Community participation has been a popular method of people centred, grassroots development in many developing countries. With an emphasis on primary health care (PHC) through the signing of the Declaration of Alma Atta in 1978, there was a renewed commitment to community participation within the health care system. In South Africa, the end of the apartheid era announced a new dedication towards the principles of a comprehensive, promotive and preventative health care in line with the principles of PHC. These changes were outlined in The White Paper on Transformation of the Health System (1997) and advocated the importance of community involvement in the health care system. These roles were formalised in the National Act Health (61 of 2003) with the provision for the establishment of the clinic and community health centre committees as statutory bodies. The initial implementation of the committees had no guidelines or policy to direct their functioning and therefore led to them being differentiated and poorly functioning. In 2009, the Eastern Cape Department of Health issued a Policy on the Establishment and Effective functioning of Clinic and Community Health Centre Committees. In 2010, the Nelson Mandela Metropolitan University’s Community Development Unit, in collaboration with the Health Department, provided a program to formally establish and train all the community health committees in the Nelson Mandela Bay Municipality in accordance with the new policy. This research aimed to investigate the community health committees (CHCs) in the Nelson Mandela Bay District, specifically the way in which they were functioning, three years on from this establishment process, with regards to the roles and functions outlined in the Policy document. This report highlights the extent to which the roles are being met, the challenges impeding the fulfilment of these roles and other factors which inhibit the effective functioning of the CHCs. A qualitative research method was used including focus group discussions and in-depth interviews with key informants to illicit the necessary data. These results were transcribed and analysed to identify recurring themes in order to draw conclusions. The CHCs were found to have varying levels of functionality but had similar challenges in fulfilling the roles. Generally there was a poor level of awareness of the policy and the roles defined within and in addition to this there was confusion over the terminology used within the Policy. The role of Advocacy was undertaken enthusiastically by the CHCs with many forms of education and health programs being promoted. However, a lack of knowledge of the PHC model was evident, which inhibited the CHCs from advocating the importance of this. Oversight was seen by the CHC members as being the most important role for them to fulfil, as the level of medical care received in the clinic was perceived to be poor. The CHC members readily monitor levels of medication, staff presence and service provision but do not feel that they have much power to improve the situation. The role of Social Mobilisation was poorly fulfilled due to a lack of outreach into the community and therefore social upliftment only takes place when community members come to the clinic to use the services. Finally, fundraising was the most unsuccessfully achieved role of the CHCs. A combination of a lack of formal recognition and misguided ideas, have resulted in little means of funding for the CHCs. Generally the major inhibiting factors that the CHCs face are; an incomplete fulfilment of the outlined membership of the committees, lack of comprehensive community representation, a lack of commitment from the Health Department and a feeling of isolation. All of these factors are reducing the motivation of the dedicated CHC members. Recommendations were made at the end of the study to help increase the impact these committees are having on their communities. It is hoped that the Provincial Health Department can work together with the CHCs and other stakeholders to implement these recommendations to help sustain the CHCs further.

ABSTRACT Sickle cell disease is a group of inherited blood disorders in which the hemoglobin of the red blood cells is abnormal, cause the shape of the cell to be sickle, and cause severe pain. The purposes of this study were to discover if music therapy could decrease pain, anxiety, and heart rate, while increasing mood and oxygen saturation. Hospital inpatients (N=30) between the ages of four to fourteen participated in a two day randomized control study. Participants were either randomized into the experimental portion of the study and received a thirty minute music therapy session (N=15), or in the portion with no intervention (N=15). A pre and post-test was administered on each day for both groups patients were asked about their pain, anxiety and mood, and the heart rate and oxygen saturation were taken down. An exit survey was given to those in the experimental group. Results indicated that the music therapy session did have a statistically significant decrease on heart rate (p=.024) and increase in oxygen saturation (p=.048) from pre-to post-session on both days. No other significant differences were found. Implications for future research studies and clinical practice are examined. / A Thesis submitted to the College of Music in partial fulfillment of the requirements for the degree of Master of Music. / Summer Semester 2015. / May 14, 2015. / Music Therapy, Pediatrics, Sickle Cell Disease / Includes bibliographical references. / Jayne M. Standley, Professor Directing Thesis; Clifford Madsen, Committee Member; Diane Gregory, Committee Member.

Swaziland is a British Protectorate of approximately 6,700 square miles. It is a subtropical country, border in the East by Mozambique and in the North, West and South by the Transvaal. There are approximately 270,000 Africans and 10,000 persons of other races living in the Territory. The country is divided into Highveld, Middleveld and Lowveld regions. The work described here was carried out in the South Western highveld. This is mountainous terrain, with an approximate altitude of 3,500 feet and an annual rainfall of about 30". The terrain is a succession of mountains and valleys, with several perennial streams and rivers coursing through it. The climate is variable, with hot summers and cold winters, with rainfall predominantly in the summer. Large man made forests are scattered throughout the area, and there is some cutting and processing of timber, but industries as such are not found in that part of the Territory.

A dissertation submitted in partial fulfillment of the requirements for the degree of Master of Arts (Counselling Psychology) in the Department of Psychology in the Faculty of Arts at the University Of Zululand, South Africa, 2012. / The overarching aim of this study was to explore the use of mental health services in UMhlathuze district. A further aim was to explore the experiences and opinions of mental health users. Sixty mental health users participated in the study. The mental health needs of the predominantly poor, black population and people in rural areas are consequently left unmet. For mental health services to be improved and stay effective, constant evaluation is necessary. This will allow the use of mental health services as well as delivery to build upon its strengths as well as respond to short comings and new emerging needs indicated by research participants. This study investigated the use of mental health service in certain parts of UMhlathuze district. It records valuable aspects of the mental health services usage and identifies experiences and opinions for improvement. Findings in this study were guided by mental health service users from different service providers. The procedure for data collection involved direct conversations in which participants reflected on their experiences when mental health services are offered to them. A convenient sample was used in that the criterion of inclusion of participants in the sample was based on people consulting at health care facilities for mental health services, for example mental health users from psychology clinic, district hospital and NGOs. The opinions given were speaking back to the experiences thus participants came up with suggestions on how mental health services can be improved. Participants' experiences of the mental health service delivery were generally positive and negative on the other hand. The experiences of mental health users mainly appreciated for the essential services provided to the community and the fact that it also easy to access services because of providing psychological services at affordable rates. / National Research Foundation

The purpose of this research was to demonstrate one way in which the analytical and creative components of policy can complement one another to provide insight for understanding emergent (developmental) and cooperative systems. As a case study, this research examined a perinatal regionalization project--a new health care delivery system--to determine how it might develop from this point in its history, i.e., what form it might take. The key questions were: how do we design a workable and significant system? How much is science; how much art? Given the emergent social nature of the system, a twofold approach was required. The first approach, analytically organized, used multiple perspectives in gathering information for policy planning and implementation. The second approach, process oriented, used a new form of Delphi as a creative, participatory decision technique to design a policy structure. Application of multiple perspectives to a prospective issue, combining them with the participatory approach of the decision Delphi and distinguishing methods appropriate for emergent policy systems were departures from previous research. Data collection involved content analysis, extensive interviewing, and participant observation. Analysis based on three perspectives, technical-rational (T), organizational (O), and personal (P), yielded distinct pictures of the emerging social technology of regionalized perinatal health care delivery. The T perspective emphasized the well-ordered approach to implementation and indicated some areas to reinforce and develop based on measured outcomes. The O perspective emphasized the network of interrelated roles, procedures, and reinforcements (sources of satisfaction). It noted junctures for making inroads into the existing system. The P perspective provided the most immediate grasp of the essential and unique world of the participants. It found that images serve as both compelling visions and forces for change characterized by this non-trivial uniqueness. Delphi found that systems structures can be generated endogenously. Analysis of the three perspectives found that each of the three requires a type of research appropriate to it. In fact, the elusive P perspective can be formulated experientially--a self-reflective type of research--and communicated creatively. Both enhance its value. Analysis also found that while the three are distinct, each adds a dimension to understanding that would be lost without it. They can be integrated as mutual contexts of each other. Analysis found that the form of communication is as important as the form of research. Non-traditional means are more appropriate. Analysis found that design considers form as system self-image, system boundary, and system control. These distinguish the new system from the old. The concept is quite different from implementation as a sequential process in policy.

The purpose of this non-experimental descriptive study was to identify the cultural beliefs and practices surrounding pregnancy. The study aims at collecting data which will function as baseline information on cultural beliefs and practices surrounding pregnancy. The study was conducted in the city of Francistown, the second largest to the capital of Botswana situated in the north-east. A structured interview guide with both open and close-ended questions was used to collect data from 230 pregnant women who were 18 years of age and above and who were willing to participate. The data was processed on computer and a statistical software package known as Statistical Package for Social Sciences (SPSS) was used. The study revealed that pregnant women used a combination of care givers which either included a modem midwife and an elderly woman at church or a modem midwife and a traditional midwife. This is done in order to follow the traditional and cultural beliefs surrounding pregnancy and childbirth. The majority (92.2%) of the antenatal women in this study had primary and secondary education but still follow their cultural beliefs and practices, thus education does not appear to influence cultural beliefs and practices. The most common reasons cited for adhering to the beliefs and practices were that defiance was a taboo punishable by the ancestors. This study has highlighted the cultural beliefs and practices related to pregnancy. Further in-depth investigation into the impact of these cultural beliefs and practices is needed as it is imperative to determine their impact on pregnancy and its outcome. The limitation of the study was that data was only collected in one city and therefore the results cannot be generalised to the entire population.

Following the successful introduction of antiretroviral therapy (ART) in resource-limited settings, we have observed an unprecedented explosion in the expansion of ART programs throughout sub-Saharan Africa, resulting in a 13-fold increase in coverage since 2004. In spite of these achievements, uptake of ART remains low. The gap in treatment coverage is approximately 50% of those who need ART in South Africa, while the country boasts the largest ART program worldwide. Rural areas are particularly prone to lower ART coverage rates, largely a result of existing health care inequities. The ART coverage gap will widen given the recent introduction of new treatment guidelines, which allows for ART commencement at CD4 350 cells/mm3. Furthermore, approximately one-third of ART patients are lost to follow up after two years of treatment initiation in sub-Saharan Africa. This study explores factors associated with ART access and utilisation in a rural area, in order to reduce the gap in knowledge on patient and health system factors. Unaddressed, these factors may continue to hinder adoption of rigorous interventions to improve ART uptake and retention. This research employs the A-Framework to conceptualize access to health care, where dimensions of access include availability (physical access), affordability (financial access), and acceptability (cultural access). A data triangulation approach was adopted as very little was known on the utilization patterns of health care by HIV/AIDS patients. Quantitative research (2008-2010) employed a four-site rural-urban comparative analysis of 1266 participants, and was part of a 5-year project Researching Equity and Access to Health care (REACH).This was complemented by a more in-depth qualitative assessment (2006-2007) that followed the treatment experience of 32 patients before and after ART initiation in the rural Bushbuckridge site. We found plural utilisation of health care to be a cross-cutting theme throughout this thesis. While the movement of patients between providers at various levels within the traditional and formal health sector may be a sign of agency, it may also result in excessive health costs that threaten the livelihoods of individuals and their households. We discuss a number of strategies to improve ART initiation and adherence including the need to incorporate metrics for pluralism into routine assessments; the importance of decentralized, humane and high quality care and support services; support for efforts to enhance patient self-efficacy through education, awareness and social support interventions; the incorporation and regulation of traditional healers into the formal system; risk protection mechanisms that reduce financial barriers and consequences of HIV care including grants, subsidies and National Health Insurance, and support for wider efforts to reduce urban-rural inequalities.

Electronic cigarettes, or e-cigarettes, are devices that allow users to inhale an aerosol, which contains chemical additives. E-cigarettes are becoming common for nicotine delivery in addition to traditional cigarettes. The goal of this study was to determine how college students perceive e-cigarettes, how often college students use e-cigarettes, and how they view e-cigarettes compared to tobacco cigarettes. This was accomplished through sending a survey built on Qualtrics to UCF students via Knights Email. This survey included questions about demographics, perceptions, and usage of e-cigarettes. The collected data was downloaded into SPSS and analyzed to compare data among different groups. The demographics of the participants reflected the overall student demographics at UCF including age, ethnicity, and academic status, which allowed for the results to be related to the university population. A little over half of the students who participated in this study have tried e-cigarettes. Those who use e-cigarettes reported that the availability of variety of flavors was the most attractive reason for them. Most participants believe e-cigarettes to be equal in harm or less harmful than tobacco cigarettes. Gender, major, and work status differences were observed in survey responses related to use of e-cigarettes and perception of potential harm. The results of the study provide valuable information that can be used in health education programs about e-cigarettes. The results also support the need for future studies to assess the health impact of e-cigarettes on the physiological functions of lungs and other tissues and compare that to tobacco cigarette damage.

No description available.

Dissatisfaction amongst US physicians has been steadily increasing over the past few decades as health care reform changes the practice of medicine (Hoff, Young, Xiang, & Raver, 2015; Rosenstein, & Mudge-Riley, 2010). In 2008, physician dissatisfaction rates had increased to 19% (Mazaurenko & Menachemi, 2012). By 2012, 42% of physicians voiced dissatisfaction, with family medicine reporting most likely to be dissatisfied (Sorrell & Jennings, 2014). One factor that could affect physician career dissatisfaction/satisfaction that has not been studied is collaborative relationships with other healthcare providers, such as nurse practitioners. This study used secondary quantitative data from the National Survey of Primary Care Physicians and Nurse Practitioners (2012). Logistic regression was used to analyze the relationship of nurse practitioner collaboration and the other independent variables with the dependent variable of physician career satisfaction. In order to address the research goals the independent variables of primary interest were as follows 1) whether PCPs work with NPs in their office; 2) what the quality of the PCP relationship is with the NPs; 3) what is the share of work performed by NPs. Descriptive statistics and binary logistic regressions were run to test the significance of the three hypotheses. Analysis yielded many observational results on the PCPs descriptively but did not show any significant results on the proposed hypotheses regarding PCP career satisfaction. However, one of the greatest strengths of this study was the attempt to bridge the gaps of knowledge regarding PCP and NP collaboration and physician career satisfaction. The fact that results were not significant does not negate the need for further studies on this issue, especially since no other studies exist. In conducting future research, obtaining a larger sample of PCPs, including PCPs who work with NPs, would be an important step in correcting some of the limitations of this study. The lack of significant results also raises further questions regarding the difference between career and job satisfaction with the latter referring to the current work environment rather than the cumulative career experience.