The potential role of local government in NSW to address public health nutrition issues has received encouraging reports. This treatise deals with the question of whether intersectoral collaboration theory is useful to assist development of a relationship with local government to develop food and nutrition policy. Intersectoral collaboration theory describes six conditions necessary for successful action: necessity, opportunity, capacity, relationships, planned action, and sustained outcomes. The project was a feasibility study carried out in a densely populated and multicultural local government area in Sydney�s southwest during April 1998. Eight Council employees and one elected representative were interviewed using the semi-structured questionnaire to collect a range of opinions and knowledge about Council�s involvement in a food and nutrition policy. Conceptual frameworks for the study included the Ottawa Charter and the food and nutrition system. Theoretical underpinning�s were provided by intersectoral collaboration theory and organisational change theory. Using intersectoral collaboration theory, analysis of the interviews revealed that participants were very concerned with conditions of necessity, opportunity and capacity to develop food and nutrition policy. Intersectoral collaboration theory correctly predicted that the action proposed would have to assist Council to achieve their core business, gain social and political support and be possible within the current economic environment and level of other resources available. Participants were not able to identify how a food and nutrition policy would meet these conditions and be feasible within the current capacity of the organisation, and therefore did not become fully engaged in the feasibility study. The health sector needs to develop arguments for local government involvement from their perspective. Organisational change within the heath sector is required to develop capacity for intersectoral partnerships, as an effective strategy to address public health nutrition issues.

The potential role of local government in NSW to address public health nutrition issues has received encouraging reports. This treatise deals with the question of whether intersectoral collaboration theory is useful to assist development of a relationship with local government to develop food and nutrition policy. Intersectoral collaboration theory describes six conditions necessary for successful action: necessity, opportunity, capacity, relationships, planned action, and sustained outcomes. The project was a feasibility study carried out in a densely populated and multicultural local government area in Sydney�s southwest during April 1998. Eight Council employees and one elected representative were interviewed using the semi-structured questionnaire to collect a range of opinions and knowledge about Council�s involvement in a food and nutrition policy. Conceptual frameworks for the study included the Ottawa Charter and the food and nutrition system. Theoretical underpinning�s were provided by intersectoral collaboration theory and organisational change theory. Using intersectoral collaboration theory, analysis of the interviews revealed that participants were very concerned with conditions of necessity, opportunity and capacity to develop food and nutrition policy. Intersectoral collaboration theory correctly predicted that the action proposed would have to assist Council to achieve their core business, gain social and political support and be possible within the current economic environment and level of other resources available. Participants were not able to identify how a food and nutrition policy would meet these conditions and be feasible within the current capacity of the organisation, and therefore did not become fully engaged in the feasibility study. The health sector needs to develop arguments for local government involvement from their perspective. Organisational change within the heath sector is required to develop capacity for intersectoral partnerships, as an effective strategy to address public health nutrition issues.

Intersectoral collaboration for health is widely recognised as a critical component of interventions to address complex public health issues. However, there is limited research that has examined how intersectoral approaches are formulated and implemented, especially in low- and middle-income countries. As a result, although the literature is populated with calls for action, little exists that can inform the evidence on how to sustain intersectoral action for health. This thesis is a case study of intersectoral action in the Western Cape Province of South Africa, examining the unfolding policy formulation and implementation processes of an initiative referred to as First 1,000 Days, in the period 2016 to 2019. Within early childhood, the First 1,000 Days (FTD) period presents a favourable window for intersectoral interventions that can ensure positive outcomes from early years of life to adulthood. The FTD initiative emerged in the Western Cape Province of South Africa in response to the growing number of children exposed to the social challenges of violence and of alcohol and drug abuse.

Magister Public Health - MPH / Background: Actions on addressing the social determinants of health are necessary for reducing health inequities and improving health outcomes. These actions can, however, fall outside the scope of the health sector alone and require collaborative actions across sectors. Through the Western Cape Government’s stated commitment to following a whole-of-society approach to increase the wellness of people, this Province has committed to exploring intersectoral collaboration and action for health. This study is therefore aimed at exploring the experiences and perceptions of intersectoral collaboration and action for health amongst mid-level and frMethodology: The study design was qualitative and explorative in nature, using non-probability sampling to deliberately select study participants that were both relevant to the study and represented a diversity of views. Semi-structured interviews were conducted with seven health managers and non-participant observation of one intersectoral meeting was utilised to observe interactions that were relevant to the study. A thematic coding analysis approach was followed to inductively determine themes and analyse the data.ontline health managers working at the primary health care level in two sub-districts within the City of Cape Town, Western Cape Province. Results: Intersectoral collaboration for health at the primary health care level tends to take the form of collaborations between government departments, between the department of health and non-governmental organisations, between the public and private health sectors and between the Department of Health and the communities it serves. These collaborations overwhelmingly focus on expanding health services provision rather than addressing the social determinants of health. Conclusion: The concept of intersectoral collaboration and partnerships at the primary health care level in two sub-districts of the City of Cape Town, Western Cape, is perceived by health managers as being critical in addressing the social determinants of health. In practice, however, intersectoral collaboration and partnerships tend to focus on expanding health service provision and have limited value for addressing social determinants of health.

This research examined intersectoral relationships and community participation in policy processes across the mental health and housing sectors. The focus was on the development of suitable housing options for people with a psychiatric disability. The study period covered five years of mental health system reform in South Australia (2000-2005). The research found a shortage of housing and support options for people with psychiatric disability and lack of significant strategic policy coordination or ongoing cross-sectoral programmes. The problems faced by people in gaining access to housing and disability support services and the ways in which families provide housing or support in the absence of public services are documented. This case study used qualitative research methods which were triangulated across four stages: 1) a thematic analysis of national and state policies in the health, housing and disability sectors; 2) participant observation of NGO activity, a thematic analysis of NGO documents, and interviews and focus groups with NGOs; 3) interviews and focus groups with consumer and carer representatives and a thematic analysis of the minutes from state-level groups; 4) interviews with professionals from the health, housing and disability sectors The housing situation for people with psychiatric disability was explained in terms of a number of key issues in the policy environment; „X The overarching neo-liberal policy context synonymous with a decline in public housing resources and increasing tension between NGOs service provider and advocacy roles. „X The political nature of the local mental health policy context and lack of political commitment to ongoing resources. Broad community stigma reflected in the media and government, affecting ongoing political commitment to mental health and housing and the introduction and progress of housing ¡¥projects¡¦. „X The slow development of peak NGO and consumer organisations and alliances in South Australia which affected access to policy networks and contributed to the dominance of professional interests within policy processes. „X The separation of health, housing and disability policy and networks within and across levels of government. This was associated with bilateral agreements (between Australian and state governments) tied to resources within departments, the programme objectives and the goals of bureaucrats. „X The separation of policy networks by sector was also connected to the dominance of bio-medical discourses and interventions and associated professional interests in the health policy sector. Medical discourses on health and disability and ¡¥consumerist¡¦ discourses on participation also led to social determinants of health such as housing being overlooked within policy processes. „X Governance reform at a state level contributed to organisational instability within departments, causing some problems for cross-sectoral initiatives and protocols. Kingdon¡¦s (2003) multiple streams analysis of policy helped to explain what missed or reached political agendas within each policy sector of the case study. Kingdon predicts that the unity of policy networks is important for the realization of policy solutions, and the lack of unity in policy sectors was an obstacle to policy agendas on housing for people with a psychiatric disability. However, the way in which problems were being represented (Bacchi 1999) was also important to understanding this policy environment. For example, a medical discourse on disability (Fulcher 1989) tied to the health sector led to a narrow focus on clinical mental health services. Similarly, neo-liberal discourse (Dean 1999) supported private housing solutions and resources or NGOs advocating ¡¥within sectors¡¦ for the types of services they already provided or wished to provide. The case study suggested strategies for ¡¥policy change¡¦ need to address a number of factors across service delivery, policy and political realms. Firstly, better recognition is warranted of the difficulty experienced by many people with psychiatric disability in achieving stable housing, and the need for indicators on housing access and stability for this group. Secondly, processes to address stigma (particularly that perpetuated in the media) will be instrumental for policy change and political commitment. Thirdly, ongoing cross sectoral advocacy and alliances require development at both a national and state level and support by a political culture which encourages advocacy. Developing processes for working across sectors such as policy learning forums involving both experts and community groups could counter problems arising from professional culture and territories that were documented in this study. Finally, the cross-sectoral development of policy, programmes and accountability mechanisms and the stability of policy networks will be important to ensuring stable housing for people with psychiatric disability.

Background: Using telemedicine to provide health services for seafarers represents a special case of intersectoral co-operation.Since 2006, several North Sea drilling platforms and internationally operating Norwegian merchant ships have usedonboard telemedicine equipment continuously. Experience gained through this new technology has improvedintersectoral co-operation regarding seafarers’ health care. Aim: This study aimed to analyze the need for intersectoral co-operation and networking in maritime medicine by usingtelemedicine equipment at sea. Various Norwegian maritime organizations and institutions participated in the study. Methods: I conducted a qualitative descriptive survey using a Web-organized interactive interview technique, a new mode ofinteraction based on a semi-structured interview guide for data collection. After conducting exploratory personalinterviews in October 2006, I developed a Web-based questionnaire comprising 53 questions. Participants receivedan e-mail invitation containing an online link to an Internet-based questionnaire. Individuals unable to use the Webbasedlink could return the completed questionnaire as an e-mail attachment. I collected data between April and June2007 and evaluated some questions according to the principles of content analysis and others with simple quantitative analysis, e.g., frequency and distribution. Results: Among 33 persons contacted, 31 (94%) agreed to participate in the study. Respondents represented 11 variousmaritime organizations and companies. Fourteen worked as maritime officers, nine as maritime managers, and eightas medical professionals. Importantly, fourteen respondents (45%) had demonstrated practical working experiencewith telemedicine at sea. According to content analysis, the following categories were developed: communicationandevidence-based telemedicine; maritime e-health standardization and knowledge management; improvingtelemedicine quality management; organizational, technical, and medical competences and intersectoral approach;technical standardization and networking; and communication and information. Four main categories illuminated theparticipants’ demands, i.e., information, communication, standardization, and centralization, and led to thedevelopment of national e-health policy and strategy to support the Norwegian maritime e-health society vianetworking and intersectoral co-operation. Conclusions: Intersectoral co-operation in maritime telemedicine requires interorganizational networking in order to introduceeffective and compatible international maritime e-health standards for seafarers’ healthcare. The Norwegian Centrefor Maritime Medicine (NCMM), a Centre of Excellence in maritime medical research, will participate importantlyin this process. The study also showed that a Web-based survey in maritime research offers an easily managedresearch tool that quickly yields a very good overview of a special situation. / <p>ISBN 978-91-85721-50-4</p>

Orientador: Margareth Aparecida Santini de Almeida / Resumo: Introdução: A violência que permeia o universo do adolescente atinge magnitudes muito maiores do que mostram as atuais estatísticas, sendo considerada um grave problema de saúde pública. Por sua complexidade, demanda intervenção abrangente e intersetorial. Objetivo: Conhecer as percepções e experiências de profissionais da saúde, educação e assistência social sobre a violência que envolve os adolescentes. Método: Trata-se de estudo de cunho qualitativo, cuja coleta de dados se deu por meio de três grupos focais com profissionais que atuam nos setores referidos, por entrevistas individuais com os gestores dos respectivos serviços, localizados em um distrito do município de Botucatu/SP e por intermédio de um grupo de discussão com conselheiras tutelares do mesmo município. O material foi gravado, transcrito na íntegra e sistematizado para análise segundo o método de análise de conteúdo proposto por Bardin, na modalidade de análise temática. Resultados: Foi comum, entre os profissionais participantes, a concepção abrangente sobre a violência que envolve o universo do adolescente e suas diversas formas de manifestação e as consequências danosas a este grupo e à sociedade. Apesar da tentativa pelos três setores e pelo conselho tutelar de trabalhar com este público e sua família, notou-se forte despreparo profissional e, por vezes, culpabilização das famílias e dos próprios adolescentes, sendo também manifestados sentimentos de impotência no trato diário com adolescentes em situaçã... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

O presente trabalho visa analisar as percepções, vivências e experiências dos profissionais da saúde e da educação envolvidos no Programa Saúde da Escola (PSE) do Município de Guarulhos (SP), incluindo a pesquisadora. Pela saúde, foram entrevistados 10 profissionais da Unidade Saúde da Família (USF) (gerente, enfermeira, auxiliar de enfermagem, três agentes comunitárias com maior tempo de serviço na Unidade, além de nutricionista, assistente-social, educador físico e psicóloga que atuam no Núcleo de Apoio à Saúde da Família (NASF) da Unidade; da pesquisadora, foi utilizado o diário de campo. Pela educação, foram entrevistados os profissionais da Escola da Prefeitura de Guarulhos (EPG) escolhida, sendo 6 da gestão (supervisora, diretor, vice-diretora, coordenadora pedagógica, assistente de gestão e agente escolar) e mais 9 educadoras, selecionadas segundo amostra intencional (maior tempo de contato com PSE e tempo de trabalho na escola). Foram propostas entrevistas individualizadas, com 6 questões abertas que nortearam as conversas, no local de trabalho do entrevistado. Para analisar o conteúdo das falas, foi escolhida um método qualitativo da Hermenêutica-Dialética. Como resultado notou-se que a presença constante da coordenadora em todos os grupos, no planejamento e nas conversas pode ter sugestionado um viés mais positivo na educação e mais negativo na saúde, pois nesta não há reuniões e encontros. A grande maioria não participa das ações nas escolas e não entende a sua função e importância no programa. Pelas quatro categorias criadas concluem-se que há falhas a serem trabalhadas, mas se houver mais momentos de compartilhamento entre os profissionais, seja na Saúde quanto na Educação e ações de formação (educação continuada), haverá uma melhora nas relações intersetoriais e trabalho multiprofissional. Foi proposto um encarte para ajudar na criação de estratégias para consolidar as ações dos profissionais, para melhorar a padronização das ações e de continuidade do programa. / The present study aims to analyze the perceptions, experiences and experiences of health and education professionals involved in the School Health Program (PSE) of the Municipality of Guarulhos (SP), including the researcher. For health, 10 professionals from the Family Health Unit (USF) (manager, nurse, nursing assistant, three community agents with a longer period of service in the Unit, as well as a nutritionist, social worker, physical educator and psychologist In the education, the professionals of the chosen School of the City of Guarulhos (EPG) were interviewed, being 6 of the management (supervisor, director, assistant coordinator, pedagogical coordinator, management assistant and school agent) and 9 other educators, selected according to an intentional sample (longer time of contact with PSE and working time in school). Individualized interviews were proposed, with 6 open questions that guided the In order to analyze the content of the speeches, a qualitative method of Dialectic Hermeneutics was chosen. it was noted that the constant presence of the coordinator in all groups, in planning and in conversations may have suggested a more positive bias in education and more negative health, since there are no meetings and meetings. The vast majority do not participate in school actions and do not understand their role and importance in the program. For the four categories created it is concluded that there are flaws to be worked out, but if there are more moments of sharing among the professionals, whether in Health or Education and training actions (continuous education), there will be an improvement in intersectoral relations and multiprofessional work. An insert was proposed to assist in the creation of strategies to consolidate the actions of professionals, to improve standardization of actions and continuity of the program.

A Dengue avança como um problema social cada vez mais expressivo. Por isso, foi desenvolvido este estudo cujos objetivos foram conhecer os significados da Dengue para os Enfermeiros da Atenção Primária à Saúde de Alfenas, Minas Gerais, bem como identificar forças restritivas e propulsoras para o controle da doença. Tratou-se de uma Pesquisa de Representação Social, de abordagem qualitativa, que adotou a Teoria das Representações Sociais e o Método do Discurso do Sujeito Coletivo como o referencial teórico-metodológico. O trabalho de campo contemplou entrevistas individuais aos Enfermeiros nas Unidades de Atenção Primária à Saúde do Município, entre junho e julho de 2015; os depoimentos foram gravados, transcritos e posteriormente analisados/apresentados por meio do Método do Discurso do Sujeito Coletivo. Os 17 profissionais de nível superior em enfermagem eram do sexo feminino e a média das idades foi de 40 anos; observou-se mediana de cinco anos de atuação na Atenção Primária à Saúde, sendo a maioria destas Enfermeiras integrantes de Equipes de Saúde da Família urbanas; três entrevistadas já tinham sido acometidas por Dengue. Do sujeito coletivo emergiram as seguintes Representações Sociais: desconforto enorme, problema de saúde pública, descuido das pessoas, consequência da falta de educação, doença viral, preocupação e medo, doença grave, doença causada pela picada do mosquito, epidemia, doença de país pobre, mais uma doença para a gente cuidar e uma guerra. Em relação ao controle da Dengue, foram reconhecidos como dificultadores: a falta de conscientização da população, a resistência e falta de responsabilidade das pessoas, a alta proliferação do mosquito, a grande quantidade de foco, os boatos, a falta de informação sobre a doença em si, o desconhecimento da causa, a capacitação dos Agentes de Controle de Endemias e a falta de mais cobrança dos Agentes Comunitários de Saúde; como facilitadores, o trabalho de orientação e de conscientização, a educação da população, a consciência das pessoas, o saneamento básico, as parcerias das Equipes de Saúde da Família com os Agentes de Controle de Endemias, a cobrança da população, a capacitação e a remuneração dos Agentes de Controle de Endemias e o dever da população. O conhecimento das Representações Sociais sobre a Dengue é importante para a compreensão da sua causalidade e para o enfrentamento do problema de Saúde Pública/Saúde Coletiva na atualidade. Do estudo emergiram valores e símbolos do sujeito coletivo de Enfermeiros da Atenção Primária à Saúde de Alfenas-MG sobre a Dengue e o enfrentamento da epidemia, que contribuíam com a inteligência dos serviços de saúde, por se tratar de profissionais que atuam na linha de frente do Município, promovendo o enfrentamento da doença. / Dengue advances as an increasingly significant social problem. Thus, this study was developed with the aim to learn the meanings of Dengue for primary health care nurses from Alfenas, in the state of Minas Gerais; and to identify limiting and driving forces for its control. A social representation study was developed, with a qualitative approach, and the adoption of the social representation theory as its theoreticalmethodological framework. Field work consisted of individual interviews with nurses from the primary health care units of the city, between June and July of 2015; which were recorded, transcribed and later analyzed and presented by means of the discourse of the collective subject method. The 17 professionals interviewed had a nursing undergraduate degree, were women and had a mean age of 40 years. They presented a median length of activity in primary health care of five years, with most nurses being members of urban family health teams; and three nurses had already been infected by the Dengue virus. The collective subject resulted in the following social representations: extreme discomfort, public health problem, people\'s negligence, consequence of the lack of education, viral disease, concern and fear, severe disease, disease caused by a mosquito bite, epidemic, poor country\'s disease, one more disease for us to care for, and a war. According to the nurses, factors that make the control of Dengue difficult include: the population\'s lack of awareness, people\'s resistance and lack of responsibility, the mosquitoes\' rapid spread, the high amount of focuses, rumors, lack of information on the disease, lack of knowledge on its cause, lack of qualification of workers of endemic diseases control, and lack of supervision on the work of community health workers. Factors that facilitate the disease control include the work to guide, educate and raise people\'s awareness, basic sanitation, partnerships of family health teams and endemic diseases control workers, demanding the population\'s commitment, better qualification and remuneration of endemic diseases control workers and the population\'s duty being served. Knowledge about social representations on Dengue is important to understand its causality and to cope with this current public health problem. This study managed to give rise to values and symbols of the collective subject of primary health care nurses from Alfenas on Dengue and the coping with the epidemic, which contributed to enhance the intelligence of health services, since these professionals work at the frontline of the city, promoting the fight against the disease.

Over twenty years ago, the World Health Organization launched a health promoting school movement as part of its settings approach to creating healthy environments. Partnerships across the public health and education sectors are vitally important in efforts to improve the health of children and youth in a school setting. In support of this principle, major advancements have been made within Ontario’s education sector, such as mandating local school systems to incorporate the goal of student well-being into their improvement plans and promoting the use of their Foundations for a Healthy School framework. Furthermore, the provincial ministries of education and health are actively encouraging the strengthening of local school health partnerships. However, there is a lack of knowledge within the health promoting school literature as to how to go about establishing well-functioning partnerships within local school systems. To address this problem, the thesis project aimed to generate knowledge about partnerships between public health professionals and local school system actors, and to shed light on the potential for collaboration toward the creation of healthy schools. Before embarking on this thesis project, however, a conceptual framework was developed to gain a firm understanding of cross-sector collaboration for social change, since collaboration represents a partnership at the highest level of engagement. Two other literature reviews were carried out to understand further the partnership component of health promoting school models, and to show the extent of the knowledge gap existing in this area. The literature review on health promoting schools identifies, to a limited extent, the fundamental elements that specifically constitute school health partnerships at both the school and school board levels. Likewise, the scoping review that examines the knowledge-base on the different types of partnership for health promotion within school systems revealed an absence of in-depth knowledge on this topic. When setting out to fill this knowledge gap, an exploratory research methodology that was primarily qualitative in design was chosen. It included a participatory orientation, whereby a research steering committee of 10 public health managers provided guidance with the formulation of the research question, and with the data collection and interpretation stages of the research project’s public health sector phase. An online survey of school health partnership actors from all 36 Ontario public health units was carried out, along with semi-structured interviews with key school health informants from 32 of these public health units and from six school boards in the province. Although the contribution from the education sector was not as pronounced, school board participants corroborated the findings from participating public health professionals and provided additional insights to gain a clearer understanding of partnership challenges and how to strengthen school health partnerships. Thematic analysis of the collected data was performed based on both deductive and inductive reasoning. From the public health perspective, a school health partnership model for student well-being was constructed. This model was enhanced to some extent by the views of school board representatives. It is composed of two dimensions: the Partnership Generator, and the Collaboration Continuum. The Partnership Generator comprises four inter-related components, namely cross-sector engagement, connection, capacity, and continuity, with relationship building at its core. The cross-sector engagement component encompasses various elements that enrich engagement across the public health and education sectors, while the other three components consist of those elements that enable this engagement. The connection elements motivate school health partners to engage, whereas the capacity elements determine the extent to which engagement can take place. Finally, the elements that make up the continuity component maintain the momentum that motivated cross-sector engagement created based on the capacity that was made available through this engagement. Each of these elements contribute to a school health partnership’s strength. The Collaboration Continuum dimension refers to school health partners’ movement from one partnership arrangement to the next, with increasingly more extensive levels of cross-sector engagement. It includes three sets of supporting conditions to promote movement along the continuum, going from networking to cooperation and then to collaboration. The resulting model provides the knowledge base for assessing the strengths of a given school health partnership and for shedding light on which partnership areas would need to be further developed. Overall, this model offers any professional, from the field of public health, education, or mental health, a closer look at what would be required for a school health partnership to become truly collaborative and reach its maximum potential. It promises to inspire and guide school health partners in their pursuit of more meaningful engagement with one another toward greater improvements in the well-being of school-age children, in recognition of their shared responsibility.