This study analyzed the role of traditional healing as a health care delivery system in the context of a transcultural society. The perspectives, experiences and personal accounts of 90 respondents were assessed with respect to the categories used by the World Health Organization in its goal of primary health care. Focusing in the research setting that was based in the Limpopo Province, in South Africa the researcher sought to determine whether health practitioners appreciated and understood traditional healing system; if health institutions could integrate traditional healing systems; and how collaboration of the two health systems can be realized. Furthermore, drawing on a blend of qualitative and quantitative research design, the research project was intended to establish the extent to which traditional medicine equipped health practitioners with knowledge of traditional healing techniques and whether practitioners would reconcile traditional and conventional medicine. Drawing on a modified version of the structure of Leininger's Sunrise model, which states that cultural, physical and social structure dimensions are influenced by multiple factors. The research findings offer insights into the historical, social, economic, cultural, among other developments, that lead to integrationist approach in health care systems. Concluding remarks that health practitioners should pursue a policy of neutrality follow a discussion of the findings, emphasizing, the need to allow health consumers to seek traditional health care system, if they so desire. Recommendations include suggestions for further research to determine effective partnerships between traditional and conventional health care systems. / Health Studies / M.A. (Health Studies)

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Chinese Historical Studies / Master / Master of Arts

abstract / Public Health / Doctoral / Doctor of Philosophy

This research evaluates government education and health spending in China and explores the underlying determinants of its spatial pattern. A framework defining local needs at three levels is proposed to analyze whether the expenditure has been reasonably allocated. Results show that both government education and health spending closely respond to local needs at the general level. The illiteracy rate is positively correlated with government education spending while the life expectancy is negatively correlated with government health spending. On the demand and supply sides, while government education spending is more responsive to local demand measured by student number, the needs from the supply side represented by the number of medical personnel appear to be more relevant when governments distribute resources into the health sector. One particular area that needs more effort is the responsiveness to the needs arising from the lack of teaching staff. The student-teaching ratio is now largely ignored when governments make decisions of education outlays. Given that the adequacy of teaching staff is a must to ensure the quality of teaching, governments are thus suggested to put more weights to this aspect in its decision-making process. As for the determinants of government education and health spending, this study takes a close look at three groups of key potential explaining factors identified in the existing literature – economic development, openness and decentralization. The findings pose challenges to the existing mainstream theories developed in the western context. Only per capita gross regional product is found to have significant explanatory power for budgetary expenditure on education and a significant negative relationship is revealed. On the other hand, both economic development and the degree of fiscal dependency are significant in explaining the spatial pattern of government health spending; and their relationships are both non-linear. The fixed-effects panel data regression model predicts that, ceteris paribus, a province with a per capita gross regional product of 20,265 yuan would have the most government health outlays while a province with a fiscal dependency ratio of 63.6% would have the lowest public health expenditure. Provinces with either higher or lower per capita GRP (fiscal dependency ratio) than the threshold value allocate fewer (more) resources into government health outlays. The most important recommendation derived from the findings of this dissertation is that the central government should keep an eye on those provinces that are neither fully financially dependent nor fully financially independent, because their government health spending tends to be particularly inadequate. / published_or_final_version / China Development Studies / Master / Master of Arts in China Development Studies

The purpose of this research was the development of an instrument to measure the complexity of nursing care requirements in ambulatory care settings. Charles Perrow's sociological theory of organizations was adapted to nursng in order to define the complexity concept. Four research questions were investigated in this study. These questions related first, to the construct validity of the instrument's activity category system; second, to the criterion validity of the complexity weighting system; third, to the equivalent reliability to the instrument and fourth, to the instrument's clinical generalizability. Construct validity was evaluated through the regression of subjective estimations of complexity on the individual categories which make up the 154 ratings that contained measurement error, 641 independent client ratings remained for analysis. This data indicated that the classification instrument accounted for 52 percent of the total nursing care complexity in the ambulatory setting. An 18 variable equation was as statistically effective in explaining complexity as was the original 44 variable equation. Criterion validity was examined by comparing empirical complexity weights established through the regression of subjective complexity estimations on activity categories with theoretical weights determined by nurse experts in a Delphi exercise. Kendall's tau, a measure of rank association, was used for analysis. This examination revealed no statistically significant direct association between empirical and theoretical sets of complexity weights. Equivalent reliability was investigated by looking at the percent agreement among six trained raters using the classification instrument. The data indicated agreement on ratings was above 90 percent which met the criterion pre-established for interrater reliability. Finally, by a graphical analysis of residuals from regression equations, instrument generalizability across clinical services was examined. The Ambulatory Care Client Classification Instrument was not found to be generalizable in explaining the complexity of nursing care requirements across the clinical services used in this research.

No description available.

A nursing concern for patients with chronic obstructive airway disease (COAD) is to assist the patient/family in improving adaptation strategies and self-care abilities. Identification of emotional and behavioral characteristics impacting on symptoms and life quality may predict individuals at risk for greater utilization of health care resources. The purpose of this descriptive study was to apply Traver's Prediction Formula for Emergent Use to a more general COAD population to determine if the formula would accurately predict those subjects who have high versus low emergent use of institutional health care resources. Fifty subjects with a range of COAD severity were studied. Subjects completed instruments which measured symptoms and life quality: the Bronchitis-Emphysema Symptom Checklist and the Sickness-Impact Profile. Findings demonstrated Traver's Formula predicted low emergent subjects with 76 percent accuracy, high emergent subjects with 53 percent accuracy and predicted the overall emergent status of subjects with 67 percent accuracy.

This thesis is about UK healthcare decision-makers’ responses to guidance that a new interventional procedure is safe and efficacious, and whether additional information would be helpful.  The aims were to conceptualise how evidence could be used to best inform decision-making; investigate the ways in which decision-makers currently respond to such guidance; identify types of additional useful information, and assess the feasibility and value of providing these. The study was based on the UK Interventional Procedures Programme (IPP).  A multidimensional framework for categorising evidence (explanatory vs. pragmatic) was developed and tested using IPP-evaluated procedures.  A qualitative study explored how local NHS decision-makers respond to IPP guidance and whether additional information might be useful to them.  A range of approaches – from simple descriptive data, through evidence syntheses, to economic models of cost-effectiveness – were explored in a case study of radiofrequency ablation (RFA) for snoring. NHS decision-makers’ responses to IPP guidance varied and they indicated additional information would be helpful.  Available evidence on the effects of procedures went beyond ‘efficacy’.  The case study showed it was possible, within limitations, to provide useful additional information but at increasing costs as complexity increased. Decision-makers vary in their responses to IPP guidance.  Additional information (such as prevalence, incidence, costs and likely cost-effectiveness), which they indicated would be useful, is potentially available but the feasibility of providing this varies depending on the nature of the evidence available and the related costs.  The thesis indicates that the quality of decision-making would be improved if guidance that a new procedure is safe and efficacious were to be contextualised through specific extra information.