Objective: From a patient-centered perspective, this study sought to explore cancer patient experiences using integrative health techniques, while undergoing or after having completed conventional cancer therapy. Methods: Recruitment and data collection both occurred within the Supportive Care Medicine Department of a comprehensive cancer center in the southeastern United States. The primary collection method was semi-structured interviews, of which 13 were conducted. Results: Patients using integrative therapies experienced a variety of physical and mental/emotional benefits from their chosen therapy, such as management of lymphedema and nerve damage, increased mobility, and improved self-confidence. Conclusion: Integrative therapies can provide many benefits to patients in mitigating treatment side effects and other cancer related symptoms. CAM practitioners themselves played an important role in post-treatment cancer support; both by acting as a health educator and by administrating the therapy itself.

The development of community health services (CHS), characterised in particular by the emergence of general practitioners and the establishment of community health centres, is one of the top priorities on the policy agenda for urban health reform in China. The primary and secondary levels of hospitals are being urged to change functions, shifting from traditional hospital services to CHS. This study aimed to contribute to the development of training strategies for CHS through documenting the policy, administrative and institutional arrangements of the CHS programs, identifying performance problems, and analysing relevant determinants that underpin the practice and performance of CHS. Document analysis, indepth interview and questionnaire survey were adopted as main methodological approaches. The study was undertaken in Chengdu and Panzhihua, which included observation of 14 community health centres, interview with 23 general practitioners and managers, and a random sample survey among 1041 residents. This study revealed that the top priority of the CHS programs was to try to stay alive through competing with other health institutions for consumers who could afford medical charges and to provide clinical services that would generate good revenues. The accessibility to medical care for the community residents had not been improved significantly. Poor response to local population health issues, inefficient use of resources and poor quality of services were amongst the key performance problems. There was little prospect of the CHS institutions achieving sustainable development. There was a widespread agreement among the CHS managers and practitioners that training is an essential strategy in improving the CHS performance. However, when policy, system, and cultural barriers are not properly addressed, training means little. There were evident organisational failings and lack of inter-governmental collaborations and leaderships in developing CHS. The lack of policy coherence with respect to organisational incentives impeded the achievement of the goals of CHS. There was also a lack of consumer participation and support. These findings have implications for both policy development and training arrangements. The development of CHS needs to be considered as a system change rather than in terms of isolated institutional developments. Training arrangements for CHS need to offer competencies for a wide range of organisations and professionals to enable them to improve their daily works and also to contribute to solving some of the system problems. The training programs developed for governmental officials, hospital and CHS managers, general practitioners, community nurses, public health workers, pharmacists and other CHS practitioners need to be aligned with a unified goal and facilitate the development of the supportive environments and inter-organisational collaborations (partnerships).

<p>The World Health Organization (WHO) states that working intersectorally and internationally with health issues is crucial in creating a change towards healthy public policy at a local level. Healthy Cities is one of the programmes where WHO uses a health governance approach (governing through networks) to try to reach this objective. The aim of this bachelor thesis is to identify the factors that make member cities of the WHO European Healthy Cities Network successful in reorienting local public policy towards healthy public policy. An analysis of nine documents corresponding to the selection criteria set up by the authors was conducted. These documents consisted of reports published by WHO on the Healthy Cities programme, but also of independent research articles and one thesis published on other networks similar to Healthy Cities. Also, further data was collected through telephone interviews with contact persons in four member cities. The interviews were transcribed word by word. Both data (documents and interviews) were analysed using a qualitative content analysis.</p><p> </p><p>The results show that the four key “elements for action” (political commitment, leadership, readiness for institutional change and intersectoral collaboration) crystallized by WHO for creating healthy public policy were mainly confirmed in this research study. Therefore, the authors draw the conclusion that WHO has succeeded in making the member cities commit to the Healthy Cities philosophy and in spreading the idea of health governance in Europe. However, additional factors were found both in the document analysis and in the interviews. When looking at the top four frequently occurring factors in the documents, community participation and status were highlighted. The two additional factors found in the interview data was holistic thinking and systematic, goal-oriented work. Also, the importance of political commitment was questioned by a minority of the respondents. This might indicate that the four key “elements for action” crystallized by WHO might not have as big of an effect in creating change at a local level as has been made out by WHO. Furthermore, respondents stated that difficulties existed in translating theory into practice at a local level. This might indicate that potential changes made in the member cities after joining the Healthy Cities programme are mainly ideological. Despite this, the attitudes among the respondents towards membership in the WHO European Healthy Cities Network were overall positive, and even though difficulties still exist, the respondents maintained that Healthy Cities enables them in taking the next step towards healthy public policy at a local level.<strong></strong></p>

Background: The challenge of research in resource-poor settings remains a profound concern and is closely linked to African social development. Work of this thesis spans the end of apartheid and first decade of the democratic era in South Africa, along with emergence of the HIV/AIDS pandemic. It also covers the founding decade of the INDEPTH Network. Aims: Through appraising health and population research in a rural southern African sub-district over the past decade, to evaluate the utility of health and socio-demographic surveillance in rural African settings for: • capturing the dynamics of health, population and social transitions • supporting a mix of research designs, and • contributing to policy and programme development and evaluation. To extend this appraisal by examining the multi-site opportunities offered by the INDEPTH Network. Methods: Work was sited in the Agincourt sub-district, a heavily populated border area of rural north-eastern South Africa. Health and socio-demographic surveillance, introduced in 1992, involved prospective follow-up of the entire sub-district population of 70,000 people (including some 30% Mozambican immigrants) who lived in 11,700 households and 21 villages. Annual census rounds systematically updated household membership and recorded all vital events (births, deaths and migrations) since the previous census. A maternity history was asked of women of reproductive age and a verbal autopsy carried out on all deaths registered. The resulting ‘data and research platform’ – a core feature of all INDEPTH field sites – provided data for computation of trends in vital events and supported an extensive interdisciplinary project portfolio. The population under surveillance can be disaggregated into cohorts selected by age, sex or other criteria. Analyses are possible at multiple levels (individual, family/household or neighborhood) and can include socioeconomic factors. Findings: The Agincourt community experienced a serious worsening of mortality among most age-sex groups, rapidly declining fertility to near replacement level, and changing patterns of labour migration. This resulted in major changes in population structure and household composition. The rising burden of chronic disease involved both chronic infectious illness (HIV/AIDS and tuberculosis) and non-communicable disorders (such as stroke and related vascular disease). The burden of illness requiring chronic care increased disproportionately to that needing acute care. Potential contributions of field sites based on health and socio-demographic surveillance to local and national health policy are considerable yet remain underexploited. Interpretation: Rural South and southern Africa is in the midst of multiple, interrelated transitions with implications for health, social and development sectors. Health and socio-demographic surveillance systems are effective research instruments that can capture the rapidly-changing dynamics of health and social transitions in developing settings. Similarly, they can support a range of observational and intervention study designs including policy evaluations. The INDEPTH Network should boost much-needed comparative research; yet singly, and as a group, many of these sites have yet to fulfil their undoubted potential.

The World Health Organization (WHO) states that working intersectorally and internationally with health issues is crucial in creating a change towards healthy public policy at a local level. Healthy Cities is one of the programmes where WHO uses a health governance approach (governing through networks) to try to reach this objective. The aim of this bachelor thesis is to identify the factors that make member cities of the WHO European Healthy Cities Network successful in reorienting local public policy towards healthy public policy. An analysis of nine documents corresponding to the selection criteria set up by the authors was conducted. These documents consisted of reports published by WHO on the Healthy Cities programme, but also of independent research articles and one thesis published on other networks similar to Healthy Cities. Also, further data was collected through telephone interviews with contact persons in four member cities. The interviews were transcribed word by word. Both data (documents and interviews) were analysed using a qualitative content analysis.   The results show that the four key “elements for action” (political commitment, leadership, readiness for institutional change and intersectoral collaboration) crystallized by WHO for creating healthy public policy were mainly confirmed in this research study. Therefore, the authors draw the conclusion that WHO has succeeded in making the member cities commit to the Healthy Cities philosophy and in spreading the idea of health governance in Europe. However, additional factors were found both in the document analysis and in the interviews. When looking at the top four frequently occurring factors in the documents, community participation and status were highlighted. The two additional factors found in the interview data was holistic thinking and systematic, goal-oriented work. Also, the importance of political commitment was questioned by a minority of the respondents. This might indicate that the four key “elements for action” crystallized by WHO might not have as big of an effect in creating change at a local level as has been made out by WHO. Furthermore, respondents stated that difficulties existed in translating theory into practice at a local level. This might indicate that potential changes made in the member cities after joining the Healthy Cities programme are mainly ideological. Despite this, the attitudes among the respondents towards membership in the WHO European Healthy Cities Network were overall positive, and even though difficulties still exist, the respondents maintained that Healthy Cities enables them in taking the next step towards healthy public policy at a local level.

Objectives. The objective of this project was to ascertain and quantify the effects of gender, age, payment method, and practice size on clinical output of GP/FPs. While the identification of these effects has been undertaken previously, this study is the first attempt to quantify the proportion of variance in physician output explained by this group of variables.<p>Background. The question is of vital importance to academics, health professionals, and citizens. The physician population is aging and feminizing while physicians are softening their opposition to fixed remuneration methods and displaying a greater predilection to group practice. Implications exist for the supply of physician services as gender, age, payment method, and practice size have been found to influence physician output, and therefore the availability of primary care services. <p>Methods. The study employed self-reported data obtained from 1006 Canadian general and family practitioners in 2004. Respondents provided their gender, age, payment method, and practice size, as well as the number of patient visits they conducted (both during regular hours and while on call) and the number of hours they worked in an average week. These data were used to measure the effects of the four independent variables on GP/FP output and to quantify their total collective affect. <p>Results. By and large, the analysis confirmed the prevailing view of the literature, as female physicians; physicians in the youngest and oldest age categories; physicians remunerated mainly through fixed payment methods; and physicians in group practice reported lower levels of output than their counterparts. Despite the presence of obvious trends in the data, in some cases the analysis was unable to uncover statistically significant differences in output between groups of physicians.<p>In terms of the contribution made by these four variables to the variance in GP/FP output, significant and parsimonious models contributed 16.2% of the variance in total patient visits, 19.3% of the variance in patient visits during regular hours, 2.5% of the variance in patient visits while on call, 11.1% of variance in hours worked per week, and 8.9% of the variance in patient visits per hour worked. <p>Conclusion. The four factor variables explained less than one fifth of the variance in all output categories. This first attempt to quantify their contribution identifies an important question: what accounts for the remaining variance? If the unidentified factors are measurable, perhaps they can be added to these models in the future in order to increase our understanding of the forces behind GP/FP output of primary care services.

Objectives. The objective of this project was to ascertain and quantify the effects of gender, age, payment method, and practice size on clinical output of GP/FPs. While the identification of these effects has been undertaken previously, this study is the first attempt to quantify the proportion of variance in physician output explained by this group of variables.<p>Background. The question is of vital importance to academics, health professionals, and citizens. The physician population is aging and feminizing while physicians are softening their opposition to fixed remuneration methods and displaying a greater predilection to group practice. Implications exist for the supply of physician services as gender, age, payment method, and practice size have been found to influence physician output, and therefore the availability of primary care services. <p>Methods. The study employed self-reported data obtained from 1006 Canadian general and family practitioners in 2004. Respondents provided their gender, age, payment method, and practice size, as well as the number of patient visits they conducted (both during regular hours and while on call) and the number of hours they worked in an average week. These data were used to measure the effects of the four independent variables on GP/FP output and to quantify their total collective affect. <p>Results. By and large, the analysis confirmed the prevailing view of the literature, as female physicians; physicians in the youngest and oldest age categories; physicians remunerated mainly through fixed payment methods; and physicians in group practice reported lower levels of output than their counterparts. Despite the presence of obvious trends in the data, in some cases the analysis was unable to uncover statistically significant differences in output between groups of physicians.<p>In terms of the contribution made by these four variables to the variance in GP/FP output, significant and parsimonious models contributed 16.2% of the variance in total patient visits, 19.3% of the variance in patient visits during regular hours, 2.5% of the variance in patient visits while on call, 11.1% of variance in hours worked per week, and 8.9% of the variance in patient visits per hour worked. <p>Conclusion. The four factor variables explained less than one fifth of the variance in all output categories. This first attempt to quantify their contribution identifies an important question: what accounts for the remaining variance? If the unidentified factors are measurable, perhaps they can be added to these models in the future in order to increase our understanding of the forces behind GP/FP output of primary care services.

This study presents an analysis of policies addressing child mortality in Pakistan focusing on problem structuring, using a comparison with Bangladesh. Pakistan's progress in addressing child mortality rate has been much slower than that of Bangladesh despite the fact that Pakistan has excelled in economic growth, and the two countries have comparable populations and share political history. This study analyzes and provides an explanation for differential outcomes in terms of problem structuring in the two countries. A comparative analysis of policy documents reviewed for the two countries illustrates the fact that Bangladesh, in formulating its child health policy, has emphasized the input factors such as nutrition and environmental aspects, besides health services. Pakistan, on the other hand, maintains a general problem formulation strategy focusing mainly on health service and ignoring the social, environmental, and other factors causing morbidity and mortality in children. Another comparison between policy formulation in each country and the extensive literature available on child mortality suggest that neither country pays as much attention to structural factors as the literature does. The analysis provides some insight into differentials in policy formulation associated with child mortality in the two countries, but more importantly, it provides an understanding of the underlying elements for inadequate policy outcomes in case of Pakistan.

Latino immigrants encounter an entanglement of rights and policies after occupational injury or illness. In collaboration with an immigrant worker center, ethnographic research and a survey are used to analyze injured workers’ experiences. The center uses survey results to identify common threads and systematic problems, and to explore potential direct action. Through interviews with workers and medical and legal professionals, I investigate the barriers Latino immigrants face following occupational injury or illness, how their lived experiences relate to the greater medicolegal frameworks that demarcate most formal processes of compensation and treatment, and the experiences of professionals who mediate these structures. Research results confirm that immigrant workers lack information about their labor rights and the workers’ compensation system, which prevents them from filing claims, and contributes to the underreporting of workplace injuries. However, this research project also documents how workers who do file claims and report injuries are systematically barred access to redress due to a confluence of factors including unresponsive and fraudulent employers, biases in the medical system, discourses of deservingness, insufficient protections from retaliation, and the effects of a market-based medical system. I argue that future work-related injury prevention efforts should go beyond rights education, and include reforms to the compensation system.

Purpose: The thesis determined how policy implementation and change management can be improved in Nigeria, with the health insurance scheme as the basis for narrative exploration. It sets out the similarities and differences in assumptions between supra-national organisations such as the World Bank and World Health Organisation on policy implementation and change management and those contained in the Nigerian national health policy; and those of people responsible for implementation in Nigerian organisations at a) the federal or national level and b) at sub-federal service delivery levels of the health insurance scheme. The study provides a framework of the dimensions that should be considered in policy implementation and change management in Nigeria, the nature of structural and infrastructural problems and wider societal context, and the ways in which conceptions of organisations and the variables that impact on organisations' capability to engage in policy implementation and change management differ from those in the West. Design/methodology/approach - A qualitative approach in the form of a case study was used to track the transformation of a policy into practice through examining the assumptions and expectations about policy implementation of the organisations financing the policy's implementation through an examination of relevant documents concerning policy, strategy and guidelines on change management and policy implementation from these global organisations, and the Nigerian national health policy document. The next stages of field visits explored the assumptions, expectations and experiences of a) policy makers, government officials, senior managers and civil servants responsible for implementing policy in federal-level agencies through an interview programme and observations; and b) those of sub-federal or local-level managers responsible for service-level policy implementation of the health insurance scheme through an interview programme. Findings - There are conflicts between the rational linear approaches to change management and policy implementation advocated by supra-nationals, which argue that these processes can be controlled and managed by the rational autonomous individual, and the narratives of those who have personal experience of the quest for 'health for all'. The national health policy document mirrors the ideology of the global organisations that emphasise reform, efficiencies and private enterprise. However, the assumptions of these global organisations have little relevance to a Nigerian societal and organisational context, as experienced by the senior officials and managers interviewed. The very nature of organisations is called into question in a Nigerian context, and the problems of structure and infrastructure and ethnic and religious divisions in society seep into organisations, influencing how organisation is enacted. Understandings of the purpose and function of leadership and the workforce are also brought into question. Additionally, there are religion-based barriers to policy implementation, change management and organisational life which are rarely experienced in the West. Furthermore, in the absence of future re-orientation, the concept of strategy and vision seems redundant, as is the rationale for a health insurance scheme for the majority of the population. The absence of vision and credible information further hinder attempts to make decisions or to define the basis for determining results. Practical implications: The study calls for a revised approach to engaging with Nigerian organisations and an understanding of what specific terms mean in that context. For instance, the definitions and understanding of organisations and capacity are different from those used in the West and, as such, bring into question the relevance and applicability of Western-derived models or approaches to policy implementation and change management. A framework with four dimensions - societal context, external influences, seven organisational variables and infrastructural/structural problems - was devised to capture the particular ambiguities and complexities of Nigerian organisations involved in policy implementation and change management. Originality/value: This study combines concepts in management studies with those in policy studies, with the use of narrative approaches to the understanding of policy implementation and change management in a Nigerian setting. Elements of culture, religion and ethical values are introduced to further the understanding of policy making and implementation in non-Western contexts.