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Magister Public Health - MPH / Long waiting times have, for many years, been synonymous with primary health care in South Africa, and this is evident by the long queues and consistent client dissatisfaction. There are multiple contributing factors that exacerbate waiting time in Primary Health Care (PHC) facilities such as shortage of health care providers, increase in the uninsured population and South Africa’s quadruple burden of diseases. Health establishments have initiated numerous strategies to reduce long waiting times with varying degrees of success. These strategies have mostly been quantified and linked to indicators to measure their level of success in relation to quality healthcare. This research explores the clients’ perception of one such intervention, which is the implementation of an appointment system in primary care facilities in the City of Cape Town. Qualitative, exploratory descriptive methods were used to gain understanding of the impact the appointment system has had on the clients’ experience of attending health care services. The researcher also explored how clients perceive their role with regard to the shaping of their clinic’s appointment system. Semi-structured in-depth interviews were conducted with fifteen purposively sampled clients from five City Health clinics, who have implemented an appointment system through the guidance of the Appointment System Learning Initiative (ASLI). Maximum variation in sampling ensured the inclusion of small, medium and larger facilities within different geographical settings. Data analysis was done using a thematic coding approach, the themes were derived from the emerging data and were used to guide the researcher in gaining a rich picture of the clients’ experiences within the clinics. Ethical approval was requested and received from both the University of the Western Cape (UWC) and City Health prior to engaging any participants.

This dissertation examines the question how do group therapy members perceive the therapeutic relationship in process group therapy? The study fits within the interpretivist paradigm and employs a phenomenological qualitative research approach (Moustakas, 1994). The theoretical framework used to orient the study drew on process group theory according to Rutan, Stone, and Shay’s (2007) psychodynamic group psychotherapy approach and Yalom and Leszcz’s (2005) interpersonal process model of group psychotherapy. Participants were 10 university counseling center clients who were members of process therapy groups at a large urban university. Data collection consisted of in-depth interviews and demographic questionnaires. Phenomenological data analysis procedures followed recommendations by Creswell (2007) and Moustakas (1994). To enhance the rigor and trustworthiness of the study, the researcher engaged in member checking, use of an external auditor, reflexive and methodological journaling, and negative case analysis. Results of the study are presented as descriptions of how participants perceived the therapeutic relationship and the relationship’s influence on the experience of group therapy. Eight categories emerged from the interviews: (a) presence of group leaders; (b) safety; (c) caring; (d) sharing; (e) running the group; (f) levels of leadership; (g) developing understanding; and (h) intimacy with boundaries. Categories consisted of one or more related themes. There is a consideration of how the researcher’s experiences and beliefs played a role in the study. The results are discussed in relation to relevant group therapy theory and research. Strengths, weaknesses, and considerations of the study findings are offered. Implications of the study findings for group therapy practice and research are noted.

BACKGROUND In recent years, there has been a push to measure and monitor the quality of health care and the delivery of effective services. Substance use disorders are debilitating and in order to better understand this facet of substance abuse, it is important for organizations and providers to assess the quality of services, client satisfaction, and the relationships that exist between clients and treatment providers. PURPOSE The purpose of the study was to (1) assess the extent of the relationship between measures of client perceptions of satisfaction and treatment outcomes and (2) to assess the relationship between measures of therapeutic alliance and treatment outcomes. METHODS Data was obtained from a larger study assessing organizational factors affecting the implementation of evidence-based practices in the treatment of substance use disorders. This study was focused on the client satisfaction survey data obtained during the months of August and December of 2008, consisting of several five-day periods, during which clients were asked to complete the survey. The study population consisted of 371 clients aged 18 to 64 years. Logistic regression was used to evaluate demographic and other substance use-disorder factors for each of the scales pertaining to client satisfaction (general satisfaction, access, and quality/appropriateness) and therapeutic alliance (bond, goal, and task) in order to obtain odds ratios and 95% confidence intervals. Pearson correlation coefficients were used to assess the strength of the relationship of each of the measures of client satisfaction and therapeutic alliance with client perceived outcomes. Due to the nature of the survey questions being adapted from validated measures, Cronbach's coefficient alphas were used to determine internal consistency and reliability within each of the scales. To further assess client measures of satisfaction, multivariate linear regression was used to examine whether a specific client satisfaction measure or therapeutic alliance measure was a significant predictor of better client perceived outcomes. RESULTS Client perceptions of satisfaction - general satisfaction, access, and quality/appropriateness (worse vs. better) were significantly associated with better client perceived outcomes. Therapeutic alliance measures were also significantly associated with better client perceived outcomes. The strongest predictors from logistic regression analysis were quality/appropriateness (OR = 14.45, 95% CI 1.16-19.01) and general satisfaction (OR = 11.96, 95% CI 7.04-20.33) followed by WAI Goal (OR = 5.56, 95% 3.29-9.39), access (OR = 5.81, 95% CI 3.55-9.50), WAI Task (OR = 4.42, 95% CI 3.29-9.39), and WAI Bond (OR =3.61, 95% CI 2.06-5.22). Cronbach's coefficient alphas were all above the .70 threshold indicating strong internal consistency among the measures of client satisfaction, therapeutic alliance and client perceived outcomes. Pearson correlation coefficients indicated moderate relationships between access, general satisfaction, WAI Bond, Goal and Task with client perceived outcomes. The strongest correlation was that of quality/appropriateness of treatment services and client-perceived outcomes (r = 0.61, p<0.0007) CONCLUSIONS Client perceptions of satisfaction and therapeutic alliance were found to be significantly associated with better client perceived outcomes. Age, time in treatment, and number of times a client moved in the past 6 months was implicated in the association of general satisfaction and better client perceived outcomes. Age and race were implicated in the association of access and better client perceived outcomes. Further research is needed to measure the effectiveness of treatment services to ensure that clients are receiving appropriate evidence-based services that result in better outcomes.

This study was undertaken to investigate the influence of a military counselor s attire on potential clients expressed perceptions of and preferences for a counselor. Ninety volunteer participants were selected from a large southwestern Air Force base. Participants ranged in age from 18 to 46 years, with 68 male and 22 female volunteers. Rank was divided into 69 enlisted personnel (56 males and 13 females) and 21 officers (12 males and 9 females). Three videotapes were made depicting a counselor in three attire conditions: civilian; military officer; and military enlisted. A pilot study was completed which validated the research assumption that the videotapes differed only in the counselor's attire conditions. Participants were randomly assigned to three treatment groups. After each group was shown a videotape portraying the counselor in one of the three attire conditions, the participants were administered the Counselor Rating Form and the Referral Questionaire. The Counselor Rating Form is composed of three scales which assess perceptions of a counselors' trustworthiness, attractiveness, and expertness. The Referral Questionaire assesses subjects preferences to see a specific counselor in the event counseling is desired. Two main hypotheses, each having three subhypotheses, were developed for the study. The first hypothesis compared participants reactions to a counselor in civilian and military attire conditions. The second hypothesis compared participants' reactions to a counselor in two military attire conditions representing officer and enlisted ranks. Data was analyzed by analysis of variance procedures, with Scheffe' methods used, when appropriate, for multiple comparisons of mean scores.