Gender-based Violence has a considerable prevalence globally, but it is South Africa that has recorded the highest femicide rate in the world. Prehospital Emergency Care providers appear to be well positioned (as first responders) to respond to abuse early. The aim was to understand and strengthen current/potential practice of domestic violence intervention by prehospital emergency medical systems in the context of global health-sector responses. The paradigm was critical theory and the methodology was exploratory sequential mixed methods. Interviews with managers/policy-makers, focus group discussions of clinician-educators and non-participant observation of simulated practice resulted in hypothesis generation. The quantitative phase involved a survey and cohort study with a screening intervention in a public emergency service. The qualitative phase found challenges and threats to responses require organisational/ideological change as paradoxical practice exists relative to the domestic violence behavioural pathology. Further, role-definition, identity and violence re-contextualisation is needed amidst ambivalent and contradictory positions. Emergent theoretical propositions include: typologies of victims, perpetrators and stakeholder responses; an eco-systemic relationship of state/societal expectations; and a 'conceptual compass' for preventing systemic research bias. The cohort study found bio-psycho-social responses and prehospital screening for domestic violence effective and that the evaluation of prehospital met/unmet need was prudent. The historical domestic violence detection rate was found to be 5,1/1000. A nine-fold increase in detection following the screening training and implementation translated to 47,9/1000 emergency care patients, with no adverse events. These rates are unprecedented for South African emergency care and support screening-policy implementation. The difference in domestic violence detection, quantifies the extent of the practice gap, with an alarming missed case detection of 42,8 per 1000 patients (females, 14 years plus). Conceptualisation of the emergency care burden of domestic violence and an awakening to the unacceptability of current practice is warranted. There is a risk of regulatory and organisational 'capture' mediated by masculine hegemony and resuscitation bias. Professionalization should enable a community of practice approach to violence prevention. Recommendations include the national implementation of screening policy; mitigation of regulatory capture risk and professionalising responses through curriculum-reform. The proposed Risk-Need-Responsivity practice-model promotes clinical coherence in Emergency Care. This elevation of the emergency care discourse is likely to benefit the victim and emergency medicine community. Research is warranted in the evolving epidemiology of domestic violence, the acute/clinical needs of victims/perpetrators and the role of emergency medical systems and surveillance, in promoting health and preventing the associated morbidity/mortality, both as a forensic emergency care burden and as a social determinant of health.

This thesis explores how gender can affect experiences of health and illness, with the understanding that gender is constructed differently across the life course, and is mediated by 'race' and class relations in Britain. Research was conducted with a small sample of informants drawn from African-Caribbean community groups in east London, using focus groups and in-depth interviews. Findings are three-fold. First, participation in health research itself was problematic for informants, relating directly to their experiences of personal and institutional racism in Britain. Evidence showed that these experiences encouraged informants to use public accounts of health and illness when more structured research methods were used. In-depth interviews encouraged informants to develop more private accounts of their illness experiences. A second finding was that social relations and low social status were often implicated in private accounts as contributing factors to illness. Women and men felt that racialised experiences, especially in the workplace, were problematic for black people collectively. Older female informants also connected personal health problems to their efforts in fulfilling the more traditional expectations of women in the home, family and workplace. Finally there is evidence that women and men have developed a variety of strategies to mediate the impact that social circumstances may have on their health. Some strategies influenced the way that illness discourses themselves were constructed, whilst others focused on building self-esteem through Caribbean or Black identity, or through developing a sense of 'self. ' Besides these findings, the methodology of this study is discussed. This was developed in response to the sensitive nature of the racialised research context. Key concerns have been to develop trust and rapport with informants, and to offer them the opportunity to comment critically on this research project and its findings. It was felt that this approach enhanced the insight into informants' reporting and understandings of health and illness. Conclusions of this research have theoretical, methodological and policy implications. Most topical are implications relevant to east London's Health Action Zone strategy. There are specific recommendations for understanding the mental health needs for African-Caribbean communities, and for developing appropriate ways to involve these communities in this initiative and offering them better access to information.

‘First line healthcare’ is offered via telephone in many Western countries. The overall aim of this thesis is to describe Telephone Nursing (TN) from three viewpoints: telenurses, parents calling for their children, and operation managers. Four empirical studies were conducted. Telenurses described their work in five different ways: ‘Assess, refer and give advice to the caller’, ‘Support the caller’, ‘Strengthen the caller’, ‘Teach the caller’ and ‘Facilitate the caller’s learning’, which all constitute a TN ‘work map’. Authentic paediatric calls between parents and telenurses revealed that 73% of callers were mothers and children were aged between 5 days and 14.5 years. The top three contact reasons were ear and skin problems, and fever, with a median call length of 4.4 minutes. More than half of the calls resulted in referrals and 48% received self-care advice. The likelihood of fathers being given referrals as a result of their call was almost twice as high as that for mothers, while mothers were almost twice as likely to receive self-care advice as fathers. Parents described their degree of worry and trust that influenced their decisions whether to contact SHD or not. Their calls were carefully prepared, and the parent calling often depended on family routine. Parents reported to follow recommendations. Most relied upon their own intuition if further worried, but some indicated they would never seek healthcare unless it was recommended. Operation managers described four main goals of TN work: ‘create feelings of trust’, ‘achieve patient safety’, ‘assess, refer and give advice’, and ‘teach the caller’. Equitable healthcare was regarded as important, whereas health promotion was not considered as part of the goals. Conclusion: The studied TN viewpoints present concordance and discrepancies. Paediatric health calls appear mostly to be a woman-to-woman activity. Telenurses’ increased gender competence might increase TN safety. For that matter, telenurses’ collaboration with parents and making parents aware of holding the ultimate responsibility for their child’s condition is important. Goals of TN work and their relationship with healthcare obligations such as equitable healthcare and health promotion need further clarification. The viewpoints described in this thesis may contribute to the development of TN.

This study investigated the health needs of immigrant women from the African Great Lakes living in South Africa in the province of Gauteng, Tshwane Metropolitan city. It described their challenges and related factors compromising their holistic wellness, and identifies their context specific health needs as a gender group. A qualitative approach was utilised concurrently with participatory action research method. Data collection involved triangulation of instruments. A literature study was conducted to select relevant information usable as basis for this study. Data analysis and interpretation revealed factors that make it difficult for immigrant women from the African Great Lakes region to gain access to health care services in South Africa, identifying their specific women’s health needs. Recommendations proposed that policy makers and implementing professionals rendering women’s health care services should consider utilising a holistic and interdisciplinary approach to meet these basic needs. / Health Studies / M.A. (Public health)

This study investigated the health needs of immigrant women from the African Great Lakes living in South Africa in the province of Gauteng, Tshwane Metropolitan city. It described their challenges and related factors compromising their holistic wellness, and identifies their context specific health needs as a gender group. A qualitative approach was utilised concurrently with participatory action research method. Data collection involved triangulation of instruments. A literature study was conducted to select relevant information usable as basis for this study. Data analysis and interpretation revealed factors that make it difficult for immigrant women from the African Great Lakes region to gain access to health care services in South Africa, identifying their specific women’s health needs. Recommendations proposed that policy makers and implementing professionals rendering women’s health care services should consider utilising a holistic and interdisciplinary approach to meet these basic needs. / Health Studies / M.A. (Public health)