D.Cur. / Not only do communities and individuals have the right to participate in their own health care, but a key means to reducing the risk of potential social and psychological harm of people participating in clinical health research, especially efficacy trials, is to ensure that the community in which the research is being carried out, as well as health service providers, are meaningfully involved in the research process. One of the requirements of the South African White Paper for the Transformation of the Health System (South Africa, 1997: 74-78) which refers to Essential National Health Research (ENHR), is that the research agenda should initiate a process whereby stakeholders are equal inclusive partners in the research. Therefore researchers are no longer perceived as having the right to exercise a monopoly on conducting and explaining their research but now have a duty to empower their research participants and the research community to understand their own situation and become a collaborative partner in the research process. In this participatory approach to research, a collegiate partnership needs to be facilitated, but the power differentials that exist between stakeholders in community research make this a difficult partnership. The researcher, having had prolonged interaction with a community which has been targeted for large efficacy trials, initiated this research to gain insight into some of these difficulties and to describe the understanding and expectations of key stakeholders into community participation in clinical health research and develop a model to manage this participation. The critical elements in the study took cognisance of the research context, the dynamics within that context, the relevant stakeholders in a participatory approach to clinical health research and the processes within which they engage. Literature was reviewed throughout the study that was conducted in two phases. Phase one of the research design is ideographic, contextual and descriptive in nature. A perception survey, within a targeted community, was conducted to describe the understanding and expectations of community representatives, health service providers and researchers of community participation in clinical health research. The analysis of the perception survey endorsed the notion that community participation needs to be an v integral part of all clinical health research. The findings from the perception survey and a further literature search enabled the researcher to develop a theoretical framework for the construction of a model to manage community participation in clinical health research. The model is overarching with multiple processes namely: the participatory management process central to the model; the preparatory process; research process and quality improvement process. The model facilitates a collegiate partnership between stakeholders where there is mutual influence and collaborative interaction. Its implementation requires a radical paradigm shift in research and a commitment on the part of those "in power" to share power. It is recommended that standards that monitor, measure and evaluate community participation in clinical health research be developed to operationalise the model. Funders increasingly mandate community participation in clinical health research and the challenge is to ensure that this process goes beyond tokenism. A model to manage community participation in clinical health research will facilitate the conscious integration of key stakeholders into the research process to provide a platform for the voiceless and powerless within the research community, so that they become active participants and partners, not merely 'objects' in the process of research and knowledge creation. This will not only meet the requirements of funders and the ENHR, but this collaboration and partnership will foster trust between researcher, health service providers, community representatives and trial participants. There will be mutual understanding of the research issues and this will ensure that the study or clinical trial respects cultural and ethnic differences among participants. The primary outcome of the operationalisation of the model will be to facilitate quality management of community participation in clinical health research.

Magister Educationis - MEd / Decentralization of health services in Uganda, driven by the structural adjustment programme of the World Bank, was embraced by government as a means to change the health institutional structure and process delivery of health services in the country. Arising from the decentralization process, the transfer of power concerning functions from the top administrative hierachy in health service provision to lower levels, constitutes a major shift in management, philosophy, infrastructure development, communication as well as other functional roles by actors at various levels of health care. This study focused its investigation on ways and levels to which the process of decentralization of health service delivery has attained efficient and effective provision of health services. The study also examined the extent to which the shift of health service provision has influenced the role of local jurisdictions and communities. Challenges faced by local government leaders in planning and raising funds in response to decentralized health serdelivery were examined. / South Africa

Magister Commercii - MCom / The aim of this mini-thesis is to investigate the factors linked to access in the South African public health sector - using General Household Survey Data - in order to contribute to a better understanding of the role of access in achieving the National Department of Health’s primary goal of universal coverage. Even though the multi-dimensional interpretation of health system performance has gained acceptance and traction in recent years, much of the research linked to it remains supply-focused. The implicit truth is that demand-side health issues are largely ignored, under-researched and ominously absent from health policies. This is particularly true with regard to the access dimension of health performance, where research and policy focus almost exclusively on availability and affordability perspectives of access while neglecting demand-side aspects of health-seeking behaviour, such as acceptability. The study, therefore, pursues an in-depth exploration of access across its three dimensions - availability, affordability and acceptability - in the South African public health sector and aims to empirically investigate access to public health care from 2002 to 2012. It also identifies the underlying reasons for the observed trends, supplementing and reorienting the current understanding of access to public health care. The empirical findings reveal mixed results: it supports current literature by suggesting that equity has been achieved in terms of making public health care services more affordable, especially for the most vulnerable groups of South African society. However, acceptability and availability issues persist. It is safe to say that the availability of public health care – mainly a supply-side issue – is being addressed in the South African context with Government taking steps to address it. Unfortunately the same attention has not been given to issues of acceptability on the demand-side. Failure to fully understand the demand-side dimension of access and the role health-seeking behaviour plays in public health issues threatens to weaken health policies aimed at improving access. It is imperative that demand-side aspects of health-seeking behaviour and institutional responsiveness to health-demand occupy a more prominent role in South African public health debates, research and policy.

A dissertation submitted in partial fulfillment of the requirements for the degree of Master of Arts in the Department of Psychology, University of Zululand, South Africa, 2006. / The University of Zululand Community Psychology Centre (CPC) is a joint project of the Department of Psychology, Educational Psychology and Industrial Psychology. It was established in response firstly to the University's need to provide relevant training for its post-graduate psychology students and secondly to meet the need within the Zululand community for affordable psychosocial and psycho-educational services. The Centre works in partnership with other local Zululand Mental Health centres. The Centre is accredited with the Professional Board for Psychologists of the Health Professions Council of South Africa (HPCSA). This board ensures that institutions providing psychological services observe ethical codes of conduct and good practice (HPCSA, 2002). The present research was motivated by the fact that the CPC functioning has never been evaluated in terms of service delivery and relevance. The desire to know whether the CPC serves the purposes for which it was established, and to identify areas that need improvement, is a strong motivation. This helps to identify its viability, effectiveness, and value for the University of Zululand and the community served by the University. The aims of the study were to evaluate the CPC in terms of clients' perceptions with regard to effectiveness of the centre in meeting their needs and improving their psychological well-being. An accidental or convenient sample was used. An invitation to volunteer was extended to clients who happened to come for the CPC services. Volunteers completed a questionnaire^ which included a biographical inventory needs analysis questionnaire and RyfTs Scale (1995) of psychological well-being. Participants were pre and post-tested on the variable of psychological well being. The study concluded that the CPC still serves the purpose for which it was established. It is still relevant to the demand of the community. The results revealed that pre and post testing was associated with a significant improvement in total psychological well-being as with special reference to personal growth and positive relations with others. / NRF

The nursing workforce increasingly faces issues that affect clinical and managerial practice. One such issue is work-family conflict (WFC) and family-work conflict (FWC). Nurses face role strain as they confront the pressures from often competing work-and-family roles. This study assessed WFC/FWC among varying nurse roles: staff nurses, managerial nurses, and nurse executives. A random sample of 5,000 nurses, generated from registered nurses practicing in the state of Florida, was surveyed for this research study. Nurses were surveyed on demographics, perceptions regarding the work environment, and perceptions of WFC/FWC. Descriptively, nurses experienced more work-family conflict than family-work conflict. Regression analyses and ANOVAs indicated that staff nurses experienced less work-family conflict than nursing managers (second most) and nursing executives (highest). None of the nurse roles experienced significant levels of FWC. White nurses, compared to non-white nurses, experienced less WFC and FWC. WFC increased with shift length but FWC was not significantly affected by it. Paid leave for childbirth was associated with lower FWC. This study holds significant implication for the nursing workforce. Nurse managers and executives showed significantly higher WFC than staff nurses. This may discourage a nurse from taking on leadership roles or lead to leaving them. In an era where nurse managers and leaders are needed, efforts must be taken to decrease WFC/FWC factors. Nonwhite nurses reported higher levels of both WFC and FWC. This may contribute to tension at the workplace and a difficult family life. Leaders must continue to create platforms for nurses of all races and ethnicities to voice their work and family needs, and to be supported when doing so. Nurses working shifts over 8 hours had higher WFC levels. Although 12-hour shifts have been popular among staff and management, their use should be reevaluated. Finally, paid leave for childbirth is a program worth supporting, as it was a factor in lower FWC.

<p>Inappropriate ambulance use can be defined broadly as the use of emergency medical services (EMS) transport for non-urgent medical conditions, or when the patient does not use alternate transportation available. It drains health system resources, contributes to low morale among paramedics, and can delay care for patients who may be appropriately treated in alternative settings. An increasing number of studies indicate <em>that</em> inappropriate EMS use occurs, but few studies investigate how perspectives of inappropriate use are constructed. This study explores the construct of appropriateness in the context of ambulance use, and examines the implications of varying perspectives on ambulance billing policies.</p> <p>We present a grounded theory on the construct of appropriate ambulance use from interviews with paramedics in Ontario, national media reports and online reader commentary. Findings show that the role of paramedics varies across regions, and includes various types of care (e.g., emergency response, primary care and preventative care), and transportation (e.g., to the emergency department or urgent care clinics). In turn, constructs of appropriateness vary. In ambiguous cases, paramedics use their perception of the patients’ ability or attempts to cope with the medical situation to evaluate the appropriateness of ambulance use. Unexpectedly, the most frustrating cases of inappropriate ambulance use tend to be initiated by organizations, such as long-term care facilities, rather than members of the general public. These findings raise questions about the potential for ambulance user fees conditional on ‘appropriateness’ to improve either the effectiveness or the efficiency of ambulance services.</p> / Doctor of Philosophy (PhD)

<p>The organization of Health Care in Canada is such that many of the crucial decisions affecting the health of our population are made by politicians whose previous experience has not been in the health sector. This thesis is an attempt to present some of the medical and economic issues related to the prenatal diagnosis of disease in a form which can be readily understood by individuals who are neither physicians nor economists.</p> <p>The technology responsible for prenatal diagnosis has developed very rapidly over the past few years and now the need for an evaluation of the potential role of these techniques in, the prevention of serious genetic disease is widely recognized. This thesis evaluates the effects of prenatal diagnosis on Down's Syndrome, which is the most common serious genetic disease identified in this way, but many of the findings can be applied to other serious genetic disorders.</p> <p>The extent of the problem presented by Down's Syndrome was evaluated by reviewing the literature related to the medical, developmental and epidemiological characteristics of the disease. The findings indicate that this serious disorder is fundamentally irreversible despite the major effects that are made to provide special medical, educational and residential facilities for affected individuals. In addition, Down's Syndrome is a relatively common disorder and it is estimated that there are approximately 130 affected infants born each year and that there are 9,000 affected individuals in Ontario at the present time. The specific cause of the disorder remains unknown although the increasing incidence of affected infants with advancing maternal age is well recognized. The new techniques of prenatal diagnosis and selective abortion offer the only effective method of preventing the birth of these seriously and irreversibly handicapped infants.</p> <p>The procedures involved in obtaining a prenatal diagnosis are reviewed in some detail and it is concluded that the techniques are both medically safe and diagnostically reliable when provided by experienced personnel. Parents are offered a therapeutic abortion when a defective fetus is identified and although a mid-trimester abortion is associated with some morbidity and mortality, the risks are not greater than those associated with a full-term delivery. These findings suggest that prenatal diagnosis could be made available to all those parents who would benefit from health information of this sort without imposing unacceptable health hazards.</p> <p>A major section of this thesis devoted to the evaluation of the economic effects of a program proving prenatal diagnosis, using the technique of cost-benefit analysis. The implications of several diagnostic and patient management policies are examined and the results indicate that prenatal diagnosis should be offered to all women aged 35 years or more. The use of less conservative estimates would suggest that the service could be extended to younger women and still remain economically feasible.</p> <p>The final conclusion, based on medical economic and administrative considerations is that the existing prenatal diagnosis programs should be expanded to provide this service to all women aged 35 or over as soon as possible.</p> / Master of Science (MS)

No description available.

The effective management of professionals requires achieving a balance between organizational control and professional autonomy. The problem of achieving a balance is important currently in the United States healthcare industry. This dissertation examined the antecedents and consequences of physician autonomy in both traditional fee-for-service (FFS) and non-traditional managed care settings. The population of physicians in one county were surveyed. Two models were developed arguing that physician practice choice affects autonomy. The antecedents and consequences of autonomy were compared both between FFS and managed care practice and between different types of managed care organizations (MCOs). Results indicate that most physicians in the survey area choose managed care practice, and the value physicians place on income is positively associated with the volume of patients from MCOs. FFS practice generated greater autonomy than MCO practice, and autonomy within MCOs positively affected practice satisfaction. Group practice positively affected autonomy within MCOs. Autonomy did not vary across different MCO types but was influenced by the process variables physician decision involvement and organizational formalization, thus suggesting that classifying organizations by autonomy requires knowledge of the processes used in the MCO.

No description available.