Background: The health sector has ‘duty of care’ to provide comprehensive health services to survivors of violence, to act as a referral point, to collect and document evidence, to report data on violence and to engage in preventive services. In Malawi, 48% of women experience some form of intimate partner violence (IPV) and a significant number report conditions requiring health care services, although few actually report to health services, which are in turn limited in scope and availability. Understanding how health care providers, relevant stakeholders and IPV survivors perceive the role of health care services in IPV is necessary to promote the development of context-relevant and sustainable health care interventions. Aim: To understand the health service responses to IPV in Malawi from a wide range of perspectives Objectives: i) to critically analyze written legislation, policy and strategy documents in relation to IPV and the health sector in Malawi; ii) to describe the perceptions and experiences of IPV and of health sector responses among survivors of violence, community members, health care workers and other key stakeholders in Malawi; iii) to estimate the extent of intimate partner and sexual violence from a health service uptake perspective using proxy determinants at one referral hospital in Malawi iv) To explore the policy implications of the study findings for the health sector responses in Malawi. Methods: In 2011, a multi-method situation analysis was conducted in three areas of Blantyre district, with additional data collected in Mangochi and Lilongwe districts. Seventeen relevant national documents were analyzed. A total of 10 focus group discussions (FGDs), 2 small groups and 14 individual interviews (IIs) were conducted with health care providers; 18 FGDs and one small group discussion were conducted with male and female, urban and rural community members; 12 in-depth interviews (IDIs) with survivors; 26 key informant interviews (KIIs) with donor agencies, GBV service providers, religious institutions; police officers and other stakeholders were conducted. A review of 3,567 register records for the month of January 2011 was done in Queen Elizabeth Central Hospital and police records on violence cases in Blantyre for the same month were reviewed. Qualitative data was analyzed using the ‘framework’ approach, assisted by NVIVO 9 software. Hospital records were analyzed using Epi Info™. Feminist approaches and the ecological framework for analysis of violence informed data analysis and interpretation. A range of quality assurance measures were undertaken and data were triangulated across all methods: policy analysis, interviews and records reviews. Findings: A review of legislation and policy combined with qualitative stakeholder interviews revealed conflicts, gaps and lack of awareness of the available documents that undermined coordinated health sector responses. Survivors, community members and health care workers revealed that IPV is perceived as a massive, though under-recognised problem. IPV in its various forms was seen as widespread and normalised, except perhaps in the perceived severe forms (such as femicide and child rape). IPV, though considered as shameful, was not necessarily a very private matter with involvement of neighbours, families, friends and significant others. Various factors at individual, interpersonal, society and institutional levels were described as affecting under-reporting, access to services and responses from sources of support. The review of registered data confirmed that IPV is generally underreported in health services and that relying on trauma as a proxy for IPV against women would prove difficult to implement. This multi-method approach highlighted the importance of diagnostic identification and the difficulties of universal screening. The actual role of health services in IPV seemed fuzzy from the service user’s perspectives and narrowly confined to the bio-medical model or acute model of health service provision. However, both potential service users and health care providers were optimistic about new developments such as ‘One Stop Centres’ and about the potential role of health services, particularly those linked to HIV programmes. They suggested these be provided as a continuum from prevention to rehabilitation. Conclusions: This study found a range of laws and policies that define and promote action to prevent IPV in Malawi. These have had some positive influences on both community norms and health sector responses. However, ineffective promotion has limited their effectiveness. In addition there are gaps and inconsistencies that reduce their potential in guiding the health sector response to IPV. The study explored stakeholders’ perceptions of IPV, the health sector response and the factors shaping it. This revealed a complex web of interconnected socio-economic, cultural, political and institutional factors. Perceptions of violence are culturally normative and related to gender roles and expectations. The inclusion of male voices on IPV against men, and using emic definitions of violence revealed conflicts between women’s and men’s interpretations of IPV, particularly with regard to sexual violence and the transgression of gender and marital roles. The specific socio-economic and cultural context strongly favours a conflict resolution model of responding to violence, which raises questions about the mandate and the potential roles of the health sector. Most stakeholders perceive IPV as a significant problem and recognise multiple impacts on health. However there is a clear disconnect between the magnitude of the problem and the health sector response. Nevertheless, the health sector is well placed to play a leadership role and has some resources, such as HIV Testing and Counselling staff and curricula to offer in a multi-sectoral response. Proxy determinants as reflected in the health service registers proved to be inadequate due to poor reporting and recording, and under-reporting to health services. Under-reporting was influenced by a range of inter-connected barriers to formal help-seeking, including normative attitudes and ineffective responses by both informal and formal sources of support. However, knowledge was generated about the challenges to recording and reporting IPV in this setting. The study findings suggested a number of key opportunities for improving the health sector response to IPV in Malawi that may be appropriate in this specific context and considered their potential sustainability.

The diffusion of geospatial technologies, including Geographic Information Systems (GIS) and Computer Aided Mass Appraisal Systems (CAMA), among Louisiana Assessors has been slowed by limited resources, a lack of communication and slow innovation decision processes. This research considers analysis of the speed of adoption, identifies the key players in decision making and the issues that influence the process based upon the theory of the diffusion of innovation developed by Dr. Everett M. Rogers (1995). The research data collected from online surveys, field visits and interviews of Louisiana Assessors between 2007 and 2013 was compared to identify factors that spurred or impeded the adoption of geospatial technologies among assessment offices. The research finds that proximity, communication, resources and the type of adopter predicts the adoption of GIS and/or CAMA by Louisiana Assessors.

Many studies exist on whether Voluntary Environmental Programs (VEPs) improve firms’ environmental performance. Furthermore, the literature on VEPs theorizes that specific features contribute to program performance. This study examines the ability of Voluntary Environmental Programs to reduce emissions and the role of institutional design on their performance. Specifically, this study aimed to identify if specific features influence performance more than others do. The indicator of performance focuses on the overall emission reductions of firms across years 2007-2009. To analyze performance and features, the study examines the emission data and design features of each program. The results reveal the ability of the VEPs to reduce emissions and a combination of features that may have a greater influence on performance. This suggests that the success of VEPs rely on their ability to institute these features.

The primary goal of this degree paper is to critically examine arguments advanced by both the proponents and opponents of mandatory drug testing in the workplace. This study is very significant because it not only addresses a very important issue in the U. S. government and private employer's attempt to solve the drug abuse problem in the workplace, but also helps to highlight the importance of the United States Constitution which protects people from prosecution until they are proven guilty. The U. s. Constitution guarantees the right to "due process" and protects people from illegal search and seizure. Proponents of mandatory drug testing in the workplace argue that the practice helps them to identify and eliminate drug users from the workplace. Above all, mandatory drug testing helps the employer to safe guard and protect the work force which is generally jeopardized by drug users. They assert that no one employee has the right to endanger the lives of other employees. On the other hand, opponents of mandatory drug testing argue that subjecting employees and job applicants to a urinalysis test violates their right to privacy.They claim that the U. s. Constitution protects Americans from illegal search (e.g., urinalysis) and seizure. It is, therefore, not constitutional for employers to keep subjecting their employees to a mandatory drug test. The study revealed that mandatory drug testing has been upheld by various judges in cases where there were "reasonable suspicion" or probable cause to believe that an employee was abusing drugs. Random testing of employees as part of the requirement of an annual examination, as a condition for continued employment and without probable cause, has been declared by most judges as unconstitutional. The study utilized a descriptive approach in its analysis. Information in the study was gathered through interviews, library research (secondary sources) of government documents, reports, books, journals and studies conducted by the National Institute on Drug Abuse and the American Management Association.

1 Abstract The topic of the presented thesis are issues related to public spaces. Public spaces are defined in the Municipalities Act and the Capital City of Prague Act and comprise all squares, streets, marketplaces, sidewalks, public green areas, parks and other areas accessible to anyone without restrictions, i.e. serving public use and irrespective of the ownership of the space. This is the only definition in the Czech legal system and several other norms refer to it. The main purpose of public spaces is their public use. Therefore, the relevant legal rules regulate also the limits of various activities in public spaces. The current legal regulation is rather brief and the topic has not been covered extensively in the legal doctrine as of yet. The aim of the thesis is to summarize the legal rules relevant to public spaces and the regulation of activities on them, as well as to identify issues and ambiguities stemming from the insufficient legal regulation. The first part of the work introduces the definition of public space and its history and illustrates the emergence and abolishment of public spaces. The legal definition characterizes public spaces using the listing of specific types of places and referring to a common characteristic, i.e. accessibility to public. It emphasizes that public spaces are...

Via six published papers, this thesis assembles a body of work by Simmons on user participation and involvement in the governance and delivery of public services in the UK. Collectively, the papers examine how users are able, and what makes them willing, to interact with public services in order to maintain or improve them. Cumulatively, the published papers contribute to a more detailed and nuanced understanding of user involvement and participation, enabling deeper understanding of users’ motivations and experiences, the choices available to them and how these are constrained. The published papers are contextualised in a linking narrative. This locates the papers within wider debates about the place and role of service user involvement and participation and how this has evolved over the last fifty years (Section 3). It then considers a range of broader literatures, selected to capture key elements of the conceptual and theoretical questions to which the papers are addressed (Section 4). A summary of each publication is provided, detailing its individual contribution to the participation literature (Section 5). The papers’ cumulative contribution is then considered (Section 6). Together, the six publications contribute to deeper understandings of both user involvement (establishing nuances in user attitudes and behaviour), and the possibilities that arise within different spaces for involvement (according to such factors as who the participants are, what they connect with (service, service providers, service context), and how these connections form distinctive ‘fields' of relationships). This thesis suggests these things all matter when it comes to users finding their voice - and user knowledge being incorporated into the governance and delivery of public services. It concludes that users’ ‘projects’ of involvement and participation (and the environments for those projects) are often complex, bringing together a range of different forces that must be balanced within the public service system.

Este trabalho busca analisar políticas de redução das taxas de homicídios em municípios da Região Metropolitana de São Paulo, baseadas especificamente na restrição do horário de funcionamento de bares. O objetivo geral é analisar comparativamente a implementação da chamada Lei Seca nesta região, considerando a necessidade de coordenação da ação de diversos atores para a sua efetivação. A hipótese principal é que os resultados alcançados pela Lei Seca dependem da articulação entre diversos atores (estatais e civis) ligados à segurança pública, de um desenho institucional bem delimitado para garantir a coordenação desses agentes e da fiscalização das ações. Os processos de implementação da lei foram analisados comparativamente, bem como o consórcio de instituições e atores civis responsáveis pela elaboração, execução e fiscalização da lei. O trabalho baseou-se em pesquisa bibliográfica e documental, levantamento de estatísticas criminais e entrevistas qualitativas com agentes envolvidos na formulação e implementação dessa política pública. Esta análise se insere nos debates sobre a articulação entre instituições responsáveis pela segurança pública, participação da sociedade civil, municipalização da segurança pública, relação entre o consumo de álcool e homicídios e outros, mas a contribuição pretendida refere-se especialmente ao debate sobre a produção de bens coletivos. Pode-se concluir que os resultados da interação entre os atores envolvidos e a cooperação para a efetivação da política analisada dependem de investimentos dos atores públicos para o estabelecimento de condições iniciais de implementação baseadas no diálogo e convencimento dos demais atores, aproximando-se assim daquilo que a literatura passou a denominar governança colaborativa. / This thesis aims to analyze policies to reduce homicide rates in cities within the Metropolitan Region of São Paulo, based on restricting bars business hours. The overall objective is to analyze the implementation of the Dry Law in the area, taking into consideration the need to coordinate the action of many players in order to make it effective. The main assumption is that Dry Law results depend on the joint effort from various players in public safety (state and civil), a well-defined institutional structure to ensure coordination of these agents and actions surveillance. The law implementation process was analyzed, as well as the consortium of institutions and civil players responsible for the preparation, enforcement and supervision of the law. The work was based on literature and documents review, crime statistics and qualitative interviews with stakeholders involved in the formulation and implementation of this public policy. This analysis is part of the debates about the articulation among institutions responsible for public safety, civil society participation, municipalization of public safety, the relation between alcohol consumption and homicide and others. Nevertheless, the contribution is intended to refer specifically to the debate on the production of collective goods. In conclusion, results from the interaction among players and cooperation to put this policy into effect depend on public players investment in order to establish initial conditions for implementation, based on dialogue and persuasion of other players, approaching what literature has defined as \"collaborative governance\"

Over recent decades health care policy in the English NHS has focused on the role of patient choice of provider as a lever for health care improvement (Mays 2010; Fotaki 2013). The thesis explores the degree to which patient choice policy has been successful in its aim. Specifically, it explores the influence that patient choice policy has on changing and shaping organisation culture in an acute hospital trust. A qualitative case study was undertaken in a teaching hospital Trust involving interviews with 30 interviewees drawn from different levels of the hierarchy in the hospital. The study also reviewed documents to understand where PCP was positioned in the hospitals ambition. The study found that patient choice had not changed organisational behaviour in the hospital and did not have the desired impact as expected by policy makers. The study identified that the PCP programme theory had failed to recognise the impact that the culture of an organisation has on change. The culture of the hospital was still one of ‘knowing what was best for its patients’ and rejecting the notion that patients wanted choice. Also, the incentives of patient choice policy were considered weak in the context of hospitals overrun with demand and competing priorities.

This thesis presents the findings of a qualitative exploration of how Community Health Workers (CHWs) conceptualise their role in delivering health improvement. The characteristics of CHWs described in the literature, and their role in health improvement, are examined critically. Interview data from 27 CHWs and 15 others across four services is used to explore the health improvement mechanism from the perspective of CHWs. Theory from a range of disciplines is used to explain it. The literature provides incomplete accounts of the mechanism. The empirical work suggests that, in the services sampled, the mechanism may predominantly be one of social support (informational, instrumental, appraisal and emotional support). Three distinct and essential processes emerge (needs assessment, effective service provision, and client engagement). The analysis reports how who CHWs are, and what they do, appear to be important influences on the social support processes, and that CHWs may be better at delivering this kind of support than traditional professional workers, particularly to socially excluded individuals. Overall, this work suggests that CHWs may perform a unique role, as experts in social support. The proposed mechanism can be used to inform service design and evaluation, to maximise CHWs’ potential to deliver effective social support.

Whilst there is evidence of a range of effective treatments available for people with severe mental health problems (SMHP), people frequently disengage from mental health services (MHS). This thesis investigates experiences of disengagement of people with SMHP and comprises two studies: 1) semi-structured interviews to elicit the experiences of people with SMHP and a history of disengagement from MHS; and 2) building on those findings, focus groups with staff from assertive outreach teams (specialising in providing care for people with SMHP and a history of disengagement). The participants were those perceived as the most disengaged from MHS yet they were willing to engage with the research. Interpretative phenomenological analysis was used to develop themes for individual participants and then across the participants. Disengagement from MHS was part of a wider experience of a limited connection to social structures, including an ambivalent and complex relationship with MHS. There was a sense of sadness in all aspects of the participants’ experience but they had developed strategies to reinforce personal resilience and to reassert personal identity. The findings of this thesis can be employed to better understand the context of disengagement from MHS and consequently better inform future engagement with this client group.