Home physiotherapy is a valid service option for the patient who was recently discharged from hospital after sustaining a stroke, as it enhances functional independence in friendly and familiar surroundings, as opposed to an outpatient clinic (Bader 2008). The aim of this study was to investigate the system responses to the planning and implementation of a home physiotherapy service as an innovation within the Maltese Public Health Service, uncovering barriers or constraints that influenced the introduction and development of state-run home physiotherapy in Malta. Method A qualitative approach was used for this research. A case study design was selected because it possessed contextual, descriptive and heuristic characteristics. Study participants planned and implemented the service using the available resources. Policy makers, physiotherapists, stroke patients and caregivers contributed to the study through their responses to, and experiences of, this service innovation. It was both an exploration and an opportunity to learn about service innovation from a Maltese perspective. A group of stakeholders were interviewed during the planning stage (Phase 1) of the home physiotherapy service. The main purpose of these interviews was to inform the design of the service. Another group of participants was interviewed in the active service stage (Phase 2) - at the beginning and at the end. The purpose here was to gather data from their direct experiences with home physiotherapy. Documents relevant to home rehabilitation were accessed and analysed hermeneutically. These included newspaper media, as it was considered a sensitive instrument to understand social context (Catalán Matamoros 2007; Davis 1990). Findings and discussion Data analysis identified categories of findings such as ¿barriers to the implementation of a new service¿, ¿attitudes to home physiotherapy¿ and ¿fragmented rehabilitation service¿. The category components were discussed and linked to the hermeneutical analysis of documents, offering a deeper understanding of the categories within the local context, and revealing a reinforcement of establishment-based health care. Conclusion The findings of this study provided an insight into the constraints that would appear if home physiotherapy, indeed home rehabilitation, were introduced by the Maltese Public Health Service. This research had an impact on the state physiotherapy services. Recommendations to help mitigate the constraints in an overarching manner were offered at the end of the thesis. To the international reader with experience in organised home physiotherapy, this study gives a glimpse into how issues that would seem trivial and obvious at first glance become significant challenges¿.challenges that the uninitiated would need to overcome.

The public sector, particularly healthcare organisations are under ever increasing pressure to do more with less. This coupled with the need to keep up to the constant technological changes and ever increasing abundance of information has led to many public sector organisations adopting Business Intelligence (BI) in order to leverage business value and improve decision-making. However, many organisations such as the National Health Service (NHS) continue to fail in their Information Technology (IT) related initiatives. While the rise of BI and its growing influence in organisations has attracted much academic attention, this has largely been from architectural, design and technological perspectives, whilst little is known about how BI is used by various organisational actors to reach decisions, nor much is understood regarding its resulting impact on organisational power dynamics. Thus, there remains an under researched area of discussion in the literature from the perspective of BI users. While studies report how BI can impact organisational effectiveness, facilitate data driven decision making and supposedly overcome intuitive decision making, the extent to which BI impacts and alters power dynamics between organisational actors across the organisation has received little attention. Accordingly, this research adopts a qualitative case study approach to explore power resulting from BI use within a large NHS trust by conducting 30 semi-structured interviews consisting of operational managers and BI analysts. Through taking a human-centric approach, this research uncovers how BI is altering power dynamics between organisational actors, whereby BI analysts are becoming increasingly influential as a result of their analytical skills. It was found that operational managers are becoming more reliant upon data analysts, resulting in the analysts having more and more influence. However, this research finds it is only when the analysts supplement their technical skill-set with their institutional knowledge, that they have the ability to influence and enact power within the organisational settings. The research also offers insights into the contestations and conflicts which arise from the use of BI, between operational managers and analysts as well as between in-house analysts, based in the operation setting and the centralised analysts, operating across the entire trust. Accordingly, this research empirically validates a BI Power Enactment Framework and proposes the BI Power Matrix, which may assist policy makers in identifying determining key factors which are contributory to the success or failure of technological initiatives.

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<p>As psychologists continue to engage the growing diversity within the United States and around the world, there is an imperative need for psychological services that are specific to cultural needs and integrate relevant sociohistorical and community factors. Currently, ethnocentrism in psychological interventions, research, and graduate training limit psychologists’ international engagement and perpetuate a focus on U.S. psychology. For graduate programs in health service psychology (i.e., clinical, school, and counseling psychology), there is a dearth of literature on their methods of preparation of health service professionals engaging in psychological work outside of the U.S. However, graduate training programs have opportunities to intervene on the field’s colonialism by preparing professionals to effectively engage internationally. Addressing ethnocentrism in training is a critical next step for the field of health service psychology.</p><p>This dissertation is comprised of two distinct chapters that are conceptually related. In the first chapter, I review health service psychology’s current international engagement. As psychologists engage outside of the United States, the field of psychology and the training community must critically examine the applicability of psychological interventions, research, and graduate education to international contexts. I propose six recommendations for training programs to deconstruct colonialism and enhance preparation of graduates for competent work outside of the U.S.</p><p>In the second chapter, I report an original, empirical study, using qualitative descriptive methodology, which critically examines how U.S. training prepares graduates to work internationally. Through semi-structured interviews, I explored internationally based psychologists’ reflections on their training experiences and preparation for their current roles in teaching, practice, research, consultation and policy, and psychological infrastructure. Data analysis utilized consensual qualitative research methodology (CQR). Results provided valuable information regarding psychologists’ professional roles outside of the U.S., factors contributing to their vocational experiences, country-specific mental health attitudes, values, and practices, the impact of U.S.-centric psychology in the country of location, lessons taken from their graduate training, and recommendations for international work. Findings provided recommendations to the training community to incorporate more of an international focus and enhance preparation of students for work outside of the U.S.</p>

Background The Sustainable Development Goals provides targets that foster greater mobilization of global resources and efforts. SDG Goal 3 Ensure healthy lives and promote well-being for all at all ages, sets targets for the reduction of maternal mortality rates and mortality rates for children under-five. Health insurance coverage is thought to provide access to needed primary services to accomplish these goals. West Africa is the region of the world with the highest burden of disease and it is unclear if insurance coverage does provide needed access to services. The articles within this thesis examine whether or not health insurance provides greater access to primary services for mothers and children, while determining other factors to be considered. Method For the systematic review, we carried out a search on four databases. Eligible studies included mother’s under-five and children in West Africa. The primary outcome was insurance impacting the rate of utilization of services. Data was extracted using standardized form, and methodology was assessed using the Joanna Briggs Institute forms. Our cross-sectional study used DHS data from 10 West African countries. Data was cleaned, weighed and analyzed using Stata. The independent variable was health insurance, and the variable of outcome was making a minimum of four antenatal care visits. Data was analyzed using binary logistic regression and we presented results using crude and adjusted odds ratio at 95% confidence interval. Results The narrative synthesis was chosen for the review. We found that in most study settings, insurance increased access to services. The cross-sectional study found that women with insurance were more likely to make the recommended number of ANC visits than their uninsured counterparts (aOR [95% CI] =1.55 [1.37-1.73]). Socio-economic status also impact access to services. Conclusion Health insurance does increase access to services and should be pursued as a viable long-term policy, but access is still dependent on socio-economic status. Due to the COVID-19 pandemic, burden of disease of the region and systems challenges, other solutions should be pursued in the near-term. Future investigation should consider the role of equity as a guiding principle.

Bakgrund: Tobaksanvändande är kraftigt associerat med ohälsa i munnen. Socioekonomiskt svaga grupper har högre tobaksanvändning, vilket resulterar i att de drabbas av mer tobaksrelaterad ohälsa. Denna ojämlikhet i hälsa minskar möjligheten till en hållbar utveckling. I synnerhet är rökare överrepresenterade bland patienter med tandlossningssjukdom. Tidigare forskning har fokuserat på tandvårdens upplevelser av att tillhandahålla tobaksrådgivning och tobaksavvänjning, mycket få studier har fokuserat på patienternas perspektiv. Sveriges åtta folkhälsopolitiska mål strävar åt en mer jämlik hälsa och betonar vikten av att agera mot tobaksanvändning. För att nå framgång i detta arbete måste organisationer samarbeta och samverka tvärsektoriellt. Detta har givit tandvården incitament att ge rökande patienter tobaksrådgivning och stöd i tobaksavvänjning. Syfte: Syftet är att utforska patienters upplevelse av råd och stöd för tobaksavvänjning inom tandvård genom en systematisk litteraturöversikt. Metod: Systematisk litteraturstudie har genomförts på 15 artiklar publicerade mellan 1999–2021. Samtliga artiklar hämtades från PubMed och behandlade patienters upplevelser kring tobaksrådgivning och stöd för tobaksavvänjning. Resultat: Majoriteten av patienterna upplever tandvården som en god arena för tobaksrådgivning och tobaksavvänjning. Tandläkare har möjlighet att påverka patienterna, då resultatet visar att yrkesrollen erhåller ett högt förtroendekapital. Tobakens påverkan på munhälsan betonas vara en viktig faktor för att inse att en beteendeförändring måste ske. Slutsats: Efter analys av granskade artiklar visar resultatet att en majoritet av patienterna förväntar sig råd om tobaksanvändning och även stöd i tobaksavvänjning av sin tandläkare. Genom att använda samtalsmetoder för att stärka empowerment kan tandläkare och tandvårdspersonal bidra till folkhälsofrämjande interventioner.

Yes / Objective: To better understand the factors influencing the uptake of direct oral anticoagulants (DOACs) across different health economies in National Health Service England from the perspective of health professionals and other health economy stakeholders. Design: Qualitative interview study using a critical realism perspective and informed by the Diffusion of Innovations in Service Organisations model. Setting: Three health economies in the North of England, United Kingdom. Participants: Healthcare professionals involved in the management of patients requiring oral anticoagulants, stakeholders involved in the implementation of DOACs and representatives of pharmaceutical industry companies and patient support groups. Intervention: Semistructured interviews (face-to-face or telephone) were conducted with 46 participants. Interviews were analysed using the Framework method. Results: Identified factors having an impact on the uptake of DOACs were grouped into four themes: perceived value of the innovation, clinician practice environment, local health economy readiness for change, and the external health service context. Together, these factors influenced what therapy options were offered and prescribed to patients with atrial fibrillation. The interviews also highlighted strategies used to improve or restrict the uptake of DOACs and tensions between providing patient-centred care and managing financial implications for commissioners. Conclusions: The findings contribute to the wider literature by providing a new and in-depth understanding on the uptake of DOACs. The findings may be applicable to other new medicines used in chronic health conditions. / This work presents research funded by the Pharmacy Research UK (grant number: PRUK-2018-GA-1-KM) and Leeds Teaching Hospitals NHS Trust (grant number: N/A).

Yes / This article reports on case study research conducted in a hospital Trust and explores the impact that the Investors in People award had on employees. Investors in People is widely seen as the principal mechanism for increasing workforce skills within a voluntarist system as well as supporting `good¿ employment policies. Yet in this case study, as elsewhere, most of the `soft¿ human resource initiatives had existed prior to accreditation and the internal marketing of corporate value statements was met with both amnesia and cynicism. More worryingly, training activity was focused on business need, and business need was defined in the narrowest sense, with the result that some employees had fewer opportunities for individual development. Motivation and commitment levels were high, staff were enthusiastic about their work and many actively engaged in training and development. But this owed little to Investors in People and its impact here raises questions about its influence on skill levels more broadly.