Die Ziele der Dissertation sind es, die Effektivität von Rauchentwöhnungsprogrammen in der stationären Behandlung von berufsbedingten Hauterkrankungen zu prüfen und den Forschungsstand zum Einfluss des Rauchens auf berufsbedingte Handekzeme zu beleuchten. In einer Längsschnittstudie wurden dazu zwei Rauchentwöhnungsprogramme in der stationären Behandlung für berufsbedingte Hauterkrankungen evaluiert. Das Rauchentwöhnungsprogramm „Rauchfrei nach Hause!?“ der IFT-Gesundheitsförderung wurde hinsichtlich der Bewertung der Teilnehmer, der Steigerung der Motivation und Zuversicht, das Rauchverhalten aufzugeben, und der Abstinenz vom Rauchen mit dem bisher durchgeführten Rauchentwöhnungsprogramm verglichen. Zudem wurde die Ausprägung des berufsbedingten Handekzems von Rauchern und Nichtrauchern während und bis zu sechs Monate nach dem stationären Aufenthalt analysiert. Die Ergebnisse bestätigen, dass sich die Implementierung des zeitlich und inhaltlich intensiveren Rauchentwöhnungsprogramms „Rauchfrei nach Hause!?“ in die stationäre Behandlung von berufsbedingten Handekzemen als effektiv erweist. Dieses Programm führt zu einer höheren Motivation und Zuversicht, das Rauchverhalten zu ändern, sowie zu einer höheren Abstinenzquote drei Wochen nach dem Aufenthalt im Vergleich zum bisherigen. Auch der negative Einfluss des Rauchens auf die Ausprägung des berufsbedingten Handekzems bestätigt sich zu bestimmten Messzeitpunkten. Mit den Ergebnissen wird die Diskussion um den schädigenden Einfluss des Rauchverhaltens auf die Ausprägung des Handekzems vorangebracht und sie regen zu weiterer Forschung auf bspw. ambulanter Behandlungsebene von berufsbedingten Hauterkrankungen an.

Thesis (PhD)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: This study is a case study of the motivation for and application of a theory-driven evaluation approach to a community development programme in South Africa. The motivation for a theory-based approach is explicated within the context of the inability of experimental or ‘black box’ designs to evaluation to provide the requisite information to programme implementers, programme managers as well as policy makers. It also argues that experimental design in evaluation has not lived up to its promise of producing systematic and robust evidence about the impact of projects or programmes. Instead, experimental designs have struggled to maintain the integrity of the designs and are fraught with deficiencies that influence the quality of the results. The research context of a South Africa in the midst of political, economic and social transformation from 1994 to the present, is presented to highlight the complex challenges facing the country in terms of economic upliftment, poverty alleviation and social transformation. The need to evaluate the various interventions and initiatives through policy changes and development programme is then established. One such intervention, a community development programme initiated by the Centre for Community Development (CCD), is introduced as an example of an intervention with the objectives to deal with the challenges listed above. The history and development of programme evaluation as an interdisciplinary, applied field of research are presented to illuminate the multiple purposes assigned to programme evaluation and to create the platform for further arguments for the use of a theory-based approach to evaluation. The history, growth and potential benefits of a theory-driven approach are shared as well as the barriers and critiques from various quarters. A meta-theoretical analysis of the philosophical debates about the paradigmatic choices available to researchers is used to construct the ontological,epistemological and methodological landscape that influences various orientations to research. It shows how different researchers interpret this landscape or framework and locates the theory-based approach to evaluation within a particular brand of realist ontology. Community development is showcased in terms of its central concepts, that is ‘community’ and ‘development’. These concepts, individually and their interconnections, are interrogated and explained for the purposes of generating a conceptual and theoretical framework that is used later in the analysis of the evaluation findings. The research context of the community development programme is then introduced and the evaluation findings are outlined and discussed. The analysis of the evaluation findings reveals the essence of the community development programme and provides guidance for further refinement of the theory-based approach. / AFRIKAANSE OPSOMMING: Die gevallestudie ondersoek die motivering vir die gebruik en implementering van `n teoriegedrewe benadering vir die evaluering van `n gemeenskapontwikkelings program in Suid Afrika. Die motivering vir `n teoriegedrewe benadering word bespreek in die konteks van die onvermoë van eksperimentele of ‘black-box’ benadering tot evaluering om genoegsame informasie aan program implementeerders, program-bestuurders en beleidmakers te verskaf. Daar word ook geargumenteer dat die eskperimentele benadering tot evaluering, ondanks die belofte om sistematiese en gegronde bewyse van die uitwerking van projekte of programme daar te stel, nie aan hierdie belofte voldoen nie. Die eksperimetele benadering worstel ook om die integriteit van die ontwerpe te behou en dit beïnvloed die kwaliteit van die resultate. Die politieke, ekonomiese en sosiale transformasie in Suid Afrika, vanaf 1994 tot die hede, word beskryf as die navorsing-konteks om sodoende die uitdagings van ekonomiese opheffing, armoede verligting en sosiale transformasie uit te lig. Die dringende behoefte om verskeie initiatiewe en intervensies, wat in die lewe geroep is deur beleids-veranderinge en ontwikkelings-programme, te evalueer word vervolgens bespreek. `n Voorbeeld van so `n initiatief is die van die Sentrum vir Gemeenskaps- Ontwikkeling (CCD) wat ten doel het om van die sosiale uitdagings, hierbo genoem, vas te vat. Verdere argumente vir die gebruik van die teoriegedrewe benadering tot program evaluering word aangevoer deur middel van `n uitbreiding van die geskiedenis en ontwikkeling van program-evaluering . Program-evaluering word uitgebeeld as `n interdissiplinêre toegepaste veld van navorsing en word aangewend vir verskeie doeleindes. Die geskiedenis, groei en potensiële voordele van die teoriegedrewe benadering tot evaluering word bespreek asook die probleme van, en kritiek teenoor die benadering. Die ontologiese, epistemologiese en metodologiese raamwerk wat die sosiale wetenskappe omskryf en beïnvloed, word bespreek deur `n meta-teoretiese analiese van die filosofiese debatte oor die paradigmatiese keuses wat navorsers maak en beïnvloed. Dit wys ook hoe navorsers hierdie raamwerk interpreter en die teorie-aangedrewe benadering tot evaluering word vas gele binne `n bepaalde soort realistiese ontologie. Gemeenskaps-ontwikkeling word ook ontleed in terme van die sentrale konsepte naamlik ‘gemeenskap’ en ‘ontwikkeling’. Hierdie konsepte word ontleed en verduidelik met die doel om `n teoretiese raamwerk te ontwikkel wat later gebruik word in die analise van die evaluasie resultate.Die navorsings-konteks van die gemeenskaps ontwikkeling program word ook uitgebeeld en die resultate van die evaluasie aangebied en bespreek. Die ontleding van die resultate van die evaluasie ontbloot die kern van die gemeenskaps ontwikkeling program en bied riglyne vir die verdere verskerping van die teoriegedrewe benadering tot evaluasie.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: This study examined the origins and development of theory-based evaluation (TBE) and the logic models associated with this approach. This was done in order to better understand the roots and evolution of these models which are currently used by donor agencies both nationally and internationally. It was found that logic models, which are used for both project management and evaluation, had their origins in a range of domains including management, education and curriculum design from as early as 1909. Early evaluators from the education, training and health sectors as well as contextual factors such as the professionalization of evaluation and an ever- increasing demand for accountability contributed significantly to the development of both TBE and its associated models. A systematic review of a large sample of logic models and logical frameworks was conducted in order to bring some order and clarity to the plethora of models facing stakeholders in the field of evaluation. It was discovered that four key types of logic models and two key types of logframes face developers and users of models but that the "branding" of donors of their particular demand for accountability, obscures this fact. In order to understand the experience of South African Non-Governmental Organisations when engaging with donors and their demands for accountability a survey was carried out of those organisations which were utilising a specialised form of planning tool. The findings of this study show that South African donors, like their international counterparts, mainly use the models associated with TBE to obtain standardised and focused evidence of results from projects albeit with a distinct scepticism about the actual necessity of some of the donor requirements. Most Non-Governmental Organisations view the donor requirements, such as the logic model and logical framework, as necessary in the funding relationship despite indicating that they find the models inflexible. The study not only makes a contribution to an under-researched area in programme evaluation, it also provides insights into an under-researched area of the South African Non-Governmental sector. / AFRIKAANSE OPSOMMING: Die doel van die studie was om 'n in-diepte begrip van die ontwikkeling van logika modelle ("logic models") en logika raamwerke ("logical framework") te ontwikkel ten einde die ervarings van Suid-Afrikaans nie-regeringsorganisasies met donateurs beter te begryp. In besonder was die doel om vas te stel hoe sodanige organisasies die vereistes rondom projekbeplanning, monitering, evaluasie en rapportering ervaar. Die studie het gevind dat die oorspronge van hierdie modelle, wat beide vir projekbestuur en evaluasie gebruik word, te vinde is in verskeie areas insluit bestuur, opvoedkunde and kurrikulumontwerp. Die eerste generasie evalueerders in opvoedkunde, opleiding en gesondheid sowel as kontekstuele faktore soos die professionalisering van evaluasie en die immer-toenemende vereistes van rekenpligtigheid het alles beduidend bygedra tot die ontwikkeling van logika modelle. 'n Sistematiese oorsig en ontleding van 'n beduidende steekproef van logika modelle en raamwerke is uitgevoer ten einde meer helderheid en sistematiek te kry in 'n domein waar daar uiteenlopende benaderings en modelle is. Daar is gevind dat vier sleuteltipes logika modelle en twee sleuteltipes logika raamwerke deur die meeste organisasies gebruik word maar dat verskillende befondsingsagentskappe en organisasies hul eie betekenis en inhoud aan hul logika modelle gee. Ten einde die ervarings van Suid-Afrikaanse nie-regerings organisasies te begryp is 'n opname uitgestuur aan alle organisasies wat hierdie raamwerke gebruik. Die resultate van die opname wys dat Suid-Afrikaanse befondsagentskappe, soos hulle internasionele vennote, veral modelle gebruik wat geasosieer is met teorie-gebaseerde evaluasie ten einde gestandaardiseerde en gefokusde getuienis van projektesultate te genereer. Die meerderheid Suid-Afrikaanse nie-regeringsorganisasies aanvaar die vereistes van donateurs alhoewel hierdie "aanvaarding" gepaardgaan met 'n duidelike skeptisisme oor die absolute noodsaaklikheid van somige van hierdie vereistes. Die meerderheid organisasies beskou donateur vereistes, veral wat betref die logika model en die logika raamwerk, as noodsaaklik binne die konteks van die befondsingsverhouding ten spyte van persepsies dat sodanige modelle some uiters rigied kan wees. Die studies maak 'n bydrae, nie alleen in area in programevaluasie waar daar weinig navorsing is nie, maar dit bied ook insig in die gedrag en persepsies van die Suid-Afrikaanse nie-regeringsektor wat programevaluasie praktyke betref.

Thesis (MA)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: The cultural industries have been identified by the South African government as having significant potential to generate employment and hence alleviate the wide spread poverty suffered by many in the country. They have invested in the cultural industries with a view to developing SMMEs that have the potential to generate sustainable livelihoods. Craft, in particular is seen as an ideal vehicle through which poverty alleviation can take place, due to the combination of low technology requirements with high levels of manual labour. This study looks at one such multi-site craft-based poverty alleviation programme, Phumani Paper, and assesses the impact that it has had on the poverty of its participants (so far). Drawing on relevant theory “poverty” is defined as a deficiency with regard to three aspects of people’s lives: income, “human development” and capacity building. The results of the study indicate that the program did contribute to human development, but that income generation was less successful. In this regard success seems to depend on conditions at three levels of a programme: the programme management, the project model and the individual participants. Strategic intervention on these three levels will ensure that the impact of craft on poverty is more effective. / AFRIKAANSE OPSOMMING: Die kulturele nywerhede is deur die Suid-Afrikaanse regering geïdentifiseer as ‘n potensiële bron van werkskepping om te help om wydverspreide armoede in die land aan te spreek. Die regering het op kulturele terrein belê in klein- en medium sakeondernemings met die hoop dat hulle kan bydra tot die skepping van volhoubare bestaansgeleenthede. Kunsvlyt word as ‘n ideale roete tot armoede verligting gesien a.g.v. die kombinasie van lae tegnologie vereistes en intensiewe handearbeid. Die studie kyk na een sodanige kunsvlyt-gebaseerde programme vir armoedeverligting, nl. Phumani Paper, en meet die impak wat dit (tot dusver) op die armoede van diegene gehad het wat aan die program deelneem. Gebasseer op relevante teorie word “armoede” in hierdie studie gedefinieer as 'n gebrek op drie terreine van mense se lewens: inkomste, “menslike ontwikkeling” en kapasiteitsbou. Die resultate van die studie toon aan dat die program bygedra het tot menslike ontwikkeling, maar dat die skepping van inkomste minder suksesvol was. Sukses in hierdie verband blyk af te hang van kondisies op drie vlakke van 'n program: die programbestuur, die projek-model en die individuele deelnemers. Strategiese intervensie op hierdie drie vlakke sal verseker dat die impak van kunsvlyt op armoede meer effektief is.

Diss. (sammanfattning)--Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

This thesis evaluates experiences, effects, and costs of abdominal massage for people with constipation. The thesis comprises four papers: Paper I is a literature review of health economic analysis of nursing practice. Paper II and III is a prospective randomized controlled trial that evaluates abdominal massage in terms of effects and costs. Paper IV uses a qualitative approach to illuminate the experiences of receiving abdominal massage. Paper II and III included 60 participants who were constipated in accordance with Rome II criteria. Paper IV included nine participants. Paper I investigated the application of economic evaluation in studies of nursing practice. Systematic database searches were performed and gave nearly 600 papers that were screened and 115 studies were relevant according to stipulated inclusion criteria. The result showed that there was a trend of increased publications from the year 2000. Few studies reported the health economic methods used and the perspective of the economic analysis. There was a large variability in number of included cost items. Because the methodological weaknesses in many studies, it was difficult to use some studies as ground for discussion of resource distribution. Paper II investigates the effects of abdominal massage on gastrointestinal function and laxative intake on persons with constipation. The questionnaire Gastrointestinal Symptom Rating Scale (GSRS) was used and data were analyzed using multiple linear regression. The results showed that after eight weeks of abdominal massage the intervention group experienced significantly fewer gastrointestinal symptoms and had significantly more bowel evacuation compared with the control group. There were no differences in laxative intake. Paper III evaluated the change in health-related quality of life (HRQoL) for people with constipation when receiving abdominal massage and estimates the cost-effectiveness of two alternative implementation scenarios: 1) abdominal massage given by enrolled nurses in a department; and 2) participants giving themselves abdominal massage after receiving training in self-massage. Both scenarios imply that all participants received abdominal massage for eight weeks and those who found the treatment effective continued to receive treatment for eight more weeks. EQ-5D was used to assess HRQoL and for calculating QALY. The intervention group had after eight weeks of abdominal massage significantly higher HRQoL assessed with EQ-5D VAS compared with the control group. No significant differences were assessed with the EQ-5D index. Abdominal massage is initially expensive, but for those who respond favourably abdominal massage can be a cost-effective long-term treatment. Paper IV examines the experiences of receiving abdominal massage when having constipation. Four themes were formulated: being on one’s guard, becoming embraced by safe hands, feeling touch to body and mind, and being in a fragile state. Receiving abdominal massage was described as comfortable and lead to decreased problems with constipation. The improvement was described as easily disturbed and it was associated with demands to continue massage to maintain the new state. Conclusion: Abdominal massage is a pleasant treatment that provides significantly fewer gastrointestinal symptoms and increased health-related quality of life. As a long- term treatment, abdominal massage can be a cost-effective treatment.

Abstract The purpose of this study was to evaluate characteristics, the cost of the intervention and effects of participation on the first year preterm cost of care. Home-based intervention is a new preventive nursing intervention, which focuses mainly on early interaction between an infant and its mother. Many long-term advantages have been found in developmental issues of preterm infants, on mothers caring skills and the mother-child relationship. Even though those positive effects are well known, there still remains a gap of information concerning effective characteristics of the intervention as well as costs of such an intervention. The study focused on two main questions: 1) What are the characteristics of the intervention perceived by the mothers with preterm infants? 2) What are the costs of the intervention and what kind of effects did the intervention have on the first year cost of care of preterm infants? This was a retrospective evaluation study. The population consisted of preterm infants (≤ 32 gw), who were treated in eastern an northern Finland during 1996?1998. All infants received usual preterm care. In addition to this, the intervention group participated in the intervention. Data was gathered during 1998?1999. Two groups of mothers were interviewed. The first were mothers (N = 17), who described the care for a preterm infant at home. The other group of mothers (N = 7) evaluated the intervention. Content analysis was performed inductively and deductively. The last one was based on concept and characteristics of social support. Cost of the intervention was evaluated as salary, time and travelling cost for the nurse. Costs of preterm care were computed as direct and indirect social and family costs and compared the first year cost of intervention (N = 18) and control (N = 118) group of preterm infants. Data was gathered by a questionnaire and from hospital statistics and patient files. Descriptive statistical methods as well comparing the means were used. The results indicated an exceptional motherhood of the mothers with preterm infants. The exceptionality consisted of challenges of care for the infant, needs for information related to prematurity and care for the infant. Many fears, worries and feelings of guilt burden the mothers. The home-based intervention supported the mothers of the intervention group by equipping them with situation suitable information concerning prematurity and giving them emotional, integrative and active support. The mean cost of the intervention was 970 euroa per an infant to the hospital. Costs of new episodes of care and primary health care were smaller among the intervention group than among the control group. Cost-analysis indicated that the initial phase of care formed the main proportion of infants' first year cost of care. The results suggest that the home-based intervention may have potential to support mothers with preterm infant without significantly increasing the cost of care. / Tiivistelmä Tämän tutkimuksen tarkoituksena oli kuvailla vauvaperhetyön sisältöä, arvioida vauvaperhetyön tuottamisesta aiheutuvia kustannuksia sairaalalle sekä vertailla siihen osallistumisen vaikutuksia keskosten ensimmäisen elinvuoden hoitokustannuksiin. Vauvaperhetyöllä on havaittu olevan vuosia kestäviä suotuisia vaikutuksia keskosten kehitykseen, äidin hoivataitoihin ja vuorovaikutukseen. Kuitenkaan ei ole tietoa siitä, millaisena tuen vastaanottajat sen näkevät. Samoin on niukasti tietoa siitä, paljonko vauvaperhetyön tuottaminen maksaa. Tutkimustehtävinä olivat: Millaisena tukena vauvaperhetyö ilmeni keskosten äideille? Millaiset olivat vauvaperhetyön kustannukset sairaalalle ja miten siihen osallistuminen vaikutti keskosten ensimmäisen elinvuoden hoitokustannuksiin? Tutkimus toteutettiin retrospektiivisena arviointitutkimuksena. Tutkimusjoukko koostui vuosina 1996?1998 Itä- ja Pohjois-Suomen alueilla hoidetuista keskosista (≤ 32 vk). Kaikille keskosille annettiin tavanomainen hoito, jonka lisäksi interventioryhmän keskoset osallistuivat vauvaperhetyöhön. Aineistot koottiin vuosina 1998?1999. Vauvaperhetyön sisällöllisistä piirteistä koottiin tietoa kahden äitiryhmän teemahaastattelulla. Ensimmäisen aineiston äidit (N = 17) kuvailivat keskosten hoitoa kotona. Toisen aineiston äidit (N = 7) kuvailivat vauvaperhetyön sisältöä. Haastatteluaineistot analysoitiin aineisto- ja teorialähtöisellä sisällönanalyysilla. Jälkimmäisen luokittelurunko rakentui sosiaalisen tuen ominaispiirteiden mukaan. Vauvaperhetyön kustannusten arviointi perustui perhetyöntekijän palkkaan sekä kotikäyntien matka- ja aikakustannuksiin. Interventioon osallistumisen vaikutuksia hoitokustannuksiin arvioitiin vertailemalla interventio- (N = 18) ja verrokkiryhmän (N = 118) keskosten hoitokustannuksia. Tietoa koottiin vanhemmille suunnatulla kyselylomakkeella, sairaalan tiedostoista, potilasasiakirjoista ja perhetyöntekijän tiedostoista. Kustannukset laskettiin suorina ja epäsuorina yhteiskunnalle ja perheille aiheutuneina kustannuksina. Tulokset analysoitiin taulukkolaskennalla käyttäen kuvailevan tilastotieteen menetelmiä ja keskiarvotestejä. Aineistolähtöisen sisällönanalyysin mukaan keskosen äitiys oli erilaista äitiyttä, jota määritti keskosten hoidon asettamat vaatimukset ja äitien emootiot. Hoidon vaatimuksissa korostuivat päivittäisen hoidon, tiedon tarpeen ja erilaisen arjen asettamat tiedolliset ja taidolliset haasteet. äitien emootiot sisälsivät keskosten terveydentilaan ja kehitykseen sekä äitiin itseensä liittyviä pelkoja, huolia ja syyllisyyden tunteita. Teorialähtöisen analyysin perusteella vauvaperhetyön keskeinen sisältö muodostui tilannekohtaisen, keskosten hoitoon sovelletun erityistiedon antamisesta sekä perhetyöntekijän saavutettavuudesta. Muita vauvaperhetyön antaman tuen muotoja olivat emotionaalinen, integroiva ja aktiivinen tuki. Vauvaperhetyön tuottaminen maksoi sairaalle keskimäärin 970 euroa lasta kohden. Vauvaperhetyöhön osallistuneiden interventioryhmän keskosten uusien hoitojaksojen ja perusterveydenhuollon kustannukset olivat verrokkien kustannuksia matalammat. Tulokset viittaavat siihen, että vauvaperhetyöllä voidaan vastata keskosten äitien tuen tarpeisiin lisäämättä merkittävästi hoitokustannuksia.

The emotional aspect of caregiving is extremely complex and caregivers face tremendous emotional challenges as they react to the reality of their loved one's increasing disability. When it comes to making the placement decision, caregivers have frequently reached a burnout point in making decisions.

This thesis focuses on the intersection of social entrepreneurship and community gardening. In the middle of both of these initiative is man, his wellbeing and the wellbeing of the whole planet. Both of these social and civil initiatives can potentially become places of social integration of handicapped people. Therefore, this work is paying attention to concepts of social exclusion and inclusion, social entrepreneurship and community gardening. Moreover, it deals with the notions of employment and work of disabled people. This theses also contains a program evaluation of a community garden and a social enterprise, Kokoza,o.p.s, which employs people with a mental disease. Looking at the case of this enterprise we can see that the conjunction of a community garden and a social enterprise can be a fitting solution for all the stakeholders: for the establishing organization, for the employees as well as for the community using the garden. KEY WORDS Social entrepreneurship, Social Economy, Community garden, Urban gardening Social exclusion, Social inclusion, People with mental disorder, Evaluation, Evaluation research

Social value incorporates economic, environmental, and social impact in public policy decision- making. Social Return on Investment (SROI) has emerged as a popular way to measure social value. SROI is a tool for nonprofit organizations and social enterprises to measure their impact and express it in a common economic unit. This study employed a systematic review approach to assess the quality of SROI reports in the advocacy and human rights sector. The goal of this study was to determine whether SROI can measure the broader social effects of a program. Findings indicate that SROI has been used primarily by health and social services and significantly less often by advocacy and human rights groups. As such, the methodology has not yet been robustly applied to study very broad social effects associated with advocacy and human rights interventions. The social outcomes are usually captured qualitatively and not often quantitatively. Further, the social outcomes are rarely monetized due to a lack of financial proxies. SROI would benefit from being applied to a robust advocacy or human rights program, specifically focusing on broad social effects.