Background: This study identified, addressed and validated risk factors that can be measured in the peri-traumatic period which may eventually be used in predicting the development of traumatic stress. Many people in South Africa possibly suffer from Posttraumatic Stress Disorder (PTSD) if we consider the extent of trauma exposures that is apparent within the South African population. Traumatised individuals are at risk but may remain undiagnosed and untreated. It makes sense for first line and primary health care practitioners (i.e., not highly qualified psychological practitioners) to screen for risk since they have the initial contact with trauma individuals. A relatively easy screening instrument that can be administered time efficiently would be useful in this regard. The principles of this instrument are that it needs to be objectively measurable, quick and easy to administer. No consistent measure geared towards identifying risk factors in such a manner immediately post trauma currently exists in South Africa. Objectives: The overall aim was to start a process of designing a psychometric instrument that is valid in predicting the development of traumatic stress. Since this is the initial stage of constructing a new measure, content validity was of utmost importance. It became imperative to ensure that items were not only relevant and appropriate, but also accurate and capable in identifying at-risk individuals. The proposed end goal is to develop effective identification strategies in South Africa geared towards helping victims of traumatic events. Method: A pilot psychometric questionnaire was compiled using three major international reviews, South African research on known risk factors, and literature on PTSD risk assessment considerations. This preliminary assembled item pool was used as a departure point and evaluated quantitatively as well as qualitatively by expert reviewers who have research and/or clinical experience with PTSD in a South African context. Their feedback resulted in either the omission or the modification of certain items; for some items, further exploration was recommended. The questionnaire was further scrutinised and modified accordingly after qualitative interviews with and critical feedback from the intended administrators or primary health care professionals, namely Registered Counsellors (RCs) and/or nursing staff from a participating general government hospital and a non-government organisation. Findings: Expert reviewers did not agree consistently across all the items. At times they rated certain items as relevant according to the necessity of the information rather than with regards to the relevance of the content of the item – in terms of prediction of PTSD. It was also observed that intended administrators did not always agree with expert reviewers.

The main objective of this thesis is to present concepts and knowledge involved in manpower planning, health manpower planning, hospital manpower planning, and the development of manpower and staffing guidelines in hospitals. Along with this objective, it was felt necessary that this thesis offer a good review of approaches or techniques used in manpower planning, health manpower planning, and the development of manpower and staffing guidelines in hospitals. It was also felt that to receive the proper attention, a list of criteria or functions that are necessary to develop such guidelines be given. All of the foregoing was accomplished through a review of the literature and case studies which the author has found helpful. It is the main conclusion of this thesis that both manpower and health manpower planning have received wide respect and recognition. Hospital manpower planning for the development of staffing guidelines in hospitals has not been so fortunate. This type of planning is still in the embryo or infancy stage. Although it has not received the attention as manpower or health manpower planning, recognition for the importance of developing staffing guidelines is growing rapidly. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

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Stroke is the fifth leading cause of death in the United States. Minority groups are disproportionately affected, particularly African Americans, who are three times more likely to be affected than their White counterparts. An effective strategy for addressing these disparities is to improve knowledge of stroke risk factors through innovative and culturally tailored education programs delivered by community health workers (CHW), such as the Columbia Institute for Training Outreach and Community Health (InTOuCH) program. The purpose of this study was to develop and validate outcome measures generated by the Stroke Literacy Assessment Test (SLAT) designed for use with community health workers (CHW) in a stroke prevention training program. The specific aims were to: 1) identify gaps in the literature related to assessment measures in stroke literacy for CHWs, 2) assess and evaluate the need for a stroke literacy assessment test for CHWs, 3) demonstrate evidence of the validity and reliability for the stroke literacy assessment test, and 4) assess stroke literacy in a sample of CHWs participating in the Columbia InTOuCH stroke prevention training program. The scoping review of literature demonstrated that CHW–specific competency assessment methods were limited, with few or no domain-referenced tools on stroke risk factors that complied with measurement standards. Guided by the CHW assessment context, the study applied a unified instrument design and validation approach using an iterative Process Model to develop the SLAT. The SLAT content domain was first specified to produce an initial item pool. Both were content validated by external expert review and refined. Next, empirical validation continued with evidence on examinee response processes, diagnostic item statistics and quality, total score reliability and verification of theoretically expected subgroup differences in SLAT scores. The iterative design process yielded a subset of well-functioning items of the initial 46. These were assembled to construct a final assessment test for empirical evaluation. The final SLAT was administered to 68 CHW alumni of the InTOuCH training program. Results showed that a 34-item SLAT that assesses the factual knowledge and application levels of cognition demonstrates sufficient validity and reliability for use with CHWs specializing in stroke prevention efforts.

The sequence of events leading to the implementation of a change in emergency physicians' practice and the learning activities and processes undertaken are examined and described in this study. A qualitative case study design was utilized and semi-structured interviews were employed as the primary means of data collection. Thirty emergency physicians were interviewed in face-to-face or telephone interviews. One change that required learning was selected per physician for an in-depth interview. The following factors were examined: motivation to change a practice behavior, time to implementation of changes, source of awareness, barriers to change, use of learning resources, stages in the change process, and method of learning.

Bibliography: p. 100-105. / Culture plays a significant role in the treatment of certain illnesses and in the maintenance of good health in communities. In hospitals, professionals are constantly faced with medication non-compliance and other defaulting behaviour by health consumers or patients due to lack of their sensitivity towards cultural issues. It is true that most Africans are faced with a dilemma of choosing between Western treatment approaches and their own traditional healing. Therefore some may need still to adopt both Western and African approaches. The study examines the attitudes of both the professionals and mothers with malnourished children towards the cultural values linked to the treatment modalities. An exploratory- descriptive method is used as a focus for the study. Because of the illiteracy of the mothers, an interview schedule was used to collect data and get impressions about certain issues. A questionnaire was used to collect data from the professionals; which included nurses, an occupational therapist, a physiotherapist, and people working for the Kwashiorkor Centre. Both the literature review and other studies showed that there is a difference in attitudes regarding cultural issues in the treatment of malnourished children between the health consumers and the health professionals. Findings of this study revealed negative attitude towards mothers who used traditional medicine before coming to hospital. Mothers felt that they were reprimanded regarding their cultural value systems. This study includes recommendations that health professionals need to be sensitive to the cultural belief system of the health consumers for better compliance and service delivery. It is recommended that health care providers be aware of their value systems and above all respect those of the consumers. To facilitate better participation in health education programmes it is important that these programmes are culturally sensitive.

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