local public health teams, commissioning services that work and are cost effective is important. Having ways of evaluating and assessing their cost effectiveness is invaluable. Health economics and public health have a natural kinship as they both take a population approach to maximising health. The aim of this investigation is to give examples of how a mixed methods approach can be used. This thesis gives three case studies where public health commissioned services for alcohol, tobacco and drug addiction in the North West of England have been evaluated for their cost effectiveness using a mix of economic evaluation techniques combined with elements of realist evaluation and equity impact analysis. These mixed methods evaluation techniques involve engaging with stakeholders to develop a common understanding of outcomes and assumptions in reaching a common understanding of the causal mechanisms that make an intervention work. This thesis outlines how the results of these evaluations were useful in informing strategy and the commissioning process and how they may be used more in the future. There were some novel analyses including matching up crime data and putting a cost on these crimes for people in contact with a drugs test on arrest programme, which found that costs were lower after the drug intervention. The researcher found that there was not a significant change in admissions post-detoxification which indicates that perhaps inpatient residential detoxification has only a limited effect on long term health prospects. This thesis has shown that economic evaluation and realist evaluation methods pose some challenges but can be carried out at a local level as a way of looking at public health interventions through a more complex lens.

Recently, increasing attention has been given to behavioural and relational aspects of health systems, placing actors at the core. Indeed, health systems comprise of numerous actors, and one of the most important and influential is the medical doctor, playing a vital role in policy transfer at the national level (Benson 2013). The influence of medical professionals stems beyond shaping the implementation of health policies, to also potentially altering the policy content and process (Koon & Mayhew 2013). In lowand middle-income countries (LMICs) the health system is a dynamic mix of multiple stakeholders, including supra-national organizations, Global Health Initiatives and NonGovernmental Organizations (Samb et al. 2009), resulting in an environment where contesting interests and values are competing for relevance and authority. This study examined the power dynamics of medical professionals in the Nigerian health system through an in-depth case study of the interactions between the Global Fund grant and Nigerian medical professionals. Results are based on an in-depth qualitative study involving 34 semi-structured key informant interviews with policy makers, board-meeting observations, and documentary analysis. Data was analysed iteratively in order to gain insight into the power dynamics of medical professionals in policy processes and to analytically identify structural and agential factors within the health system that encourage or discourage professional dominance. Medical professionals maintained dominance and professional monopoly, thereby controlling policy spaces. Global actors and the local government were challenging interest groups, with a preference for rapid biomedical models that focus on medications and test kits, and the supply of health services, while neglecting social science narratives and demand creation. This work explores such issues in detail and presents contextual factors of relevance to the Nigerian setting, thereby adding to existing literature on health systems and the sociology of medical professionals.

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Although working within forensic inpatient settings can be emotionally challenging and stressful, no research has investigated the role of coping and mindfulness upon occupational stress and burnout amongst mental healthcare professionals (MHCPs) employed within secure hospitals (SHs). The literature review explored the effectiveness of Mindfulness Based Stress Reduction (MBSR) programmes on psychological functioning in healthcare professionals. MBSR appeared to be effective in reducing anxiety, depression, trait anger, rumination and stress, and increasing mindfulness and self-compassion. However, MBSR did not prove to be as effective in reducing burnout or improving resilience. Abbreviated MBSR programmes of less than four weeks appeared to be a viable alternative to the standard eight week programmes. Improved quality studies with more robust study designs were recommended. The research study investigated the role of coping and mindfulness upon occupational stress and burnout amongst MHCPs employed within forensic inpatient settings. A total of 151 MHCPs from five SHs in Wales completed four questionnaires, measuring dispositional mindfulness, coping, occupational stress and burnout. MHCPs reported elevated levels of occupational stress. Despite moderate levels of emotional exhaustion and depersonalisation, MHCPs retained a positive sense of personal accomplishment, and felt confident in performing their duties. Higher levels of mindfulness were significantly associated with lower levels of maladaptive coping, stress and burnout levels, therefore, mindfulness based interventions (MBIs) could prove to be a viable intervention to support MHCPs in SHs. Section 1 - 3 - Higher levels of the mindfulness facet, acting with awareness, were found to significantly predict lower levels of emotional exhaustion and depersonalisation. This research also suggested that higher levels of acting with awareness may help prevent emotional exhaustion and depersonalisation in MHCPs employed in SHs. The literature review and research paper findings were discussed in relation to theory development, clinical implications and future research, followed by a reflective commentary detailing process and personal issues that the researcher encountered from conducting the research study.

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Correct understanding of the risks of treatments is essential for consumers of health services. Yet, existing research has not examined how consumers understand risk in mixed-market health service environments, where private sector firms operate alongside established public sector providers, such as is the case in the UK. As the range and complexity of private sector health services increases, there remains uncertainty about how individuals will perceive, and respond to, the risks involved in using such services. In this research, I examine the role of the professional service encounter as a moderator of risk perception. I manipulate two key variables in the service encounter: emotional labour and professional role. Emotional labour, and the perception by the consumer of affect arising from the use of emotional labour, is a key technique used by service employees to create empathy and increase consumer engagement. Professional role refers to the varying levels of credence attached by consumers to health professionals representing either the private or public sector. My hypotheses are that risk perception will be more strongly reduced by deep acting than surface acting (H1)and that high credence professional roles will more strongly reduce risk perception than low credence ones (H2). Through interaction effects, deep acting is hypothesised to have a greater impact on reducing the perception of risk where the professional role is private sector than where it is public sector (H3). Data on consumers' worry levels is also gathered, and it is hypothesised that health consumers would have high levels of pathological worry (H4), and that worry is positively related to gender (H5) and education level (H6). Finally, general risk perception and risk taking data are gathered, and I hypothesise that health risk taking would be negatively related to health risk perception (H7). These hypotheses are tested using online video stimuli with a sample (n=285) of health service consumers. Findings suggest that the consumer perception of risk is moderated not by emotional labour on its own, but by the interaction effects between emotional labour and professional role. Whilst surface acting reduces risk perception when the doctor holds a private sector role, the opposite is the case when the doctor is from the NHS. This suggests that the role of emotional labour is dependant on the professional context in which the health service is offered, and the relative position and status of the health service consumer. Furthermore, it was found that there was little evidence of pathological worry amongst health service consumers. This supports the concept that the ‘worried well’ are a reflection of the increased awareness of psycho-social conditions amongst health service consumers, and the challenges this provides to the professional status of health professionals. The implications of this research suggest that a combination of higher consumer demands for health services and the lack of political will to reform the NHS system will lead to a larger ‘grey market’ for health services in the UK, where private and public services are used together by consumers to meet their changing needs.

Measuring the Return on Marketing Investment (ROMI) and marketing's impact on sales has initiated a great deal of discussion in the field of healthcare marketing research, with some researchers identifying such measurements as a necessity and others seeing them as an impossible task due to the complex nature of marketing projects in the healthcare industry. The key objective of this research is to develop a systematic approach to guide pharmaceutical industry managers in deciding how and where to invest in the sales and marketing of their Over the Counter (OTC) products. This research aims to identify how to optimize sales and marketing investment decisions, with the goal of improving marketing's impact on sales and the Return on Marketing Investment (ROMI). Achieving this aim would help executives meet the challenges resulting from on-going changes in the healthcare sector. This research was conducted in an emerging market, looking at a range of pharmaceutical OTC products from the researcher's organization. A quantitative method of data collection was used, followed by an action research (AR) approach. The quantitative method consisted of a survey targeting pharmacists working in pharmacies in the Kuwaiti private sector. The AR methodology was used to analyse the research data and to develop the intervention plan. Results from the AR phase reveal that the ROMI achieved through indoor promotional activities was higher than the ROMI achieved through medical detailing. Reducing the amount of free-of-charge goods supplied to pharmacies had no significant impact. Pharmacists' recommendations were found to be the most influential sales driver. This was reinforced by additional findings in which the medical detailing of pharmacists at community pharmacies achieved a 7% ROMI, higher than the set target of 3%. The strong influence of pharmacists in polyclinic pharmacies was also considered, with polyclinic pharmacies achieving a 30% ROMI, greatly surpassing the set target of 4%. The use of action research in this project facilitated the learning process by generating innovative and creative solutions to real-life challenges.