Problematic substance use is a continuing public health and safety concern in Canada, as is in many countries, and is seen as a health issue that can be prevented, managed, and treated through a proper focused response; however, according to recent studies and reports, Canadian youth are experiencing massive difficulty in accessing evidence-based services. The aim of this study is to explore youths’ barriers and facilitators in seeking and utilizing treatment services for substance use problems from service care providers’ perspectives in Ontario, Canada. In addition, treatment models that are organized to fit the needs of youth are also explored. A qualitative study with an inductive approach was used. Data was collected through six semi-structured interviews with youth service professionals working in school or community-based problematic substance use organizations in Ontario, Canada. The obtained data material has been analyzed by thematic analysis. The results showed that professionals viewed harm reduction and motivational interviewing models as designs fitted for youth. Professionals viewed unclear pathways to available services and stigma as external barriers to seeking treatment and shame and guilt and the loss of autonomy as internal barriers. Results viewed open conversation and active participation by schools as facilitators for seeking treatment. Further, professionals viewed insensitivity on behalf of the staff and funding as the main barriers for youth utilizing treatment, while sympathy from staff a major facilitator. This conclusion highlights the need for more open conversation and cooperation with the government and other youth service care professionals to coordinate effective and integrated services available for youth in school and community settings.

Bakgrund: År 2010 infördes det fria vårdvalet i Sverige och därmed har även privata aktörer rätt att etablera sig som vårdgivare samt har också patienten rätt att själv välja mellan olika vårdgivare inom primärvården. Det övergripande målet inom primär- vården är att erbjuda vård på lika villkor för hela befolkningen och på så vis uppnå en god folkhälsa. Ett sätt att säkerställa att man som organisation arbetar i linje med sin strategi och når upp till de övergripande målen är att använda sig av prestations- mätningar och inom primärvården kan det bidra med en förbättring av effektiviteten med syftet att kunna erbjuda vård med en högre kvalitet till ett större antal patienter. Syfte: Syftet med uppsatsen är att skapa förståelse för hur privata vårdcentraler använder sig av prestationsmätningar för att nå upp till de övergripande målen om kvalitativ vård och samtidigt sina egna finansiella målsättningar samt hur de mäter och utvärderar resultaten av dessa mätningar. Metod: Uppsatsen är en intervjustudie där 11 verksamhetschefer från 11 olika privata vårdcentraler inom 6 olika regioner i Sverige inkluderas. Vidare har uppsatsen antagit en kvalitativ forskningsstrategi med semistrukturerade intervjuer. Slutsats: I uppsatsen identifieras ett antal steg som ingår i processen med att mäta och utvärdera prestationer, dessa är strategi, måtturval, mätning och utvärdering. Upplevelserna av huruvida mätningarna bidrar till kvalitativ vård skiljer sig dock åt beroende på i vilken utsträckning mätningar valts ut av respektive enhet. I frågan om finansiella målsättningar anses dock prestationsmätningar vara ett viktigt verktyg. / Background: In 2010, free choice of healthcare provider was introduced in Sweden, which means that private actors also have the right to establish themselves as health- care providers and patients have the right to choose between different healthcare providers within primary care. The overall goal within primary care is to offer healthcare on equal terms for the entire population and thereby achieve good public health. One way to ensure that an organization is working in line with its strategy and achieving its overall goals is to use performance measurements, and within primary care, this can contribute to improving efficiency with the aim of providing higher quality care to a larger number of patients. Purpose: The purpose of this essay is to create an understanding of how private healthcare providers use performance measurements to achieve the overall goals of providing high-quality care while also meeting their own financial objectives, as well as how they measure and evaluate the results of these measurements. Method: The essay is an interview study that includes 11 managers from 11 different private healthcare providers in 6 different regions in Sweden. Furthermore, the essay has adopted a qualitative research strategy using semi-structured interviews. Conclusion: The essay identifies a number of steps involved in the process of measuring and evaluating performance, which include strategy, metric selection, measurement, and evaluation. However, experiences of whether the measurements contribute to high-quality care differ depending on the extent to which metrics are chosen by each unit. In the question of financial objectives, however, performance measurements are considered an important tool.

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This study investigated access and use of information in the health-care of home-based elderly people (EPs) in Nakuru District, Kenya. The literature review revealed a gap with respect to information behaviour in health-care of EPs in a development context. The researcher used qualitative methods; with exploratory and descriptive research design because the focus of the study was on the littleknown and socially disadvantaged community of EPs in Nakuru District. Respondents were sampled by using the snowball technique. At the end of an interview session, each respondent was encouraged to nominate someone who either shared the same or had different experiences, views, socio-economic levels and gender. The researcher collected data through face-to-face interviews with EPs, informal care providers (ICPs) and formal health-care providers (FHCPs), in order to gain insight of information behaviour in health-care of EPs, by focusing on aspects of information needs; sources; use of information and factors that influence the respective groups of respondents to access and use health-care information health-care of EPs. The findings showed that the respective groups of respondents had similar as well as diversified needs for information for health-care. The groups used both formal and informal sources of information and channels of communication to access information for health-care, with FHCPs using authoritative sources more than the EPs and ICPs. Factors such as being a professional or a lay person, cost, ease of accessibility, availability of sources and channels of communication, time and trustworthiness of a source or channel of communication determined preference for use of information. The major contribution of the study is to the theory about information behaviour: some EPs and ICPs used CAM services without informing FHCPs, thereby revealing a form of concealed information use behaviour (CIUB). / Information Science / D. Litt. et Phil. (Information Science)

This study investigated access and use of information in the health-care of home-based elderly people (EPs) in Nakuru District, Kenya. The literature review revealed a gap with respect to information behaviour in health-care of EPs in a development context. The researcher used qualitative methods; with exploratory and descriptive research design because the focus of the study was on the littleknown and socially disadvantaged community of EPs in Nakuru District. Respondents were sampled by using the snowball technique. At the end of an interview session, each respondent was encouraged to nominate someone who either shared the same or had different experiences, views, socio-economic levels and gender. The researcher collected data through face-to-face interviews with EPs, informal care providers (ICPs) and formal health-care providers (FHCPs), in order to gain insight of information behaviour in health-care of EPs, by focusing on aspects of information needs; sources; use of information and factors that influence the respective groups of respondents to access and use health-care information health-care of EPs. The findings showed that the respective groups of respondents had similar as well as diversified needs for information for health-care. The groups used both formal and informal sources of information and channels of communication to access information for health-care, with FHCPs using authoritative sources more than the EPs and ICPs. Factors such as being a professional or a lay person, cost, ease of accessibility, availability of sources and channels of communication, time and trustworthiness of a source or channel of communication determined preference for use of information. The major contribution of the study is to the theory about information behaviour: some EPs and ICPs used CAM services without informing FHCPs, thereby revealing a form of concealed information use behaviour (CIUB). / Information Science / D. Litt. et Phil. (Information Science)

The purpose of this study was to describe the experiences that HIV and AIDS patients who are on Community Home Based Care Programme have in the Lilongwe district of Malawi. Finally; concrete propositions were developed for the implementation of quality community and home based care programmes in Malawi. A qualitative research design using an interpretive phenomenology was used. The study took place in semi-rural and urban areas of Lilongwe district using patients from 3 major organizations dealing with people living with HIV and AIDS. Purposive sampling technique was used to choose the sample and a total of 15 in-depth interviews were conducted. Data was analyzed using ATLAS ti version 5. Findings revealed that the majority of the participants were concerned that they were living with HIV and AIDS. Most of them expressed anxiety, worries and fears of death. Another majority complained about the burden of opportunistic infections. Almost half of the participants felt guilty bringing misery to their families and complained of stigma and discrimination. However, a minority group of participants felt that to live with HIV and AIDS is not the end of life. Relatives were mentioned as the main care providers to HIV and AIDS patients. However, they were also cited high as a source of stigma. Conclusions were made that women and girls are at the highest risk as they bear the burden of care. It was therefore recommended that the Government of Malawi and all Non Governmental Organizations should develop women social economic status through promotion of education, provision of loans and provision of Gender Sensitive trainings. Formal training for care of HIV and AIDS patients should be introduced to all primary caregivers to render quality care in the homes and therefore this study has developed and pre-tested an educational program for this group. / Health Studies / D. Litt. et Phil. (Health Studies)

我國女性勞動參與率逐年上升，雙薪家庭比例逐年升高，然而在家庭中幼兒的照顧工作仍以女性為主力，透過完備的公共托育政策將有助於平等性別分工。我國自2001年起推動社區保母系統服務，自2008年起開辦保母托育管理與托育費用補助計畫，旨在於使雙薪家庭父母親能夠安心使用保母托育服務。 本研究目的在探討幼兒父親與母親決定使用保母服務及選擇保母的動機及考量因素，以及使用保母服務托育後父親與母親自覺對自己的父職角色及母職角色的認知有何影響。並透過研究結果以提供保母與保母托育服務管理者參考及協助媒合。 本研究屬質化研究，透過位於台北的彭婉如基金會提供9對父母親受訪者，為避免夫妻權力干擾，訪談方式為研究者與父母親分開之單獨訪談。研究結論歸納九點：一、因家庭經濟考量與無法由家裡長輩照顧而尋求保母托育，且「人際管道」為主要的找保母管道；二、父母親普遍重視保母證照；三、選擇保母時，父母親重視托育持續性，意即可固定保母長期托育；四、父母親期待保母能有其他托育幼兒，使幼兒可學習人際互動；五、父母親選擇保母時重視幼兒感受；六、家長使用有系統管理的保母較安心；七、家庭對於選擇保母是以「母親」意見為主導，且母親考量較細緻；八、母親對於使用保母服務有愧疚感且感受深切，父親則無；九、使用保母服務有助於親職角色的發揮。最後，提出幾點關於承辦社區保母系統基金會的角色、保母訓練課程，以及托育政策等的相關建議。 / Taiwan's female labor force participation rate increased year by year, the proportion of double-income family is gradually increased, however, still women in the care of the children in the family as the main force, through a comprehensive public childcare policy will contribute to equal gender division of labor. Taiwan since 2001 to promote Communal Nurse the System service, Child care management and child care fee allowance program offered since 2008, aims to double income families, parents can feel at ease to use the Family child care providers nursery service. The purpose of this study was to investigate fathers and mothers decided to use the family child care providers nursery service and the motives and considerations of selecting the family child care providers, as well as after the use of the family child care providers nursery service, the father and the mother is conscious awareness of fatherhood and Motherhood what impact. And through research results to provide Family child care providers and the Family child care providers nursery service managers Reference and assist in matching. This study is a qualitative research, nine pairs of parents of respondents through the Peng Wan-Ru Foundation located at Taipei. The way of interview in this study to separate researcher and the parents is for avoiding the interference from parents by marital power. Conclusion this study of nine points:1.Due to the family economy and at home elder cannot take care of children, seeking for a child care, and seeking for a child care “interpersonal channels” is the main way; 2. Parents generally value the Family child care providers’ license; 3.Select a family child care provider parents attach importance to child care sustained, meaning family child care providers can be long-term childcare; 4.Parents look forward to the family child care providers can take care other children so that children can learn social interaction; 5.Parents choose family child care providers focus on children feeling; 6.Parents use family child care providers of systems management service feel trust; 7.Family select the family child care providers leading on the views of "mother", and mother considerations is in greater detail; 8. Mother feeling guilt and deep feelings for the family child care provider service, but no father; 9.The family child care providers nursery service contribute to the parenting role to play. Finally, offer some points of the foundation’s role to host the Communal Nurse System service, family child care providers training courses and childcare policy recommendations.

The purpose of this study was to describe the experiences that HIV and AIDS patients who are on Community Home Based Care Programme have in the Lilongwe district of Malawi. Finally; concrete propositions were developed for the implementation of quality community and home based care programmes in Malawi. A qualitative research design using an interpretive phenomenology was used. The study took place in semi-rural and urban areas of Lilongwe district using patients from 3 major organizations dealing with people living with HIV and AIDS. Purposive sampling technique was used to choose the sample and a total of 15 in-depth interviews were conducted. Data was analyzed using ATLAS ti version 5. Findings revealed that the majority of the participants were concerned that they were living with HIV and AIDS. Most of them expressed anxiety, worries and fears of death. Another majority complained about the burden of opportunistic infections. Almost half of the participants felt guilty bringing misery to their families and complained of stigma and discrimination. However, a minority group of participants felt that to live with HIV and AIDS is not the end of life. Relatives were mentioned as the main care providers to HIV and AIDS patients. However, they were also cited high as a source of stigma. Conclusions were made that women and girls are at the highest risk as they bear the burden of care. It was therefore recommended that the Government of Malawi and all Non Governmental Organizations should develop women social economic status through promotion of education, provision of loans and provision of Gender Sensitive trainings. Formal training for care of HIV and AIDS patients should be introduced to all primary caregivers to render quality care in the homes and therefore this study has developed and pre-tested an educational program for this group. / Health Studies / D. Litt. et Phil. (Health Studies)

Contexte : De nos jours, la plupart des femmes ont intégré le milieu du travail et les services de garde font partie du quotidien pour la majorité des enfants. Ces derniers représentent un milieu-clé dans la promotion de saines habitudes de vie. Les haltes-garderies communautaires (HGC) sont fréquentées par beaucoup d'enfants, dont certains en contexte de vulnérabilité, et n’ont pas encore été étudiées à l'échelle nationale en ce qui a trait à leurs pratiques, préoccupations, perceptions et besoins en lien avec l'alimentation et la nutrition à la petite enfance. Objectif : Décrire les pratiques et identifier les préoccupations, les besoins et les perceptions des HGC du Québec en lien avec l’alimentation des enfants fréquentant ces lieux. Méthodologie : À l’hiver 2018, un questionnaire autoadministré, en format électronique, a été envoyé aux représentants des 242 haltes-garderies communautaires membres de l’Association des haltes-garderies communautaires du Québec. L’approbation éthique a été obtenue du Comité d’éthique de la recherche en santé de l’Université de Montréal. Résultats : Un total de 104 HGC ont répondu au sondage pour un taux de participation d’environ 43 %. Le contexte socio-économique des parents est la barrière à la promotion des saines habitudes alimentaires la plus rapportée. Plusieurs thèmes de formation proposés engendrent un intérêt chez plus de 75 % des HGC . Les deux formats préférés pour les outils éducatifs sont le partage de ressources ou d’activités exemplaires développées par d’autres HGC et les textes simples à imprimer pour le personnel. Discussion : La situation particulière des enfants vivant en contexte de vulnérabilité et les communications aux parents semblent être des enjeux importants en HGC. Les éducatrices en HGC ressentent le besoin d’être davantage outillées sur plusieurs thèmes en nutrition, tels que les bonnes pratiques d’hygiène et de salubrité. Les formats d’outils usant de la technologie numérique correspondent aux besoins rapportés par le personnel en halte-garderie pour les formations et le partage d’informations. / Background: Today, most women have entered the workplace and child care is a daily part of most children's lives. These are a key environments in promoting healthy lifestyle habits. The haltes-garderies communautaires (HGC)are frequented by many children, some of whom are vulnerable, and have not yet been studied in Quebec with respect to their practices, concerns, needs and perceptions related to feeding and nutrition in early childhood. Objective: To describe the practices and identify the concerns, needs and perceptions of the HGC of Quebec related to the feeding of children attending these places. Methodology: In the winter of 2018, a self-administered questionnaire, in electronic format, was sent to representatives of the 242 HGC that are members of the Association des haltes-garderies communautaires du Québec. Ethical approval was obtained from the Comité d’éthique de la recherche en santé of the University of Montreal. Results: A total of 104 HGCs responded to the survey for a participation rate of approximately 43%. The socio-economic background of parents is the most reported barrier to promoting healthy eating habits. Several proposed training themes generated interest among more than 75% of HGC. Themes related to parent / educator interactions are the most desired. The two preferred formats for educational tools are the sharing of resources or exemplary activities developed by other HGC and texts that are easy to print for staff. Discussion: The special situation of children living in a context of vulnerability and communication to parents seem to be important issues in HGC. Educators in HGC feel the need to be more equipped on several topics in nutrition, such as good hygiene and salubrity practices. Tool formats using digital technology correspond to the needs reported by day care staff for training and information sharing.