Trans* studies and issues have recently increased in coverage by the media and popular press. With recent changes in the DSM-5 (APA, 2000; APA 2013) and insurance law (HHS, 2014), trans* healthcare has been under increasing scrutiny. While a small number of studies (Bradford, Reisener, Honnold, & Xavier, 2013; Grant et al., 2011; Rounds, McGrath, & Walsh, 2013; Tanner et al., 2014) have documented discrimination and lack of cultural competencies from the perspective of trans* patients, little research exists that examines the training, support, and decision-making processes of medical professionals who treat trans* patients (Snelgrove et al., 2012, p. 2). The goal of this research study is to explore the training and cultural competencies of healthcare professionals in treating trans* patients by surveying and interviewing healthcare professionals about their experiences of trainings, familiarity with practices/protocols, and attitudes toward treating trans* patients. A survey of 35 health care professionals and nine interviews were conducted. These health care professionals, while generally accepting of trans* individuals, still had some reservations about working with trans* patients and suggested that there were many barriers and challenges to providing trans* health care. A majority of health care professionals had little or no familiarity with treatment protocols or diagnoses for trans* patients, and very few had received any type of training (formal or informal) before or after starting working in the health care about trans* patients. While there are many areas in which there perceived challenges and barriers to care, several participants did observe that there has been a shift in health care recently that is moving towards being more inclusive and responsive to trans* patients.

Clinical practice guidelines are one way of ensuring that healthcare is based on the evidence-based practices. In a dynamic unit, like the critical care unit, where sound decision-making and critical thinking are required in the care of critically ill patients, the implementation of such guidelines for care is of utmost importance. Guideline implementation is however not so simplistic, and various studies have proven that there are various barriers linked to guideline implementation. However, most the barriers have proven to be related to individual factors. Therefore, a greater focus has been placed on organisational contextual factors that might have an influence on clinical practice guideline implementation. The research study followed a positivistic, quantitative paradigm, where the hypothesised relationship between the organisational contextual factors and clinical practice guideline implementation were investigated. A structured pre-existing questionnaire, namely the Alberta Context Tool, was used to collect data from 65 registered nurses in private critical care units. Descriptive and inferential statistics were used to analyse the data. The findings revealed that although the organisational contextual factors were prevalent in the private critical care units sampled, some factors like leadership and culture scored higher than the other factors. Positive relations were reported between the organisational contextual factors and clinical practice guideline implementation. The results imply that the alternative hypothesis H1 is supported, and thus proved that there are significant relationships between organisational contextual factors and clinical practice guideline implementation in private critical care units in the East London area.Recommendations were made on how to enhance organisational contextual factors in the implementation of clinical practice guidelines. Ethical principles were maintained throughout the study.

When the current South African government came into power two decades ago they inherited a fragmented health care system whose main focus was on the tertiary care level. The strategy of the current government was to re-focus the whole health care system and prioritize primary health care system. That included setting up district health care systems and building primary health care centres in the areas within the communities in order to make health care accessible to everybody. Due to financial difficulties the majority of the people staying in these communities solely depend on these clinics as they cannot afford to buy health care services in the private sector. The study seeks to assess the current medication supply chain to these clinics with a view of coming up with recommendations that, when implemented, will ensure that the supply of medication by the clinics is able to meet the demands of their patients. Lean management is a system that was started in the manufacturing sector and because of its success there it was later adopted by the service industry. Lean is a system that seeks to eliminate all forms of waste and improve the quality of the service rendered to the satisfaction of the customer/patient. Literature review and discussion of lean implementation is discussed extensively. The findings of the study are presented, analyzed and discussed. In these findings it is noted that the system is functioning very well but there are challenges in these clinics that need to be addressed. Recommendations of how lean management can be implemented successfully to optimize the functioning of the current system are discusse The permission received from the Department of Health to conduct this study came with contractual obligations that the researcher promised to honour. One of those requirement stated clearly that the findings of the study should not be published anywhere without the permission of the Department (see addendums A & C). It is under that premise that the researcher wants to bring this to the attention of the relevant university departments, with the hope of ensuring that this contractual obligation is honoured.

Since the early 20th century, the view has developed that high quality health care can be delivered only when all the pertinent data about the health of a patient is available to the clinician. Various types of health records have emerged to serve the needs of healthcare providers and more recently, patients or consumers. These health records include, but are not limited to, Personal Health Records, Electronic Heath Records, Electronic Medical Records and Payer-Based Health Records. Payer-Based Health Records emerged to serve the needs of medical aids or health care plans. Electronic Medical Records and Electronic Health Records were targeted at the healthcare provider market, whereas a gap developed in the patient market. Personal Health Records were developed to address the patient market, but adoption was slow at first. The success of online social networking reignited the flame that Personal Health Records needed and online consumer-based Personal Health Records were developed. Despite all the various types of health records, there still seems to be a lack of meaningful use of personal health records in modern society. The purpose of this dissertation is to propose a framework for Personal Health Records in online social networking, to address the issue of a lack of a central, accessible repository for health records. In order for a Personal Health Record to serve this need it has to be of meaningful use. The capability of a PHR to be of meaningful use is core to this research. In order to determine whether a Personal Health Record is of meaningful use, a tool is developed to evaluate Personal Health Records. This evaluation tool takes into account all the attributes that a Personal Health Record which is of meaningful use should comprise of. Suitable ratings are allocated to enable measuring of each attribute. A model is compiled to facilitate the selection of six Personal Health Records to be evaluated. One of these six Personal Health Records acts as a pilot site to test the evaluation tool in order to determine the tool’s utility and effect improvements. The other five Personal Health Records are then evaluated to measure their adherence to the attributes of meaningful use. These findings, together with a literature study on the various types of health records and the evaluation tool, inform the building blocks used to present the framework. It is hoped that the framework for Personal Health Records in online social networking proposed in this research, may be of benefit to provide clear guidance for the achievement of a central or integrated, accessible repository for health records through the meaningful use of Personal Health Records.

South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.

The public healthcare sectors within developing nations face a lot of challenges because of constrained resources available to them. The South African public healthcare sector is no different. Although it serves the majority of the South African population, most of the financial resources are directed towards the private sector, which serves very few individuals when compared to the public healthcare sector. Apart from that, other challenges that the National Department of Health has to deal with include the lack of sufficiently trained healthcare employees who can work on the different levels of the public healthcare sector, as well as the burden of diseases such as HIV and Aids, tuberculosis and other chronic diseases. In order to improve service delivery, the National Department of Health is introducing Information and Communications Technology interventions that can increase efficiency and reduce costs, thereby improving the quality of service delivery. This research delivers an m-health application user experience framework to be proposed to the National Department of Health in South Africa, in order to assist in scaling up of m-health applications. The m-health applications that can benefit the South African population if scaled up successfully include those that can be used in remote data collection, treatment and compliance, accessing patients records, remote monitoring, communication and training for healthcare workers and applications that can be used for education and awareness. The study focused on three domains: the Human-Computer Interaction domain, public healthcare domain and Health Informatics domain. The proposed framework was realized by investigating mobile user experience components, mobile health requirements and the South African public healthcare domain components that contribute to the m-health user experience framework. This research was conducted through the interpretivist philosophy. Due to the exploratory nature of the study, an application of qualitative methodology was used. The conceptual theoretical framework was validated through a single case study approach by m-health user experience experts, who reside in South Africa. Data were analysed inductively. An m-health user experience framework was provided at the end of the study. An m-health user experience framework can assist the National Department of Health to look into design issues, address m-health requirements and put the domain needs in place, thus enabling the Department to successfully scale up implementations of m-health applications nationwide.

Human Immune Deficiency Virus (HIV), which results in Acquired Immune Deficiency Syndrome (AIDS), has many manifestations. Literature reveals that some of these manifestations may compromise the infected individual’s sense of well-being and negatively impact on health related quality of life. As the number of people living with HIV/AIDS disease grows, so does the need for their care. In the early days of the AIDS epidemic, care was primarily handled by special agencies, hospitals and clinics. These agencies have been inundated with the demands of people living with HIV/AIDS, while their resources are shrinking. As it stands now, the total assistance given to people living with HIV/AIDS is provided by relatives and this responsibility of caregiving will more increasingly rest with families. This situation is particularly salient for the rural community in South Africa, which has been disproportionately affected by the AIDS epidemic. AIDS has a tremendous impact on the entire family system, particularly on the individual who has primary responsibility for caregiving. The caregiver must cope with many circumstances that are frustrating and often beyond their control. Caring for a Person Living with HIV/AIDS (PLWHA) appears to be a major stressor in the lives of caregivers, and can be very demanding, impacting on carers financially, physically, emotionally and socially. Given the lack of research on HIV/AIDS family caregiving from a salutogenic approach, this study aimed to explore and describe the sense of coherence and coping of family caregivers of HIV/AIDS patients in the Kwazakhele area in Port Elizabeth. The sample consisted of 50 participants aged between 21 and 65 years, recruited via the Kwazakhele Masizakhe Project. An exploratory-descriptive design was employed. Data was obtained by a biographical questionnaire, the Coping Resources Inventory (CRI) and the Sense of Coherence (SOC-29) Questionnaire. A non-probability convenience sample of adult male and female family caregivers were sampled. Descriptive statistics and correlation coefficients were utilized to describe and explore the coping and sense of coherence of the family caregivers and the correlation between these constructs, respectively. The data obtained from the biographical questionnaire was analysed by using descriptive statistics and frequency counts. Key findings include the following: Results from the coping resources measure indicated that this sample perceived themselves as having an average level of coping resources. The sample tended to rely more readily on spiritual resources and less on cognitive resources. Results from the SOC-29 revealed fairly high mean scores. There is no positive relationship between the SOC-29 and the CRI for the current sample. No significant relationship existed between the SOC and the subscales of the CRI. Suggestions are made for future research, the limitations and value of research were outlined.

It is argued that the holistic health care movement in the United States has emerged as a response to dissatisfactions with the existing health care delivery system—a system which has become too concerned with technological solutions and insufficiently concerned with social and psychosocial issues. The holistic health care movement is defined. The movement's emphasis on prevention through the use of teamwork and its concern with whole patient care is explained. Next consideration is given to the present process of planning, financing and delivering health services in the United States; and the other models which have been developed to try to take account of prevention, social and psychosocial issues are described and criticized. The way in which holistic health care needs to be organized is described—the need for involvement of allied health professionals such as nutritionists and psychologists is discussed and better record keeping is examined. The need to be open to new techniques such as acupuncture and other marginal activities is argued. The difficulties in financing are discussed. However, discussion of a model health center presently operating in Illinois gives hope that demonstrations may convince Americans that it is a service worth paying for. The method of introducing new models of health service delivery into the United States is examined. They are generally accepted by the upper-middle class and then work down through the system. It is argued that the model (holistic health care) is quite likely to become more widely accepted because it appeals to the American individualistic, selfhelp ideology. Whilst it may work itself down the class structure it is not likely to solve social problems because the orientation is psychosocial and individualistic. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

M.Comm. / Health care in South Africa has been well described in terms of structure. However, to what extent would it be possible to describe the health care sector in South Africa in terms of that used to describe an industry? What conclusions could be drawn at the end of the study if this was or was not possible? Strong emphasis in industry analysis is placed on the nature of the competitive forces and on levels of profitability. Can the South African health care sector also be described in those terms? The following objectives can be identified in this study: To complete a literature review on the structure of health care in South Africa in terms of facilities, geographic location, services offered, manpower, financing, remuneration, population served and legislation. To complete a literature review on models and methods that can be used to analyse industries. To determine to what extent it is possible to apply Porter's model (and others) of industry analysis to the South African health care industry. To identify key success factors for the industry. To draw conclusions from the study and make some recommendations.

The study was undertaken when St. Bartholomew's Hospital, in Lytton, B.C., a 27 bed facility, was experiencing under-utilization and the threat of closure. This study examines the health and social services of the area, and suggests alternatives for the hospital. Three methods of investigation were used, involving survey methods, documentary analysis, and oral histories. Two survey instruments were prepared by the researcher and applied to a stratified sample of key informants from the community. The respondents in these surveys were divided into either provider or consumer categories, and stratified within each of these as to the degree of contact with the local hospital. Twenty-five such interviews were held with each major category for a total of fifty completed interviews. A comparative questionnaire was also given to patients of St. Bartholomew's Hospital, asking for specific comparison between that hospital and any other with which the patient may have had personal contact. Documentary analysis involved examination of data from three major sources. The hospital maintained records were examined to present utilization rates according to age, sex, diagnosis, residence location and ethnic origin of patients for specified years. Information from British Columbia Hospital Plan was relied on to provide similar information for the school district of South Cariboo, and for the Thompson-Nicola Regional District, for comparison with local rates. The Medical Services Commission of British Columbia was approached to supply information on the volume of physician visits in the local community for selected years. Oral histories were prepared from various persons in the local health field, and from many other individuals in the community. The purpose of these oral histories was to substantiate the factual material, and to generate new and different information not available from the data. The results of this study indicate that Lytton is probably not going to change much in the next decade, but that patterns of health care delivery, and modes of demand for health services are experiencing a significant change at the present time. The result is that the local hospital has become less favoured, and therefore less used by the local people in satisfying their health service wants. Five alternatives for this hospital were examined in some detail. Alternative A involved no change in the present system. From medical, economic and political viewpoints this alternative is not acceptable. Alternative B suggests a reduction in the present inpatient capacity of the hospital, a restructuring of the governing body, the attraction of a second primary health care worker to the area, and the placement of the present doctor and the additional primary care person within the hospital setting. The additional primary care worker could be either a nurse-practitioner, or a physician on salary to the hospital. This alternative has many strengths, but attempts to facilitate change in the hospital in isolation with little regard to the other health and social agencies in the area. Alternative C has all of the attributes of B but goes one step beyond to house the primary health care workers in a Community Clinic built adjacent to the hospital, and include most of the other health and social services available to this community. This alternative requires substantial initial capital, but represents the optimum for the people of Lytton. Alternative D suggests the closing of the inpatient services, and the creation of a comprehensive Diagnostic and Treatment Centre housing most of the health and social services. Alternative E would be for the hospital to close its doors, offer no services, and make no effort to meet the community's health care requirements. Similar to A, this alternative is deemed unacceptable. The last alternative suggests that the University of British Columbia Faculty of Medicine might take over the hospital as a teaching hospital providing rural exposure to a rotation of resident physicians as part of their formal education. The final report was presented to the Board of Directors of St. Bartholomew's Hospital for their consideration. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate