Thesis (MScMedSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Lower limb amputations cause multiple physical, psychological, environmental and socioeconomic barriers. Individuals who have suffered a lower limb amputation require comprehensive rehabilitation to ensure social integration and economic self-sufficiency. In addition, constant monitoring and evaluation is an essential part of human service delivery programmes. However, the amputation rehabilitation programme offered at Elangeni an outpatient rehabilitation centre for clients with physical disabilities in Paarl, Western Cape, South Africa is not monitored, and has not been evaluated since its inception in 2000. Thus, the current study evolved to describe and evaluate the rehabilitation programme for persons with lower limb amputations at Elangeni. A mixed method descriptive design was implemented. All persons who received rehabilitation, after a major lower limb amputation at Elangeni, between 2000 to 2011, were included in the study population. In addition, the physiotherapist and occupational therapist that provided amputation rehabilitation at Elangeni, at the time of the study, were interviewed. Thirty participants who met the study inclusion criteria were identified. Quantitative data was collected using a researcher designed, structured demographic questionnaire, an International Classification of Function checklist based questionnaire and a participant rehabilitation folder audit form. Two interview schedules one for clients and one for therapists were used for guidance during semi structured interviews. Quantitative data was entered onto a spread sheet and analysed by a statistician using Statistica, version 8. Qualitative data was thematically analysed according to predetermined themes. No programme vision, mission or objectives could be identified for the amputation rehabilitation programme. Poor record keeping practices and a lack of statistics were found. Rehabilitation was impairment focused with no attention given to social integration. Clients who received prosthetic rehabilitation showed improved functional ability with regard to picking up objects from the floor (p = 0.031) getting up from the floor (p = 0.00069), getting out of the house (p = 0.023), going up and down stairs with a handrail (p = 0.037) and moving around in the yard (p = 0.0069), climbing stairs without a handrail (p = 0.037), going up and down a kerb (p = 0.0082) walking or propelling a wheelchair more than 1km (0.0089) and walking in inclement weather (0.017). A lack of indoor mobility training had a statistically significant negative impact on the participants’ ability to lift and carry objects (p 0.011), standing up from sitting (p = 0.042), getting around inside the house (p = 0.00023), picking up objects from the floor (p = 0.00068), getting up from the floor (p = 0.0072), getting out of the house (p = 0.0016), going up and down stairs with a handrail (p = 0.019), moving around in the yard (0.0013), going up and down stairs with-out a hand-rail (p = 0.019), getting up and down a kerb (p = 0.0022), walking or wheeling 1km or more (p = 0.0032) and using transport (p = 0.0034). Failure to address community mobility during rehabilitation had a statistically significant negative impact on all aspects of community mobility scores except doing transfers and driving. In conclusion, for the study participants, Elangeni failed to provide rehabilitation according to the social model of disability and Community Based Rehabilitation principles. It is recommended that managers, service providers, and clients re-consider the purpose of Elangeni and develop a vision and objectives for that service. In addition, management should take an active role in service monitoring and evaluation and provide guidance and mentorship to therapists. / AFRIKAANSE OPSOMMING: Onderste ledemate amputasies impak negatief op `n persoon se fisiese, sielkundige en sosiale funksionering. Individue wat ’n amputasie ondergaan het benodig omvattende rehabilitasie om sosiale integrasie en ekonomiese onafhanklikheid te verseker. Konstante monitering en evaluasie is ’n essensiële deel van rehabilitasie programme. Nietemin die amputasie rehabilitasie program wat by Elangeni aangebied word, word nie gemoniteer nie en was nog nooit geëvalueer nie. Dus het hierdie studie dit ten doel om die rehabilitasie programme vir persone met onderste ledemate amputasies by Elangeni te beskryf en te evalueer. Kwantitatiewe en kwalitatiewe navorsingsmetodes is in kombinasie gebruik in die studie. Alle persone wat rehabilitasie by Elangeni ontvang het na ’n onderste ledemaat amputasie, sowel as die terapeute wat by Elangeni werk, het die studie populasie gevorm. In totaal het 32 persone aan die studie deelgeneem. Kwantitatiewe data is met behulp van `ʼn demografiese vraelys, `ʼn ICF gebaseerde vraelys, en `ʼn leer oudit vorm ingesamel. Twee onderhoud skedules, een vir die kliënte en een vir die terapeute, is gebruik as riglyn tydens insameling van kwalitatiewe data. Kwantitatiewe data is statisties ontleed deur ʼn statistikus wat gebruik gemaak het van Statistica 8. Voorafbepaalde temas is gebruik tydens tematies ontleding van kwalitatiewe data. Geen program visie, missie of doelwitte kon geïdentifiseer word nie. Swak rekord houdings praktyke was gevind. Rehabilitasie het gefokus op die fisiese en nie op sosiale integrasie nie. Die kliënte wat prostetiese rehabilitasie ontvang het, het statisties beduidend beter gevaar ten opsigte van optel van voorwerpe van die vloer af (p = 0.031), om van die vloer af op te staan (p = 0.00069), om uit die huis uit te kom (p = 0.023), om trappe met `ʼn handreling te klim (p = 0.037), om op die erf rond te beweeg (p = 0.0069), om trappe sonder `ʼn reling te klim (p = 0.037), om by sypaadjies op en af te gaan (p = 0.0082), om meer as `ʼn kilometer te loop of met die rolstoele te ry (0.0089) en om in ongure weer te loop (0.017). `ʼn Tekort aan heropleiding van mobiliteit binne die huis het `ʼn statisties beduidende impak gehad op die vermoë om goed te dra (p 0.011), op te staan van sit af (p = 0.042), in die huis rond te beweeg (p = 0.00023), voorwerpe van die vloer af op te tel (p = 0.00068), van die vloer af op te staan (p = 0.0072), uit die huis uit te kom (p = 0.0016), trappe met `ʼn handreling te klim (p = 0.019), in die erf rond te beweeg (0.0013), trappe sonder `ʼn handreling te klim (p = 0.019), by `n sypaadjie op en af te gaan (p = 0.0022), meer as 1km te loop of met die rystoel te ry (p = 0.0032) en om vervoer te gebruik (p = 0.0034). `ʼn Gebrek aan heropleiding van gemeenskapsmobiliteit het `ʼn statisties negatiewe impak gehad op alle aspekte van gemeenskapsintegrasie behalwe die doen van oorplasings en bestuur. Rehabilitasie praktyke was nie gebaseer op die sosiale model van gestremdheid en Gemeenskap Gebaseerde Rehabilitasie beginsels nie. Dit word aanbeveel dat diens verskaffers, kliënte en bestuurders oor die fokus van rehabilitasie by Elangeni moet besin. Daar moet ʼn visie en doelwitte vir die diens ontwikkel word. Voorts moet bestuurders van distrik vlak ʼn aktiewe rol speel in die monitering en evaluasie van dienste en mentorskap aan terapeute verseker.

<p> </p><p>Program utvärderingar utgör till stor del grunden till det formella lärandet inom Sida (Swedish International Development Cooperation Agency). Utvärderingars syfte är att bistå med kunskap och Utvärderingar ska garantera att insatser är baserade på god förståelse om verkligheten i mottagarländerna. Genom att gynna organisatoriskt lärande förmodas utvärderingar bidra till biståndets effektivitet (Stefan Molund, 2004).</p><p> </p><p>Teorier om den lärande organisationen hävdar att organisationers fall beror på medlemmars tendens att förenkla och misstolka verkligheten. Medvetet eller omedvetet leder detta till att organisationens vision försvagas, medlemmars engagemang försvagas och den verklighet man sökt att förändra förblir den samma (Peter M. Senge, 1994).</p><p> </p><p>Genom att bistå sektorer som hälsa, utbildning och demokrati mm. har det svenska biståndet präglats av en objektiv eller positivistisk syn på verkligheten i utvecklingsländer. Insatser inom hälsa leder onekligen till effektivitet i fattigdomsbekämpningen.</p><p> </p><p>Min uppsats visar hur Sidas strävan efter objektivitet löper risken att försvaga organisationens vision. I de fattigaste och mest socialt komplexa utvecklingsländerna finns inte förutsättningarna[1] för objektiv utvärdering, och resultaten av en utvärdering blir ofta öppna för olika tolkningar. Trots att utvärderingarna skildrar en sann bild av verkligheten så leder detta till frustration hos handläggare. Resultatet blir att utvärderingar görs av program som handläggarna redan har god kunskap om. Mitt resultat visar att denna trend successivt försvagar Sidas vision då insatser ämnade åt att öka effektiviteten i biståndet allokeras från de ”fattigaste länderna” till länder som kommit längre i utvecklingsprocessen.</p><p>[1] De “fattigaste” utvecklingsländerna saknar de institutioner för datainsamling som krävs för objektiv utvärdering. Att skapa förutsättningarna för den kostnadseffektiva objektiva utvärderingen i utvecklingsländer är ett utvecklingsmål som vilket annat som ingår i den övergripande fattigdomsbekämpningen.</p><p> </p> / Presentation har ägt rum

Northern Arizona women of childbearing age are at disproportionately higher risk for poverty and persistent health disparities in maternal risk factors and maternal child health outcomes. Preconception care is a lifespan and population-based approach to providing health promotion activities to women of childbearing age to improve the health of women, their families, and communities. The county's Reproductive Health Program offers comprehensive reproductive and preconception healthcare to underserved women and men throughout the county without regard for ability to pay, serving as a critical safety net for this vulnerable population. A formative evaluation was performed using the CDC's Framework for Program Evaluation in Public Health and retrospective chart review to assess program implementation. In 2010, 1,561 patients received care over 2,575 visits; the majority of patients (69.4%) were women of childbearing age (females 15-44). Most patients (92.9%) were ≤ 150% FPL, and uninsured (77.8%). Program patients were racially/ethnically diverse, with nearly half identifying themselves as White (48.8%), followed by Hispanic (35.3%), and American Indian/Alaskan Native (11.6%). Program reach was limited. Comprehensive medical and social risk assessment and health promotion activities were consistent with evidence-based recommendations. More than 3,400 STI and pap screenings were performed, with identification of 178 abnormal results at the primary program site. One hundred forty-five females had a positive pregnancy test at the primary program site, one-third (33.1%) to teens. For women of childbearing age not trying to become pregnant (98%), a range of family planning methods were provided, which most commonly included oral contraception (36.9%), followed by condoms (15.4%), and Depo-Provera injection (12.6%). More than 10% of low-income females 15-44 received referrals for further medical care not provided with program. Logistic regression analysis revealed program visits associated with a decreased risk of unplanned pregnancy, though this was not significant (OR 0.87, 95% CI 0.59-1.29, p>0.05). In conclusion, this program provided evidence-based preconception care to underserved women of childbearing age, though reach was limited. Additional studies are recommended to explore patient needs and barriers to improve reach and tailor services. Development of a community advisory council is recommended to guide program activities.

The purpose of this study is to investigate the stress experienced by teenage mothers attending school and the need for multi-faced and strength-based stress management programs. Trends of teenage pregnancy in developing and developed countries are looked at. Causes and consequences of teenage motherhood stress are also explored. One of the consequences of teenage motherhood is stress. There are programs aimed at alleviating stress of teenage motherhood. Some of these programs are evaluated. The findings of this study indicate that there is a need for multi-faced and strength-based interventions for teenage mothers. After the literature study, an empirical research was conducted to explore challenges faced by teenage mothers. Data was collected by means of semi-structured interviews with ten teenage mothers attending school and ten educators teaching teenage mothers. Collected data was analysed using the thematic data analysis approach. The major findings of the study include opinions that teenage mothers do not get assistance from school, home and in the community; teenage mothers are not ready for motherhood; they experience a feeling of vulnerability and poor performance at school. There is a need for educators to be trained in handling teenage mothers, as well as the need for multi-faceted and strength-based interventions. However, it was evident through empirical research that some teenage mothers cope with their lives through talking to caring parents, spending quality time with their children, having a vision, keeping themselves busy and accepting that having a child while attending school is a challenge. Lastly, conclusions from the literature study and empirical research are presented in chapter five. Recommendations for practice, the contribution of the study, limitations of the study and recommendations for further study are also detailed. Motivation for designing and implementing intervention programs is also outlined. / Thesis (MEd (Learner Support))--North-West University, Vaal Triangle Campus, 2013

This paper analyzes the impacts of the Malawi Social Cash Transfer Scheme. The goal of this paper is to help improve the design of cash transfers. First of all, I analyze whether the cash transfer positively affects child health variables despite occurring in a region with poor supply side health institutions. I find significant results for many child level variables, such as frequency of illnesses, but insignificant improvements in anthropometric measurements. Secondly, I examine whether female-headed households invest more in child health than male-headed households. The results show that the impacts of the cash transfer did not depend on the sex of the household head. This result provides some evidence that females do not always have systematically different preferences for expenditure on children than males. The paper uses the imperfect randomization of the cash transfer in combination with difference-in-differences regressions, propensity score matching, and Lee Bounds tests in order to ensure the robustness of the results.

Academic writing programs are one way universities seek to increase the academic achievement of first-year students and decrease attrition. This paper examines data from an evaluation of a first-year academic writing program at Canadian Mennonite University. The original program evaluation was conducted to determine student attitudes toward the program and whether the academic writing lab program increased students’ writing abilities. This thesis goes further by examining relationships between affective outcomes (motivation, self-regulatory ability, perceived writing ability), writing ability, and cumulative grade point average. Data was collected using student surveys and writing samples. The results indicated that academic attainment was positively correlated with: writing ability, motivation, and self-regulation. Motivation and self-regulation, but not perceived writing ability, correlated with actual writing ability. Participation in the Academic Writing Lab did not affect student affective characteristics. However, student writing ability did improve which indicates that even a small program can improve students’ writing skills. / October 2016

Education reform initiatives continue to push schools to improve methods of measuring accountability intended to improve student achievement in the United States. Federal programs like the Teacher Incentive Find (TIF) provide school districts with funds to develop and implement school accountability and leadership programs. Teacher leadership is one of the concepts being formally developed amongst these initiatives. My applied thesis project focused on work I conducted with a team of researchers at American Institutes for Research, where we evaluated a teacher leadership program in its third year of implementation. Teacher leadership is facilitated through distributive leadership. School leaders distribute responsibilities that provide teachers with opportunities to extend their expertise outside of their own classrooms. My thesis explores teacher leadership roles and investigates implementation across the client school district. It also discusses how particular anthropological theories about communities of practice, learning, and identity can provide a foundation for conceptualizing teacher leadership implementation and the social interactions between program actors.

This study utilizes the Longitudinal Study of the Vocational Rehabilitation Program to examine the impact of state-federal vocational rehabilitation services on the quality of life of consumers. The theory that guides this study is an amalgam of theories of Allardt, Halpern, Campbell, and Cummins which indicate that quality of life is made up of various domains which parallel Maslow’s Hierarchy of Needs. The study followed the theory that improvement in the individual domains of life would improve its overall quality. The domains of physical functioning, self-esteem, community integration and productivity were assessed prior to and after the receipt of vocational rehabilitation services. Results indicate that consumers who obtain an employment outcome obtain higher scores on measurements of self-esteem, physical functioning and activities of daily living and productivity than do consumers who do not obtain an employment outcome. The linkages that specific VR services have on individual life domains were also explored. Consumers who receive more education and training services show an increase in community integration scores. Suggestions for state-vocational rehabilitation services change are provided based on a socio-ecological model.

Although integrated primary care psychology services are becoming increasingly common, the literature lacks adequate research support for the longitudinal durability of treatment effects following the conclusion of brief primary care interventions. This study served as a follow-up program evaluation of psychological services for depression and anxiety provided at the Medical College of Virginia’s Ambulatory Care Center in Richmond, Virginia. Data were collected on 47 adult primary care patients who received treatment for depression and/or anxiety between six and 18 months prior to the follow-up telephone call. Data were collected on the trajectory of depression scores throughout and following treatment, treatment received by patients in the interim, and reasons provided by patients for discontinuing treatment. Analyses of these data indicated that primary care psychology services were effective in reducing patient anxiety and depression as measured by the GAD-7 and PHQ-9 respectively, even when controlling for additional treatment in the interim, and that patients as a group continued to improve over time following the conclusion of treatment. These preliminary results should be interpreted with caution, however, due to the study’s small sample size and lack of a control group. Study limitations, strengths, and future directions are addressed.

Through collaboration between the Substance Abuse and Addiction Recovery Alliance (SAARA) and several community partners, a need was identified for a new measurement tool to gather comprehensive client histories for program evaluation and development. The purpose of this study was to (1) develop a culturally relevant and organizationally appropriate mechanism for the collection of comprehensive client histories and (2) to provide the opportunity for staff to engage in a new process of developing and implementing data collection strategies. As a result of the use of a community-based participatory approach, (1) a missed opportunity for program evaluation and development was identified, (2) a community-based research study was developed, (3) staff were invested in development of the tool, and (4) staff engaged in a capacity-building exercise in which they were provided the skills and tools needed to replicate this process independently in the future.