Trata-se da meta-avaliação de um processo avaliativo desenvolvido por secretários e assessores técnicos municipais de uma região de saúde do estado de São Paulo, com foco nos critérios de utilidade e participação. É uma pesquisa qualitativa, cuja base empírica foi 1) o material produzido em sete oficinas realizadas com os representantes municipais, com vistas à avaliação de um aspecto da linha de cuidados em saúde sob a ótica da integralidade; e 2) as entrevistas semiestruturadas realizadas com os mesmos atores após a finalização do processo avaliativo. Para a avaliação do critério de utilidade, utilizou-se principalmente o referencial de KIRKHART (2000), com o objetivo de ampliar a análise para além do uso instrumental dos achados avaliativos e focá-la na identificação de influências múltiplas exercidas por um fenômeno complexo como um processo avaliativo. A análise do critério participação se deu com base no referencial de COUSINS e WHITMORE (1998), buscando a identificação no material empírico de decisões ou aspectos contextuais que fizeram com que a opção participativa fosse aprofundada ou limitada no processo em foco. O trabalho destaca a importância de explicitar pressupostos que baseiam a metodologia da avaliação/ meta-avaliação escolhida, e a necessidade de se buscar referenciais teóricos de análise compatíveis com a opção realizada, frisando a inexistência de posturas neutras ou estudos totalmente objetivos; e a importância de capacitar avaliadores a acompanharem a demanda dos participantes de um processo participativo com a flexibilidade necessária para conferir-lhe o maior aproveitamento possível. Conclui-se pela viabilidade, com vantagens, da realização de processos participativos locais com gestores na Saúde Pública, destacando a possibilidade de ganhos em formação e o enriquecimento dos processos de negociação em nível do território, de forma coerente à política de construção das regiões de saúde no SUS. / This study aims to meta-evaluate an evaluation process developed by policymakers and technical advisors of a Health Region of Sao Paulo, centering on criteria of utility and participation. It analyzes the feasibility and possible benefits of using a participatory methodology in Public Health evaluations, highlighting aspects that facilitate and hinder this undertaking. It is a qualitative research, which empirical basis was 1) the material produced in seven workshops with municipal representatives, aiming the evaluation of an aspect of health care from the perspective of integrity; and 2) semi-structured interviews with the same actors after completion of the evaluation process. KIRKHART´s theoretical framework (2000) was used to evaluate the utility criterion, in order to expand the analysis beyond the instrumental use of the evaluation findings, and focus it in identifying multiple influences exerted by a complex phenomenon as an evaluation process. The evaluation criterion of participation was based on references of COUSINS e WHITMORE (1998), aiming to identify decisions or contextual aspects in the empirical material that made participatory option limited or depth in the focused process. The work highlights the need to seek theoretical frameworks of analysis consistent with the methodological choice carried out in order to enhance the identification of evaluation gains and limitations, and enable evaluators to monitor the demand of participants in the evaluation process with flexibility to reach its best use, even in those cases where there are limitations on the possibilities of participation. The results confirmed the viability, with advantages, of holding local participatory processes with policymakers and managers in Public Health, highlighting the possibility of gains in education and the enrichment of the negotiation process in the territory level, consistent with the policy of building health regions in SUS.

<p>This thesis assesses the uptake of the national Prevention of Mother to Child Transmission of HIV (PMTCT) programme in South Africa, and the challenges of achieving safe infant feeding practices in the context of HIV. The research studies contained in this thesis utilised a variety of quantitative and qualitative research methods in order to provide a full understanding of the challenges of moving from efficacy to effectiveness in PMTCT programmes. The first paper utilised a cross-sectional approach to a programme evaluation, papers two and three utilised qualitative methodologies, and paper four was based on a longitudinal cohort study design. The findings highlight the low uptake of PMTCT interventions and inappropriate infant feeding choices. The experiences of women with HIV provide an important insight into the difficulties of operationalising the WHO/UNICEF HIV and infant feeding recommendations in real life settings, where rates of HIV disclosure are low and mixed feeding is the norm. Several personal and environmental characteristics were identified that contributed to success in maintaining exclusive infant feeding practices. The research provides some guidance on the definition of appropriateness in infant feeding choices, and highlights the poor outcomes associated with formula feeding under unsafe conditions. Modifying infant feeding practices is essential in order to reduce postnatal HIV transmission and improve child survival. Interventions to improve infant feeding need to include improving the quality of counselling and support provided by health workers, with more structured assessments used to guide infant feeding choices. Efforts are also needed at the community level to increase rates of disclosure and to promote exclusive infant feeding as a norm.</p>

This thesis assesses the uptake of the national Prevention of Mother to Child Transmission of HIV (PMTCT) programme in South Africa, and the challenges of achieving safe infant feeding practices in the context of HIV. The research studies contained in this thesis utilised a variety of quantitative and qualitative research methods in order to provide a full understanding of the challenges of moving from efficacy to effectiveness in PMTCT programmes. The first paper utilised a cross-sectional approach to a programme evaluation, papers two and three utilised qualitative methodologies, and paper four was based on a longitudinal cohort study design. The findings highlight the low uptake of PMTCT interventions and inappropriate infant feeding choices. The experiences of women with HIV provide an important insight into the difficulties of operationalising the WHO/UNICEF HIV and infant feeding recommendations in real life settings, where rates of HIV disclosure are low and mixed feeding is the norm. Several personal and environmental characteristics were identified that contributed to success in maintaining exclusive infant feeding practices. The research provides some guidance on the definition of appropriateness in infant feeding choices, and highlights the poor outcomes associated with formula feeding under unsafe conditions. Modifying infant feeding practices is essential in order to reduce postnatal HIV transmission and improve child survival. Interventions to improve infant feeding need to include improving the quality of counselling and support provided by health workers, with more structured assessments used to guide infant feeding choices. Efforts are also needed at the community level to increase rates of disclosure and to promote exclusive infant feeding as a norm.

This feminist project explores the experiential accounts of twenty-five women who have lived through abuse within their intimate relationships. Their stories, gathered through a series of semi-structured face-to-face interviews intended to elicit accounts of resilience were saturated with emotion-talk, especially shame-talk. To address questions of the relationship between these accounts and theoretical accounts of abuse, and shame the women’s texts were engaged in an analytic dialogue with feminist knowledges of abuse against women, Erving Goffman’s sociological understandings of shame, stigma and mortification of the self, Thomas Scheff’s sociological theory of shame and social bonds, and feminist poststructuralist understandings around the constitution of human subjectivity. These conversations enabled development of a conceptual representation of the special and highly specific form of social bonding experienced by victims of abuse within intimate relationships. This bonding begins with processes of mortification of the self, the gradual erosion of a sense of self through the systematic imposition of various shaming and shameful actions. These processes take place within a specific social context created through the constitutive power of dominant discourses of gender, heterosexual coupledom, matrimony and motherhood which work to shape the lives of individual women. Because of the specific ways in which these discourses currently operate within Aotearoa New Zealand they result in the constitution of a narrow range of tightly prescribed subject positions available to victims of intimate partner abuse. This analysis leads to an argument that women’s inability to ‘do’ motherhood or intimate partnership in line with dominant discourses of mothering and relationships (because these simply cannot be achieved within an abusive context), opens them to the debilitating effects of shame. Shame, both actual and threatened, promotes silence, isolation and dangerous private spaces as women seek to protect themselves from its painful experience. I argue that it is therefore crucial to promote the availability of discursive positioning for women living through abuse which offers non-shaming and realistic choices.

Context: The purpose of this research was to examine if the educational approach (the Approach) adopted at Kilnbarn Residential Special School (the School) secured the developmental learning pathways for its pupils. All pupils were diagnosed with Autistic Spectrum Disorder (ASD), Severe Learning Difficulties (SLD) and many had single or multiple comorbid conditions. The research sought to understand how their parents could be substantive partners and co-creators in the design, modification, and implementation of the Approach. It was a unique feature of Kilnbarn’s Approach to fulfil the potential of parents to be co-creators and co-therapists in their child’s progress. Objective: The case study became one of the instruments in which to test the School’s effectiveness in meeting the needs of its pupils. It enabled a review of the School’s methodology, curriculum and organisational practices. The Approach was designed to provide secure developmental learning pathways for its pupils, improving their quality of life and independence. Method: The case study design, was chosen as it was considered the most appropriate research model. A Parents’ Questionnaire, distributed annually over 3 consecutive years (2004-6) was the evidential basis for this study. Interviews and collected data were used to analyse and evaluate the progress of the School through parents’ eyes. Results: The combination of parents working with professionals to maximise the culture of “technical eclecticism” seems to be, in the light of this case study, best suited to the needs of children diagnosed with autism, SLD and comorbid conditions. The child should be immersed in a consistent approach across all areas of their life. Improvements in well-being, communication and joint action routines, sleep balance, a healthy diet, physical exercise, incontinence and behaviours was observed. Conclusion The study identified that parents could be substantive partners and influencers in the design and modification of the Kilnbarn Approach. The Approach secured developmental learning pathways for its pupils and appeared to improve their quality of life. Parents as co-creators and co-therapists had regained ownership of their child’s quality of life, learning outcomes and personal development. From the experience and unique evidence of this case study schools should utilise and profit from the mass resource of their parents. It has been shown that the Kilnbarn Approach was, during the research, an effective and suitable intervention for the many children it served. It is hoped that further studies in this field will explore the concept of a “technical eclectic” approach that further validates and brings together interventions that are conceptually grounded and incorporates evidence-based focused intervention practices.

There seems to be a lack of synchronisation between the acquisition of skills, knowledge, values, teaching techniques, and so forth from professional learning interventions and the application thereof in practice by teachers in general and language teachers in particular. Those charged with ensuring that teachers‟ development needs, in terms of Collective Agreement 8 of 2003 (DoE, 2003), receive attention, seem to be complying with that prerequisite without establishing whether such interventions really do address the need for development. This study focuses on the quality assurance of workshops meant to address the professional development needs of language teachers. This was explored in terms of learning theories informing methods used when facilitating professional development workshops for teachers and the assessment of teachers during the workshops, including evaluation of the workshops themselves and the quality assurance of those workshops. The study has found, among others, that the methods used during facilitation are not sourced from a variety of professional learning theories, including different learning styles that accommodate teachers who learn differently from others; a variety of assessment methods is not used to assess language teachers during the workshop sessions and quality assurance of the workshops internally and externally scarcely takes place. / Dissertation (MEd)--University of Pretoria, 2013. / gm2013 / Science, Mathematics and Technology Education / unrestricted

The state of poverty in South Africa dictates how social policies should intervene to make an impact on poverty alleviation. Government formulated the three pillars of Land Reform Programme i.e. the Land Restitution Programme, Land Redistribution Programme and the Security of Tenure Programme. The Land Restitution Programme was utilised, through which people were given the opportunity to choose their preferred option ranging from original land, alternative land, financial compensation and involvement in development projects. The Programme aimed to reduce the unequal distribution of land amongst the racial groups of South Africa and alleviating poverty. During the process of land restitution the subjective impacts were debated more than the objective impacts, which were exacerbated by the experience of Zimbabwe as one of South Africa’s neighbouring countries. To date, little empirical evidence exists concerning the actual objective and subjective impact of the Land Restitution Programme. The aim of the study was to evaluate the objective and subjective impacts of the Land Restitution Programme on poverty. A quantitative research approach was used to conduct an impact evaluation study. Data was gathered by means of self-administered questionnaires. Respondents included land restitution applicants, namely: the claimants who were dismissed because they did not meet the acceptance criteria, the claimants who rejected the offer of financial compensation and the claimants who accepted the land restitution offer of financial compensation and eventually became the beneficiaries of the Land Restitution Programme. The research findings revealed that the Land Restitution Programme has both objective and subjective impacts on poverty. The subjective and objective impacts have both positive and negative impacts. The positive objective impacts were revealed to include the improvement in the aspects of quality of life as individuals and as communities, reconciliation at an individual, family and community level, and personal development such as improvement in community participation, empowerment and capacity building. The line, however, between the subjective and objective impacts was found to be very thin. The greatest impacts were amongst the accepted land restitution claimants and the least impact was amongst the dismissed and refused claimants in comparison with the accepted land restitution beneficiaries. The findings confirmed the hypothesis of the study, namely that if the poorest of the poor beneficiaries receive the land restitution compensation their levels of poverty decreases, compared to those that are refused or dismissed for land restitution compensation. The study revealed that the negative impact of the Land Restitution Programme is on its ability to acquire title to land. The claimants and beneficiaries of the Land Restitution Programme still regarded the programme as effective even though it has challenges in terms of addressing poverty alleviation. The study concluded that the Land Restitution Programme should be implemented within a Framework for Poverty Alleviation. Such a framework needs to go beyond the legalistic framework that is provided by the Land Restitution Act no 22 of 1994 which currently do not address approaches to poverty alleviation, strategies for alleviating poverty and aspects of quality of life that are measurable. The study recommended the implementation of a Land Restitution Programme Framework for Poverty Alleviation, which include elements of measuring poverty and aspects of quality of life and poverty alleviation approaches such as the livelihood approach, asset vulnerability approach, compulsory asset redistribution approach, and social development strategies. It is further recommended that the Land Restitution Programme Framework for Poverty Alleviation should be informed by the voices of the poor, professionals and international donor communities in order to comprehensively make an impact in graduating the poor from being poverty stricken to being self sufficient and self reliant. / Dissertation (MSD)--University of Pretoria, 2008. / Social Work and Criminology / unrestricted

Doctor Educationis / Health professionals worldwide are currently inadequately trained to address the health issues of communities, particularly in developing countries where there are major health disparities. This study argues for an alternative and more appropriate education, one which would better prepare future health professionals to address these needs. The study draws attention to how the University of the Western Cape (UWC) responded to preparing its health professional graduates to better meet the needs of South African society. The thesis explores the rationale for a shift in health professions education to one which supports service-learning, locating the study within the broader developments in higher education within South Africa. The specific aim of this thesis was to evaluate a community-based interdisciplinary health promotion course offered to the undergraduate health sciences students from the faculties of Community and Health Sciences and Dentistry at the University of the Western Cape (UWC). It focused on evaluating the perceived effectiveness and the impact on the stakeholders of the Interdisciplinary Health Promotion course, with the aim of developing an appropriate framework to guide the teaching of health promotion at higher education institutions in South Africa. Ten primary schools in three disadvantaged communities in the Western Cape were used as the health promotion settings for the Interdisciplinary Health Promotion course. The study design was a program evaluation that used the explanatory sequential mixed-methods design. An evaluation matrix was developed, consisting of three core concepts (curriculum, community-based learning, and university-school collaboration) against which the course was evaluated. Indicators and criteria were developed for each core concept. Questionnaires were distributed to all the stakeholders, that is, the university students, the lecturers, the supervisors, and the school educators, involved in the Interdisciplinary Health Promotion Course during 2006. Focus group discussions with the stakeholders were also conducted at the UWC campus and in the Delft community. There was a good response from all the stakeholders who participated in the study (students (72.4%), lecturers (85%), supervisors (100%), and school educators (71.5%)). A main finding of the study was that the Interdisciplinary Health Promotion course was relevant and up-to-date with developments in the field of health promotion. Course topics were dealt with in sufficient depth and the assignments were clear, specific, and related to the course outcomes. The interdisciplinary teaching and learning approach allowed the university students to learn and develop a better understanding of the roles and contributions that the various professions played in health promotion in a community. The course was perceived as having been of value to all the stakeholders and having a positive impact on the schools. The findings revealed that the health promotion projects implemented in the schools helped the university students to learn how to plan, implement and evaluate a project in a community setting. Furthermore, the findings suggest that the schools offered an ideal placement for university students to learn about health promotion and its application. In addressing a concern about the course not making any meaningful long-term impact on the schools and the surrounding communities, the study showed that it is important to revisit the current teaching and learning approach of the Interdisciplinary Health Promotion course. It revealed that service-learning as an alternative to the field education approach would facilitate a closer relationship between theoretical and practical knowledge, where the practical application was translated into a service that met the needs of a community. The study further revealed that the collaboration model between the university and the school also needed to be reconceptualized, to include all the stakeholders as well as their needs concerning health promotion in the schools. It was recommended that the Health Promoting School framework should be seen as the overarching framework for the sustainability of school-based health promotion. In conclusion, this study showed that the recognition and establishment of university-community partnerships and reliance upon them in the educational process would provide many new opportunities for relevant and meaningful health professional education and training. These efforts would contribute to improving the quality of higher education delivered to students, thereby ensuring their competency to better meet the needs of the communities they will serve.

The aim of this study was to evaluate a 24-week support group intervention programme which was designed to enhance adaptive behaviour of latent-phase children affected by maternal HIV/Aids. The meta-theoretical paradigms underlying the study were pragmatism and realism. The study was embedded in a concurrent nested (QUALquan) mixed-method design. The quantitative approach in the main study followed a quasi-experimental research design whereas the qualitative approach in this study, contributing to the largest part of the analysis in the study, followed a nested multiple case study design. The theory-driven outcome programme evaluation model applied in this study was the integrative process/outcome evaluation approach. The participants (n=139) were purposefully selected from among previously identified HIV-positive women (n=220) with children between the ages of 6 and 10 years at clinics in the Tshwane region, South Africa. Data were collected over a period of five years in multiple waves of intervention implementation. Prolonged, in-depth engagement by the researcher with participants was prioritized. The data collection strategies comprised of mother-and-child psychological questionnaires, group process notes, careworker focus groups, quality assurance questionnaires and field notes. The data were quantitatively analysed by means of a paired-sample t-test for within-group comparisons and descriptive statistics were furthermore applied. The qualitative text and narration obtained through the interviews, documents and focus groups were coded and analysed for themes. The themes of the emergent concepts were re-coded to establish improved defined categories. The different data sampling strategies assisted the researcher in triangulating the data for increased evaluation reliability. The PhD-study was conducted within a broader longitudinal study on resilience in South African mothers and children affected by HIV/Aids – the Promoting Resilience in Young Children Study. The findings of the Child Support Group Evaluation Study (e.g. PhD) showed that the content, methods and processes employed in the group-based sessions were effective and culturally sensitive. The intervention sessions enhanced the children’s coping skills, internalised and externalised behaviour and daily living, communication and socialisation skills. The group provided a buffer for the children and supported them in coping with their mothers’ illness. The children displayed normative values through their religious coping styles, their quest for and display of respect and their unambiguous assertion of right and wrong. A specific finding of this study was that the children created a sphere or space in which to order their thoughts, behaviours and emotions within the intervention. This provided them with parameters in their adverse circumstances to display adaptive behaviour or resilience which they could use to function adequately. The study suggests that the use of support groups should be incorporated into intervention programmes dealing with latent-phase children affected by HIV/Aids. / Thesis (PhD)--University of Pretoria, 2013. / gm2014 / Educational Psychology / unrestricted

Der folgende Beitrag schildert erste Ergebnisse einer Evaluationsstudie des Fortbildungsprogramms «Patientenseminar Angst» für Ärzte. 109 Teilnehmer der Veranstaltung I und 104 Teilnehmer der Veranstaltung II wurden vor und im Anschluβ an die Veranstaltungen sowie 3 Monate später bezüglich ihrer Beurteilung des Fortbildungsprogramms sowie zu ihren Einstellungen, Erfahrungen und Kenntnissen zu Angstpatienten befragt und mit einer Kontrollgruppe verglichen. Es zeigte sich, daβ Angstpatienten in der Allgemeinarztpraxis viel Zeitaufwand beanspruchen und sowohl die diagnostischen als auch die therapeutischen Kenntnisse nicht zufriedenstellend sind. Das Fortbildungsprogramm wurde von den Teilnehmern sehr gut beurteilt. Durch die Teilnahme wurde in Teilgruppen eine Verbesserung vor allem der Kenntnisse im Bereich «Angststörungen erkennen/Diagnostik» erreicht. Das Patientenseminar wurde vom Groβteil der Teilnehmer sowohl in Gruppen als auch bei einzelnen Patienten in der Praxis durchgeführt. Es wird deutlich, daβ trotz des hohen Aufwandes eine groβe Akzeptanz für den Einsatz solcher Patienten-seminare vorhanden ist und daβ insgesamt die bisher untersuchten Variablen für eine überraschend hohe Effektivität der Fortbildungsmaβnahmen sprechen. / This artide describes preliminary results of an evaluation study of the patientseminar 'anxiety', an educational programme for physicians. Before and after the two seminar meetings, 109 participants of part land 104 participants of part II filled in a questionnaire about their opinion on the programme as weil as their attitudes, experience, and knowledge about anxiety patients. They were compared with a control group, which did not take part in the programme. It is found that anxiety patients call for a lot of attention at general practitioners' and that the physicians' diagnostic and therapeutic knowledge is not sufficient. The educational programme was highly rated by participants. The patientseminar was conducted, for the greater part of participants, by the physicians both in groups and for single patients. It became evident that in spite of high expenses there is a wide acceptance of such patientseminars and that the variables so far examined up to now indicate surprisingly high efficiency of the educational programme.