The way healthcare services are delivered in remote and rural Scottish communities is in a state of reconfiguration. At the same time the NHS faces pressure to plan these new services in partnership with communities themselves. Evidence, however, suggests that this is not necessarily being done well. This study considered the contextual aspects of remote and rural Scottish communities that may impact on healthcare-related engagement, and examined current understanding of what constitutes a ‘good’ engagement process. It then went on to consider a two-year action research project (RSF) that took place in four remote and rural Scottish communities to engage local residents in an anticipatory process co-designing their own future healthcare services. Finally, this study examined ways in which individuals were able to wield power within the engagement described in the RSF project, by using a combination of participant observation and Foucauldian Discourse Analysis. As well as making a number of practical recommendations for future engagement practice in a remote and rural context, this study makes three key contributions. Firstly, it contributes further contextual knowledge about the challenges of engaging with remote and rural Scottish communities for local healthcare service design; a topic about which little has been written. Secondly, it contributes a novel method for anticipatory healthcare budgeting aimed at a remote and rural Scottish context, namely the RSF Game. Thirdly, it draws the conclusion that individual (non-elite) community members have the ability to use French and Raven’s bases of social power to impact the engagement process at all stages, and also posits that discourse can be used within rural engagement as a new ‘base of power’, which contributes to the debate around individual power and agency within remote and rural community engagement for healthcare, which few studies have examined.

Esta investigaÃÃo discorre sobre as experiÃncias intersubjetivas de trabalho situando-as na micropolÃtica cotidiana de um CAPS que vem reorganizando algumas de suas aÃÃes. Buscamos compreender tais experiÃncias articulando-as Ãs posiÃÃes e disposiÃÃes dos agentes que as vivenciam, o que nos levou a identificar algumas configuraÃÃes relacionais relevantes entre os trabalhadores. Dialogamos com diversos autores que vem abordando a temÃtica do trabalho em saÃde no Brasil e em equipes comunitÃrias de saÃde mental na literatura estrangeira. A literatura nacional neste campo, caracterizada por uma propositividade importante para a constituiÃÃo de um ideÃrio sobre o trabalho em saÃde, apresenta, no entanto, lacunas em relaÃÃo a estudos empÃricos que enfoquem ambivalÃncias e contradiÃÃes emergentes nos microprocessos cotidianos. Isto nos levou a trilhar uma trajetÃria alternativa, referenciada no percurso histÃrico da constituiÃÃo do trabalho em saÃde e dos processos de profissionalizaÃÃo, de maneira a enfocar as interaÃÃes estabelecidas entre os trabalhadores considerando as relaÃÃes e conflitos interprofissionais, bem como as concepÃÃes, dificuldades e limites do trabalho coletivo e multiprofissional em saÃde mental. Utilizamos um referencial metodolÃgico fundamentado na hermenÃutica crÃtica, de maneira a compreender as experiÃncias intersubjetivas de trabalho nas suas diferentes versÃes emergentes entre os trabalhadores. Apresentamos uma contextualizaÃÃo de Ãmbitos sÃcio-histÃricos, locais e singulares de maneira a inscrever processual e dialeticamente tais experiÃncias, dotando-as de mÃltiplos sentidos. As experiÃncias intersubjetivas de trabalho sÃo permeadas por ambivalÃncias e contradiÃÃes emergentes no cotidiano que representam limites e possibilidades para a constituiÃÃo de uma nova prÃxis coletiva entre os trabalhadores. Ãs dimensÃes Ãticas e polÃticas que referenciam o trabalho em saÃde, devem associar-se dimensÃes afetivas, por compreender o afeto como uma potÃncia mobilizadora de disposiÃÃes e de posiÃÃes que permitem reconfiguraÃÃes em relaÃÃes de saber/fazer/poder estabelecidas. / This reasearch investigates the intersubjective experiences of work in the cotidiane micropolitical processes of a community mental health service. We tried to understand the experiences in articulation to the dispositions and positions of the workers. This process conducted us to the identification of some relevant relational configurations considering the perspective of the workers. We established a dialogue with several authors that investigate the health work in Brazil and the mental health community work in other countries. The national literature presents a propositive tendency that contributes to the elaboration of some principles for the health work. However, new empirical studies are necessary to understand the ambivalences and contraditions that appear in the cotidiane between the health workers. Thus, we decided to study this subject considering the historic process of health work and profissionalization, in order to understand interprofessional interactions and conflicts that affect conceptions and establishe possibilities and restrictionas for the constitution of a collective multiprofessional work in mental health. We used a critical hermeneutic approach presenting the multiple versions of the workers experiences relating them to different contexts. Ambivalences and contradictions are relevant in the intersubjective experiences of work and they represent restrictions and possibilities for the constitution of a new praxis among the workers. Ethical and political dimensions of the health work may be associated to affective dimensions, understanding the affect as a potent agent in the mobilization of positions and dispositions that may conduct to reconfigurations of established relations.

Thesis (Ph.D.)--University of Wollongong, 2002. / Typescript. Includes bibliographical references.

Thesis (Ph. D.)--Northeastern University, 2008. / Title from title page (viewed Feb. 27, 2009). Graduate School of Arts and Sciences, Dept. of Political Science. Includes bibliographical references (p. 302-324).

Thesis (Ph. D.)--University of Virginia, 1991. / Includes bibliographical references (leaves 139-152). Also available online through Digital Dissertations.

Thesis (M.S.P.H.)--University of Michigan, 1939.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis (M.S.P.H.)--University of Michigan, 1942.

Thesis (M.S.P.H.)--University of Michigan, 1938.

Thesis (M.P.H.)--University of Michigan, 1945.