Thesis (Ph. D.)--University of Washington, 1990. / Vita. Includes bibliographical references (leaves [115]-123).

Due to the growth of the national income and the increases of the medical knowledge of the general population, personal health was much more valued. The medical service market has reached an era of overall competition. One of the most important strategies for improving competitiveness is providing a better service quality. It relies on the realization of the medical demands of the patients. This study examined the major factors affecting patients¡¦ perception of cumulative satisfaction for rehabilitation services. The results show that patients usually get rehabilitation services from local hospitals and clinics. In addition, quality of interaction and quality of processes have significantly positive effect on both patients¡¦ satisfaction and loyalty. Quality infrastructure has significantly negative effect on patients¡¦ loyalty. Quality of object does not affect patients¡¦ satisfaction and behavior intention. The result can be used by the hospitals to reengineer and redesign creatively their quality management processes and the future direction of their more effective health-care quality strategies. Keywords: Service quality, Patient satisfaction, Patient behavior intention, Rehabilitation services

This dissertation examines the effects of hope and perceptions of control on compliance and satisfaction with medical regimens recommended to patients living with a chronic illness. The present research advances a model that attempts to predict compliance health behaviors and satisfaction with health treatments by incorporating perceptions of control conceptualized using locus of control and self-efficacy, and hope as identified by appraisal theories of emotions and measured using the Herth Hope Index. The proposed model is empirically tested in the context of a lifestyle changing chronic illness: Diabetes Type II. The concept of `perceptions of control' constitutes a central component of most social cognition models and its positive effects on health have been well documented in the literature. However, in health care services, customers experience illness, pain, uncertainty, fear and mainly perceived lack of control. What happens when patients experience loss of control? Does this explain the low compliance levels that we witness today? What if patients experience loss of control, but have high levels of hope? Hope has been associated with higher medical regimen adherence and higher levels of satisfaction. People need hope and manage to have it even in the worst circumstances. In an attempt to answer these questions, the basic premise of the formulation offered here is that the emotion of hope can play an important mediating role between perceptions of control and health behavior and health service evaluation. The empirical findings of this dissertation are mainly based on cross-sectional panel survey data from 222 Diabetes Type II patients, multiple regression analyses, and structural equation procedures following mediation analysis guidelines. The data analyses results from testing three competing models about the dynamics between hope and control support the role of hope as a mediator between perceptions of control dimensions and compliance and satisfaction with the medical treatment. In particular, the results revealed that hope mediates the effects of self-efficacy and doctors health locus of control on compliance and satisfaction. It appears that individuals have higher levels of hope only to the extent that they believe they are capable of performing the actions required by their Diabetes Type II treatment, and/or that their health outcomes are under the control of powerful doctors. These two dimensions of control lead to higher levels of compliance and satisfaction with the treatment regimen through hope. The developed model contributes to transformative consumer research by assisting in solving the challenge of patient compliance with recommended health behaviors. The low levels of compliance across various medical conditions and the increasing rate of people suffering from chronic illnesses constitute pressing research concerns in consumer research. The current research enhances the understanding of compliance behaviors and satisfaction with health services by exploring two of their potential antecedents: hope and perceptions of control; and it represents a step towards enhancing consumer health and well-being. / Business Administration/Marketing

As lesões por esforços repetitivos (Ler) tem-se apresentado como um importante problema de Saúde Pública, tanto por sua alta e crescente incidência, como pela dificuldade de abordagem adequada nos 3 níveis de atenção: preventivo, curativo e reabilitador. O presente trabalho tem como objetivo as LER, descrevendo o significado da doença do ponto de vista do adoecido, investigando-se os possíveis aspectos relacionados à percepção, sentimento, crenças e conduta do paciente em relação a sua doença. Discute-se a importância de se definir o ponto de vista do adoecido como uma contribuição para aumentar a abrangência do conhecimento sobre a problemática das LER, uma vez que somente o adoecido é capaz de informar o que significa vivenciar a situação geradora da lesão, a doença em si e suas conseqüências. Para se atingir o objetivo desse trabalho, utilizou-se a metodologia qualitativa. A partir da coleta de 10 depoimentos de bancárias adoecidas, sua transcrição integral e analise temática, construiu-se o Discurso do Sujeito Coletivo (DSC) onde uma adoecida síntese descreve sua relação com a doença e suas diversas implicações. Vários aspectos presentes do DSC são dscutidos a partir do referencial teórico adotado. Aponta-se que o material produzido (DSC) pode ser utilizado no desenvolvimento de atividades educativas que colaborem para o esclarecimento dos diversos aspectos relacionados com a doença entre os atores sociais envolvidos na questão. Espera-se, assim, contribuir para a adoção de ações que levem em conta a complexidade do problema, possibilitando a transformação da situação atual / The Repetitive Trauma Disorders (RTD) has shown to be an important Public Health issue because of both its high and increasingly occurrence as well the difficulty to find the adequate approach for 3 health attention stages: preventing, curing and rehabilitating. This study has the RTD as subject and describes what is disease meaning from the ill person point of view. To achieve this purpose, it was assessed the possible aspects related to the patient perception, feeling, belief and behavior regarding the disease. The study discuss the importance of defining the ill person point of view which can contribute for enlarging the RTD problem knowledge, once that the ill person is the only one able to report precisely how it is to experience the situation which caused the injury, the disease itself as well the its consequences. A qualitative approach was used in order to reach the work objective. It was collected depositions from 10 ill bank workers. After the integral depositions transcription and its thematic analysis, it was built the Collective Subject Discourse (CSD), where a synthesis ill person describes its relationship with the disease and the consequent implications. Many aspects present in the CSD are discussed based on the theoretical referential adopted. It is indicated that the result of this study, the CSD, could be used as a guide line for developing educational activities to help clarifying many issues related to the disease among the social actors. Is is expected as a result a contribution for selecting actions that takes in account the problem complexity transforming the current situation.

As lesões por esforços repetitivos (Ler) tem-se apresentado como um importante problema de Saúde Pública, tanto por sua alta e crescente incidência, como pela dificuldade de abordagem adequada nos 3 níveis de atenção: preventivo, curativo e reabilitador. O presente trabalho tem como objetivo as LER, descrevendo o significado da doença do ponto de vista do adoecido, investigando-se os possíveis aspectos relacionados à percepção, sentimento, crenças e conduta do paciente em relação a sua doença. Discute-se a importância de se definir o ponto de vista do adoecido como uma contribuição para aumentar a abrangência do conhecimento sobre a problemática das LER, uma vez que somente o adoecido é capaz de informar o que significa vivenciar a situação geradora da lesão, a doença em si e suas conseqüências. Para se atingir o objetivo desse trabalho, utilizou-se a metodologia qualitativa. A partir da coleta de 10 depoimentos de bancárias adoecidas, sua transcrição integral e analise temática, construiu-se o Discurso do Sujeito Coletivo (DSC) onde uma adoecida síntese descreve sua relação com a doença e suas diversas implicações. Vários aspectos presentes do DSC são dscutidos a partir do referencial teórico adotado. Aponta-se que o material produzido (DSC) pode ser utilizado no desenvolvimento de atividades educativas que colaborem para o esclarecimento dos diversos aspectos relacionados com a doença entre os atores sociais envolvidos na questão. Espera-se, assim, contribuir para a adoção de ações que levem em conta a complexidade do problema, possibilitando a transformação da situação atual / The Repetitive Trauma Disorders (RTD) has shown to be an important Public Health issue because of both its high and increasingly occurrence as well the difficulty to find the adequate approach for 3 health attention stages: preventing, curing and rehabilitating. This study has the RTD as subject and describes what is disease meaning from the ill person point of view. To achieve this purpose, it was assessed the possible aspects related to the patient perception, feeling, belief and behavior regarding the disease. The study discuss the importance of defining the ill person point of view which can contribute for enlarging the RTD problem knowledge, once that the ill person is the only one able to report precisely how it is to experience the situation which caused the injury, the disease itself as well the its consequences. A qualitative approach was used in order to reach the work objective. It was collected depositions from 10 ill bank workers. After the integral depositions transcription and its thematic analysis, it was built the Collective Subject Discourse (CSD), where a synthesis ill person describes its relationship with the disease and the consequent implications. Many aspects present in the CSD are discussed based on the theoretical referential adopted. It is indicated that the result of this study, the CSD, could be used as a guide line for developing educational activities to help clarifying many issues related to the disease among the social actors. Is is expected as a result a contribution for selecting actions that takes in account the problem complexity transforming the current situation.

Purpose of the Study The thesis of this study is that personality characteristics can be shown as factors in the variation of behavior which occurs during labor and childbirth. It is felt that if personality traits can be measured by a standard device they will correlate with various types of behavior expressed during labor. The Minnesota Multiphasic Personality Inventory is one instrument which tests all of the more important phases of personality. This test was chosen as the device to be used in this study to determine the personality traits of the women involved. Therefore, the purpose of this study is to determine if the scores obtained in the Minnesota Multiphasic Personality Inventory can be used to correlate personality traits with the behavior expressed during labor. Assuming that behavior can be predicted, it can be hypothesized that doctors could use the Minnesota Multiphasic Personality Inventory or some other personality test to study their patients personalities early in pregnancies and could counsel them in overcoming emotional and personal problems. This should make the patients labors and deliveries much easier. With the increased interest during the past few years in the psychological factors involved in pregnancy, it is felt that a study of personality traits might point a way to further study in this field. To this end the chief objective of this research has been to determine whether a positive correlation can be found between observed types of behavior during labor and delivery and scores on the Minnesota Multiphasic Personality Inventory. Method of procedure Seven basic behavior types showing reactions expressed during labor and delivery were devised by six nurses with obstetrical experience. Patients were chosen who had no previous childbearing experience and who received a limited amount of medication. The patients were observed during labor and then placed in one of the behavior categories. The day after delivery the patients were given the Minnesota Multiphasic Personality Inventory. This method of procedure is discussed more fully in Chapter Three.