Thesis (Ph.D.)--Edith Cowan University, 2006. / Submitted to the Faculty of Computing, Health and Science. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 2001. / Includes bibliographical references.

Thesis (Ph.D.)--Victoria University (Melbourne, Vic.), 2008. / Includes bibliographical references.

Thesis (M. A ) - - University of the Western Cape, 2008. / Summary in English. Includes bibliographical references.

No description available.

No description available.

published_or_final_version / Social Work / Master / Master of Social Sciences

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006 x, 65 leaves, Annexures A-H / Patient satisfaction is an important, desired measure of quality of care and has a significant influence on the perceived quality of care and outcome of treatment, and for this reason, it holds great value to the treating clinician. Satisfied patients are more likely to comply with treatment instructions and advice, remain with their service provider and refer others. Dissatisfaction, in the event of an unfavourable outcome, can result in legal action and complaints to regulatory bodies. Studies have indicated a high level of satisfaction with chiropractic care; however, none have been in a student clinic setting even in view of the suggested importance in the literature. In view of this significance and lack of understanding of the patients’ satisfaction / dissatisfaction in the history of DIT’s clinic operation the question remains as to what extent the students at the DIT Chiropractic Day Clinic satisfy their patients. This study evaluated the patient satisfaction at the DIT Chiropractic Day Clinic in order to establish a baseline for future comparison. Cronbach’s alpha scores were used to determine questionnaire reliability in a South African student context.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Objectives: The aim of this study was to determine the current role of the Chiropractor in the Patient-Centred Approach to Stress Management. Methods: Chiropractors were contacted telephonically in order to discuss a convenient time in which they are free to receive the questionnaire at their practice. The questionnaire was developed specifically for this particular research project and verified through the use of a focus group and pilot testing. The researcher waited outside the room whilst the Chiropractor completed the questionnaire. The questionnaire was then collected after completion prior the researcher leaving the practice, in order to improve the return of the questionnaires. Results: Seventy-five percent of chiropractors, in the study indicated that they took a psychosocial history which may indicate that they utilised the fundamental biopsychosocial theme of ‘patient-centeredness’. 68.9% of chiropractors who took a psychosocial history indicated that they are equipped with the necessary skills to evaluate psychosocial stressors in patients and 55.6% indicated that their patients responded ‘Very Positively’ to their stress management protocols. All the Chiropractors in the study indicated that they had consulted patients who had associated their main complaint with stress related issues. 38.3% of Chiropractors felt that their patients ‘Often’ associated their main complaint with stress-related issues whilst 35% felt that their patients ‘Very Often’ relate their main complaint with stress-related issues. Muscle spasm (85%) was the most common symptom or sign found or elicited in a patient suffering with chronic stress. Referral was the most common primary method of treatment with 36% of Chiropractors utilising this method in the clinical setting when dealing with a stressed patient. iii Conclusion: Chiropractors in the study indicated that they took a psychosocial history therefore they utilised the fundamental biopsychosocial theme of ‘patientcenteredness’ and that the majority indicated that they are equipped with the necessary skills to evaluate psychosocial stressors in patients and that patients responded positively to their stress management protocols.

Digitized using a Konica Minolta 211 PCL Scanner. 300dpi (OCR). / Thesis (MA (Psychology))--University of Stellenbosch, 2006. / AFRIKAANSE OPSOMMING: Hierdie studie ondersoek die uitvoerbaarheid van die implementering van 'n benadering genaamd Kort Motiverende Onderhoud (KMO) in die konteks van die behandeling van tuberkulose (TB) in Suid-Afrika. TB is 'n ernstige bedreiging vir wereldwye gesondheid en is nog nie onder beheer gebring nie, ten spyte van die feit dat dit geneesbaar is. Sedert die beskikbaarheid van effektiewe medisyne-middels, is die oorsaak vir die voortdurende verspreiding van die siekte gesien as 'n probleem van gebrekkige deurvoerbaarheid van die behandeling. Hierdie eng begrip van die epidemie is deur die psigologiese en sosiale wetenskappe, asook andere, verbreed. Daar is baie debatering oor en om die onderwerp van deurvoerbaarheid en die internasionale TB beheer beleid, bekend as Direkte Observerings-Behandeling, Kortkursus (DOBK). Sekere deskundiges argumenteer dat DOBK 'n onvoldoende respons is tot die uitdaging van die verbetering van deurvoerbaarheid en die kontrolering van TB. Dit skyn asof die meelewende aspekte van die TB behandeling nagelaat word in die TB beleide en protokol en sommige beweer dat hierdie faktor sowel as gebrekkige aandag aan ander sistemiese faktore verantwoordelik is vir swak programuitvoering. Suid-Afrika is 'n voorbeeld hiervan, waar die kommunikasie tussen verpleegsters en TB pasiente beskryf word as outoriter, verpleegstergesentreerd en taakgeorienteerd. 'n Pasientgesentreerde benadering (PGB) is 'n wyse waarop die pasientversorger kommunikasie en die bevredigingsvlak van die pasient bevorder word en sommige promoveer dit as a wyse om die behandelingsdeurvoerbaarheid en genesingsuitkomste te verbeter. Die uitdaging is egter dat die konsep van 'pasientgesentreerdheid' op verskeidenheid van wyses geinterpreteer en geimplimenteer kan word. KMO is 'n PGB tot kommunikasie wat bestem is om 'n gees van samewerking te bevorder en om mense se gemengde gevoelens oor gedragsverandering by te le. KMO as 'n aanpassing van Motiverende Onderhoudvoering, is 'n spyskaart van konkrete vaardighede of middels wat gesondheidsvoorsieners in onderhoude rakende geneeskundige gedragsverandering kan gebruik. KMO is gebaseer op teoriee oor gedragsverandering en word gebruik in 'n wye verskeidenheid van genesingsbehandeling, insluitende deurvoerbaarheidsbehandeling. Alhoewel dit selde in minder ontwikkelende lande toegepas is en nog nooit in TB, is KMO suksesvol toegepas in ander besige kontekste vir gesondheidsvoorsiening. Die ontwerp van die huidige studie oor die lewensvatbaarheid van KMO in die konteks van TB behandeling in Suid-Afrika het ontstaan uit die ontwerp van 'n groter studie wat ander intervensies vir 'n PGB ingesluit het. Die doelstellinge van die huidige studie was om die konteks te beskrywe en wat gebeur het gedurende die intervensietydperk en om die uitvoerbaarheid van KMO te verduidelik. / ENGLISH ABSTRACT: This thesis explores the feasibility of implementing an approach called Brief Motivational Interviewing (BMI) in the context of tuberculosis (TB) treatment in South Africa. TB is a serious threat to global health and has not been controlled despite the fact that it is curable. Ever since effective drugs became available, continued spread of the disease has been understood as a problem of poor adherence to treatment. This narrow understanding of the epidemic has been broadened by psychological and social science perspectives among others. There has been much debate around the topic of adherence and the international TB control policy known as Directly Observed Treatment, Short-course (DOTS), as some suggest that it is an incomplete response to the challenge of improving adherence and controlling TB. The caring aspects of TB treatment seem to be neglected in TB policies and protocols, and some argue that this and the lack of attention to other systemic factors are responsible for poor programme performance. South Africa is an example of this, where the communication between nurses and TB patients has been described as authoritarian, nursecentred and task-oriented. A patient-centred approach (PCA) is a way of improving patient-provider communication and patient satisfaction, and some promote it as a way of improving treatment adherence and health outcomes. The challenge, however, is that the concept of 'patient-centredness' can be interpreted and implemented in a variety of ways. BMI is a PCA to communication that is designed to promote a spirit of collaboration and resolve people's mixed feelings about behaviour change. An adaptation of Motivational Interviewing, BMI is a menu of concrete skills or tools that health providers can use in consultations about health behaviour change. BMI is based on theories about behaviour change and has been used to address a wide variety of health behaviours, including treatment adherence. Although seldom applied in less developed country settings and never before applied in TB, BMI has been successfully applied in other busy health care settings. The design of the present study of the feasibility of BMI in the context of TB treatment in South Africa evolved within the design of a larger study that included other interventions designed for a PeA. The present study aims were to describe the context and what happened during the intervention period and to describe BMI's feasibility. Using elements of participatory action research, BMI communication training was developed and implemented with TB staff based in four urban primary health care facilities. A grounded theory approach was used to describe the dynamics of the implementation process and generate a theory about what made BMI more or less feasible in this context. A multidisciplinary team contributed to the study design. Data were gathered largely through participant observation, focus groups and key informant interviews and generated volumes of diverse materials including field notes, training materials, video and audio-taped interactions. The data were analysed using the inductive approach to grounded theory analysis promoted by Glaser (1992) and relied on theoretical sampling and constant comparative analysis. The quality and trustworthiness of the data were ensured through an emphasis on researcher reflexivity and triangulation of the perspectives of different materials, participants and health facilities. The study was implemented as a pilot BMI training process at one facility in Port Elizabeth (Eastern Cape Province) followed by expanded training targeting TB staff of three facilities in Cape Town (Western Cape Province). Data analysis resulted in a categorised description of the research settings, the interactions and relationships among patients, providers, managers and researchers, the training interventions and the way participants responded to it during each phase of the process. Although seemingly similar at the outset, analysis began to show that dynamics of implementation at each facility were complex and multidimensional. The categories that were generated during each cycle of implementation were used to shape the categories selected for the next. Examining the categories across the four health facilities yielded a grounded theory with seven core categories regarding the role of: (1) the personal qualities of the TB staff involved, (2) the way staff moved in and out of the TB service, (3) the leadership, hierarchy and staff dynamics in the health facilities, (4) the pressurised working conditions of TB staff, (5) the poverty of patients, (6) mismatches between the TB programme's protocols and BMI, and (7) the capacity of staff to innovate and improve care. These findings are discussed in terms of the way they respond to the study's research questions and the way the grounded theory categories relate to each other. Their significance is understood from a social constructivist perspective as bound within the context of the study. The findings are also compared to the theoretical perspectives included in the study design and new literature on the diffusion of innovations in service organisations. Recommendations are made for future context-focused research and adherence related intervention development. If interventions like BMI are to be implemented successfully in contexts such as those included in this thesis, policy-makers and managers need to consider the ways in which working conditions, policies and protocols and patient poverty may be counter-productive, and focus on the innovative potential of health staff and teams for delivering patient-centred care.