In recent years, the term "Healthy Communities" has become a catch phrase among planners, health promotion workers, social workers and government agencies, and increasing numbers of professionals have taken a role in the development of healthy communities projects. The literature on the healthy communities concept has increased in size and scope. Yet the concept itself is byno means clearly defined. Nor is there a standard method for developing a successful healthy communities project, or a regional collaboration of healthy communities projects. The question remains, when a planner undertakes a role in the development of a healthy communities project, what are the most important factors to consider? This thesis examines the influence of various project inputs on the ability of a regional healthy communities project to achieve its objectives. The thesis uses a case study of the Tri-City Health Promotion Project, a collaborative healthy communities project undertaken in the cities of Castlegar, Trail and Nelson in the West Kootenay region of British Columbia. In this study, documentary analysis and interviews with Tri-City project staff illuminate the importance of several influences on a regional healthy communities project. Some of these are: the approach used by the participants (task- orprocess-orientation), the resources and constraints specific to each community, the context from which the project grew, the personalities of those involved, the ability of the collaborating communities to work together, and the relationship between the community and regional bodies in the project structure. Conclusions: While every healthy communities project will be affected differently by various inputs, in the case of the Tri-City Health Promotion Project, the relationship between the regional and community bodies in the project structure had the greatest influence on the ability of the community Steering Committees to achieve their goals. Planners working on a regional healthy communities project must carefully examine the design of the project, in order to develop a structure which enhances the working relationship between regional and community bodies. This is particularly crucial in the healthy communities context, where decision-making power often resides at the community level, rather than being centralized in the regional body. / Applied Science, Faculty of / Community and Regional Planning (SCARP), School of / Graduate

The purpose of this research project is to report on a comprehensive organizational audit of the Urgent Care Service of Desert Valley Medical Group in Victorville, California.

To examine the safety and acceptability of providing antiretroviral therapy (ART) in a resource poor setting. DESIGN: Two-stage observational and qualitative study. SETTING: Rural hospital in Southern Africa. METHODS: Structured observation using failure modes and effects analysis (FMEA) of the drug supply, dispensing, prescribing and administration processes. The findings from the FMEA were explored further in qualitative interviews with eight health professionals involved in the delivery of ART. To obtain a patient perspective, a stratified sample of 14 patients receiving ART was also interviewed. RESULTS: Key vulnerabilities in the process of ART provision include supply problems, poor packaging and labelling, inadequate knowledge among staff and lack of staff. Key barriers to successful patient adherence include transport inconsistency in supply and personal financial difficulties. There is, however, strong evidence of patient commitment and adherence. IMPLICATIONS AND CONCLUSION: Medication safety is relatively unexplored in the developing world. This study reveals an encouraging resilience in the health system and adherence among patients in the delivery of complex ART. The vulnerabilities identified, however, undermine patient safety and effectiveness of ART. There are implications for drug manufacturers; international aid agencies funding and supplying ART; and local practitioners. FMEA can help identify potential vulnerabilities and inform safety improvement interventions.

Health Studies / D. Litt. et Phil. (Advanced Nursing Science)

Health Studies / D. Litt. et Phil. (Advanced Nursing Science)