This thesis examines the implementation of mental health reforms in Britain and Italy since the 1950s from a geographical perspective. Both countries have experienced the policies of deinstitutionalisation and community care, yet the timing, methods and outcomes of implementation have varied considerably, both between the countries and within them. This situation suggests that underlying social, political, economic and cultural differences have been important influences on the implementation of the respective mental health reforms, and this is a theme that is considered throughout the thesis. The research was conducted at three levels of enquiry: firstly by comparing the implementation of mental health reforms at the national scale in Britain and Italy, looking in particular at the influence of politics and place; secondly by focusing upon the implementation of the reforms in two cities, for which Sheffield and Verona were selected; thirdly a case study approach was adopted in order to study in greater detail one community-based mental health service in each city. It was at this level of enquiry that the more intensive research was carried out, in the form of two local resident questionnaire surveys, one in each city, and semi-structured interviews with mental health professionals from the two case study services. This research illustrates that the implementation of mental health reforms in Britain and Italy has led to a geographical unevenness in the distribution of community-based services at all spatial scales. However, the social, cultural and political contexts in which the reforms have occurred in the two countries have been quite different and therefore when contemplating direct comparisons between mental health reforms in Britain and Italy, the argument that 'place matters' is highly pertinent.

Many of the assumptions underlying health care issues appear to be taken for granted by policy makers, when if fact they ought to be examined for their relevance to today's problems. This research attempts to do so, by analysing the non-economic issues and factors involved in the financing and provision of health care. It will be argued that policy makers commonly have a unidirectional economic perspective in both policy making and in health care system reform directives, a situation which leaves issues such as the health status of the population and of equity in resource allocation to political rhetoric, while in practice, policies deal with the issue of cost reduction. Of major importance is the moral dimension in policies dealing with health and welfare, which is clearly either forgotten or is afforded too little consideration in policy making. This is particularly relevant to the issue of rationing of health care in publicly provided health care systems. While always quietly practised by clinicians in the past, rationing is now required to be overt because demand for health care has outstripped available resources.The substance of the argument comes from the analysis of a very large literature on the broader issues affecting health care policy, such as concepts of social justice, ethics of resource allocation and the physician-patient relationship, all of winch ought to underpin policies for the mechanisms of funding and provision of health care systems.A conceptual diagram of a health care system is offered to provide a framework for the discussion of how the issues are interrelated at micro, meso and macro levels in policymaking. Examples of reforms to health care systems are taken from five OECD countries which share a common social, political and economic heritage: Australia, United Kingdom, New Zealand, Canada and the United States of America.The conclusions ++ / from this research show that theoretical incoherence pervades this most complex of policy areas, allowing the economic imperative to take precedence over the substantive health care issues.

Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased  interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome. Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers. Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage. Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.

Thesis (M.S.)--Ohio University, August, 2009. / Title from PDF t.p. Includes bibliographical references.

Thesis (Ph. D.)--University of Oregon, 2001. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 234-242). Also available for download via the World Wide Web; free to University of Oregon users.

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references. Available also from UMI/Dissertation Abstracts International.

Thesis (M.A.)--York University, 2008. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references. Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR45926

Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1997. / Source: Masters Abstracts International, Volume: 45-06, page: 2943. Abstract precedes thesis as 1 preliminary leaf. Typescript. Includes bibliographical references (leaves 66-67).

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references (leaves 255-293). Available also in a digital version from Dissertation Abstracts.

Thesis (B.A.)--Haverford College, Dept. of Political Science, 2007. / Includes bibliographical references.