Thesis (doctoral)--Rijksuniversiteit te Utrecht.

Thesis (Ph. D.)--University of Missouri--Columbia, 1998. / "May 1998." Typescript. Vita. Includes bibliographical references (leaves 67-70). Also available on the Internet.

Includes bibliographical references and index.

Este trabalho se propÃs conhecer o universo representacional dos psicÃlogos que atuam na rede PÃblica de Fortaleza e de sua clientela no que se refere a processo saÃde - doenÃa, relaÃÃo psicÃlogo-paciente, conceito de SaÃde e papel do psicÃlogo na SaÃde bem como investigar os obstÃculos para sua atuaÃÃo profissional no contexto da SaÃde PÃblica a fim de propor intervenÃÃes mais adequadas à realidade atual. A pesquisa dentro da Ãtica da Teoria das RepresentaÃÃes Sociais- TRS à uma maneira de se ter uma visÃo do mundo envolvendo o nÃvel intrapessoal, interpessoal e o grupal. Partiu-se de um roteiro de entrevista aberta adaptado do âEliciting Patients explanatory illness modelsâ procurando abarcar sete temas: 1. Processo saÃde-doenÃa 2. relaÃÃo psicÃlogo-paciente; 3. prevenÃÃo; 4. conceito de SaÃde; 5. aÃÃo do psicÃlogo na SaÃde; 6. AtuaÃÃo na Ãrea e 7. formaÃÃo na Ãrea. A amostra constou de dez psicÃlogos que atuavam na rede pÃblica de Fortaleza sorteados aleatoriamente da relaÃÃo do Conselho Regional de Psicologia â 11 regiÃo e vinte clientes, dois de cada psicÃlogo, indicados pelo prÃprio profissional. Os dados tiveram tratamento qualitativo pela tÃcnica de anÃlise de conteÃdo. O processo utilizado foi a anÃlise temÃtica na qual se destacou as categorias significantes para o objeto analÃtico visado. A RepresentaÃÃo Social do processo saÃde doenÃa da clientela à sempre inserida em dimensÃes sÃcio-familiares e espirituais enquanto que, para os psicÃlogos, ela à mais especifica da vida individual do paciente apesar destes profissionais jà relacionÃ-la com aspectos familiares. Outro fato que chama atenÃÃo à o modo como as intervenÃÃes psicolÃgicas estÃo sendo apreendidas por estes: afora as intervenÃÃes de praxe, os exercÃcios fÃsicos de relaxamento, as condutas mais diretivas como orientaÃÃo para lazer e laboterÃpica tem grande valÃncia para a clientela. O que se infere com este resultado à que a populaÃÃo absorve bem intervenÃÃes mais concretas e prÃximas de sua realidade. Houve uma equiparaÃÃo nos dois nÃveis de representaÃÃo social sobre saÃde no que tange à bem estar mas os clientes tambÃm a vÃem como ausÃncia de ocorrÃncia, ter sossego, paz e tranquilidade e viver melhor como se estivesse representando seu prÃprio momento existencial (ruptura de vida na doenÃa e, consequente, busca pela SaÃde. Percebeu-se que, enquanto a clientela tem a representaÃÃo do psicÃlogo que atua na SaÃde PÃblica idÃntica aos psicÃlogos de clÃnica, para estes profissionais a representaÃÃo social de sua atuaÃÃo ainda nÃo se firmou apresentando apenas um conteÃdo valorativo. Constatou-se que todos os psicÃlogos entrevistados nÃo vivenciaram experiÃncias na Ãrea da saÃde durante sua graduaÃÃo. Verifica-se, com relaÃÃo a atuaÃÃo e a formaÃÃo, que hà trÃs tipos de representaÃÃes que dizem respeito ao conhecimento como ter experiÃncia anterior, aprender a trabalhar em equipe, fazer disciplinas aplicativas da Ãrea, estudar psicologia institucional, atender em psicoterapia breve-focal e entender de saÃde em geral. Outras falam sobre a sua atuaÃÃo, por exemplo, falta de espaÃo fÃsico, reconhecimento da profissÃo, conquistas lentas, questÃo salarial, limitaÃÃo institucional, trabalhar com clientela de baixa renda e a Ãltima dificuldade à com relaÃÃo a si mesmo: âgostar de doenteâ, âfazer tratamento psicoterÃpicoâ e ânÃo ficar entre quatro paredes". As conclusÃes principais sÃo de que a TRS deu a condiÃÃo para apreender as formas de conhecimento empregadas pelos psicÃlogos e pela clientela. Aos psicÃlogos cabe: nÃo esquecer a dimensÃo bio-psico-socio-espiritual do indivÃduo, agir de modo mais preventivo e prospectivo, dar mais atenÃÃo ao planejamento e aÃÃes baseadas institucionalmente e socialmente, fazer uma revisÃo de sua metodologia e de suas tÃcnicas intervencionais criando novos recursos, dar vez Ãs tÃcnicas grupais e focais para lidar com problemas de sua clientela, priorizar o atendimento multidisciplinar em busca da interdisciplinaridade nas aÃÃes de saÃde. / The aim of this work is to know the representation universe of the psychologists working in Fortaleza public area and their clientele regarding the health process-illness, psichologist-patient relationship, health concepts and the psychologistâs role in public health and also to investigate the hindrances toward his professional perfomance in the context of public health, in order to sugest some more suitable interventions to the present reality. The research viewed by the social representations theory â SRT is a way of having a view of the whole world encompassing the intrapersonal, interpersonal and group levels. The beginning source was an open interview adapted from âEliciting Patients explanatory illness models" and moving on from there to include seven topics: I. Health-illness process; 2. Psychologist patient relationship; 3. Prevention; 4. Health concept; 5. Psychologist action in public health; 6. Performance and 7. Graduation into the community. Ten psychologist, which worked in the public area in Fortaleza, were chosen at random from Eleven Regional Committee of Psychology, as well as twenty clients, two for each psychologist that were indicate by the professional himself. The data had qualitative treatment though the analysis of the technical contents. The process applied was the thematic analysis in which the significant categories stand out toward the analytical object in view. The social representations of the health process-illness of the clientele is always inserted in socio-familiar and spiritual dimensions while for the psychologists it is more specific from the individual life of the patient, although those professionals related it to familiar aspects. Another fact that calls oneâs attention is the way the psychological interventions are being fully understood by the psychologists: besides the common interventions, there are great values for the clientele in physical exercises for relaxation more direct procedures like orientation for recreation and labotherapeutic occupation. As a result, the population absorbs more concret and closer interventions that fit their reality. There was a balance between the two levels of the social representation about public health refering to the welfare, but the clients also see it as na absence of occurrence, calm, peace and tranquility ans a better life, as they were representing their own existential moment (rupture of life in illness and as a consequence the search for health). .1 One can notice that the clientele "doesnât differenciate the psychologist that works at the public health from the ones who works at the clinic. As for the professionals, the social representation of their perfomance is not formulated yet; it only has a worthy content. it became evident that all of the psychologists interviewed didnât undergro experiences working in health area prior to their graduation It is possible to see, regarding, the performance and graduation that there are three kinds of representation, namely: knowledge â how to have prior experience, learn how to work as a team, make applicable disciplines that can be applied to the area, study Institutional Psychology, to assist in short-term psychotherapy and to understand health in general. The second kind of representation is performance: the lack of physical space, professional recognition, stow victories, salary problems, institutional limitations, working with clientele of lower income. The last representation has to do with themselves: they have to like the patient, do a psychotherapic treatment and not staying behind four walls. The main conclusions are: SRT offered conditions to understand the forms of knowledge used by the psychologists and clientele. It is responsability of the psychologists not to forget the biological, psychological, social and spiritual dimentions of the person, act in more preventive and prospective way, pay more attention to the planning and actions that are institucionally and socially based, review their methodology and interventional technics creating new resources, use also focal groups techinics in order to cope with their clientele problems, giving priority to the multidisciplinary attending in search of the interdisciplines in health care.

Includes bibliographical references / The purpose of this study was to understand the life-world of transsexual women in relation to their awareness of their unique health needs as a direct result of sexual realignment treatment, and their health-seeking behaviours, practices and experiences of responses in negotiating health care for their transgender-related health needs in the healthcare system. The overarching question asked in this research was: What are the lived experiences, and meaning of these experiences, for transsexual women during the sexual-realignment process when negotiating health care for their transgender-related healthcare needs in the healthcare system? Participants in this study were selected through purposive and snowball sampling. In-depth interviews were conducted with ten participants selected from urban, peri-urban, and rural areas of the Western Cape. Theoretical saturation was reached with the tenth participant, and further selection of participants was ceased. The data was viewed through a trans-inclusive feminist lens with a concurrent collection and analysis process as guided by the steps of analysis of Interpretative Phenomenological Analysis (IPA), as developed by Smith (2010). IPA is a modern qualitative approach to research inquiry which harnesses the strengths of phenomenology, hermeneutics, and ideography. The analysed data were illustrated in a master theme graphic which contained one superordinate theme, two subordinate themes and various categories. The superordinate theme of this study was named "Towards organic Womanhood", while the two subordinate themes were coined "Embracing Womanhood", and "Facing the Giant in order to Become". The subordinate theme Embracing Womanhood gives insight into aspects of transsexual women's journey of moving towards a state of organic womanhood, whereas the subordinate theme Facing the Giant in order to Become maps out powers in the healthcare system which prevent transsexual women from having a smooth transition journey. This study illustrates that transsexual women have a need to align their bodies with their gender identities, but even though South Africa has legislation which protects the health and rights of transsexual women, transsexual women find it challenging to make the transition. Health practitioners are ill-equipped to manage transsexual women, the care which they receive in the government-funded healthcare system is of a poor standard, and they are4subjected to extremely long waiting periods to have access to surgical sexual realignment services. Recommendations are made for the healthcare system, policy makers and educational institutions in order to stimulate the South African healthcare system to become inclusive and affirming to the needs of transsexual women. Furthermore, recommendations for researchers are made to stimulate the debate around transsexual health care in the scientific literature.

In Southern Africa, as elsewhere, public-private engagement (PPE) for the provision and financing of healthcare is considered a pervasive and valuable mechanism for meeting the health needs of the population. A wide range of mechanisms for engagement are available, each with organisational models that make them suited to overcoming particular barriers in particular health system contexts. The extent to which a PPE initiative produces the desired outcome is largely dependent on the organisational structure of the collaboration. This study uses scoping and systematic review methods to develop a typology of PPE models visible in Southern Africa and investigate the organisational variations between them. While a variety of PPE models are utilised in the current Southern African context, donor-dependency remains high and there is room to expand engagement of this sort by adopting more innovative mechanisms for engagement and organisational models. An account of the models of PPE being initiated in the Southern African context constitutes a first step toward an analysis of the effectiveness of various mechanisms, and points the way to areas of possible expansion of efforts to engage with the non-state health sector to more effectively align goals in the interest of public health. To some extent, possible models are determined by country context and state capacity. Nonetheless private resources for health, including capital, human resources and technical capacity of for-profit and not-for-profit non-state health sector organisations, represent a rich source of health systems resources that could be more fully utilised through more innovative PPE initiatives for delivery and financing of health care.

Abstract not available

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: Dept. of Health Administration. Bibliography: leaves 239-260. Also available online.

Every mother and child has the right to survive childbirth which requires skilled birth attendants together with referral and available emergency obstetric care (EmOC). The objective of the study was to describe delivery care routines at different levels in the health care system in Quang Ninh province, Northern Vietnam. The design was cross sectional using a structured questionnaire. Two districts in Quang Ninh province with 40 Community Health Centres (CHC), three district hospitals and one region hospital was included in the study, in total 138 (CHC n=105 and hospitals n=33) health care providers participated. In our study 20% (CHC) of the health care providers assisting deliveries at CHC were midwives and health care provider’s in our study further report to have assisted at less then 10 deliveries/year (81% of respondents at CHC). Findings show that the health care provider’s routines and care for women during labour and delivery vary and that there is a need for re-training and that women in labour should be cared for by health care providers with adequate training like midwifery. In our study CHC had poor resources to provide basic or comprehensive EmOC. Our findings indicate that there is a need for re-training in delivery care among health care providers and since the number of deliveries at CHC is few they should be handled by someone who is a skilled birth attendant. Our findings also show a variation in care routines during labour and delivery among health care providers at CHC and hospital levels and this also show the need for re-training and support from proper authorities in order to improve maternal and newborn health.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 4 uppsatser.