The district nurses' duties with all organisational changes, above all during the last 20 years, have been changed. Economy and listing governs which visits that to be prioritized. The aim with this study was to examine what district nurses in the primary care in Uppsala län has for view about their occupational role. The method was qualitative and the selection comprized ten district nurses in Uppsala län that were interviewed individually on the basis of a semi structured interview guide that the authors the actual created. In the wide analysis of the results could a theme, As a rubber screw in a shrinking hole and three central categories be discerned, Occupational role, Diversity and Organisation. The district nurses enjoy with work and their choice of profession despite higher demand, stress and low staffing. They experience that the profession role have become unclear and others professions has poor knowledge about which competence they hold. They have an interest of working preventive and a holistic view when thinking about nursing care among children and adults. The feeling of not be needed as a profession, not to become seen with the competence that they possesses, is experienced very frustrating and the obvious role the district nurse earlier had in the primary health care and society seem to fade increasingly. The district nurses description of their profession role can compared as a rubber screw which reflects the flexibility but also the resistance against increasingly healthcare. The shrinking hole symbolize the majority organization changes as forced the district nurses to priority other duties than public health work and a decreased sphere of activity.

No abstract available. / Thesis (MPA)-University of Durban-Westville, 2004.

The goal of this study is to identify factors which may be preventing use of an experimental health care program in the People's Republic of Benin. While previous surveys have focused more specifically on the impact of fees on use and demand, our aim to identify a wider range of factors. / There are two principle methods by which this can be done. One is to extract possible factors from a review of the relevant literature. The other is to carry out an exploratory, qualitative study in the field. We have used both these methods. / A qualitative study is a necessary prelude to a survey, since we initially have no specific idea about which factors to measure and investigate. The aim is to identify factors which may be relevant so that a subsequent survey, with a larger number of cases, could quantify and measure their influence and statistical significance.

Accessibility is a key tenet of the Canadian health care system. As many older persons, age 60 years and older, are managing ongoing chronic health conditions as part of their everyday lives, issues of access to health services are particularly important. Vancouver has a substantial number of older Korean immigrants, yet little is known about their experience and perceptions about accessing Primary Health Care (PHC) services. This study explored issues related to PHC access by older (aged 60 years and older) Korean immigrants. This qualitative study employed purposive sampling and interpretive description methodology. Open-ended interview data and field notes were gathered from 10 older Korean immigrants (five male and five female) recruited in Vancouver from mid-October 2006 to April 2007. The findings revealed that older Korean immigrants have had difficulty gaining access to appropriate PHC services because of the shifts in their social positioning and other barriers which contributed to an inappropriate use of PHC services, delays in care and lack of continuity in PHC. Also, the data revealed a number of ways the PHC system is unresponsive to the health care needs of older Korean immigrants. This study offers insights that may assist health care professionals to understand the nature of the challenges older Korean immigrants face when seeking health care and how they seek to resolve them. The analysis proposes a number of interventions that respect the older Korean immigrants’ values and interventions that may improve their access to PHC.

Primary health care is a part of health care chain, in which primary contact of individuals, families and society is made with national health system, making health care nearer to people’s living and work places. In Lithuanian health program it is estimated to decentralize the management of health care institutions and create conditions for the development of private health institutions. In Lithuanian national health system it is possible to distinguish three models (types) of institutions, providing primary health care, depending on service organization and ownership type. This research is seeking to evaluate the changes of primary health care institutions in the context of health care reform, evaluate them among institutions of different models, depending on service organization and ownership type. The aim: to distinguish the differences of Vilnius region institutions providing primary health care, depending on peculiarities of work organization. Methods: In years 2003 – 2005 a cross-sectional descriptive research was carried out. The data of State Patient Fund information system database Sveidra was analyzed. The research includes all institutions of Vilnius region, which provided primary health care services in years 1998 – 2003 and signed agreements with Vilnius Territorial Patient Fund. All the chosen institutions were divided into three groups: public institutions, providing primary care and secondary health care services, the establishers of which are... [to full text]

SUMMARY The aim of the study is to evaluate attitude of physicians and patients towards primary health care reform. The objectives: 1) to assess patients' attitude to primary health care reform and its relations to demographic and social factors. 2) to evaluate physicians' attitude to primary health care reform. 3) to compare viewpoint of patients and physicians on primary health care reform. Methods. The subject of the survey is the attitude of the patients and physicians towards primary health care reform. The survey was conducted in five primary health care centres and three private primary health care practices in Prienai region. Of the 400 questionnaires handed out to patients 82.5% were returned and of the 112 questionnaires given to doctors 87.5% were returned. The participants in the survey were 330 patients and 98 medical doctors. The questionnaires were compiled both for the patients and the doctors. The questionnaire for the patients covered 24 questions, for the doctors - 19 questions. The data analysis was done applying the statistical package SPSS 11.0 version. The statistical procedures were employed by Chi-square’s (χ2) parameters, degree of freedom and statistical significance. The difference of indices were statistical significant at p<0.05. Results. 55.9% of the patients’ attitude towards primary health care reform is positive, while 29.9% of the patients - negative. 18.3% of the patients have the opinion that due to health care reform the quality of... [to full text]

No description available.

This thesis has explored the implementation of the primary health care strategy in Ghana, focusing on the Maternal Child Health program, one of main components of the strategy and the program that seems to have been most widely implemented in the country. / The analysis has been concerned primarily with identifying the obstacles to the implementation of this strategy in rural areas of the country, where levels of utilization and participation have been found to be lower than what was hoped for by the government. It does this by using data collected through in-depth interviews and participant observation in three rural villages of the country. / The findings reveal that a complex range of interrelated factors influence or deter women from utilizing and participating in the MCH program.

Introduction: Integrated management of childhood illness (IMCI) is a child survival strategy that has been adopted in South Africa (SA) as the standard of care for managing sick children in the primary health care setting. IMCI includes guidelines for management of paediatric HIV. This study aimed to investigate effectiveness of IMCI as a vehicle to deliver essential child survival interventions, particularly HIV interventions, in routine practise in a high HIV prevalence setting, and to investigate barriers and enabling factors for IMCI implementation. Methods: The study was conducted in Limpopo and KwaZulu-Natal provinces, SA. In the qualitative component, focus group discussions were conducted with IMCI trained health workers and carers of children under 5 years, to explore experiences of IMCI implementation, particularly the HIV component, from the perspective of both target groups. A comparative survey was then conducted. Randomly selected IMCI trained nurses were observed for up to 20 consultations with sick children presenting consecutively to the facility, and their findings compared to those of an IMCI expert who subsequently assessed the child. Observed children were tested for HIV. Results: IMCI trained nurses found IMCI training informative and empowering, and there was agreement among nurses that their skills in managing sick children improved after training. Barriers to IMCI implementation included increased time required for IMCI consultations and lack of support from colleagues. IMCI trained nurses expressed reluctance to implement the HIV component of IMCI, believing it to be unnecessary, unacceptable to mothers and that they lacked the skills to implement HIV care. In total, 77 IMCI trained nurses were observed for a total of 1357 consultations between May 2006 and January 2007; nurses were observed for a mean of 17.7 consultations. Components of the IMCI assessment were frequently omitted; 14/77(18%) nurses asked about all main symptoms in every child. IMCI classifications were often incorrect; 52/112 (46.4%) children with a general danger sign were correctly classified. The HIV component was poorly implemented, 342/1357 (25.2%) children were correctly classified for HIV, although the HIV algorithm performed well when implemented by IMCI experts. Conclusion: IMCI implementation is fragmented and incomplete. Interventions are urgently needed to achieve and maintain high quality health worker performance in implementing IMCI. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.

Canadians are worried about the future of the health care system, and provincial governments are questioning the ability of the existing system to support Canadians health care needs in the 21st Century(Industry Canada, 2011). Health care providers and system administrators are both driving and experiencing a paradigm shift; moving away from paternalism and toward an egalitarian approach. In order to practice patient centredness, health care providers must prioritize patient needs; provide information regarding treatments while taking patient preferences into account (Romanow, 2002). While there is a growing body of literature regarding patient centredness, there is scant information from the patient perspective. If the most effective and acceptable health services are those that realize the expectations of the users, this is an important area of study. Using phenomenological research methods and the theory of planned behaviour as a theoretical framework, the purpose of the study was to explore the influence of beliefs, attitudes and experiences on behaviour from the perspective of patients in primary health care or stroke rehabilitation. A second purpose was to explore the degree to which beliefs, attitudes and behaviour were similar between clinical contexts. The theory of planned behaviour was unsuitable for understanding peoples’ beliefs, attitudes and behaviour about being a patient. Being a patient was not a single, observable behaviour, but rather a set of contextually dependent strategies patients’ directed at a particular goal. The goal for each participant group was different; rehabilitation patients focused on the specific goal of recovery and discharge, while PHC patients focused on a broader goal of accessing and receiving best health care possible. These goals were reflected in their respective approaches to accessing health care services, an experience they described as socially oriented, governed and reinforced. Although patients described themselves as actively engaged, they did not approach each interaction with health care with a set of behavioural beliefs about being a patient. During the course of their participation, patients identified, developed and adopted strategies to assist in achieving the target; and evaluated those strategies more positively.