Information and communication technology (ICT) greatly influence today’s business processes be it in public or private sectors. Everything that is done in business requires ICT in one way or the other. Research in ICTs is therefore critical. So much research was and is still carried out in projects that develop or enhance ICT but it is still apparent that the success rate of these projects is still very low. The extensive coverage of ICTs implies that if the success rate is still that low, many resources are being wasted in the failed projects; therefore, more research is needed to improve the success rate. Previous research has focussed on factors which are critical for the success of ICT projects, assuming that all ICT projects are the same. As a result, literature is full of different suggestions and guidelines of the factors critical to ICT projects’ success. This scenario brings challenges to project managers who end up using their own personal judgement to select which factors to consider for any project at hand. The end result is the high failure rate of ICT projects since there is a very high chance of applying the same critical success factors to different types of ICT projects. This research answered the question: which factors are critical to the success of computer networking projects in Zimbabwe and how these factors could be used for building a model that determines in advance the success of such projects? Literature reviewed indicated that most CSFs were not focused on specific types of ICT projects, hence were generalised. No literature was found on ICT projects’ CSFs in Zimbabwe. More so, no CSFs were found for computer networking projects as a specific instance of ICT projects. No model existed that predicts computer networking projects’ success. This study addressed the gaps by developing a CSF framework for ICT projects in Zimbabwe, determining CSFs for computer networking projects in Zimbabwe and the development of a logistic regression analysis model to predict computer networking projects’ success in Zimbabwe. Data was collected in Zimbabwe using a unique three-staged process which comprise metasynthesis analysis, questionnaire and interviews. The study was motivated by the fact that most available research focused on CSFs for general ICT projects and that no research was found on CSFs influencing projects in computer networking. Meta-synthesis analysis was therefore conducted on literature in order to identify CSFs as given in literature. The approach was appropriate since the researcher had noticed that there were extensive ICT projects’ CSFs and that no such research has been carried out in Zimbabwe. These CSFs formed the basis for the determination (using a questionnaire) of ICT projects CSFs for Zimbabwe in particular. Project practitioners’ viewpoints were sought through questionnaires. Once CSFs for ICT projects in Zimbabwe were determined, they formed the basis for the determination of unique critical success factors for computer networking projects in Zimbabwe. Interviews were used to get further information that would have been left out by questionnaires. The interview questions were set to clarify some unclear or conflicting responses from the questionnaire and providing in-depth insights into the factors critical to computer networking projects in Zimbabwe. The data i.e. critical success factors for computer networking projects guided the development of the logistic regression analysis model for the prediction of computer networking projects’ success in Zimbabwe. Data analysis from the questionnaire was analysed using SPSS Version 23.0. Factor analysis and principal component analysis were some of the techniques used in the analysis. Interview data was analysed through NVivo Version 10.0. From the results it was deduced that factors critical to ICT project management in Zimbabwe were closely related to those found in the literature. The only apparent difference was that CSFs for ICT projects in Zimbabwe were more specific thereby enhancing their applicability. Computer networking projects had fewer CSFs than general ICT projects. In addition, CSFs for general ICT projects were different from those critical to computer networking projects in Zimbabwe. The development of a comprehensive set of general ICT projects’ CSFs was the first contribution of this study. This was achieved through meta-synthesis analysis. The other contribution was the development of a CSF framework for ICT projects specific to Zimbabwe and those specific to computer networking projects in Zimbabwe. The major contribution was the development of the logistic regression analysis model that predicts computer networking projects’ success in Zimbabwe. These contributions will provide literature on ICT project management in Zimbabwe which will subsequently assist ICT project managers to concentrate on specific factors. The developed prediction model can be used by project managers to determine possible success or failure of ICT projects; thereby possible reducing wastage of resource. / School of Computing

This dissertation examines the state of development of the environmental cost accounting method material flow cost accounting (MFCA). To counter the ever more serious environmental problems such as resource depletion and climate change, environmental management research is searching for solutions on how companies can use the Earth's resources more efficiently. Unlike financial data, resource efficiency data is rarely used for corporate management. Managers have limited attention and specific goals, which is why MFCA links financial data with resource consumption data, making quantities of waste and emissions more visible and controllable. Regardless of its 30-year history, from a theoretical point of view there is no clear picture regarding the accounting method MFCA. While there are some MFCA case studies that demonstrate that MFCA works for its intended purposes, such as detecting inefficiencies, the rather limited number of individual case studies is not sufficient for a general assessment of the method. In addition, practitioners lack a systematic classification of MFCA into categories of conventional accounting methods in order to evaluate the applicability of MFCA in existing accounting systems. Moreover, in spite of a clear exemplification of the accounting method in DIN EN ISO Standard 14051, there is a lack of knowledge about the reasons behind the low diffusion of MFCA in business practice. With this in mind, the dissertation applies the elements of the constructive approach, an approach to solving practical problems, to investigate to what extent MFCA is suitable for addressing the problem, namely the inefficient use of materials in companies, by considering the theoretical connections and contributions as well as the practical relevance and functionality of the MFCA method. To this end, this dissertation examines the relation of MFCA with traditional methods and principles of cost accounting by means of a survey and a literature review. Furthermore, the contribution of MFCA to improving environmental sustainability is explored. Moreover, this dissertation analyzes the practical relevance of MFCA through a meta-synthesis of MFCA case studies. In addition, to better understand the practical functioning of MFCA, the dissertation uses a survey to investigate how MFCA is embedded in the control systems of environmental management which aim to improve and widen the circular economy. The contribution of this dissertation to knowledge about MFCA in theory and practice is diverse. The theoretical classification of MFCA in traditional cost accounting relativizes earlier points of criticism of MFCA and improves the theoretical basis of MFCA. In addition, the meta-synthesis of the case studies enables generalized statements about the ecological and economic effects of MFCA for the first time. Furthermore, the examination of the relationship between MFCA and environmental management control systems in the company reveals the importance of personnel controls in the application of MFCA. In addition, MFCA has been shown to contribute to the Sustainable Development Goals. Based on these findings, researchers and practitioners should be able to better understand the MFCA method and thereby improve the use and diffusion of innovative management instruments such as MFCA. As a result, researchers can contribute to economic and ecological improvements of products and production processes and thus to more sustainable consumption and production, as required in Sustainable Development Goal No. 12.:Summary I Table of Contents III List of Figures IV List of Tables V Abbreviations VI 1 Introduction 1 2 Research articles of the cumulative dissertation 3 2.1 Overview of the research articles 3 2.2 Material flow cost accounting in the light of the conventional cost accounting understanding: attempt at rapprochement (Materialflusskostenrechnung im Lichte eines klassischen Kostenrechnungsverständnisses: Versuch einer Annäherung) (Article 1) 12 2.3 What effects does material flow cost accounting have for companies? Evidence from a case studies analysis (Article 2) 14 2.4 Enhancing the circular economy: Incorporating material flow thinking into business through environmental management control systems (Article 3) 17 2.5 Human needs and Sustainable Development Goals in science and in management accounting (Article 4) 21 3 References 24 Appendix A: Article 1 Appendix B: Article 2 Appendix C: Article 3 Appendix D: Article 4 / Die vorliegende Dissertation untersucht den Entwicklungsstand der Umweltkostenrechnungsmethode Materialflusskostenrechnung (MFKR). Um den immer größer werdenden Umweltproblemen wie Ressourcenverknappung und Klimawandel zu begegnen, sucht die Umweltmanagementforschung nach Lösungen, wie Unternehmen die Ressourcen der Erde effizienter nutzen können. Im Gegensatz zu Finanzdaten werden Daten zur Ressourceneffizienz nur selten für die Unternehmensführung genutzt. Manager haben nur begrenzte Aufmerksamkeit und spezifische Ziele. Deshalb verknüpft MFKR Finanzdaten mit Daten zum Ressourcenverbrauch und macht so Abfallmengen und Emissionen sichtbarer und kontrollierbarer. Ungeachtet ihrer 30-jährigen Geschichte gibt es aus theoretischer Sicht kein klares Bild über die Rechnungslegungsmethode MFKR. Zwar gibt es einige MFKR-Fallstudien, die zeigen, dass MFKR für die beabsichtigten Zwecke funktioniert, z. B. zum Aufspüren von Ineffizienzen, doch reicht die recht begrenzte Zahl von Einzelfallstudien nicht für eine allgemeine Bewertung der Methode aus. Darüber hinaus fehlt den Praktikern eine systematische Einordnung der MFKR in die Kategorien der herkömmlichen Rechnungslegungsmethoden, um die Anwendbarkeit der MFKR in bestehenden Rechnungslegungssystemen zu bewerten. Darüber hinaus fehlt es trotz einer eindeutigen Veranschaulichung der Rechnungslegungsmethode in der DIN EN ISO-Norm 14051 an Wissen über die Gründe für die geringe Verbreitung der MFKR in der betrieblichen Praxis. Vor diesem Hintergrund untersucht die Dissertation mit den Elementen des konstruktiven Ansatzes, einem Ansatz zur Lösung praktischer Probleme, inwieweit die MFKR geeignet ist, das Problem des ineffizienten Materialeinsatzes in Unternehmen zu adressieren, indem sie die theoretischen Zusammenhänge und Beiträge sowie die praktische Relevanz und Funktionalität der MFKR-Methode berücksichtigt. Zu diesem Zweck wird in dieser Dissertation das Verhältnis der MFKR zu den traditionellen Methoden und Prinzipien der Kostenrechnung mittels einer Umfrage und einer Literaturübersicht untersucht. Außerdem wird der Beitrag der MFKR zur Verbesserung der ökologischen Nachhaltigkeit untersucht. Darüber hinaus wird in dieser Arbeit die praktische Relevanz von MFKR durch eine Metasynthese von MFKR-Fallstudien analysiert. Um die praktische Funktionsweise der MFKR besser zu verstehen, wird in der Dissertation außerdem anhand einer Umfrage untersucht, wie die MFKR in die Kontrollsysteme des Umweltmanagements eingebettet ist, die auf die Verbesserung und Ausweitung der Kreislaufwirtschaft abzielen. Der Beitrag dieser Dissertation zum Wissen über MFKR in Theorie und Praxis ist vielfältig. Die theoretische Einordnung der MFKR in die traditionelle Kostenrechnung relativiert frühere Kritikpunkte an der MFKR und verbessert die theoretischen Grundlagen der MFKR. Darüber hinaus ermöglicht die Meta-Synthese der Fallstudien erstmals generalisierte Aussagen über die ökologischen und ökonomischen Auswirkungen von MFKR. Die Untersuchung des Zusammenhangs zwischen MFKR und Umweltmanagement-Kontrollsystemen im Unternehmen zeigt zudem die Bedeutung von Personalkontrollen bei der Anwendung von MFKR. Darüber hinaus hat sich gezeigt, dass MFKR einen Beitrag zu den Zielen der nachhaltigen Entwicklung leisten. Auf der Grundlage dieser Erkenntnisse sollten Forscher und Praktiker in der Lage sein, die MFKR-Methode besser zu verstehen und dadurch die Anwendung und Verbreitung innovativer Managementinstrumente wie MFKR zu verbessern. Auf diese Weise können Forscher zu ökonomischen und ökologischen Verbesserungen von Produkten und Produktionsprozessen und damit zu nachhaltigerem Konsum und nachhaltigerer Produktion beitragen, wie dies im Ziel Nr. 12 für nachhaltige Entwicklung (Sustainable Development Goals) gefordert wird.:Summary I Table of Contents III List of Figures IV List of Tables V Abbreviations VI 1 Introduction 1 2 Research articles of the cumulative dissertation 3 2.1 Overview of the research articles 3 2.2 Material flow cost accounting in the light of the conventional cost accounting understanding: attempt at rapprochement (Materialflusskostenrechnung im Lichte eines klassischen Kostenrechnungsverständnisses: Versuch einer Annäherung) (Article 1) 12 2.3 What effects does material flow cost accounting have for companies? Evidence from a case studies analysis (Article 2) 14 2.4 Enhancing the circular economy: Incorporating material flow thinking into business through environmental management control systems (Article 3) 17 2.5 Human needs and Sustainable Development Goals in science and in management accounting (Article 4) 21 3 References 24 Appendix A: Article 1 Appendix B: Article 2 Appendix C: Article 3 Appendix D: Article 4

Background: There is a great need for effective treatments for mental health problems. Randomised controlled trials are the gold standard for evaluating treatments, however recruitment into trials is challenging, highlighting a clear need for evidence-based recruitment strategies. This thesis aimed to systematically develop a recruitment intervention and evaluate its effectiveness for improving the recruitment of participants into mental health trials. Methods: A mixed-methods approach, adopting the Medical Research Council’s complex interventions framework: 1) a systematic review to identify the evidence base and describe the factors affecting recruitment into depression trials; 2) a qualitative study to understand patients’ decision-making process in declining to enrol in a depression trial; 3) development of a recruitment intervention, using Participatory Design methods; and 4) evaluation of the recruitment intervention, using a randomised controlled trial, embedded in an ongoing mental health trial (the EQUIP trial). The primary outcome was the proportion of participants enrolled in EQUIP. Results: From the systematic review, a conceptual framework of factors influencing the decision to participate was developed, which highlighted that the decision to enrol involves a judgement between risk and reward. Findings suggested that patient and public involvement in research (PPIR) might be advertised to potential participants to reduce such perceived risk. The qualitative study found positive views of trials. Interviewees’ decision making resembled a four-stage process; in each stage they either decided to decline or progressed to the next stage. In Stage 1, those with an established position of declining trials opted out – they are termed ‘prior decliners’. In Stage 2, those who opted out after judging themselves ineligible are termed ‘self-excluders’. In Stage 3, those who decided they did not need the trial therapy and opted out are termed ‘treatment decliners’. In Stage 4, those who opted out after judging that disadvantages outweighed advantages are termed ‘trial decliners’. While ‘prior decliners’ are unlikely to respond to trial recruitment initiatives, the factors leading others to decline are amenable to amelioration as they do not arise from a rejection of trials. We recruited a host mental health trial (EQUIP), and worked with key stakeholders, including mental health service users and carers, to develop an intervention using a leaflet to advertise the nature and function of the PPIR in EQUIP to potential trial participants. 34 community mental health teams were randomised and 8182 patients invited. For the primary outcome, 4% of patients in the PPIR group were enrolled versus 5.3% of the control group. The intervention was not effective for improving recruitment rates (adjusted OR= 0.75, 95% CI= 0.53 to 1.07, p=0.113). Conclusions: This thesis reports the largest ever trial to evaluate the impact of a recruitment intervention. It also reports the largest trial of a PPIR intervention and makes a contribution to the evidence base on trial recruitment as well as to that assessing the impact of PPIR. Two further embedded trials are underway to evaluate the effectiveness of different versions of the recruitment intervention in different trial contexts and patient populations. This will also allow the results to be pooled to generate a more precise estimate of effect; to evaluate the impact of the intervention on trial retention; and to explore patient experiences of receiving the intervention.

Distance education has by nature always depended on technology as a vehicle for various media used to facilitate learning. Today as technology has taken centre stage in our lives especially Internet-based technology, distance education continues to grow in its use of state-of-the-art tools and hence the need to effectively adopt these online tools for online education remains inevitable. This study presents an evaluation of the usability of social media blends in e-learning environments. Comprehensive guidelines for improving the usability of social media blends are proposed in order to facilitate learner networks where knowledge can be created that is based on the leaners’ experiences and their peer connections. In this meta-analysis study literature was searched to identify qualitative research articles that discuss social media blends most commonly used in e-learning. The search was done on South African and international academic databases which included SAe-Publications, EbscoHost, ProQuest and Google Scholar, among others. The metadata analysis was conducted following the online collaborative learning theory as a conceptual framework and the findings agreed with previous studies that the use of social media blends still lacks important empirical data. This study recommends a set of phases in designing curriculum for social media use in e-learning. The proposed guidelines should be useful to instructional designers interested in using modern learning theories in e-learning. Since African qualitative research could not be found, further work in this field could involve qualitative studies on the use of e-learning in African institutions. / Curriculum and Instructional Studies / M. Ed. (Open and Distance Learning)

Introduction: Au Nigeria, la couverture de la détection et du traitement de la tuberculose pharmaco-résistante (TPR) est toujours faible malgré la mise en place de services gratuits depuis 2011. Le pays se classe au sixième rang mondial avec une proportion de cas de patients résistants aux médicaments de 4,3% et de 15% dans les cas d’une réinitialisation au traitement. Le pays a aussi un fardeau élevé pour la tuberculose, la TPR, et le VIH, avec une prévalence de 219 et 11 pour 100 000 habitants pour la tuberculose et la TPR et de 1,28 pour 1 000 habitants pour le VIH. Sans traitement, la mortalité due à la tuberculose est d'environ 70% en dix ans, augmentant avec la coïnfection par le VIH, et la résistance aux médicaments; et descendant en dessous de 5% avec traitement. Les taux de survie de la tuberculose pharmaco-résistante sont plus faibles et le traitement est plus long, plus coûteux et plus toxique. Cela peut poser des défis différents à la fois pour les patients et les systèmes de santé comparativement à la tuberculose de la forme commune. Cependant, la réponse au traitement et la survie sont influencées par la détection précoce et à l'initiation rapide au traitement, idéalement dans les quatre semaines suivant le diagnostic, en particulier avec la coïnfection par le VIH. Les caractéristiques sociodémographiques interagissent souvent de manière complexe avec des facteurs systémiques, pour accroître la vulnérabilité et les désavantages - ces interactions sont particulièrement bien examinées à travers un cadre conceptuel d'équité à l'accès à la santé, et pourrait offrir des analyses et des recommandations pertinentes pour les politiques. Cette thèse explore les barrières et les facilitateurs à l’accès au diagnostic et au traitement au niveau des patients et du système de santé au Nigéria. Méthodes: Cette thèse est une étude transformative de méthodes mixtes. Nous avons d’abord réalisé une revue systématique mixte pour identifier les obstacles et les facilitateurs influençant l’accès au diagnostic et au traitement de la TPR en Afrique subsaharienne. Nous avons par la suite mené une méta-synthèse qualitative pour examiner en profondeur les obstacles aux soins de la tuberculose auxquels se heurtent les patients, la communauté, et le système de santé. Nous avons utilisé les résultats des deux revues systématiques pour affiner notre cadre conceptuel afin d'orienter la conception et l'analyse de l'étude empirique qui a suivi. Le cadre conceptuel adapté est basé sur le cadre de Levesque. Ce cadre centré sur les patients conceptualise l’accès aux soins selon des dimensions du système de santé et des patients. Cette étude comprenait également une analyse rétrospective d’une cohorte de patients diagnostiqués en 2015 (n = 996) à l'aide de données secondaires nationales et une analyse en cascade des soins de la tuberculose pharmaco-résistante entre 2013 et 2017. Nous avons mené des analyses statistiques descriptives et analytiques. Nous avons effectué une régression logistique et d'autres tests d’association pour mesurer la relation entre les variables catégorielles. L’étude qualitative était une étude de cas qui consistait à examiner la dynamique de soins du point de vue des patients (n = 86 participants, n = 7 groupes de discussions, 5 entretiens approfondis avec des patients diagnostiqués et non traités), leurs familles (n = 19 participants, n = 1 groupe de discussion, 7entretiens approfondis ), membres de la communauté (n = 23 , n=2 groupes de discussion), agents de santé (n = 5 entretiens approfondis) et gestionnaires de programme (n = 29 entretiens approfondis) dans quatre États du Nigéria. Nous avons analysé nos données qualitatives à l'aide d'une analyse thématique. Résultats: Notre revue systématique mixte et notre méta-synthèse qualitative ont indiqué des obstacles et des facilitateurs à l’accès aux soins de la tuberculose pharmaco-résistante au niveau du système de santé et des patients. Les problèmes de fonctionnement des laboratoires et des cliniques, l’absence de connaissances et les attitudes des prestataires de soins, et la gestion de l'information étaient des obstacles à l’accès aux soins de la TPR. Les facteurs facilitateurs comprenaient des outils de diagnostic plus récents, la décentralisation des services et le coût gratuit des soins. Au niveau des patients, la perte de suivi avant ou pendant les soins en raison de la perception négative des soins dans les services publics, le genre, la famille, l’engagement professionnel ou scolaire, et le recours aux soins dans le secteur privé constituaient des obstacles. Les facilitateurs étaient la séropositivité pour VIH, la multitude de symptômes, et le soutien financier des patients. Nos résultats quantitatifs ont révélé une certaine amélioration mais des progrès insuffisants dans le diagnostic et la couverture du traitement au Nigeria entre 2013 et 2017. Notre analyse en cascade a montré des abandons significatifs entre chaque étape des soins, en commençant par les tests et en terminant par l'achèvement du traitement. En moyenne, 80% des cas estimés n'ont pas eu accès au test; 75% de ceux qui ont été testé n'ont pas été diagnostiqués; 36% des personnes diagnostiquées n'ont pas commencé le traitement et 23% d'entre elles n'ont pas terminé le traitement pour la période entre 2013-2017. En 2015, les patients et les enfants atteints de la TB qui résident au nord du Nigéria avaient une probabilité de 0,3 [IC à 95% 0,1-0,7] et 0,4[0,3-0,5] de terminer le traitement une fois la maladie diagnostiquée comparativement aux patients et aux enfants qui résident au sud du pays. Les hommes avaient une probabilité de 1,34 [IC à 95% 1,0-1,7] plus élevée de terminer le traitement après le diagnostic comparativement aux femmes. La localisation géographique et les niveaux de soins étaient associés à un traitement et / ou à un traitement rapide. Notre étude qualitative a identifié des obstacles aux soins aux niveaux individuel, familial, communautaire, et du système de santé. Certains groupes sociodémographiques de patients avaient un accès inéquitable aux soins de la TPR. Alors que les patients étaient pour la plupart traités de manière égale au niveau de l'établissement, certains patients avaient plus de difficulté à accéder aux soins en fonction de leur sexe, de leur âge, de leur profession, de leur niveau d'éducation, et de leur religion. La dynamique familiale et conjugale influencent l’accès aux soins des patients, en particulier des enfants et des femmes. Elle agissait parfois comme un obstacle aux soins. D’autres facteurs qui ont probablement entravé l’accès incluaient l’absence de considérations sur les droits d’accès et la protection des patients dans les directives de traitement et les protocoles de soins. Les patients ignoraient pour la plupart les causes de la tuberculose pharmaco-résistante et la disponibilité des soins gratuits. Le nombre d'agents de santé et les problèmes de formation, la faible performance des laboratoires et des cliniques sont des obstacles aux soins de la tuberculose au niveau du système de santé. Les principaux facilitateurs à l’accès aux soins comprenaient le soutien familial, le soutien financier aux patients et le traitement gratuit. Conclusions: Malgré la gratuité des tests et des traitements de la TB pharmaco-résistante au Nigéria depuis 2011, les couvertures de diagnostic et de traitement restent constamment faibles. Les obstacles à l’accès au diagnostic et au traitement de la TB et de la TB pharmaco-résistante sont similaires. Toutefois, la TB pharmaco-résistante présente des défis particuliers en raison de la complexité des procédures de prétraitement et des toxicités résultant des médicaments eux-mêmes. Notre étude avait pour objectif de mieux comprendre les facteurs qui influencent l’accès à l'initiation au traitement de la TB pharmaco-résistante. Nos résultats montrent que les obstacles les plus importants sont l'accès aux tests et au diagnostic, malgré les progrès technologiques de diagnostic et des protocoles cliniques. Notre étude a identifié plusieurs obstacles liés aux patients et au système de santé. La plupart des patients atteints de TB pharmaco-résistante n'ont pas accès aux tests et ne sont pas diagnostiqués, souvent en raison d'un manque d'information. Les politiques et les programmes de lutte contre la tuberculose pharmaco-résistante ne sont pas toujours équitables, en particulier pour les populations vivant dans les zones rurales, les enfants, et les femmes. Les résultats de notre étude ont généré des données probantes pertinentes pour les décideurs et les partenaires internationaux pour remédier aux disparités systémiques et fournir des services plus équitables. L'élimination des obstacles à l’accès aux soins en temps opportun devrait être une priorité urgente pour améliorer le programme de lutte contre la tuberculose au Nigéria. Dans la faible détection des cas et la couverture thérapeutique, les interventions devraient viser l'équité en facilitant l’accès aux soins des populations vulnérables. / Background: Detection and treatment coverage for drug-resistant tuberculosis (DR-TB) in Nigeria are persistently low despite the implementation of free diagnostic and treatment services since 2011. Nigeria has a high burden for tuberculosis, ranking 6th globally with 4.3% drug resistance in new, and 15% in retreatment cases. The World Health Organization classifies the country as a high burden for TB, DR-TB, and HIV, with a prevalence of 219 and 11 per 100,000 population for TB and DR-TB, and 1.28 per 1,000 population HIV. Without treatment, mortality from tuberculosis is approximately 70% within ten years, increasing with HIV co-infection and drug resistance - and decreasing to below 5% with treatment. DR-TB survival rates are lower, and treatment is longer, costlier, and more toxic; this may pose different challenges to both patients and health systems than is the case for drug-sensitive (DS-) TB. However, treatment response and survival are positively impacted by early detection and treatment initiation, ideally within four weeks of diagnosis, especially with HIV co-infection. Socio-demographic characteristics often interact in complex ways with systemic factors, to increase vulnerability and disadvantage – these interactions are particularly well examined through an equity of health access framework and could offer policy-relevant analyses and recommendations. This study explores patient and health system barriers and facilitators to diagnosis and treatment for DR-TB in Nigeria. Methods: This is a sequential transformative mixed-methods study. First, a mixed-methods systematic review identified barriers and facilitators affecting diagnosis and treatment for DR-TB in sub-Saharan Africa. A subsequent qualitative meta-synthesis was used to examine in more depth the patient, community, and health system barriers to TB care. The results of the systematic reviews were used to refine our conceptual framework and to guide the design and the analysis of the subsequent empirical study. The adapted conceptual framework is based on the Levesque framework for patient-centred healthcare access, which conceptualises access to care as having health system and patient dimensions. This study also included a retrospective cohort analysis of patients diagnosed in 2015 (n= 996 ) using National secondary data, and a DR-TB care cascade analysis of the period between 2013 and 2017. We used descriptive statistics, logistic regression and other tests of association to measure the relationship between variables categorical. The qualitative phase used a case study design to examine the dynamics of care from patients' perspectives (n= 86 participants, N= 7 focus group discussions (FGD), 5 in-depth interviews (IDIs) with diagnosed and untreated patients), their relatives (n= 19 participants, N= 1 FGD, 7 IDIs ), community members (n=23 in 2 FGDs), healthcare workers (n= 5 IDIs ), and program managers (n= 29 IDIs) in four States in Nigeria. We analysed our qualitative data using thematic analysis. Results: Our mixed methods systematic review and qualitative meta-synthesis revealed barriers and facilitators to DR-TB care at the health system and patient levels. Health system laboratory and clinic operational issues, poor provider knowledge and attitudes and information management were some barriers. Facilitators included newer diagnostic tools, decentralisation of services and free cost of care. At the patient level, loss to follow-up before or during care due to negative public sector care perceptions, gender, family, work or school commitments and using private sector care were some barriers. Facilitators were HIV positivity, having more symptoms, and financial support. Our quantitative findings revealed some improvement but inadequate progress in diagnosis and treatment coverage in Nigeria between 2013 and 2017. Our cascade analysis showed significant dropouts between each stage of care, starting with testing and ending with treatment completion. On average, between 2013-2017, 80% of estimated cases did not access testing; 75% of those who test were not diagnosed; 36% of those diagnosed were not initiated on treatment and 23% of these did not finish treatment. In 2015, children and patients in Northern Nigeria had odds of 0.3 [95% CI 0.1-0.7] and 0.4 [0.3-0.5] of completing treatment once diagnosed; compared with adults and patients in Southern Nigeria; while males were shown to have a 1.34 [95% CI 1.0-1.7] times greater chance of completing treatment after diagnosis compared to females.. Geographic locations and levels of care were associated with ever receiving treatment and or timely treatment. Our qualitative data and document review identified barriers to care at individual, family, community, and health systems levels. Some patient socio-demographic groups had inequitable access. While patients were mostly treated equally at the facility level, some patients experienced more difficulty accessing care based on their gender, age, occupation, educational level and religion. Parental and spousal influences affected patients, particularly children, and women, and were sometimes barriers to care. Other factors that likely hampered access include the absence of considerations for patients’ access rights and protection in the treatment guidelines and workers manuals. Patients were mostly unaware of the causes of DR-TB disease and the availability of free care. Health worker numbers and training, clinic, and operational laboratory issues limited patients’ access at the health system level. The main facilitators to care included family support, patient financial support, and free treatment. Conclusions: Despite the provision of free DR-TB testing and treatment in Nigeria since 2011, coverage for diagnosis and treatment remain persistently low. Our literature review identified many of the same access factors affecting both DS-TB and DR-TB. However, DR-TB had peculiar challenges due to complexities in pre- treatment procedures, and in toxicities as a result of the medications themselves. This study was designed to investigate the access factors impacting DR-TB treatment initiation identified in literature. However, our findings showed that the biggest barriers to DR-TB care were essentially in access to testing and diagnosis, making any advances in diagnostic technology and treatment regimens of little benefit to DR-TB patients in Nigeria. Several patient and health system factors were shown to impede access to DR-TB care, particularly for certain groups of patients. Most DR-TB patients are not accessing testing and do not get diagnosed, often due to a lack of information. Also, DR-TB policies, structures and processes are not always equitable, especially for rural dwellers, children and women. Findings from our mixed methods study provided the additional insights needed by policymakers and implementing partners to address systemic disparities and provide more equitable services based on the population's needs. Eliminating barriers that negatively impact timely access to care should be an urgent priority for the TB program in Nigeria. In Nigeria's low case-finding and treatment coverage, interventions should target equity and ease of access, specifically for the barriers identified at the patient and health system levels.

Zweck: In den letzten Jahrzehnten hat das Interesse an sozial engagierter Kunst, Art in Action, stetig zugenommen. Bisher fehlt allerdings eine Praktiker-Forschung (practitioner research), welche Fragen aus der Arbeitswelt in den Forschungsmittelpunkt stellt und die glokalen Gegebenheiten praxisrelevant diskutiert. Diese Studie untersucht die Grundannahmen der Kunstgeschichte, welche bisher die Einführung der Praktiker-Forschung erschweren. Die Studie kontextualisiert und diskutiert zudem die Besonderheiten der künstlerischen Forschung sowie der Praktiker-Forschung in anderen disziplinären Feldern. Daran anschliessend formuliert diese Studie die Prinzipien der Art in Action Methodik. Methodik: Diese transformative Studie arbeitet mit dem Global Studies Paradigma. Der konzeptionelle Apparat umfasst die Kaleidoskopische Dialektik, das Konzept der Glokalisierung und die Theorien der Transdisziplinarität und der Meta-Narrativen Synthese. Ergebnis: Diese Studie formuliert die Prinzipien der Art in Action Methodik (AiAR). AiAR stellt Fragen aus der Arbeitswelt in den Mittelpunkt der Forschung, berücksichtigt lokale Gegebenheiten und organisiert den Forschungsprozess in Relation zu den projektrelevanten Partikularitäten (grounded methodology). / Purpose: In the last few decades, there has been a steadily growing interest in socially engaged art, i.e., working with art in socio-cultural settings (Art in Action). What has been missing, however, are art practitioner research methodologies that place issues emerging from art practitioner work environment at centre stage. This study explores the critical assumptions of art history, which have so far hindered a practitioner-driven research approach. It contextualises and discusses the specificities of artistic research and practitioner research. On this basis, the study formulates an Art in Action research methodology. Methodology: This transformative research applies a global studies paradigm. Its conceptual apparatus includes the kaleidoscopic dialectic, the concept of glocalisation, and the theories of transdisciplinarity and meta-narrative synthesis. Result: This study formulates principles for an Art in Action research (AiAR) methodology that places the issues emerging from the art practitioners’ work environments centre stage instead of an artwork-centred approach. It postulates that AiAR works with grounded research procedures.