Doctor of Philosophy / Persons with acquired brain injury require continuing support and care in various aspects of their lives many years post-injury. Their care and support are mainly provided by family members. While respite is one of a range of critical support systems for carers and people with life-long disability, very little is known about respite in the area of acquired brain injury. The majority of the research on respite has been undertaken in developmental disability, mental health and in aged care, but there is no research to date about respite from the perspectives of the person with a disability, the carer and respite provider. There is also no research that examines these perspectives in the acquired brain injury literature. This study was aimed to address this gap in the literature by investigating respite from the perspectives of the person with acquired brain injury, the carer and the respite provider. It also examined the profile of respite services being provided in the Australian state of New South Wales as there had not been a comprehensive mapping of respite before. Survey methodology was used to gather information from persons with acquired brain injury and their carers who were members of the New South Wales Brain Injury Association, which is the peak advocacy association of people with brain injury. The same methodology was used to gather similar information from members of Interchange Respite Care New South Wales, which is a peak association representing respite providers in the state. The survey questionnaires were developed and designed after an extensive review of the literature, and were reviewed by experts in the fields of respite, disability and acquired brain injury. The survey questionnaire was also trialled on a sample of families. The survey questionnaires for the three participant groups shared several common sections, such as demographic information; factors influencing respite use; expectations of respite; and satisfaction with respite services used by persons or carers. The responses from the three participant groups were analysed and compared using logistic regression and descriptive statistics. The key findings of the study are (a) several characteristics or factors of the person with acquired brain injury and their carer were significantly associated with the use of respite, (b) there were several common factors that all three participant groups reported to influence respite use, and (c) there were several common expectations of respite among the three participant groups. Some of the characteristics or factors that were significantly associated with respite use included the severity of disability, the high level of dependency of the person with acquired brain injury, and the number of days spent in a coma. Common factors reported by all three participant groups to influence respite use included the stress level of the carer and the severity of disability. Factors reported to influence respite use appear to be consistent with the literature in developmental disability. There were common perspectives regarding the expectations of respite among all three participant groups, such as the need for trained and qualified respite staff; a wider range of respite services and more flexibility of respite service provision. The study also indicated a reported lack of sufficient respite for persons with acquired brain injury and their carers. Some of the findings of the study appeared to be consistent with the research literature on acquired brain injury; such as the majority of carers being mainly female; there is a reliance on informal networks for the care and support of the person with acquired brain injury; and the majority of the persons with acquired brain injury being male. The study also found that many respite providers in New South Wales had extensive experience in running a respite service. The findings of the study have important implications for policy direction and development, practice and service delivery, and research. In terms of policy direction and development, implications explored included: a flexible funding model that is responsive to the needs of carer and person with acquired brain injury, and adequately trained and qualified staff and volunteers play an important role in respite provision. Further research is required to understand empirically the benefits and quality of life outcomes over a period of time, such as what types and extent of respite are more beneficial for certain demographic profiles. The study highlights the perspectives of persons with acquired brain injury, their carers and respite providers. Respite is an important support system to enable persons with acquired brain injury to receive the continuing care and support from their carers. Respite in acquired brain injury is a new field that merits further research as it holds the potential for addressing the needs of people with acquired brain injury and their carers.

In February 2001 the Minister of Health, in announcing the Primary Health Care Strategy (King, 2001), identified Primary Health Organisations as the vehicles for planning, funding and coordinating primary health care services throughout New Zealand. The requirement that communities be involved in their planning and development was integral to this strategy implementation. Investigation of the Horowhenua Primary Health Organisation establishment process from the inception of planning to the formation of a Primary Health Organisation provided an excellent opportunity to analyse the determinants of genuine community participation. This case study extended over a nine-month period. Data collected from multiple sources provided the basis for investigating the complex notion of community participation and the attributes which are essential for sustainable community engagement. The Horowhenua Primary Health Organisation Steering Committee comprised community representatives, iwi and local health professionals. This group along with the two external stakeholder groups - namely the District Health Board Funding Division and the District Health Board Primary Health Care Reference Group – were central to the analysis. The events recorded and observations made throughout the planning period formed the basis of identifying essential determinants of community participation. These included knowledge of the community and its unique “ways of doing”, the dynamic interdependencies both within the Horowhenua community and with stakeholders external to the Horowhenua, changing power relationships, managing material resourcing and accessibility to essential information. These all influenced how this rural community engaged in Primary Health Organisation planning. One common theme which emerges in the literature is the synergy between community participation and community development. A community development approach is a commonly agreed way of engaging communities in health service planning which is genuine, inclusive, self-reliant, and self-determining. This research demonstrated that the New Zealand context, where implementation of the primary health care strategy must be nationally consistent and comply with prescriptive, central government-determined criteria - as well as involving communities in a meaningful way - requires an alternative approach. The thesis presents a way of addressing power discrepancies, promoting interdependencies between stakeholders and achieving inclusiveness in all decision-making where “expert” stakeholders and community bring to the partnership a set of attributes and knowledge which collectively informs the entire planning process.

Includes bibliographical references. / iv, 398 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / The government of South Australia has developed a Primary Health Care Policy (1989) and Draft Implementation Plan (1992) in order to focus its health promotion efforts. The thesis demonstrates that implementation of these concepts will be facilitated by a clear understanding of idealogical and political issues to be faced in bringing about such change. / Thesis (Ph.D.)--University of Adelaide, Dept. of Community Medicine, 1995

Thesis (M.Sc.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science in Population Health, School of Public Health. Title from pdf file main screen (viewed on March 18, 2010). Includes bibliographical references.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Objective: This thesis aimed to advance the study of sustainability through the exploratory use of a conceptual framework for the investigation of a collaborative project. Methods: A qualitative case study design, utilizing document analysis and key informant interviews, was used to conduct a three-year follow-up of a collaborative mental health project. The study design and directed content analysis were informed by the Scheirer and Dearing (2011) conceptual framework. Results: The sustained outcomes identified by the six participating agencies included: institutionalized project components, maintained client benefits, continued collaboration and sustained attention to the issue. The sustainability of project components was associated with complex interactions between the innovation, organization, and community factors investigated. Conclusions: The study illustrated the importance of evaluating multiple aspects of sustainability to fully capture a project’s long-term effect. Complex systems theory was proposed to describe the interactions observed and as a direction for further development of the conceptual framework.

The health picture in the developing world is still very bleak. The varlOUS Black populations of South Africa (be they Africans, Indians or Coloureds) are part of this developing world. In a total world population of 4,607 million (of which 75 % are in the developing world); there are 10.3 million annual infant deaths (0-11 months) (of which 97 % are ln the developing countries); and 4.3 million annual child deaths (1-4 years) (of which 98 % are in the developing countries).*l The infant mortality rate (IMR) (infant deaths per 1,000 live births) in 1980 for the developing countries as a whole, and for Southern Africa specifically is 100; as compared to the IMR of 20 for developed countries. South Africa has an IMR of 90 (1982). However, a few relatively simple and inexpensive methods could enable parents themselves to bring about a revolution ln child survival and development. The idea that could make this revolution possible is primary health care. The vehicles that could make this revolution achievable are the spread of education, communications and social organization. The techniques which could make this revolution affordable even with very limited resources, are growth monitoring, oral rehydration therapy, breast-feeding and immunization (GOBI). These four principle life line techniques are low-cost, available now, achieve rapid results and a l most universally relevant. They involve people in taking more responsibility for their own health, and thus promote primary health care. In combination they offer an even greater degree of protection against the synergistic alliance of malnutrition and infection which is the central problem of child health and child development today. *3 In addition, three other changes-female education, family spacing and food supplementation (FFF) are also among the most powerful levers for raising the level of child survival and child health. Although more costly and more difficult to achieve, these changes in the lives of women are of such potential significance that they must also now be count ed among the breakthrough in knowledge which could change the ratio between the health and wealth of nations. *3 However, against this information is the stark reality that only up to 15 % of the world's families are using oral rehydration therapy (ORT), the revolutionary low-cost technique for preventing and treating diarrhoeal dehydration, the biggest single killer of children in the world. *4 This then rai ses the vital question that although the potential for child survival and a healthy and normal child development is there, to what extent is the average mother aware of and implementing these cost-effective methods of GOBI-FFF in her own situation? These questions are thus addressed in this study in an African and an Indian urban communities ln Natal/Kwa Zulu. / Thesis (M.Med.)-University of Natal, Durban, 1985.

No abstract available. / Thesis (M.Med.)-University of Natal, Durban, 1990.

Health education is critical to the success of a community health program. Yet the majority of research on health education is conducted from the point of view of programme designers or evaluators. Where health educators themselves are the focus, data is often generated through surveys, questionnaires, field notes, or quantitative measures. Narrative accounts by health educators describing their activities and their perceptions of programme efficacy are thus a neglected line of inquiry. My thesis examines one group of health educators who trained and worked with Sidney and Emily Kark at the Institute of Family and Community Health in Durban during the 1940s and 1950s. The importance of health educators in the Institute's project has often been acknowledged by key figures like the Kark, but few scholars have highlighted the contributions of these paraprofessionals. As catalysts of change and disseminators of knowledge, their role was encapsulated by health educator Neela Govender: "So many things people can do to [become] aware of health problems, and how much they themselves could be responsible for their own health ... that's not something they can forget. They will pass it on to another generation, or influence each other. We sow the seed, and it must grow, and spread". In focusing on the health educators' role, I seek to integrate perspectives of "history from below" to enhance previous analyses that concentrated on doctors and government administrators as the main architects of the Institute of Family and Community Health. To this end, I have collected testimony of health educators as a valuable source of historical evidence, which not only uncovers a foot soldier's view of what the Karks called a "practice of social medicine" but also illuminates various social, political, and economic contexts underpinning health education in South Africa. This study used oral history techniques to explore how retired health educators perceived their experiences at the Institute. It thematically analysed their narratives to gain a sense of their training, goals, methods and working conditions in segregationist and apartheid-era South Africa. My interview subjects were predominantly women whose work reflected the centrality of maternal, child, and family health to the Institute. As intermediaries between the clinic and the community, they were integral to the Institute of Family and Community Health's investigation of the links between health and culture. The themes of race, gender and culture were as pertinent in the mid-twentieth century as they are today in the delivery of health services; health educators' narratives might provide insights into how such conceptual factors influence the operation of community health programs in contemporary South Africa. The ways in which the Institute's health educators became active agents in the face of oppressive circumstances also contain potential lessons for their counterparts currently struggling to address an HIV/AIDS epidemic with inadequate resources and governmental support. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, 2004.

The basis of my study is the belief that governance of the local delivery of health could usefully include full and wide community representation and participation by the stakeholders and the larger community. The study was initially carried out in 2003 and now the same clinic has been targeted to carry out an update to see whether the perceptions have changed; if so why and if not what the status is. This study investigates the proposition that if communities do not participate in policy formulation processes, implementation is crippled. The case study is of free health-care policy in a small area of Pietermaritzburg, the Mpumuza area. This area is chosen because it has a local clinic that is being used by the local people to get free primary health care services, covered by the national policy. My interest in the study is influenced by the role I played as a public servant within the district Department of Health one and a half years ago. I dealt, on a daily basis, with service delivery (with a focus on facilitation of the process of service delivery). My interest is to know how the processes of policy development unfold in practice. The study will be examining what the different writers allude to in relation to policy formulation and implementation, the legislative framework pertaining to health policy, the actual case study and finally the conclusions drawn and recommendations, which are open for further exploration in other studies. The study looks at the impact of lack of involvement of the community members (who are at the receiving end) and the role of service providers (who for the purposes of this study will be confined to the nurses that offer the health services at the specific local clinic). Basically the study found that the subject of involving communities in policy formulation is a crucial one if the policy is to be successfully implemented and these are detailed later in the document. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.