This thesis adds to a stream of research suggesting that healthcare can be more patient centered and efficient by redefining the role of the patient from a passive receiver to a more active and collaborative participant. This may relate to healthcare provision (Anderson and Funnell, 2005; Berry and Bendapudi, 2007; Bitner and Brown, 2008; McColl-Kennedy et al., 2012; Nordgren, 2008) and innovation (Bate and Robert, 2006; Groene et al., 2009; Longtin et al., 2010). Through research initiative containing four healthcare units and 68 patients, the present thesis combines healthcare research (e.g., Anderson and Funnell, 2005; Nelson et al., 2002) with service research (e.g., Grönroos, 2006; Vargo and Lusch, 2008, 2004) to explore three aspects of patient involvement and service innovation. Firstly, the concept of patient involvement itself is investigated through an extensive literature review of empirical research on patient involvement. A model describing the antecedents, forms and consequences of patient involvement is proposed. What value is, and how patients can co-create value is discussed from the perspectives of healthcare research and service management thought. Secondly, the thesis proposes a diary-based methodology for involving patients in service innovation. My colleagues and I developed the methodology in collaboration with the participating care providers and applied it in practice. We used the experiences we gained from the project and the contributions from the patients to examine the opportunities for user involvement in service innovation. The participants contributed with ideas and insights stemming from their experiences in their contact with healthcare and other resources. We suggest the following three ways of learning from the collected data: As ideas for improvements; through summary reports to illustrate other quantitative data; and as narratives to promote change. Thirdly, the thesis explores patients’ motivations to participate in service innovation, a hitherto unexplored field. Through an analysis of patients’ contributions and interviews with participants we found that there are a number of factors that motivate patients to participate and that participation is perceived as a social- and meaningladen event. Patients derive psychological well-being and support from participation, but disease was sometimes a barrier to participation. This thesis elaborates on how the most motivated users can be involved in service innovation, applying thinking from the lead-user methodology to a healthcare setting. Overall, the thesis explores patient involvement from new perspectives and, by doing so, adds to our collective efforts to improve healthcare. / Denna avhandling syftar till en mer patientcentrerad och effektiv sjukvård. Den bidrar till en strömning inom forskningen som menar att sjukvården kan förbättras genom en omdefiniering av patientrollen – från en roll som passiv mottagare till aktiv, samskapande aktör. Patienten kan ses som en resurs både i utförande av vården (Anderson and Funnell, 2005; Berry and Bendapudi, 2007; Bitner and Brown, 2008; McColl-Kennedy et al., 2012; Nordgren, 2008) och inom utveckling och innovation (Bate and Robert, 2006; Groene et al., 2009; Longtin et al., 2010). Avhandlingen kombinerar sjukvårdsforskning (Anderson and Funnell, 2005; Nelson et al., 2002) med tjänsteforskning (Grönroos, 2006; Vargo and Lusch, 2008, 2004) i en forskningsansats som innefattar fyra vårdenheter och 68 patienter. Den utforskar tre aspekter av patientinvolvering och tjänsteinnovation. För det första undersöks konceptet patientinvolvering genom en omfattande litteraturöversikt av den empiriska forskningen på området. Översikten leder till en konceptuell modell för att beskriva patientinvolvering: vad dess förutsättningar är, vilka former av patientinvolvering som finns och vad patientinvolvering leder till. Avhandlingen diskuterar även begreppet värde och hur patienter kan samskapa värde, utifrån perspektiv inom vårdforskning och tjänsteforskning. För det andra föreslår avhandlingen en dagboksbaserad metod för att involvera patienter i tjänsteinnovation. Deltagande patienter skriver i denna metod ner sina ner sina idéer och upplevelser varje dag under två veckors tid. Mina kollegor och jag utvecklade metoden i samarbete med personal från de deltagande vårdenheterna och applicerade den på praktiken. Erfarenheterna från projektet och de deltagande patienternas bidrag användes för att utforska möjligheterna med patientinvolvering i utvecklingen av vården. Vi föreslår tre sätt att lära sig från det insamlade materialet: som direkta idéer till förbättringar; summerat till rapporter för att ge kvalitativ förståelse av andra kvantitativa mätningar; och enskilda patienters berättelser kan användas för att förmedla patientperspektivet i organisationen och mana till förändring. För det tredje undersöker avhandlingen patienters motivation att bidra till tjänsteinnovation, ett hittills outforskat område. Genom en analys av patienters bidrag och genom intervjuer med deltagare finner vi att patienter motiveras att delta av en rad olika anledningar, från ett behov av upprättelse till en glädje av att utföra aktiviteten. Deltagandet uppfattas som en social och meningsfull händelse. Patienter upplever psykiskt välbefinnande och stöd genom att delta, även om sjukdom kan vara ett hinder i deltagandet. Avhandlingen undersöker även hur de allra mest motiverade patienterna kan identifieras och inkluderas i tjänsteinnovation, detta inspirerat av lead  user-metoden (von Hippel, 1986). Sammantaget utforskar avhandlingen patientinvolvering och tjänsteinnovation från nya perspektiv och bidrar därmed till våra gemensamma ansträngningar för att förbättra vården och patienters välbefinnande.

Il coinvolgimento di utenti e familiari nella progettazione, gestione e valutazione dei servizi di salute mentale consente di migliorare i servizi, facendo valere gli interessi e la prospettiva di stakeholders che spesso vengono visti esclusivamente come ricettori passivi di prestazioni. La tesi prende il via da queste considerazioni, legate ad approcci recovery oriented, con l’obiettivo di analizzare come le organizzazioni sociosanitarie possono favorire la partecipazione e accogliere il punto di vista degli utenti e dei familiari attraverso l’introduzione di pratiche innovative. Per raggiungere questo obiettivo si è scelto di analizzare due casi: il Fareassieme del Servizio di salute mentale di Trento e il Social Point del Dipartimento di salute mentale di Modena. Attraverso osservazione e interviste, sono stati raccolti dati qualitativi che hanno portato a una interpretazione complessa e sfaccettata. In particolare, sono emersi due versanti: (1) quello del cambiamento culturale necessario per introdurre nell’organizzazione un nuovo approccio centrato sulla partecipazione e (2) quello della formalizzazione delle nuove pratiche partecipative, con i risvolti positivi e negati dell’incardinamento nell’organizzazione. Nelle conclusioni, si ipotizzano possibili sviluppi per la ricerca futura e si elencano i suggerimenti operativi emergenti dalla ricerca per i manager dei servizi sociosanitari. / The participation of users and family members in the design, management and evaluation of mental health services can improve services, relying on the interests and perspective of the stakeholders that are often seen only as passive recipients of services. The thesis takes away from these considerations, related to recovery-oriented approaches. The aim is to analyze how organizations can promote the health and social participation and accept the point of view of users and their families, through the introduction of innovative practices. I analyze two Italian cases: “Doing Together” (a project of the Mental Health Service of Trento) and “Social Point” (a service of the Department of Mental Health of Modena). Two issues emerged from qualitative data: (1) the organizational cultural change related to the introduction of a new approach, centered on participation and (2) the formalization of the participatory practices, with positive and negative consequences. In conclusion, I propose possible development for future research and suggestions to managers of health services.

Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6615. Adviser: Michael W. Ross. Includes bibliographical references.

Forças aplicadas no corpo humano são essenciais para o crescimento tecidual, a postura e a locomoção. Entretanto, na postura sentada, altos níveis de pressão por tempo prolongado podem ocasionar graves danos à pele e aos tecidos subjacentes, podendo levar o indivíduo à morte devido às complicações decorrentes das úlceras de pressão. Pessoas com deficiência que apresentam impossibilidade, temporária ou definitiva, de deslocar-se, adotam a postura sentada em sua cadeira de rodas. Cadeirantes que apresentam diminuição ou perda de funções sensitivas estão mais predispostos a serem acometidos por úlceras por não perceberem os incômodos dos altos níveis de pressão na posição sentada. A engenharia biomecânica tem estudado novas tecnologias em ergômetros e em equipamentos de monitoramento da pressão no assento da cadeira de rodas, com diferentes sensores de medição da pressão, considerando o custo e a constituição do equipamento. Diante disso, foi desenvolvido um novo dispositivo óptico de baixo custo e constituição simples para monitoramento da pressão, utilizando o processamento de imagens da intensidade luminosa gerada pela deformação de semiesferas de elastômeros contra uma superfície transparente rígida iluminada lateralmente sem o uso de líquidos sensores. Foi projetado e desenvolvido um programa de aquisição e processamento, de calibração, de análise das imagens e um módulo de sensores elásticos adaptado ao assento de um ergômetro para cadeirantes. Para entender o funcionamento do dispositivo e avaliar o projeto do novo sistema de monitoramento da pressão foi realizado uma modelagem numérica por elementos finitos, uma análise experimental, uma estimativa da pressão por meio de modelo analítico e um experimento que visa avaliar o efeito do apoio do pé na distribuição da pressão no assento em repouso e com propulsão manual. Por meio, do novo dispositivo de pressão no assento de ergômetro ajustável, foi desenvolvido um novo método de monitoramento da pressão no assento de ergômetro para cadeirantes utilizando um princípio óptico de captação da imagem processada da deformação de semiesferas de elastômeros utilizando aplicativos em ambiente LabVIEW. O dispositivo possibilitou a aquisição, a análise e o monitoramento da imagem do mapeamento dos níveis de pressão no assento de lesados medulares que realizam propulsão manual. Os resultados dos experimentos demonstraram que a elevação do apoio do pé aumenta significativamente (p<0,05) a pressão média e máxima na região isquiática em lesados medulares. O mapeamento óptico com semiesferas de elastômeros para monitoramento da pressão por imagem no assento do ergômetro, mostrou ser uma ferramenta importante na avaliação adequação postural e na ergonomia da configuração de uma cadeira de rodas com potencial para desenvolver novas pesquisas na área da pessoa com deficiência com usuários de cadeira de rodas. / Forces applied to the human body is essential for tissue growth, posture and locomotion. However, in the sitting position, high-pressure levels for long periods can cause serious damage to the skin and underlying tissues, may lead the individual to death due to complications of pressure ulcers. People with disabilities who have not possible, temporary or permanent, to move, adopt a sitting posture with the use of a wheelchair. Wheelchair presenting decrease or loss of sensory functions are more likely to be affected by ulcers do not realize the discomfort of high levels of pressure in the sitting position. Biomechanics Engineering has studied new technologies ergometers and pressure monitoring equipment on the seat of the wheelchair, with different pressure measuring sensors, considering the cost and the setting up of the equipment. Therefore, a new optical device of low cost and simple constitution for pressure monitoring was developed using image processing of the light intensity generated by the deformation of elastomeric hemispheres against a rigid surface transparent illuminated laterally without the use of liquid sensors. For this, it designed and developed an acquisition program, calibration, processing, image analysis and elastic sensor module that is adapted to seat an ergometer for wheelchair users. To understand the device operation and evaluate the design of the new pressure monitoring system was carried out a numerical modeling for finite element, an experimental analysis, an estimate of the pressure by means of analytical model and an experiment designed to assess the effect of support standing on the pressure distribution on the seat at rest and with manual propulsion. By means of the new pressure device on the seat adjustable ergometer it was developed a new pressure monitoring method in ergometer seat for wheelchair users using an optical principle processed image capture of elastomeric hemispheres deformation using applications in LabVIEW environment. The device enabled the acquisition, analysis and monitoring of pressure levels of mapping image on spinal cord injuries seat performing manual propulsion. The results of the experiments with spinal cord injury, demonstrated that the rise foot support increases significantly (p <0.05) and the average maximum pressure in the ischial region. The optical mapping elastomeric hemispheres for monitoring image by pressing the ergometer seat, was an important tool in assessing the ergonomics of the configuration of a wheelchair and postural adjustment with the potential to develop further research in the area of disabled wheelchair users. / Tese (Doutorado)

Made available in DSpace on 2014-12-17T15:46:17Z (GMT). No. of bitstreams: 1 AdrianaMS.pdf: 1189385 bytes, checksum: 0f5e0ae771f3df54a64288a00807bc4f (MD5) Previous issue date: 2009-10-13 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The treatment for abusive users of alcohol and other drugs suffered significant modifications until arriving to the psychosocial model that is used by Centro de Aten??o Psicossocial CAPSad II Eastern Natal/RN (Psychosocial Support Center). That model appears starting from Brazilian sanitary and psychiatric reforms which are expressed in the principles and propositions of Sistema ?nico de Sa?de SUS (Unique System of Health). The Psychiatric Reform meant a rupture with the mental hospital and hospital centered treatment pattern which was destined to the abusive users of alcohol and other drugs. The new proposal offers the universalization, democratization, regionalization and completeness of the actions in the field of mental health. It gathers a strictly interdisciplinary health staff. The purpose of this study is to evaluate the effectiveness of the treatment for abusive users of alcohol and other drugs offered by CAPSad II Eastern Natal/RN. The evaluation used, as priority, the qualitative social research through an evaluating study starting from the non-experimental model. The methodological process used different instruments of data collection: bibliographical and documental researches, systematic observations at CAPSad II Eastern Natal/RN and, mainly, the semistructured interviews (21) that were accomplished with the professionals, users and relatives of CAPSad II Eastern Natal/RN. The investigation showed the effectiveness of the service and, therefore, CAPSad II Eastern Natal/RN constitute itself as the main confronting strategy to the mental hospital and hospital centered treatment pattern of caring the abusive users of alcohol and other drugs / O tratamento para usu?rios abusivos de ?lcool e outras drogas, sofreu significativas modifica??es at? chegar ao modelo psicossocial, utilizado pelo Centro de Aten??o Psicossocial para usu?rios de ?lcool e outras drogas (CAPSad II leste Natal/RN). Esse modelo surge a partir das Reformas Sanit?ria e Psiqui?trica Brasileira expressas nos princ?pios e proposi??es do Sistema ?nico de Sa?de SUS. A Reforma Psiqui?trica significou uma ruptura com o padr?o de tratamento manicomial e hospitaloc?ntrico destinado aos usu?rios abusivos de ?lcool e outras drogas. A nova proposta prop?e a universaliza??o, democratiza??o, regionaliza??o e integralidade das a??es no campo da sa?de mental. Re?ne uma equipe de sa?de necessariamente interdisciplinar. Este estudo tem como objetivo avaliar a efetividade do tratamento para usu?rios abusivos de ?lcool e outras drogas oferecido pelo CAPSad II leste Natal /RN. A avalia??o utilizou, como priorit?ria, a pesquisa social de car?ter qualitativa atrav?s de um estudo avaliat?rio a partir do modelo n?oexperimental. O processo metodol?gico utilizou diferentes instrumentos de coleta de dados: pesquisa bibliogr?fica e documental, observa??es sistem?ticas no CAPSad II leste, e, principalmente, ?s entrevistas semi-estruturadas (21) que foram realizadas com os profissionais, usu?rios e familiares do CAPSad II leste. A investiga??o apontou para a efetividade do servi?o e, portanto, o CAPSad II leste se constitue enquanto principal estrat?gia de enfrentamento ao modelo manicomial e hospitaloc?ntrico de tratar os usu?rios abusivos de ?lcool e outras drogas.

Made available in DSpace on 2014-12-17T15:48:06Z (GMT). No. of bitstreams: 1 AquilesMFB.pdf: 2848841 bytes, checksum: aac61a15b39f85b40a70f982679a622f (MD5) Previous issue date: 2006-05-19 / O dom?nio alvo deste trabalho s?o os sistemas colaborativos distribu?dos onde o foco est? na troca d? mensagens entre usu?rios remotamente distribu?dos. Nestes sistemas, h? a necessidade das mensagens possu?rem conte?do multim?dia e poderem ser entregues tanto a um usu?rio espec?fico quanto a um grupo ou grupos de usu?rios. O objetivo deste trabalho ? desenvolver um framework que facilite: a constru??o desse tipo de sistymas e diminua o tempo gasto com desenvolvimento atrav?s da t?cnica de reuso. Este trabalho apresenta o N2N Framework - Uma plataforma para desenvolvimento de Sistemas Colaborativos Distribu?dos. O Framework foi concebido atrav?s da an?lise do comportamento de aplica??es com caracter?sticas de multim?dias colaborativas, como ambientes virtuais multi-usu?rios, chats, enquetes, e torcidas virtuais. O Framework foi implementado usando-se a plataforma Java. O N2N Framework facilita o design e implementa??o de sistemas colaborativos distribu?dos, implementando a entrega das mensagens, e direcionando o desenvolvedor de aplica??es para a preocupa??o com implementa??o de suas mensagens espec?ficas e o processamento que delas decorre

Historicamente, usuários de drogas são submetidos a tratamentos em instituições fechadas que enfocam a abstinência, sem que haja uma participação ativa do usuário nas escolhas e decisões. O Centro de Atenção Psicossocial para Usuários de Álcool e Drogas (CAPS-ad) é um serviço substitutivo ao hospital psiquiátrico que preconiza a participação do usuário em seu tratamento, no sentido de promover sua autonomia e reinserção social. Esta pesquisa tem como objetivo analisar a participação dos usuários de álcool e outras drogas na elaboração e condução de seu projeto terapêutico singular (PTS). Trata-se de uma pesquisa de abordagem qualitativa, do tipo estudo de caso, com usuários do CAPS-ad de um município do interior de Minas Gerais. Foram utilizados como instrumentos de pesquisa a entrevista semi-estruturada com usuários e profissionais do serviço, a análise de prontuários e do formulário de PTS, e a observação participante nos atendimentos de revisão de PTS. Buscou-se analisar se os planos de tratamento traçados consideram a participação efetiva do usuário na busca dos objetivos e metas compartilhados, com vistas à inserção social e ao resgate da cidadania. Pretende-se também entender o grau de responsabilização do usuário pelo próprio tratamento, avaliando os objetivos e as motivações dos usuários e profissionais do CAPS-ad. Divergências entre objetivos de usuários e de profissionais foram reveladas, demonstrando haver presença de caráter tutelar e pouca responsabilização de alguns usuários no seu tratamento. Observou-se também uma limitação no uso do instrumento PTS, com pouca participação dos usuários em sua elaboração, e sem apresentação de metas e propostas de ações singulares. Foi proposto um novo formulário de PTS que incentive o protagonismo do usuário no tratamento e que contemple diversos aspectos de sua vida. Nesta abordagem, torna-se necessário uma capacitação dos usuários sobre as premissas do tratamento, de forma a promover sua autonomia e participação efetiva na elaboração do PTS. / Throughout history, drug users have been treated in closed institutions that focus on abstinence, lacking an active participation from the user in choices and decisions. The Psychosocial Care Center for Alcohol and Drug Users (CAPS-ad) is a service that replaces the psychiatric hospital which advocates for the user’s participation in their treatment, in order to promote their autonomy and social reintegration. This research aims to analyze the participation of alcohol and other drugs users in the elaboration and conduction of their Singular Therapeutic Project (PTS). This is a qualitative, case study type research, with CAPS-ad users of a municipality in the countryside of Minas Gerais. The semi-structured interview with users and professionals from the field, the analysis of medical records and PTS form, and the participant observation in the PTS review visits were used as research instruments. This research aims to analyze whether the drawn treatment plans consider the effective participation of the user in the search of shared goals and objectives, aiming social insertion and citizenry reappropriation. It also seeks to understand the user’s responsibility degree for his or her own treatment, evaluating users and CAPS-ad professionals’ objectives and motivations. Divergences were found between the ones set by the users and the ones set by the professionals, revealing that there is a presence of tutelary character and little accountability for their treatment in the case of some users. A limitation was also observed in the use of the PTS instrument, with little participation of the users in its elaboration, and lacking presentation of goals and proposals for individual actions. A new PTS form has been proposed, one that encourages the user's role in the treatment and that contemplates several aspects of his or her life. In this approach, training users on the treatment premises becomes necessary, in order to promote their autonomy and effective participation in the PTS elaboration.

Abstract Social services are rendered to those citizens, who require them considering their health, age or unfavourable social situation and who are unable of overcoming their social burdens and less than auspicious circumstances without external aid. Social services are essential not just because many people require them but particularly because were they not to be available, a large part of the public would lose their ability to participate in all aspects of life in a society. This would make it impossible for their human and civil rights to be upheld and lead to their exclusion from society. Social development, more favourable living standards, progress in the field of medicine and championing of social rights result in less people dying in childhood or at a productive age nowadays than before. It can be argued that the number of pensioners will be constantly increasing and that this is an accompaniment of a successfully developing civilisation. Because of their numbers, pensioners are becoming an exceptionally grave subject of social exclusion. It is therefore imperative that we realise the disadvantages the elderly face and devote appropriate attention to the issues surrounding the planning of social services. In terms of the set objective, it is necessary to evaluate and compare individual mid-term plans for the development of social services at certain locations and also to compare and evaluate the communal plans of selected cities. The dissertation proved that it is indeed necessary to pay due attention to the studied planning of social services. This is because there is a need to harmonise supply and demand in relation to social services. Ensuring the availability of a high-quality social services network for the elderly is only possible given the presence of a complex concept of social and medical care. One must however always take into consideration not just the current demographic trends but also the circumstances in the particular area as well as the degree of interest of the various subjects who are immediately involved in the issues surrounding the particular type of social services. One can undoubtedly say that the quality of social services on offer (not just for the elderly) is increasing both in relation to law No. 108/2006 Col. regarding social services but also in accordance with the recipients? wishes and demands.

Background: Accessibility to health care in rural areas is globally impeded by physical, material, human, financial and managerial resources and societal barriers in the health care system. The Systems Model formed the backbone to developing a strategic action plan to address the challenges experienced by all stakeholders involved. Purpose: The purpose of this study was to describe accessibility to health care in rural areas to develop a strategic action plan to enhance accessibility to health care in these areas of Zimbabwe. Methods: A multiple methods approach combining qualitative and quantitative components during 4 phases. Phase 1 collected quantitative data with questionnaires from professional nurses and health care users who were conveniently sampled. Phase 2 collected qualitative data with a nominal group from national health directors who were conveniently sampled. Phase 3 was based on the findings from Phases 1 and 2 with a literature control to develop a draft strategic action plan. During phase 4 the strategic plan was amended and validated with a validation tool by members of the parliamentary portfolio committee on health in Zimbabwe with all-inclusive sampling. Framework: The Systems Model Framework was adopted for this study as outcomes and impact on people’s health is determined by inputs, processes and outputs. This model was relevant and applicable to accessibility to health care. Research findings: Accessibility to health care in rural areas of Zimbabwe is affected by inadequate distribution of physical resources, shortage of material and human resources, and a lack of financial resources. The strategies identified contributed to the strategic action plan which was amended and validated. The strategic action plan includes improving the health infrastructure, providing appropriate medical drugs, training and retention of health workers, providing medical equipment at the rural health facilities, reviewing the health worker workload and addressing staff shortages, providing free health care services in rural areas, and improving the capacity of the health care system. Conclusion: The strategic action plan was developed based on the inputs of the relevant stakeholders and the System Model. The inclusion of the parliamentary portfolio committee on health (members of parliament of Zimbabwe) might enhance the possibility for implementation which can enhance the accessibility to health care in rural areas of Zimbabwe. / Health Studies / D. Litt. et. Phil. (Health Studies)

No description available.