Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2003. / Abstract. Includes bibliographical references (leaves 80-85).

Australia is experiencing widespread ecosystem degradation, including dryland salinity, erosion and vegetation loss. Approximately 1 million hectares (5.5%) of the south-west agricultural zone of Western Australia is affected by dryland salinity and is predicted to rise to 5.4 million hectares by 2050. Such degradation is associated with many environmental outcomes that may impact on human health, including a decrease in primary productivity, an increase in the number of invasive species, a decrease in the number of large trees, overall decrease in biodiversity, and an increase in dust production. The resulting degradation affects not only farm production but also farm values. This study examines the effects of such severe and widespread environmental degradation on the physical and mental health of residents. Western Australia has an extensive medical record database which links individual health records for all hospital admissions, cancer cases, births and deaths. For the 15 diseases examined in this project, the study area of the south west of Western Australia (excluding the capital city of Perth) contained 1,570,985 morbidity records and 27,627 mortality records for the 15 diseases examined in a population of approximately 460,000. Environmental data were obtained from the Western Australian Department of Agriculture?s soil and landscape mapping database. A spatial Bayesian framework was used to examine associations between these disease and environmental variables. The Bayesian model detected the confounding variables of socio-economic status and proportion of the population identified as Aboriginal or Torres Strait Islander. With the inclusion of these confounders in the model, associations were found between environmental degradation (including dryland salinity) and several diseases with known environmentally-mediated triggers, including asthma, ischaemic heart disease, suicide and depression. However, once records of individuals who had been diagnosed with coexistent depression were removed from the analysis, the effect of dryland salinity was no longer statistically detectable for asthma, ischaemic heart disease or suicide, although the effects of socio-economic status and size of the Aboriginal population remained. The spatial component of this study showed an association between land degradation and human health. These results indicated that such processes are driving the degree of psychological ill-health in these populations, although it remains uncertain whether this 4 is secondary to overall coexisting rural poverty or some other environmental mechanism. To further investigate this complex issue an instrument designed to measure mental health problems in rural communities was developed. Components of the survey included possible triggers for mental health, including environmental factors. The interview was administered in a pilot study through a telephone survey of a small number of farmers in South-Western Australia. Using logistic regression a significant association between the mental health of male farmers and dryland salinity was detected. However, the sample size of the survey was too small to detect any statistically significant associations between dryland salinity and the mental health of women. The results of this study indicate that dryland salinity, as with other examples of ecosystem degradation, is associated with an increased burden of human disease.

The social phenomenon of stress and workplace burnout has spanned over five decades. Despite a plethora of literature that exists, there still remain problematic issues that neither scientific investigation or government legislation have been able to resolve. The literature examined throughout this research is extensive and does reflect this 50-year period. It demonstrates that studies into this phenomenon have attempted to define stress, identify causal factors of workplace stress, workplace burnout and environmental congruence; and discusses strategies (focused on both the individual and organizational levels) that have been implemented to effect beneficial outcomes for individuals affected by any one of these. As this thesis continues, the more recent literature gives a greater recognition to violence in the workplace and legislative enactments as preventative measures to reduce the heavy burden of costs, both physical and financial, to organizations. This extensive literature review indicates no answer to the problem has been identified to date and that this phenomenon remains, giving a clear indication that further scientific investigation is required to find a solution to what was described as the most serious health issue of the 20th century. Based on the literature examined this health issue has now gone well beyond the 20th century, giving relevance to the research study described in this thesis. The investigation is validated as vital and should be used as a basis for further research. This study undertook a collaborative social process, action research, empowering participants to identify and change stressful factors identified within their practice indicative to rural remote community mental health teams. A critical social theory arose out of the problems within the context of the research setting, based on the ideal that the significant issues for this group of individuals within this organization could be solved through the action research process. The group ‘existed’ within the issues indicative to this rural remote area, however these issues were outside their control. Through the implementation of the action research process courses of actions were undertaken that provided enlightenment in self-knowledge with dialogue heightening collective empowerment to effect change within their practice. The action research process, being a holistic process, facilitated this change in practice, developed and refined theory as it proceeded in a cyclic fashion within this local setting. It concerned actual not abstract practices in the social world in which these participants practice. This methodology facilitated examining the significant stressors identified by the Community Mental Health Support Team (CMHST) that caused distress, allowing them to implement changes in their practice. The forum provided an avenue that could reduce stressors significantly and prevent ongoing occupational stress that contributes to workplace burnout. It offered an opportunity to work with a group of participants in a nonhierarchical and non-exploitative manner and enabled members of this group to identify their roles as effective practitioners, empowering them to effect the changes they deemed as essential criteria to reduce the stress they were experiencing indicative to their remoteness. Critical reviewing throughout the data collection attempted to understand and redefine these significant issues. It aimed to acknowledge the way things were relative to how things could be improved from organizational, personal and wider community perspectives. Simple principles and guidelines of action research were followed potentiating acceptance as a rigorous research approach from a positivist perspective whilst retaining the attributes that characterise action research. There are solutions to the dilemma of the employee overcoming the debilitating effects of stress leading to workplace burnout. This includes the cooperation of managers, policy makers, academic researchers and government officials working collaboratively to reduce the impact of occupational stress. Through this collaborative process, changes can be effected to ensure the health of the nation improves and that relevant recognition is given to the fact that there is a significant threat to a healthy workforce. Examining the nursing profession from a social perspective provides alternatives to medicalising workplace injuries and illnesses. / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

MRDV / Institute for Rural Development / Traditional medicine still plays a bigger role in people dealing with health and disease. Research shows that in some Asian and African countries, traditional medicine forms the primary mode of health care for 80% of the population. This is actively promoted in South Africa and is used by at least 70% of the country’s population. This study investigated the contributory factors leading mental health care users to use a combination of traditional and modern medicine in rural areas. The study was conducted using qualitative research methods. The population of this study were MHCUs, Mental health practitioners and traditional healers. Purposive sampling was used to select participants. Data was analyzed through a computer programme called Atlas TI. The results revealed the following as contributory factors leading mental health care users to use modern and traditional medicine in rural areas : cultural factor , belief in witch craft , influence by significant others (family members and friends), poor PHC intervention and treatment method. Recommendations to the health care practitioners and policy makers around the use of traditional and modern medicine was made based on the findings.

Department of Advanced Nursing Science / MCur

The report is about participatory action research with caregivers at the 'Tsoga 0 ltirele" centre for the mentally disabled. It was a process where the caregivers were involved in a series of action, plan and reflection in researching their situation. The facilitation process assisted the caregivers to look at their problems at the centre and improve service delivery in caring for the mentally disabled children. Several meetings were held where action, plan and reflection took place. Caregivers decided on their own when to meet and discuss issues that concerned them. They planned what needed to be dealt with and took collective action to address these needs. The facilitation process enabled caregivers to research their own problems, embrace errors experienced and recognise progress. People Centred Approach, Community Development and Participatory Action Research complemented one another in capacitating caregivers. Through it they learned to improve their own programmes and to run their meetings, improve marketing skills and fundraising. / Social Work / M.A. (Social Science (Mental Health))

The report is about participatory action research with caregivers at the 'Tsoga 0 ltirele" centre for the mentally disabled. It was a process where the caregivers were involved in a series of action, plan and reflection in researching their situation. The facilitation process assisted the caregivers to look at their problems at the centre and improve service delivery in caring for the mentally disabled children. Several meetings were held where action, plan and reflection took place. Caregivers decided on their own when to meet and discuss issues that concerned them. They planned what needed to be dealt with and took collective action to address these needs. The facilitation process enabled caregivers to research their own problems, embrace errors experienced and recognise progress. People Centred Approach, Community Development and Participatory Action Research complemented one another in capacitating caregivers. Through it they learned to improve their own programmes and to run their meetings, improve marketing skills and fundraising. / Social Work / M.A. (Social Science (Mental Health))

本研究以城鄉差異觀點，評估台灣鄉村型社區心理衛生中心之服務需求，具體目的有(1)分析台灣縣市及雲林縣鄉鎮與心理衛生有關之各項社會指標，以驗證社區心理衛生相關問題的城鄉差異性；(2)瞭解雲林縣及其鄉鎮關鍵訊息提供者對高度農業地區各項社區心理衛生問題嚴重程度、問題型式、地理分佈與相關在地服務資源之看法；(3)瞭解雲林縣高度農業人口鄉鎮社區居民對其村落各項相關心理衛生問題嚴重程度、問題型式、社區壓力源、因應方式與求助情形之看法；(4)由社區居民調查結果，抽取鄉村心理衛生相關問題之共同因素，並歸納諸項調查研究與指標分析結果，初步擬定出一「台灣鄉村心理衛生指標系統目錄」。 研究方法採用多方法評估策略。社會指標分析方面，共計分析台灣地區23個縣市24項及雲林縣20個鄉鎮市16項心理衛生相關問題，以比較不同農業人口分群其發生率或盛行率之差異。關鍵訊息提供者調查方面，使用自編問卷分別調查雲林縣30位與二崙與水林兩鄉69位政府單位、民間機構或專業個人等。社區居民調查方面，二崙與水林兩鄉共發出2049份問卷，回收1074份(52.4%)，有效問卷為967份(41村、97.6%)。統計方法有描述統計、集群分析、t考驗、單因子變異數分析、皮爾森積差相關分析、因素分析等。 研究主要發現如下：(1)高度農業人口地區之老年、低教育程度、喪偶、外籍配偶、身心障礙、意外事故死亡、醫事人員平均服務人口數等比例明顯較高，離婚、全般刑案、竊盜、強盜搶奪、暴力犯罪、強制性交等比例則較低。(2)台灣縣市心理衛生相關嚴重問題社會指標之地理分佈概況不明顯，但雲林縣心理衛生相關嚴重問題比例則以高度農業人口的二崙與麥寮兩鄉明顯較高。(3)雲林縣與二崙、水林兩鄉關鍵訊息提供者皆認為人口外移與老化、老人問題(獨居、貧窮、安養等)、電話詐騙等問題比例較高。雲林縣關鍵訊息提供者主觀覺得口湖、台西與四湖為最亟需心理衛生服務的農業鄉鎮。二崙鄉關鍵訊息提供者主觀覺得大庄、楊賢與港後為該鄉最亟需心理衛生服務的村落。水林鄉關鍵訊息提供者主觀覺得水北、塭底與大山為該鄉最亟需心理衛生服務的村落。(4)二崙與水林兩鄉社區居民認為電話詐騙、人口外移、農產經營影響、人口老化、家庭經濟壓力等問題比例較高，青少女母親(含未婚懷孕)、家庭人數眾多、親友與鄰居死亡頻傳、自殺、性侵害、精神疾病、家庭暴力、家庭虐待等比例較低。(5)二崙與水林兩鄉居民認為「社區孤立與無望感」來自人口老化、多孤獨貧窮老人、人口外流嚴重、生活無聊、缺乏休閒娛樂等因素較多，「犯罪被害擔憂與恐懼」來自竊盜、詐騙、嗑藥吸毒等問題較多，「社區憂鬱現象」來自個人與家庭經濟壓力、失業、農業損害或收益等因素較多。(6)二崙與水林兩鄉居民認為其感受社會壓力源以治安惡化為主，農業壓力源以農產收益與自然災害為主，社區壓力源以治安不佳、衛生環境不良、缺乏休閒娛樂等較多，學校壓力源以城鄉差距大、教育與學習資源不足、課業或升學壓力、教育政策多變等較多，家庭壓力源以經濟收入與子女教養為主，個人壓力源以經濟收入、身體健康、工作壓力等較多。(7)二崙與水林兩鄉居民指出習慣(或主要)抒解或因應壓力方法，以「找人聊天」居首，只有6.5%曾求助於親友之外的專業人員。(8)雲林縣現有7個單位或機構(衛生局─社區心理衛生中心與長期照護管理示範中心、社會局─各課、家庭教育中心、台大醫院雲林分院精神科、雲林區心理衛生諮詢服務中心與生命線協會)共提供37個鄉村心理衛生相關服務項目。 本研究由社區居民調查結果，共抽取出七個因素構面並分別命名為「一般社區心理衛生問題」、「農業社區心理衛生問題」、「環境污染」、「經濟壓力」、「居住生活風險」、「犯罪」與「家庭婚姻特性」，並歸納諸項調查研究與指標分析結果，初步擬定出一「台灣鄉村心理衛生指標系統目錄」(5大指標向度，14個指標項目)。 文末，研究者並根據研究結果與國內外相關文獻，分別提出鄉村居民心理健康政策、鄉村心理衛生指標系統、農業危機服務、老人心理衛生、社區孤立與無望感、犯罪被害恐懼、環境污染心理影響、鄉村性別與族群心理議題、鄉村學校之預防功能、鄉村心理衛生服務模式等10項建議。 / The purposes of this thesis were: (1) to analyze the differences of some social indicators related to mental health of Taiwan (23 cities/counties) and Yunlin county (20 townships). (2) to understand the opinions of the key informants about community mental health problems. (3) to survey community residents of agricultural areas about the subjective perceptions of their mental health. (4) to set up a summative index of Taiwan Rural Mental Health indicators System. This research used a multi-method strategy. Data collected in the spring of 2005 included 24 social indicators of 23 cities/counties in Taiwan, and 16 social indicators of 20 cities/township in Yunlin, and questionnaires of 99 key informants and 967 community members of Erh-lun and Shui-lin Township of Yunlin County. Major findings of this study were as follows: (1)Significant differences were found in the social indicators about the numbers of older population, the lower educational status, the widowed, the foreign spouse, and the disabled, the accidental injury-related deaths in agricultural counties. In contrast, urbanized areas had higher rates of the divorced, all criminal case, larceny, robbery and forceful taking, violent crime, rape, and the average number of people serviced by per medical personnel . (2)The geographic analysis in terms of the mental health status and service needs of residents revealed no significant differences among 23 cities/counties, but significant differences among 20 cities/township (Yunlin County), Erh-lun and Mailiao had much more problems. (3)Yunlin County’s key informants indicated that the areas of Kou-hu, Tai-si and Sih-hu have high needs for mental health services. Erh-lun’s key informants indicated that 3 villages have high needs for mental health services. Shui-lin’s key informants indicated that 3 villages have high needs for mental health services. (4)Most respondents of resident sample ranked the following mental health problems as serious: fraudulent telephone calls, out-migrant, farm crisis, being elderly, and family economic hardship. (5)Most respondents of resident sample employed “chatting with others” as stress-relieving or coping method. Besides “family and friends”, only about 6.5% of respondents reported that they sought help from mental health professionals or specialists. (6)To set up the initial rural mental health indicator systems of Taiwan: a summative index consists of 14 items and is divided into five dimensions The recommendations for rural mental health policies, indicator systems, program strategies and rural mental health service delivery issues were also suggested.

The system of care for persons suffering from schizophrenia is in a state of upheaval and the community in general is visibly frightened of an illness it knows little about except for the information acquired often from media reporting. Considering persons suffering from schizophrenia as holistic beings, this study explored and assessed the needs of these persons residing in the Mogoto Village, Zebediela District in the Northern Province. The primary purpose of the study was to explore and describe the holistic needs of persons suffering from schizophrenia thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on the Nursing Theory for the Whole Person was carried out. Through purposive sampling 60 respondents were selected. A questionnaire was administered to the respondents. Data from questionnaires revealed that despite the diagnosis of schizophrenia, the respondents were still regarded as valuable members of the community by those who cared for them. There was also an indication that the needs of persons suffering from schizophrenia in the Mogoto Village did not differ from the needs of other persons in the rest of the world. Like any unique person they have specific needs. There was also an indication that mental illness is still rated low in the prioritisation of health problems, hence the lack of resources and support needed for the rehabilitation of persons suffering from schizophrenia, especially in the rural areas. / Advanced Nursing Sciences / M.A.(Nursing Science)

The system of care for persons suffering from schizophrenia is in a state of upheaval and the community in general is visibly frightened of an illness it knows little about except for the information acquired often from media reporting. Considering persons suffering from schizophrenia as holistic beings, this study explored and assessed the needs of these persons residing in the Mogoto Village, Zebediela District in the Northern Province. The primary purpose of the study was to explore and describe the holistic needs of persons suffering from schizophrenia thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on the Nursing Theory for the Whole Person was carried out. Through purposive sampling 60 respondents were selected. A questionnaire was administered to the respondents. Data from questionnaires revealed that despite the diagnosis of schizophrenia, the respondents were still regarded as valuable members of the community by those who cared for them. There was also an indication that the needs of persons suffering from schizophrenia in the Mogoto Village did not differ from the needs of other persons in the rest of the world. Like any unique person they have specific needs. There was also an indication that mental illness is still rated low in the prioritisation of health problems, hence the lack of resources and support needed for the rehabilitation of persons suffering from schizophrenia, especially in the rural areas. / Advanced Nursing Sciences / M.A.(Nursing Science)