Thesis (Ph. D.)--University of Washington, 1986. / Vita. Bibliography: leaves [153]-162.

Thesis (M.S.) University of Missouri-Columbia, 2006. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file viewed on (June 26, 2007) Includes bibliographical references.

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)

xi, 149 p. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Between the early 1900s and the 1952 U.S. Supreme Court case of United States v. Oregon State Medical Society, conflicts over the legality and permissibility of contract medicine raged in Oregon. Organized labor opposed the practice because it restricted their choice of physician, and because they resented mandatory wage deductions to pay for the contracts. Organized medicine resented contract medicine for its imposition of commercial power on physicians. The groups initially attempted to resolve the issue publicly through legislation, but procedural factors and a lack of group cohesiveness prevented a public solution. Beginning in the 1930s, the State Medical Society imposed its own private code of ethics on the medical services market to eliminate contract practice, and used the legislative process to preserve its independence to pursue a private sector solution. Ultimately, the Supreme Court allowed this approach, based partly on its view that medicine was distinct from business. / Committee in Charge: Dr. Daniel Pope, Chair; Dr. Glenn May; Dr. James Mohr

M.Cur. / The study on ‘Sustainability of midwifery practice within the South African healthcare system’ is stimulated by the lack of research that influences policy to support midwifery practice in South Africa. The poor database and health information systems for midwives result in the poor performance of maternal healthcare in the public sector (Parkhurst, Penn- Kekana, Blaauw, Balabanova, Danishevski, Rahman, Onama, & Ssengooba 2005) in spite of meeting the Safe Motherhood Initiative of the World Health Organisation’s criteria for skilled attendance and facilities (Penn-Kekana & Blaauw 2004). Generally, midwives remain the main provider of maternal healthcare, including South Africa, where only 3 in 10 women in the public sector see a medical doctor once in pregnancy (South African Demographic Health Survey 1998). The norms and standards recommended by the Saving Mothers Reports 1998 – 2006 for staffing and resources to improve outcomes of maternal deaths have not realised. The public sector needs help from the private sector for improved care. The Nursing Strategy for South Africa 2008 endorses Public-Private Partnerships (PPP) to support nursing and midwifery. There is no Public- Private Partnership in South Africa to support or sustain midwifery practice. The purpose of the study is to develop a model for a Public-Private Partnership for midwifery practice sustainability in the South African healthcare system. This study follows adapted explorative, descriptive, model generating research guidelines of Chinn and Jacobs (1983 & 1987), Chinn and Kramer (1991 to 2008) and Walker and Avant (1995). Analysis of the South African maternal healthcare context uses the open-system theory for sustainability of Olsen and a team of researchers (1998) and several frameworks for healthcare human resources. The main concepts of the model are identified and analysed. The main concepts are Public-Private Partnership, midwifery practice, sustainability and the related concepts are governance, task environment and quality service. The model for a Public-Private Partnership is synthesised through the relation of concepts. The 45 statements of the context empirically ground the study. The model depicts the South African healthcare context and all the factors that impact on midwifery and its context. The model and its functions are explained within a constituted framework. The Global standards for practice of the International Council for Nursing and Midwifery, the definition and core competencies of midwives of the Confederation of Midwives, the Millennium Development Goals for Sub-Sahara Africa 2020 and the newly formed World Health Organisation Partnership for Africa for maternal, newborn and child care 2008 are factors of the global (macro) context that influence the model. The South African healthcare system (meso context) factors include economics, legal-ethical, professional, service delivery and civil society dimensions that impact on policy for service delivery on micro level, where the PPP formally exists. The PPP for maternal healthcare is developed within this framework. The stakeholders of the formal PPP are the public sector, the private sector, the midwifery profession and civil society. The PPP governs the task environment for midwifery through the risk assessment strategies that include financial risk based on clinical risk and the development of norms and standards for staff and resources as expressed in service level agreements for quality service delivery. Governance implies policy standards and the accountability of the PPP to the consumer for service delivery quality and performance. The stakeholders of the PPP ensure sustainability in this model through collaboration and shared responsibility, risk and decision-making between the institution, midwifery profession and practice and civil society for a balance of interest.

It is generally accepted that a business operates more efficiently when it is able to consolidate information from a variety of sources. This principle applies as much in the healthcare environment. Although limited in the South African context, the use of electronic systems to access information is advancing rapidly. Many aspects have to be considered in regards to such a high availability of information, for example, training people how to access and protect information, motivating them to use the systems and information extensively and effectively, ensuring adequate levels of security, confronting ethical issues and maintaining the availability of information at crucial times. This is especially true in the healthcare sector, where access to critical data is often vital. This data must be accessed by different kinds of people with different levels of access. However, accessibility often leads to vulnerabilities. The healthcare sector deals with very sensitive data. People’s medical records need to be kept confidential; hence, security is very important. Information of a very sensitive nature is exposed to human intervention on various levels (e.g. nurses, administrative staff, general practitioners and specialists). In this scenario, it is important for each person to be aware of the requirements in terms of security and privacy, especially from a legal perspective. Because of the large dependence on the human factor in maintaining information security, organisations must employ mechanisms that address this at the staff level. One such mechanism is information security education, training and awareness programmes. As the learner is the recipient of information in such a programme, it is increasingly important that it targets the audience that it is intended for. This will maximize the benefits achieved from such a programme. This can be achieved through following a role-based approach in the design and development of the SETA programme. This research therefore proposes a model for a role-based SETA programme, with the area of application being in the South African healthcare environment.

University of Macau / Faculty of Social Sciences / Department of Communication

Background: Stroke is a major cause of disability in the world and its long term effects require good adherence to treatment protocols of physiotherapy. This will ensure optimal rehabilitation and reduce the burden of care in the society and the health service. Superficial analysis of existing data from the Physiotherapy Department of Mthatha General Hospital (MGH) revealed that there was poor attendance of outpatient physiotherapy by patients discharged from MGH with stroke and this had negative effects on outcomes and health care costs. Aim: To identify factors that influence poor attendance for outpatient physiotherapy by patients discharged from MGH with a stroke. Methods: Following approval from the Research Ethics Committee to conduct the study, an observational descriptive study design was used. The study population was 139 patients with stroke who attended for physiotherapy in MGH from January 2007 to December 2007. From a sample size of 103 randomly selected patients, 85 patients participated in the study with a response rate of 82%. Data collection was done using structured interviews and SPSS was used for data analysis. Results: The majority (86%) of patients did not attend physiotherapy until discharge from physiotherapy department. The major factors that influenced poor attendance were movement of patients to other areas (36%) and long distance from MGH (29%). Conclusion: The majority of stroke patients who attended for rehabilitation in MGH Physiotherapy Department lived in rural areas which were distant from Mthatha and could not attend physiotherapy at MGH as required by the physiotherapists. Recommendation: Development of a Provincial Rehabilitation Policy to address the unavailability of physiotherapy services at clinics and health care centers and ensure creation and filling of vacant physiotherapy positions at these levels of care.

The economic evaluation (EE) component of health technology assessments (HTA) often defines value in terms of health related quality of life, with many HTA agencies requiring the use of EQ-5D based Quality Adjusted Life Years (QALYs). These approaches do not capture value derived from patient experience factors and the process of care. This thesis widens the valuation space beyond this limited perspective, taking account of such factors, using monetary values generated from a discrete choice experiment (DCE), incorporating these into a discrete event simulation (DES) and conducting a cost-benefit analysis (CBA). The case study is monitoring individuals with ocular hypertension. Five strategies were compared using a DES: 'Treat All' at ocular hypertension diagnosis with minimal followup; Biennial monitoring (either in primary or secondary care) with treatment according to predicted glaucoma risk; and monitoring and treatment according to the UK National glaucoma guidance (either conservative or intensive). DCE based Willingness to pay (WTP) estimates for relevant health outcomes (e.g. risk of developing or progressing glaucoma and treatment side effects), patient experience factors (e.g. communication and understanding with the health care professional) and process of care (e.g. monitoring setting) were obtained. Conditional logit, mixed logit preference space and mixed logit WTP-space (rarely used within health economics) econometric specifications were used. These WTP valuations were aggregated in the DES, as fixed mean values or allowing variation between simulated individuals. While the standard cost-utility analysis (CUA) using EQ-5D implied 'Treat All' was most likely cost-effective, CBA with broadened valuation space identified, consistently across different econometric specifications, 'Biennial hospital' as the best choice. This thesis proposes an approach to broaden the valuation space that can be promptly used for EE-HTA. Researchers should be attentive of the valuation space considered in their EE and choose wisely the EE approach to be used (e.g. CUA and/or CBA).

There has been a growing conviction on the part of medical and nursing staff in the Homes for the Aged in British Columbia, which provide psychiatric care for the aged, that some of the residents have sufficient physical and mental health to be discharged. This study makes an analytical survey of some of the needs and resources of a group of patients considered to be ready to leave one of these institutions (the Port Coquitlam Unit). The purpose of the survey was to determine what kinds of resources these people would require to maintain an optimal level of adjustment in the community, as well as to describe the possible contribution social services could make in facilitating their discharge. The areas selected for assessment were grouped into two broad categories, (1) the patient's needs which resulted directly from his hospitalization and (2) the personal and social resources which he could employ upon discharge. There are two steps involved in selecting the group for study. First, through the use of a questionnaire submitted to the medical and nursing staff in order to determine which patients were judged to be mentally and physically ready for discharge, and second, from this larger number of patients, through the use of routine sampling procedure, a smaller group was selected for study. This final group was assessed by the clinical team in the institution primarily through the use of rating scales. An examination of the needs and resources of these patients revealed that all of these patients could benefit from the assistance of social work in one or more of the areas evaluated. Although the needs and resources of the group varied considerably, there were some indications that the patient's length of stay had a marked effect upon the type of social work service they could use. Those remaining in hospital for a period of less than two years had usually retained some resources in their former community which could be mobilized to assist them in discharge. On the other hand, the indications for these patients is that they would need an extension of hospital services after they were discharged. The patients who had remained in hospital for a longer period of time, had less need for out-patient hospital services, yet had little in the way of social resources or contacts in their former community to assist them once they had left the hospital. This group also evidenced less motivation for discharge and seemed to regard their hospitalization as a permanent living arrangement. In conclusion, the study points out the need for further definitive assessments of the areas of function of a social worker in an institution where the aged, psychiatrically ill are treated. Also pointed out is the need for social work programme planning in the light of these assessments, as well as the insurance of adequate provisions for further research to help develope it. Treatment programmes in other psychiatric institutions are mentioned, indicating that with the use of more advanced therapies, an increasing number of geriatric patients with mental illnesses are responding to treatment and are, therefore, eligible for discharge. Thus, there is a growing need for social work contributions in planning with the older person who is leaving hospital. Some indications of community concern in planning for these people are cited as evidence of awareness on the part of both the institutions for the geriatric patient and the community that the change from hospital life to community life must be an uninterrupted process. / Arts, Faculty of / Social Work, School of / Graduate