The cost of health care services is rising and the number of patients requesting overseas treatment from the Kuwait Government continues to increase; this is becoming an unsustainable financial burden. A telemedicine system has the potential to support the Kuwaiti health system to provide medical consultations from global medical centres, and thereby reduce the number of Kuwaiti patients being sent abroad for treatment, and so reduce costs. This research investigates the readiness of the key stakeholders in regard to adoption of telemedicine systems in the Kuwaiti healthcare system. This is achieved by assessing the readiness of individuals (physicians and patients), the organisation (policy makers) and the technical infrastructure (IT managers). Moreover, the lack of research on this topic, particularly in the Arabian Gulf Region, was the reason behind carrying out this study. An in-depth study was conducted by using a quantitative and qualitative approach. A questionnaire was used to explore the attitudes of specialised physicians and patients by obtaining their opinions based on specific criteria. Next, semi-structured interviews were conducted: (1) with IT managers to assess the technical infrastructure of the health system; and (2) with policy makers to assess the organisation in regard to its readiness towards telemedicine adoption. The study shows that the overseas referral patients are ready to use telemedicine systems, as a consequence of their need to receive medical consultations from global experts. However, they expressed some concerns, such as privacy and confidentiality of their data. The specialised physicians also showed readiness towards adoption of telemedicine in the Kuwaiti health system, and their responses indicated that they are willing to use such systems. However, the findings of the interviews reveal that the current technical infrastructure for ICT in the Kuwaiti healthcare system is not ready for telemedicine adoption and there are needs to be change in the way management is organized in order to improve and enhance trust among departments. The qualitative approach identified factors that would inhibit and hinder the adoption of telemedicine in Kuwait, as well as the supportive factors in the organisation. Using the results, a strategy was developed to demonstrate how the Kuwaiti health system could be made ready to receive a telemedicine system, together with policies for the use of telemedicine systems by overseas referral patients. A comparison with Jordan and Syria shows that the Kuwaiti healthcare system is more ready to adopt a telemedicine system with respect to the individuals, technical infrastructure and governmental support. Finally, an economic analysis was performed in order to investigate the cost effectiveness of the proposed system.

Although the importance of early identification and intervention of infants at risk for communication delays and disorders have been advocated and emphasized in literature, case finding and service delivery in rural areas in South Africa appears to be problematic. The implementation of early communication intervention (ECI) within public service delivery has been proposed in the past. The primary health care (PHC) package had to be considered as a possible vehicle to be utilized for the implementation of ECI functions in rural communities. Against this background the existing identification methods and referral systems, utilized in Ditsobotla sub-district, were described in the current study to determine the limitations in case finding, and the feasibility of the implementation of ECI functions in collaboration with other PHC programmes. A descriptive dominant-less-dominant model provided the design to describe the identification process and teamwork in Ditsobotla sub-district. Data triangulation was utilized to improve reliability and validity of results which entailed a rating scale, face-to-face interviews with PHC personnel (participants in Group 1) and face-to-face interviews with PHC programme managers (participants in group 2). The results indicated that the capacity of facilities and human resources to support the implementation of ECI functions vary within the sub-district. Therefore an incremental implementation of ECI functions is feasible in collaboration with the existing PHC package. The current identification methods and referral systems are limited and a great need for collaboration exists. ECI functions need to be implemented formally within the PHC package and guidelines for such an implementation are provided. Furthermore the identification process to be introduced needs to form part of the incremental implementation of ECI functions. The implications are discussed in terms of ECI service delivery in rural South Africa. The proposed process of incremental implementation of ECI functions in rural areas, i.e. Ditsobotla sub-district, within the PHC package is provided. The need to develop identification methods, referral systems and guidelines for the implementation of ECI in PHC are emphasized. Future practice-based research is recommended in order to improve ECI service delivery in rural areas in South Africa. Copyright / Dissertation (MCommunication Pathology)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / Unrestricted

The study is an exploratory investigation of Pentecostal pastors' perceptions on psychological distress, using grounded theory. Semi-structured interviews were conducted with five senior pastors, of Pentecostal churches in Soshanguve township located near Pretoria in South Africa. Data was analysed using open, axial and selective qualitative research methods. Verification of the results by the participants enhanced the validity and reliability of the research. Results indicate that there seems to be certain similarities between the established frameworks in psychology and the worldview of pastors with regard to psychological distress. It seems as if the pastors share common views about psychological distress with the medical, interpersonal and cognitive schools of thought. Therefore, psychological distress would be regarded as impairment in the social and occupational life spheres. The pastors' referral patterns and strategies to deal with religious clients' psychological distress are discussed, as well as their limitations as mental health care workers for their communities. It is suggested that, to bring psychological services to the black community, psychologists form collaborative relationships with Pentecostal pastors. / Thesis (MA(Clinical Psychology))--University of Pretoria, 2003. / Psychology / unrestricted

Dans cette thèse, nous nous intéressons aux problèmes de découverte, de sélection et de composition de services. L'objectif est de satisfaire une requête complexe d'un demandeur de services. Pour ce faire, nous proposons une approche multi-agents fondée sur la confiance et les réseaux sociaux. Nous définissions un modèle de confiance en tant que concept compositionnel formé de quatre composantes: une composante sociale, une composante d'expertise, une composante de recommandation et une composante de coopération. La composante sociale juge s'il est intéressant de suivre un fournisseur avant d'utiliser ses services. La composante d'expertise estime si un service se comporte bien et comme prévu. La composante de recommandation vérifie si un agent est pertinent ou pas et si l'on peut compter sur ses recommandations. La composante de coopération permet aux agents de décider avec qui interagir dans une composition de services. Nous proposons un algorithme distribué pour la découverte de services utilisant la confiance entre les agents ainsi que les systèmes de références dans les réseaux sociaux. Nous développons également une nouvelle méthode s'appuyant sur un modèle probabiliste pour inférer la confiance entre les agents non adjacents tout en tenant compte des rôles des agents intermédiaires. Finalement, nous présentons un processus original de formation de coalitions qui est incrémental, dynamique et recouvrant pour une composition de services dans les réseaux sociaux. Les résultats expérimentaux montrent que nos approches multi-agents sont efficaces, plus performants que les approches similaires existantes et peuvent offrir des résultats plus dignes de confiance à faible coût de communications. / This thesis deals with service discovery, selection and composition problems. The aim is to fulfill a complex requester query. To do that, we propose a multi-agent approach based on trust and social networks. We define a trust model as a compositional concept that includes social, expert, recommender and cooperation-based component. The social-based component judges whether or not the provider is worthwhile pursuing before using his services. The expert-based component estimates whether or not the service behaves well and as expected. The recommender-based component checks whether or not an agent is reliable and if we can rely on its recommendations. The cooperation-based component allows agents to decide with whom to interact in a service composition. We propose a distributed algorithm for service discovery using trust between agents and referral systems in social networks. We also develop a new method based on a probabilistic model to infer trust between non adjacent agents while taking into account roles of intermediate agents. Finally, we present an original coalition formation process which is incremental, dynamic and overlapping for service composition in social networks. %In particular, our coalition formation process engaging self-interested agents is incremental, dynamic and overlapping. Experimental results show that our multi-agents approaches are efficient, outperforms existing similar ones and can deliver more trustworthy results at low cost of communications.