Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2002. / Abstract. Includes bibliographical references (leaves 88-94).

Thesis (Ph.D.)--University of Florida, 2004. / Title from title page of source document. Document formatted into pages; contains 79 pages. Includes Vita. Includes bibliographical references.

Thesis (Ph. D.)--University of Texas at Austin, 2006. / Vita. Includes bibliographical references.

Thesis (Ph.D.) in History--University of Maine, 2006. / Includes vita. Includes bibliographical references (leaves 261-277).

This research explores the contribution which systems theories, methodologies and models can make in the design and application of effective performance-evaluation processes. Approaches to performance assessment of organisations are reviewed, and the history and structure of the NHS, its objectives, and dimensions for evaluation are described. Drawing on questionnaire and interview data from health service and civil service staff, and secondary data, current performance evaluation and planning processes in the NHS are described and some problems identified. To test the hypothesis that attention to systemic factors could improve performance evaluation, eight topics are analysed by the application of systems methodologies or models. Four of the topic and methodology or model combinations have received detailed analysis: 1. Making and implementing strategic plans; the Open University's Hard Systems Methodology. 2. Controlling NHS performance through structure and process, e. g. the use of annual reviews, performance indicators; double-loop learning and cybernetic control model. 3. Improving the quality of NHS care; Stafford Beer's Viable System Model. 4. Assessing performance through the outcomes of care; Peter Checkland's Soft Systems Methodology. The areas studied in less detail are: 5. Planning for uncertainty and complexity; 6. Issues related to the politics of health; 7. Reducing the length of waiting lists and times; 8. Planning for health (health promotion and the prevention of ill health).

In South Africa the pharmacy profession has experienced a number of changes around the turn of the century such as the introduction of the National Drug Policy (NDP), pharmacy ownership and price regulation. With this the role and earnings of the pharmacy profession, as well as to what extent the pharmacist adds value to the profession and society, are being questioned. Community pharmacists are thus faced with the challenge to prove that the value that they add to society is meaningful. Therefore, the aim of the study was to document community pharmacy availability and activities in South Africa and based on this to quantify the perceived value that the community pharmacist adds to society through the delivery of pharmaceutical services and pharmaceutical care. In order to determine the pharmacist’s true value added two surveys were conducted in 2006; an original pharmacist survey and a general public survey. The results obtained were verified by a follow–up pharmacist survey in 2009 to confirm or reject the results obtained in the original survey. The study was representative of both the community pharmacies and the general public in South Africa and was primarily quantitative in design and analysis. More than half of the responding pharmacies (63.16%) were open seven days a week. The average hours of service per day ranged from 10 hours (Monday to Friday) through to 6.45 hours on Saturdays and 3 hours on Sundays. Pharmacists continuously upgraded their professional knowledge. More than three quarters of pharmacies had the necessary equipment available to perform the services investigated in the study. The general public was not aware of all the services provided by pharmacists and as a result, depending on the service, many people did not make use of these services. The general public that made use of services delivered by community pharmacies mainly perceived the services delivered to be of good quality. The main barrier to practicing pharmaceutical care was indicated by pharmacists as not receiving payment for the advice given followed by pharmaceutical care being time consuming, and that there was not enough time to talk to patients. The general public indicated that they found it difficult to ask questions in pharmacies because other patients could hear what was discussed, or other patients had to wait longer if they asked something, and pharmacy staff being too busy. The results of the original pharmacist and the general public survey were confirmed by the results of the follow-up survey with the exception of dispensing prescription medicine (8 minutes 28 seconds), OTC medicine (7 minutes 23 seconds), counselling of prescription medicine (8 minutes 51 seconds) and OTC medicine (8 minutes) which on average took longer to conduct than in the previous analysis. The study highlighted the value added to the wellness and quality of life of the community of South Africa through the delivery of pharmaceutical care and pharmaceutical services by community pharmacy staff, and proved that pharmacists are committed to the provision of pharmaceutical care and pharmaceutical services.

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Background: Preterm birth (PTM) (< 37 weeks gestation) has been associated with low economic status characteristics like rural residence, county with low average per capita income, poverty, and unemployment. Infants born PTM are at greater risk of health and developmental problems and mortality. The primary objective of this study was to explore the trends in the association between PTM and economic level for Appalachian counties in Tennessee. The results from this study will support hypothesis development for future study on PTM in this region. Methods: PTM data from year 2009 to 2013 for each county in Tennessee was used for the analysis of trend. Proportion of PTM live births for each county and each year was computed to estimate prevalence. Appalachian Regional Commission (ARC) uses an indexbased county economic classification system applying three economic indicators – three-year average unemployment rate, per capita market income, and poverty rate – to classify each county into one of the five categories, namely, Attainment, Competitive, Transitional, At-Risk, and Distressed, that is ranked from best off to worst off respectively. Using this classification by the ARC, Appalachian counties were stratified by economic level to explore the association with PTM prevalence. Results: Forty-three out of 95 counties in Tennessee are defined by ARC as Appalachian. When classified by economic level, none of the counties in the Appalachian region fell into the highest (Attainment) sub-category of economic level for any of the five years observed, and for years 2011 to 2013 none of the counties fell into the second highest sub-category (Competitive) of economic level. Moreover, just one county was categorized as Attainment in year 2009, and just two for the year 2010. Not much difference was observed in PTM prevalence for sub-categories of economic level of Appalachian counties over the five-year period (2013 Distressed 11.67%, At risk 11.47%, Transitional 11.64%; 2012 Distressed 11.51%, At risk 12.10%, Transitional 11.58%; 2011 Distressed 10.04%, At risk 11.52%, Transitional 11.50%; 2010 Distressed 12.03%, At risk 11.42%, Transitional 11.83%, Competitive 11.40%; 2009 Distressed 10.68%, At risk 11.75%, Transitional 11.04%, Competitive 10.85%). Regardless of the inconsistent pattern of PTM prevalence observed for both Appalachian and non-Appalachian counties, the average prevalence for Appalachian counties (2009 11.19%, 2010 11.73%, 2011 11.26%, 2012 11.75%, 2013 11.59%) has been higher than non-Appalachian counties (2009 10.77%, 2010 10.32%, 2011 10.35%, 2012 10.90%, 2013 10.70%) for all years observed. Interestingly, the national prevalence of PTM is declining while prevalence in Tennessee (2009 11.00%, 2010 11.09%, 2011 10.84%, 2012 11.36%, 2013 11.19%) has remained essentially unchanged. Conclusion: PTM prevalence is higher in Appalachian counties of Tennessee compared to nonAppalachian counties. No meaningful change in PTM prevalence was observed by categories of economic level. However, it is likely that analysis based on the aggregate data could have masked the true differences in PTM birth by economic status. Therefore, individual data on PTM and economic status would be necessary to make any inference on the association.

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Healthcare providers' (HCPs) recommendations for the Human Papillomavirus (HPV) vaccine are likely to increase the vaccination uptake. However, little is known about Ghanaian HCPs' general practices regarding HPV vaccination. We used Multi-Theory Model (MTM) constructs (i.e. participatory dialogue, behavioral confidence, environment, social and emotional transformation) to examine Ghanaian HCPs' attitudes towards HPV vaccination and their vaccination recommendation practices. Methods We conducted three, 60-minute focus group discussions (FGDs) with HCP in the secondlargest government hospital in Ghana. Sixteen semi-structured open-ended questions based on MTM constructs were used to guide the FGDs. We explored HCPs' general knowledge about HPV, vaccination recommendation behavior, physical environment, and sociocultural factors associated with the HPV vaccination. Data from the FGDs were transcribed and thematically coded using NVivo software. Results The sample of (n = 29) HCPs consisting of males (n = 15) and females (n = 14) between the ages of 29 and 42 years participated in the FGDs. Our analyses showed that HCPs (a) rarely offered HPV vaccination recommendations, (b) showed varied understanding about who should be vaccinated regarding age eligibility, gender, and infection status. Perceived barriers to HPV vaccination include (a) low urgency for vaccination education due to competing priorities such as malaria and HIV/AIDS; (b) lack of data on HPV vaccination; (c) lack of awareness about the vaccine safety and efficacy; (c) lack of HPV vaccine accessibility and (d) stigma, misconceptions and religious objections. HCPs expressed that their motivation for counseling their clients about HPV vaccination would be increased by having more knowledge about the vaccine's efficacy and safety, and the involvement of the parents, chiefs, churches, and opinion leaders in the vaccination programs. Conclusion The study's findings underscore the need for a comprehensive HPV vaccination education for HCPs in Ghana. Future HPV vaccination education programs should include information about the efficacy of the vaccine and effective vaccination messages to help mitigate HPV vaccine-related stigma.