Diss. Univ. der Bundeswehr München Neubiberg, 2009. / Business and Economics (German Language) (Springer-11775) (GWV).

Research report (MMed) -- Interdisciplinary Health Sciences, Stellenbosch, 2010. / ENGLISH ABSTRACT: Background The referral system is an important component of the health care system. In public health facilities, a high number of patients’ attendance has lead to a huge burden on the secondary and tertiary level of the care system in terms of manpower, equipments and resources. Public health in South Africa consumes around 11% of the government's total budget. The state contributes about 40% of all expenditure on health; the public health sector is under pressure to deliver services to about 80% of the population. Despite the huge spending on health care in most developing countries, health outcomes and services remain poor. Few studies are available to give insights into reasons for this disparity. Therefore the findings of this may help to explain some of the reasons for this overburden of public health facilities and further to make recommendations on how health service delivery may be improve on. The results of this study can be useful in future planning; this may lead to a reduction in huge health expenditure incurred by most developing countries. Methods A cross sectional survey of three different groups of people which comprises of 273 patients, 28 referral centre participants and 19 referring centre participants was carried out. All patients referred from Motherwell community health centre to Dora Nginza hospital were eligible for the study. Questionnaires were interview administered to patients after they had finished consultations in Dora Nginza Hospital. Health professionals from both facilities were also interviewed with the use of self administered questionnaires. Results Three out of every four patients interviewed were of the opinion that their referral to hospital was appropriate which is consistent with the results from referring health professionals, eighteen of nineteen respondents. However, only one-quarter (7) of the referral centre health professionals felt the referrals from referring centre to hospital were appropriate p<0.01.The majority of the patients were satisfied with the level of service received at the referral centre. 77% (210) reported that the staff at the referral centre was friendly and 84% (230) were happy with the explanation given for their illness. However, a source of concern is that, in most of the referred patients 58% (215), there was no formal response back to their primary care. In the referring centre, participants identified transportation of patients to referral centre as the major problem encountered when referring patients 68 % (13), whereas 32 % (6) felt it is communication. In addition, 73 % (14) were of the opinion that transportation was inadequate and 89 % (17) reported the response rate of transport was unsatisfactory. In the referral centre, results showed participants were more concerned about the adequacy of information provided in the referral letters with 78% (22) reporting they were often not adequate information on the referral letters. However, half of the respondents agreed that they do not have clear referral guidelines. Conclusion Primary care health professionals and patients in this study view the referrals to higher levels of care as appropriate. However, the referral centres health professionals were of the opinion that most referrals were inappropriate. The opinion of the referral centre can be attributed to their negative attitudes towards referrals. The referral centres needs to provide more support to primary care for a more efficient referral system .They also need to improve on the continuity of care by providing feedback to referrals. On the other hand, the primary health care needs to be strengthened in terms of resource allocation in order to gain more confidence from both patients and referral centres. / AFRIKAANSE OPSOMMING: geen opsomming

Evidence-based medicine calls for the use of current best evidence (together with individual clinical expertise). Guidelines aim to distil such evidence, yet clinical practice often fails to follow guidelines, for multiple reasons that are still not well understood. One under-researched aspect of the gap between guidelines and practice is psychology. My literature review found that the application of psychology to implementation research has been limited, and such research is not well integrated into wider implementation research. In this study, I sought to a) systematically apply psychological theory to understand the different psychological processes in the stages of adoption described in the diffusion of innovations model; b) collect and analyse data to explore and test this new, psychologically-enhanced model of guideline adoption; and c) improve and extend my model in the light of my empirical data. Having populated my proposed framework with potentially relevant psychological theories based on my literature review, I undertook a first assessment of the validity and added value of this proposed theoretical framework through a case study of the implementation of guidance on universal offering of HIV testing in hospitals serving populations meeting the criteria for high HIV prevalence in the catchment population, interviewing 20 healthcare professionals across two sites. My findings broadly supported my proposed theoretical approach, and illustrated relevant psychological theories for different stages of adoption. My findings support two provisional conclusions. First, that there is potential to improve the effectiveness of efforts to implement guidelines by augmenting the widely-used innovation adoption model with specific psychological theories. Second, that policymakers would do well to shift from viewing the health system as a complicated entity that policy can control and direct is misconceived; I recommend shifting to a perspective of the health system as a complex system, and rethinking the role of policy from that perspective.

Happiness has recently gained interest as an influential variable in managing the employment relationship, as studies have suggested benefits for productivity and performance. Knowledge on workplace happiness is, however, still relatively limited and more understanding is needed on employee perceptions and benefits of and expectations for happiness, as well as happiness responsibility. Qualitative approaches can provide new information on such a highly subjective and complex phenomenon as happiness, which has mainly been addressed with quantitative methods. 24 young professionals from various fields, based in Edinburgh, took part in this study. They were requested to take photos when experiencing work-­‐ related happiness during a two-­‐week period. Afterwards they were asked to talk through their photos. Narratives were supported by semi-­‐structured interviews. Data was analysed using thematic inductive coding, leaning on the framework from Fisher (2010), psychological contract (Rousseau, 1989) and interactionist perspective (Ahuvia et al., 2015). Collected data revealed insights into workplace happiness expectations, enablers, responsibility and happiness concepts. Participants emphasised the importance of workplace happiness and expectations to be happy at work. Happiness was seen to improve performance and social behaviour, but there was also a pressure to be happy at work. The five main happiness enablers were: having sense of control, work going well, doing something that matters, physical environment and working with friends. Participants highlighted their responsibility for their own happiness at work, however, shared responsibility was also proposed. The results suggest that young professionals want to be happy at work. If they are not, they are likely to leave. The happiness requirement is mainly based on expectations on authenticity, work-­‐life integration and being a good employee. The findings suggest that listening to the employees and enhancing conversations is the key in creating happier workplaces. This study also shows how happiness is better elucidated through empirical narratives than through intellectual abstractions and definitions. Theoretical contributions include four pathways into happiness responsibility, clarifying and reasoning the importance of the five main happiness enablers and providing suggestions to existing happiness models. On the practical side, this study contributes to the gaps of knowledge from the employees' point of view based on lived-­‐experiences. It deepens understanding of employee happiness, providing vital information for the HR/management personnel, policy makers and academics about the values and expectations of young professionals. Furthermore, it supplies new insights into elucidating employee happiness, by explaining the advantages and challenges of using narrative methods and visual data.

Organizational citizenship behavior (OCB) has been suggested to facilitate organizational functioning. However, how OCB is motivated and the extent to which OCB is exhibited by highly skilled professionals remains uncertain. Very little theoretical and empirical research has focused on motivational factors that elicit the exhibition of OCB. In addition, previous research has found that information technology (IT) professionals exhibit significantly lower OCB than non-IT professionals. This particular discrepancy suggests that there is a need to study OCB exhibited by IT professionals from a motivational aspect. In order to provide a theory-based model that explains OCB, this research utilized expectancy theory to examine how an IT professional's cognitive forces affect the valence of a job outcome and how the valence of the job outcome influences his or her OCB. The hypotheses were tested using partial least squares and multiple regression techniques with a sample size of 85 IT professionals. Using IT professionals as the unit of analysis, the results indicated that the research model explained 36 percent of the variability of OCB exhibited by an IT professional. The results also confirmed the significant relationship between valence of job satisfaction and OCB and the significant relationship between OCB and actual job satisfaction. Among the five cognitive forces tested, commitment to organization and commitment to profession contributed significantly to valence of job satisfaction. Furthermore, this research found some significant relationships among trust in supervisors, trust in coworkers, job stress, commitment to organization, and commitment to profession. Finally, conclusions, limitations, and suggestions for future research directions were discussed based on the findings.

Social science research on third sector organisations in the last two decades has emphasised their growing presence and importance in healthcare. This has occurred alongside significant reorganisation of health systems in the UK, including a continued policy emphasis on partnership-working between the public sector and the third sector. However, unanswered questions in the literature remain with regard to the specific roles that these organisations fulfil within partnership arrangements. This thesis examines the role of third sector organisations within Scottish services for the chronic, neurodegenerative condition Huntington’s disease (HD). The closely connected nature of Scottish healthcare and the multitude of professionals involved in HD mean these services are an important, but currently understudied, example of professional interaction around complexity. A multi-methods qualitative research framework was used to gather perspectives of key individuals working in the Scottish HD and wider health scene. Making use of the key concepts of expertise and boundary work, this thesis argues that third sector organisations have an extensive shaping role in 1) the positioning of healthcare organisations, 2) the identities of healthcare professionals, and 3) the meanings around illness and the remit of support. The research findings revealed that organisations and professionals in HD partnership arrangements engaged in processes of boundary work in the negotiation of the roles of themselves and others. Third sector professionals occupied many positions within services, as both experts and supporters of patients. In the process they and other professionals often took on identities as ‘key, committed professionals’. Understanding around HD was also shaped by these professionals as the wider aspects of illness and its support were brought into focus. Building on these findings, it is argued that third sector professionals in coordination roles are well placed to develop a type of expertise that I term ‘aggregate know-how’ (Pols 2014), based around both their professional skills and their extensive contact with patient experiential knowledge. The research builds on and extends influential previous models of third sector ‘partnership’ in healthcare (Rabeharisoa 2003), emphasising the key role of third sector organisations in knowledge production. It also offers insights of both theoretical and practical use with regard to service delivery in healthcare, showing the potential for genuine third sector/public sector partnership around expertise when there is adequate cultural support and resources.

A community coalition is a formal alliance of organisations, groups and agencies that have come together for a common goal. Collaborative partnerships between the health professionals and the communities they serve have received attention as a strategy for achieving health gain and are spreading globally. This partnership approach has a potential for a synergistic maximization of impact and has been advocated as a means to increase citizen participation and ownership among under-privileged groups. Despite the popular appeal and theoretical promise of this approach, the precise domains that need to be fostered by the stakeholders to implement this complex model remain unclear. The aim of this study was to investigate and compare the characteristics and perceptions of the CPs' stakeholders as regards the structural characteristics and operational parameters of the partnerships, as well as the correlates of effectiveness and impact for each participant group. Of particular interest was to identify the characteristics which enable partnerships to fulfill their organizational tasks and goals, regardless of the scope or complexity of purpose. The five CPs were located across South Africa and aimed at Health Professions Education reforms. Quantitative data was collected from 668 coalition members and qualitative data from 46 strategic participants. The partnerships' documents were also scrutinized and ample participant observations were undertaken. The data was then pooled and the comparison groups were constructed: the professionals, comprising of staff from the academic institutions and the health service providers, the community members and the full-time paid employees of the partnerships, the core staff. The analyses of the partner's opinions and views as well as the predictors of accomplishment of diverse stakeholders hold lessons for managers concerned with health coalitions. Generally, training and development seem to be the main thrust of the partnerships' missions. The observation is that clarity of roles, procedures and responsibilities is imperative. Clarity requires transparency to each others agendas. Although there was an under-representation of the youth, there seemed to exist a mixture of various levels of satisfaction in the partnerships, with the community members in need for more sense of ownership. The findings also point to that consultation in decision making seem to be lacking with unilateral decision making taking place. This might lead to power struggles and hidden agendas between the partners that could hamper the advancement of the partnerships. Explanation of why stakeholders are satisfied or committed or what explains their views on effectiveness and activity levels of their partnerships may inform efforts in other settings. With diverse partners, it is important to be somewhat cautious in the consideration of the stakeholders engaged in these collaborative efforts. Partners working together need not be considered homogenous entities. The groups come from different backgrounds, organizations and cultures. The attitude to be created in collaborative interventions is one of a clear understanding that embraces the different origins and aspirations of the stakeholders and recognises the mutual roles, responsibilities, resources and limits. Only by paying due attention to their individual values and weaving it into a common vision can the partnership process be taken forward.

Submitted by Suellen Rodrigues (suellen_rodrigues18@yahoo.com.br) on 2017-09-28T18:38:45Z No. of bitstreams: 1 Versão final..pdf: 2027194 bytes, checksum: b1abe06e18e019c92d79b3c3bd5fb7b1 (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-09-29T17:28:50Z (GMT) No. of bitstreams: 1 rodrigues_ss_me_arafcl.pdf: 2027194 bytes, checksum: b1abe06e18e019c92d79b3c3bd5fb7b1 (MD5) / Made available in DSpace on 2017-09-29T17:28:50Z (GMT). No. of bitstreams: 1 rodrigues_ss_me_arafcl.pdf: 2027194 bytes, checksum: b1abe06e18e019c92d79b3c3bd5fb7b1 (MD5) Previous issue date: 2017-08-17 / A formação do professor é fundamental para assegurar um trabalho sistemático, contínuo e formal de educação sexual na escola, assim como, nos distintos ambientes de saúde. Há a necessidade de formação inicial e continuada deste profissional, considerando que os cursos de graduação geralmente não apresentam em seus currículos temas relacionados a gênero, sexualidade e, diversidade sexual. Aliado a isso, é imprescindível se ter professores aptos e que possam ser sensibilizados à necessidade de se discutir temas relacionados à sexualidade humana levando em consideração a necessidade de serem abordados no contexto escolar. O mesmo pode ser dito acerca dos profissionais da saúde. A formação acerca deste tema é incipiente diante das demandas que apresentam de abordar este assunto. Diante disso, a presente pesquisa teve por o objetivo geral averiguar as demandas dos profissionais da educação e saúde relativas à sexualidade e educação sexual, para a partir disso e neste contexto, elaborar e implementar propostas interventivas em sexualidade e educação sexual direcionado aos mesmos, acompanhando-os e assessorando-os no desenvolvimento de projetos de educação sexual. A abordagem metodológica utilizada na presente pesquisa é qualitativa, mediado pela pesquisa-ação. A pesquisa foi realizada no município de Abaetetuba-PA. E os participantes da pesquisa foram profissionais da educação (pedagogos e professor de matemática) e da saúde (psicóloga). Quanto aos instrumentos de pesquisa para a coleta de dados foi utilizado um questionário com perguntas abertas. A partir dos dados deste instrumento foram implementadas propostas interventivas para assessorar os profissionais nas efetivações de ações em sexualidade. Em linhas gerais, a elaboração de propostas interventivas visou dar legitimidade para uma formação articulada, fornecendo oficinas sobre as seguintes temáticas (história da sexualidade, diferença sexualidade e sexo, relação de gênero, gravidez na adolescência, prevenção as IST-HIV-AIDS, diversidade sexual, direitos sexuais e reprodutivos e violência sexual), assim como, sensibilizando ante à necessidade de implementação destas propostas. Contudo, por meio da implementação das propostas interventivas direcionadas aos profissionais de educação e saúde, foi notório verificar as contribuições que a formação propiciou nas concepções destes e, principalmente, no manejo para abordar o tema na prática profissional. Desse modo, percebemos que por meio dos resultados obtidos os profissionais da educação e saúde do citado município necessitam de formação e informação para desenvolver trabalhos interventivo de sexualidade, o que salienta a urgência do acréscimo de cursos contínuos para a efetivação das ações em ambas áreas. / The aim of this paper was to enhance the proper preparation concerning to teachers specialization in matters of systematical, continuous and formal-standardized sexual education, which has to be assured preparing teachers to deal with this topics in schools, as well as in all health institutions. It is extremely necessary to emphasize the urge of this initial and continuous preparation of this professional, considering that undergraduation courses at the university generally do not contemplate these issues on its course curriculum, those themes are related to gender, sexuality and sexual diversity. Still attached to this idea, it is also demanding from teachers to be prepared and cope with this sexual education themes adequately, taking into consideration the compromise of approaching those issues accordingly. Providing the same know how and preparation as the health professionals receive on their specialized courses giving thus, the important implementation and reinforcement due to the necessity to convey this sexual matters approach. To this view, the present research had its general objective to assure the demands of education and health professionals regarding to sexuality and sex education, to start from this point and in this especific context to elaborate and implement interventional proposals on sexuality and sexual education advising them on the development of sex education projects. The methodological approach, on this research was qualitative, verified via action research. The research was applied in the city of Abaetetuba-PA. And the research participants were education professionals (pedagogy professionals), (mathematics teachers) and in the health area (psychologists). In terms of tools applied, in order to, collect data, it has been used a survey-questionnaire. Based on the data collected, there were implemented inventive proposals to assist those professionals on effective actions related to sexuality issues. In general terms, the concept of elaborating an inventive proposal intended to assure authenticity in articulated preparation, providing workshops on the following themes (history of sexuality, sexuality and sex difference, gender relations, teenage pregnancy, STI-HIV-AIDS prevention, sexual diversity, sexual and reproductive rights, and sexual violence), as well as, the awareness of the massive needs on implementing these proposals. Nevertheless, through implementing those inventive proposals directed to these professionals of education and health fields respectively, there has been noticed the necessity of verifying the contributions that this preparation provided on this professionals’ conceptions, especially on how the theme has been approached in real life scenarios. In this way, we realize that through the results obtained, the education and health professionals who participated of the research need an appropriate training and information about the issue discussed in order to develop interventional sexuality educational effective work, which highlights the urgency of adding continuous courses for the implementation of actions in both areas.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Nas Ãltimas dÃcadas, a AtenÃÃo BÃsica à SaÃde (ABS) tornou-se um tema especialmente relevante, resultando na reformulaÃÃo do Sistema Nacional de SaÃde. Assim, a rede bÃsica no Brasil tornou-se um espaÃo de prÃtica potencial e necessÃria, na qual os vÃrios cursos de formaÃÃo de profissionais de saÃde deverÃo inserir seus estudantes. Neste contexto, o programa interministerial PET-SaÃde (Programa de EducaÃÃo pelo Trabalho para SaÃde) tem contribuÃdo para a integraÃÃo universidade-serviÃo. O preceptor à a figura inserida no PET-SaÃde que surge no cenÃrio de prÃtica, como o profissional de saÃde-educador que oferece ao aluno ambiente que lhe permita construir e descontruir conhecimentos e experimentar vivÃncias prÃticas de um atendimento humanizado. O presente estudo buscou analisar a preceptoria do PET-SaÃde na EstratÃgia SaÃde da FamÃlia nos MunicÃpios de Fortaleza, Pacatuba e MaracanaÃ, tendo como pÃblico-alvo 82 preceptores da EstratÃgia de SaÃde da FamÃlia (ESF) do MunicÃpio de Fortaleza, 12 de Maracanaà e 06 de Pacatuba. Em relaÃÃo aos alunos bolsistas, foi pesquisada uma amostra de 113 alunos de Fortaleza, 24 de Maracanaà e 12 de Pacatuba. Trata-se de um estudo quantitativo, descritivo, observacional e transversal. A coleta de dados foi realizada atravÃs de um questionÃrio semiestruturado direcionado aos alunos e preceptores. As informaÃÃes foram analisadas no programa estatÃstico SPSS versÃo 17.0. A pesquisa foi aprovada pelo Comità de Ãtica em Pesquisa, com o parecer n 751292. Buscou-se identificar e correlacionar as percepÃÃes dos preceptores e alunos sobre as competÃncias exigidas na preceptoria, as principais dificuldades para o seu exercÃcio e quais resultados prÃticos foram alcanÃados com a realizaÃÃo da preceptoria em relaÃÃo preceptor/serviÃo. A pesquisa mostrou que 54,43% dos preceptores realizaram curso de pÃs-graduaÃÃo apÃs inÃcio da preceptoria e 65,82% afirmaram que a preceptoria influenciou na escolha desse curso. Os resultados apontaram as seguintes dificuldades na preceptoria: despreparo pedagÃgico dos preceptores, infraestrutura deficiente e pouca valorizaÃÃo da preceptoria pelo serviÃo. Com os resultados alcanÃados, pode-se concluir que o exercÃcio da preceptoria do PET-SaÃde à uma experiÃncia que apresenta possibilidades de crescimento para o profissional e desafios em relaÃÃo ao melhor preparo dos preceptores e serviÃos que devem ser superados com uma maior interaÃÃo entre gestores, preceptores, profissionais do serviÃo, instituiÃÃes de ensino e comunidade. / In recent decades, the Primary Health Care (ABS) has become a particularly important issue, resulting in the reformulation of different national health systems. The basic field has become a potential and necessary practice space, in which the various health professionals training courses shall insert its students. In this context, the inter-ministerial program PET-Health (Education Program for Working for Health) greatly contributes to the university-service integration. The Preceptor is the figure inserted into the Pet-health that arises in practical scenario, such as health educator professional who provides the student environments that allow them to build and deconstruct knowledge and experiment practical experiences of humanized care. This study investigated the PET-health preceptorship in Family Health Strategy in the municipalities of Fortaleza, Pacatuba and MaracanaÃ, having as target 82 preceptors professionals of the Family Health Strategy (FHS) in the city of Fortaleza, 12 from Maracanaà and 06 from Pacatuba. Regarding the scholarship students will be surveyed a sample of 113 students from Fortaleza, 24 students and 12 students from Maracanaà and Pacatuba. It is a quantitative and qualitative, descriptive, observational and cross-sectional study. Data collection wasconducted through semi-structured questionnaire directed to students and preceptors. The study was approved by the Research Ethics Committee opinion n 751 292. It sought to identify and correlate perceptions of competence required on preceptorship according to the preceptors and students, the main difficulties for exercise and what practical results preceptorship in Strategy Family Health brought to preceptors, students and service. Research has shown that 54.43% of the preceptors made a graduate course after the initiation of preceptorship and 65.82% said preceptorship influenced in the choice of course. The results showed the following difficulties in preceptorship: the pedagogical unpreparedness of preceptors, poor infrastructure and little appreciation of preceptorship by the service. With the results it can be concluded that the exercise of PET-health preceptorship is an experience that offers growth possibilities for professional and challenges relative to better preparation of preceptors and services that must be overcome with greater interaction among managers, preceptors, service professionals, educational institutions and community.

Este estudo teve o propósito de compreender como os profissionais de saúde constroem o significado do sofrimento do paciente oncológico, segundo suas experiências. A investigação foi desenvolvida segundo as propostas da antropologia interpretativa de Clifford Geertz, a antropologia médica de Arthur Kleinman e no conceito de sofrimento de Morse. A amostra constou de doze profissionais, membros da equipe interdisciplinar que atuam com pacientes oncológicos. Os dados foram coletados por meio de entrevistas semi - estruturadas e de observações participantes, no contexto sociocultural hospitalar. A análise dos dados foi realizada segundo os pressupostos referencial metodológico de narrativas. Com as experiências relatadas pelos informantes foi possível compreender que os significados do sofrimento do paciente oncológico são construídos segundo os sistemas de cuidado cultural profissional e não profissional. O estudo levou a compreensão de que a experiência de sofrimento do paciente pelos profissionais leva a construção de significados comuns, integrados em temas que destacam a empatia, a emoção, o conflito, a individualização dos papéis, as estratégias de intervenção e que estão embasados nos conhecimentos culturais dos profissionais. / The purpose of this study was to understand how health professionals construct the meaning of oncology patients suffering based on their experiences. The research was conducted according to the Clifford Geertz proposal of interpretative anthropology and Arthur Kleinman medical anthropology and Morse?s suffering model. The sample was formed by twelve professionals, members of an interdisciplinary team that work with oncology patients. Data were collected through semi-structured interviews and participant observation at a hospital socio-cultural context. Data analysis was performed according to the presuppositions of the narrative method. Based on the experiences of suffering reported by the professionals, the author understood that the meanings of suffering to the oncology patients are constructed according to the professional and non-professional cultural care systems. The author concluded that the experience of suffering results in common meanings, integrated in themes such as empathy, emotion, conflict, role individualization, intervention strategies and that they are based on the professionals? cultural knowledge.