M.Com. (Business Management) / Please refer to full text to view abstract

M.Cur. / Please refer to full text to view abstract

M.Ed. / Please refer to full text to view abstract

A Thesis submitted to the Graduate School of Public and Development Management in fulfilment of 50 percent of the requirement for the degree of Master of Management in Public Policy University of Witwatersrand, Johannesburg March 2015 / The South African government has extended the constitutional mandate of the Auditor-general to cater specifically for performance information in the public sector, which has resulted in the rollout of a Government-wide Monitoring and Evaluation system designed to enhance efficiency, accountability and transparency in the public sector. This study investigated the capacity gaps and systems problems in the M&E systems that caused a majority of the North West provincial government departments to receive qualified opinion on performance information between 2010/11 and 2013/14 financial years. A qualitative approach was used, supported by interviews and documentary analysis to extract rich data. The capacity gaps and systems problems in the M&E systems in the provincial departments manifested themselves in the form of inadequate oversight role; poor leadership; malicious compliance; lack of approved M&E policies; lack of uniformity in M&E structure and location; lack of M&E skills, inadequate budget; lack of accountability and transparency. The overall conclusion of the study is that adequate oversight role and effective leadership, and political stability are central in the implementation process of M&E systems. Key recommendations of the study include amongst others capacitating the institutional oversight structures and leadership; approved M&E policies; streamline M&E systems; all programme managers should account for the M&E function; M&E systems should be fully resourced; and capacitate the M&E fora.

Thesis (MCur) -- University of Stellenbosch, 2005. / ENGLISH ABSTRACT: A non-experimental descriptive study was conducted in four prisons in the Western Cape. The research focussed on the standard of care within primary health care settings in the purposively selected prisons. No official written standards existed to measure the quality of care. After an in-depth literature study, structure, process and outcome standards were formulated and validated. The main findings of the study indicated that: • Standards in these three dimensions of care did not meet the pre-set level of performance as determined by the researcher; • The clients were generally satisfied with the hygiene in the clinics; • Aspects of concern were the lack of explanation offered to the clients before and after consultations and nursing care interventions. The researcher recommends the implementation of a comprehensive quality care model for the health care of the prisoners with adequate human and nonhuman resources Core words: Qualtiy care, Correctional services health care, Nursing care in prisons. / AFRIKAANSE OPSOMMING: "n Nie-eksperimentele beskrywende studie is in vier gevangenisse in die Wes- Kaap uitgevoer. Die navorsing het gefokus op die gehalte van sorg binne primere gesondheidsorgomgewings in die doelbewuste geselekteerde omgewings. Geen amptelike geskrewe standaarde om die gehalte van sorg te meet, het bestaan nie. Na 'n in-diepte literatuurstudie is struktuur-, proses- en uitkomsstandaarde geformuleer en gevalideer. Die belangrikste bevindings van die studie het aangedui dat: • Standaarde in hierdie drie dimensies van sorg het nie aan die voorafbepaalde vlak van sorg voldoen het nie soos deur die navorser bepaal is; • Die kliente was oor die algemeen tevrede met die higiene in die klinieke; • Kommerwekkende aspekte het ingesluit die gebrek aan voldoende verduidelikings aan kliente voor en na konsultasies en verpleegintervensies. Die navorser bevel aan dat In omvattende gehalteversekeringsmodel vir die gesondheidsorg van gevangenes ingestel word met voldoende beskikbare mensen ander hulpbronne. Kernwoorde: Gehaltesorg, Korrektiewe dienste gesondheidsorg, Verpleegsorg in gevangenisse.

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background A need for primary care practitioners to utilise clinical research evidence in practice has been identified and is well described. However a chasm between evidence and practice still exists in primary health care (PHC). Although clinical practice guidelines have been shown to improve the quality of clinical practice and attempt to bridge the gap between evidence and practice, practitioners are often not aware of practice guidelines and fail to access, adopt or adhere to evidence-based recommendations contained in them. Central question How can the implementation of clinical research evidence, using the example of the national evidence-based guideline on asthma, be improved in the PHC sector in the MDHS of the Cape Town metropole? Aim This research aimed to improve the implementation of clinical research evidence in PHC, by learning from the specific example of the national evidence-based asthma guideline in PHC practice in the Metro District Health System (MDHS) of the Cape Town metropole, and to make recommendations to key stakeholders regarding the future implementation of evidence-based guidelines. Objectives  To gain insight into the current quality of asthma care in PHC in the MDHS of the Cape Town metropole.  To determine whether the process of implementation of the new asthma guideline contributed to an improvement in the quality of care in the MDHS.  To explore ways of improving the process of implementation of the national asthma guideline in PHC in the MDHS.  To gain insight into the perceptions, attitudes and knowledge of asthmatic patients regarding their asthma management.  To explore how EBP is understood and perceived by doctors in PHC. Stellenbosch University https://scholar.sun.ac.za  To understand how PHC doctors in the public and private health sectors gain access to and use guidelines.  To explore the experiences, perspectives and understanding of family physicians (FPs) (academic, private and public sector) with regard to EBP and the implementation of guidelines in PHC practice.  To gain insight into the understanding of FPs regarding the perceived problems and main barriers to EBP and their views of the process of guideline implementation in PHC.  To gain insight into the knowledge, perceptions and attitudes of clinical nurse practitioners in the public sector with regard to EBP and the process of guideline implementation. Methodology This study was conducted in the PHC setting of the Cape Town metropole. This research was conducted in three phases and used cross-sectional surveys, quality improvement (QI) cycles, qualitative research methods, such as interviews with FPs, and participatory action research (PAR). Phase 1 involved a cross-sectional survey, which looked at the knowledge, awareness and perspectives of doctors, regarding evidence-based practice (EBP) and guideline implementation using the national evidence-based asthma guideline published in 2007. It also involved QI cycles conducted over a period of five years to assess the baseline quality of asthma care in the PHC sector and to evaluate improvement in asthma care as a result of the QI cycles and associated educational workshops. Phase 2 involved interviews conducted with FPs in academia as well as in the private and public health care sectors who were responsible for clinical governance in PHC in the Cape Town metropole. During this phase of the research the experiences, perspectives and understanding of FPs (academic, private and public sector) with regard to EBP and the implementation of guidelines in PHC practice were explored. Phase 3 involved PAR with primary care practitioners at community health centres (CHCs) using a co-operative inquiry group (CIG) to improve asthma guideline implementation in PHC. The CIG investigated how to improve the implementation of the asthma guideline in their respective CHCs and completed four cycles of planning-action-observation-reflection. The four cycles focused on implementation of an asthma self-management plan (ASMP), exploring the capability of clinical nurse practitioners to implement the guidelines, exploring the views of patients on their asthma care and implementing better patient education. A final consensus of the CIG’s learning was then constructed. Results With regard to quality improvement of asthma care in PHC: The first objective of the study was largely addressed through the baseline audits conducted in 2007 and 2008. This showed that the baseline quality of asthma care, with specific reference to the assessment of the patient’s level of control, measuring the patient’s peak expiratory flow rate (PEFR), assessing the patient’s inhaler/ spacer technique, recording the smoking status, the adequate prescription of controller and reliever metered dose inhalers (MDI) refills during visits and particularly the issuing of an ASMP during visits, was poor. The second objective was addressed through the annual audits conducted in 2007, 2008, 2010 and 2011 during the period of implementation. This showed that although clear cause and effect reasoning cannot be inferred, overall statistically and clinically significant improvements in the quality of care occurred in conjunction with the process of asthma guideline implementation. Despite the improvement in structural and process criteria there was no corresponding improvement in the outcome criteria and in fact the utilisation of facilities for emergency visits significantly increased, while the hospitalisation of patients remained constant. The third objective was to explore ways of improving the process of implementation of the national asthma guideline in PHC in the MDHS. This was largely addressed through the action-research process at selected CHCs. This showed that implementation could be improved by ongoing educational support and formal interactive training workshops with the staff members who were directly involved with patients. The development and use of educational aids and ASMPs based on the guideline recommendations were useful and encouraged patient participation in decision making regarding their care. The fourth objective, specific to asthma care, addressed by means of a survey and showed that even though the majority of asthma patients participated in decisions regarding their asthma and felt satisfied with the quality of care they received, the prevalence of smoking among asthma patients was high and opportunities for smoking cessation counselling were missed. Even though documentation of peak flow recordings and patients’ knowledge of the difference between the reliever and controller MDIs were good, patients’ perceptions with regard to education on the inhaler technique, the assessment of the level of control, the issue of written information regarding asthma and the use of ASMPs remained poor and could be improved. With regard to EBP and asthma guideline implementation in PHC: The fifth objective of the study was addressed by means of a survey which showed that the doctors in PHC used evidence in clinical decision making and agreed on the usefulness and importance of EBP in improving the quality of patient care in South Africa. There was a difference in the engagement with activities related to EBP between the public and private sector PHC doctors and there is a need for formal training in the skills and processes of EBP. The sixth objective was addressed by means of a survey which showed that a good proportion of both public and private sector doctors in the Cape Town metropole were well aware of the asthma guideline, had used the guideline and had adopted, acted on and adhered to specific guideline recommendations. There was a high level of general awareness of the asthma guideline and recommendations were being adopted in practice, although the lack of formal disease registers, monitoring and evaluation of asthma care and the utilisation of an ASMP could be improved on. The seventh objective was addressed by qualitative research which showed how the views and perspectives of FPs regarding EBP and the process of guideline implementation contributed to the development of a conceptual framework for the process of guideline implementation. The eighth objective was addressed by qualitative research, which identified barriers present in each step of the implementation process. Time constraints, practitioner workload, lack of financial resources, lack of ownership, the lack of timeous organisational support and practitioner resistance to change were important barriers to guideline implementation in an already overburdened PHC setting. A conceptual model was developed which showed that the process of guideline implementation should be tailored to the barriers identified. The ninth objective was addressed by means of a survey which showed that the concept of EBP was fairly new to CNPs in PHC and identified a need to learn more about it. CNPs agreed that clinical research evidence is useful in the daily management of patients, that their decision making is based on evidence, that evidence-based nursing can improve the quality of patient care, that there is a place for evidence-based nursing in their practices at their respective CHCs, that EBP will make a difference in the quality of care of their patients and that evidence-based nursing practice has an important role to play in South Africa. Although the awareness of CNPs with regard to the asthma guideline was poor, the vast majority reported that they personally educated patients on the difference between reliever and controller MDIs, recorded the smoking status of patients in the records, demonstrated the inhaler technique to all their asthma patients, assessed the level of control and agreed that inhaled corticosteroids are the mainstay of treatment in patients with chronic persistent asthma. However only a small minority (mainly at the CHCs where action research occurred) started issuing patients with ASMPs. In answering the central question: “How can the process of implementation of clinical research evidence, using the example of the national evidence-based guideline on asthma, be improved in the PHC sector in the MDHS of the Cape Town metropole?”, this thesis concludes that the process of guideline implementation can be improved in the PHC sector by an in depth understanding and systematic approach to the whole process. A conceptual framework is provided as a model which attempts to guide and make sense of this process of guideline implementation. A stepwise approach is presented and provides a summary of the main research findings. The model shows that the initial process of evidence creation should not only deal with research evidence of high quality, but should incorporate research evidence that is relevant to the particular context of care. In addition the model shows that guideline development should be inclusive and involve a wider spectrum of stakeholders as well as patients; that guideline contextualisation, dissemination and implementation should be carefully planned. Special consideration should be given to local decision making about adoption or prioritisation of specific recommendations as part of ongoing quality improvement cycles and the conversion of published guidelines into practical tools for practitioners to use in consultation, prior to dissemination. Implementation should anticipate that members of the PHC staff will differ in their readiness to change and that strategies should consciously embrace principles of behaviour change and build up a sense of ownership, choice and control over local adoption of the guidelines. Academic centres, such as universities and professional bodies, have a role to play in identifying, appraising and synthesising the evidence, and giving input into guideline development. They can also assist by innovating and evaluating practical tools as part of the contextualisation stage and by providing continuing education during implementation as part of their social responsibility. The health care organisation (HCO) should prevent unnecessary delays in guideline implementation by ensuring that policy, resources and recommendations are aligned during the contextualisation stage; that barriers encountered should be dealt with throughout the entire process, and that ongoing monitoring and evaluation of the quality of care occurs. Conclusion This research used different methods and innovative PAR to bridge the gap between evidence and practice. A new conceptual model for guideline implementation is recommended for use to assist with implementation and knowledge translation in PHC locally, nationally and in similar Low Middle Income Countries (LMIC) in Africa. / AFRIKAANSE OPSOMMING: Agtergrond ‘n Behoefte om kliniese navorsingsbewyse in die praktyk te benut, is by primêre – sorg praktisyns geïdentifiseer en word goed beskryf. Daar bestaan egter steeds ‘n gaping tussen bewyse en die praktyk in primêre gesondheidsorg. Alhoewel getoon kon word dat kliniese praktykriglyne die kwaliteit van kliniese praktyk verbeter, en poog om die gaping tussen bewys en praktyk te oorbrug, is praktisyns dikwels nie bewus van praktykriglyne nie, en faal daarin om toegang te verkry tot bewysgebaseerde aanbevelings wat daarin vervat is, asook om dit aan te neem en na te kom. Sentrale vraag Hoe kan die implementering van kliniese navorsingbewyse, deur die voorbeeld van nasionale bewysgebaseerde riglyne oor asma te gebruik, verbeter word in die primêre gesondheidsorgsektor in die Metropooldistrik – gesondheidstelsel van die Kaapstad – metropool? Doel Die doel van hierdie navorsing was om die implementering van kliniese navorsingbewyse in die primêre gesondheidsorg te verbeter, deur te leer vanuit die spesifieke voorbeeld van die nasionale bewysgebaseerde asmariglyne in die primêre gesondheidsorgpraktyk in die Metropooldistrik – gesondheidstelsel van die Kaapstad - metropool, en om aanbevelings aan sleutel – rolspelers te maak aangaande die toekomstige implementering van bewysgebaseerde riglyne. Doelwitte  Om insig te verkry in die huidige kwaliteit van asmasorg in die primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel van die Kaapstad – metropool.  Om vas te stel of die implementeringsproses van die nuwe asmariglyne bygedra het tot ‘n verbetering in die kwaliteit van sorg in die Metropooldistrik – gesondheidstelsel.  Om maniere te verken om die implementeringsproses van die nasionale asmariglyne in die primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel te verbeter.  Om insig te verkry in die opvattings, houding en kennis van asmatiese pasiënte met betrekking tot hul asma – bestuur.  Om te verken hoe bewysgebaseerde praktyk verstaan en deur dokters in primêre gesondheidsorg toegepas word.  Om te verstaan hoe primêre gesondheidsorgdokters in die openbare - en privaatgesondheidsektore toegang tot, en die toepassing van riglyne verkry.  Om die ervaringe, perspektiewe en begrip van gesinspraktisyns (akademies, privaat en openbare sektor) met betrekking tot bewysgebaseerde praktyk, en die implementering van riglyne in primêre gesondheidsorg, te verken.  Om insig te verkry in die begrip van gesinspraktisyns met betrekking tot die probleme wat waargeneem is, hoofhindernisse tot bewysgebaseerde praktyk, asook hul persepsies van die proses van riglyn – implementering in primêre gesondheidsorg.  Om insig te verkry in die kennis, persepsies en houding van kliniese verpleegpraktisyns in die openbare sektor, met betrekking tot bewysgebaseerde praktyk en die proses van riglyn – implementering. Metodologie Hierdie studie is uitgevoer in die primêre gesondheidsorg - instellings van die Kaapstad – metropool. Hierdie navorsing is in drie fases uitgevoer, en het deursnee – ondersoeke, kwaliteitverbeteringsiklusse, kwalitatiewe navorsingsmetodes soos onderhoude met gesinspraktisyns, en deelnemende aksienavorsing gebruik. Fase 1 het ‘n deursnee – ondersoek behels oor die kennis, bewusmaking en perspektiewe van dokters met betrekking tot bewysgebaseerde praktyk en riglyn – implementering , deur die nasionale bewysgebaseerde asmariglyne te gebruik wat in 2007 gepubliseer is. Dit het ook kwaliteitverbeteringsiklusse behels wat oor ‘n tydperk van vyf jaar uitgevoer is, om die basislyn – kwaliteit van asmasorg in die primêre gesondheidsorg te assesseer, en om die verbetering in asmasorg te evalueer as ‘n uitvloesel van die kwaliteitverbeteringsiklusse en geassosieerde opvoedkundige werkswinkels. Fase 2 het onderhoude behels met gesinspraktisyns in akademia, sowel as in die privaat - en openbare gesondheidsorgsektore wat verantwoordelik was vir kliniese staatsbestuur in primêre gesondheidsorg in die Kaapstad – metropool. Gedurende hierdie fase van die navorsing was die ervaringe, perspektiewe en begrip van gesinspraktisyns (akademia, privaat – en openbare sektor) met betrekking tot bewysgebaseerde praktyk, en die implementering van riglyne in primêre gesondheidsorg, verken. Fase 3 het deelnemende aksienavorsing met primêre sorg – praktisyns by gemeenskaps – gesondheidsentrums behels, deur ‘n koöperatiewe ondersoekgroep te gebruik om die asmariglyn – implementering in primêre gesondheidsorg te verbeter. Die koöperatiewe ondersoekgroep het ondersoek ingestel hoe om die implementering van die asma – riglyne in hul onderskeie gemeenskaps – gesondheidsentrums te verbeter, en het vier siklusse van beplanning – aksie – observasie – refleksie voltooi. Die vier siklusse het gefokus op die implementering van ‘n asma – selfbestuurplan, die bekwaamheid van kliniese verpleegpraktisyns om die riglyne te implementeer te verken, die persepsies van pasiënte oor hul asmasorg te verken, en die implementering van beter pasiënt – opvoeding. ‘n Finale konsensus van die koöperatiewe ondersoekgroep se studie was toe opgestel. Resultate Met betrekking tot gehalteverbetering van asmasorg in primêre gesondheidsorg: Die eerste doelwit van die studie is hoofsaaklik aangespreek deur die basislyn – oudit wat in 2007 en 2008 uitgevoer is. Dit het getoon dat die basislynkwaliteit van asmasorg, met spesifieke verwysing na die assessering van pasiënte se vlak van beheer, meting van die pasiënt se piek ekspiratoriese vloeitempo, assessering van die pasiënt se inhaleringstegniek, optekening van die pasiënt se rookstatus, die voldoende voorskryf van reguleerder - en verligter gemeterde dosis inhaleerderhervullers tydens besoeke, en veral die verskaffing van ‘n asma – selfbestuurplan tydens besoeke, swak was. Die tweede doelwit is aangespreek deur die jaarlikse ouditte wat uitgevoer is in 2007, 2008, 2010 en 2011 gedurende die periode van implementering. Dit toon dat, hoewel duidelike oorsaak en effek – argumentering nie afgelei kan word nie, algehele statisties en klinies - beduidende verbeterings in die kwaliteit van sorg voorgekom het, in samewerking met die proses van asmariglyn – implementering. Ten spyte van die verbetering in strukturele – en proseskriteria, was daar geen ooreenstemmende verbetering in die uitkomskriteria nie. In werklikheid het die benutting van fasiliteite vir noodbesoeke aansienlik verhoog, terwyl die hospitalisasie van pasiënte konstant gebly het. Die derde objektief was om maniere te verken om die implementeringsproses van die nasionale asmariglyne in primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel te verbeter. Dit was hoofsaaklik aangespreek deur ‘n aksienavorsingproses by geselekteerde gemeenskaps – gesondheidsentrums. Dit het getoon dat implementering verbeter kon word deur deurlopende opvoedkundige ondersteuning en formele interaktiewe opleidingswerkswinkels met die personeellede wat direk betrokke was met die pasiënte. Die ontwikkeling en gebruik van opvoedkundige hulpmiddels, en asma - selfbestuurplanne gebaseer op die riglyn – aanbevelings was nuttig, en het pasiëntdeelname in besluitneming rakende hul sorg, aangemoedig. Die vierde doelwit, spesifiek met betrekking tot asmasorg, is aangespreek by wyse van ‘n opname. Dit het getoon dat, alhoewel die meerderheid van asma – pasiënte deelgeneem het aan besluite rakende hul asma, en tevrede was met die kwaliteit van sorg wat hulle ontvang het, die voorkoms van rook onder asma – pasiënte hoog was, en geleenthede vir rookstaking – berading was gemis. Alhoewel dokumentasie van piekvloei – opnames en pasiënte se kennis van die verskil tussen die verligter en kontroleerder - gemeterde dosis inhaleerders goed was, was pasiënte se persepsies met betrekking tot opvoeding in die inhaleringstegniek, die assessering van die vlak van beheer, die uitreiking van geskrewe inligting ten opsigte van asma, en die gebruik van asma – selfbestuurplanne steeds swak en kon dit verbeter word. Met betrekking tot bewysgebaseerde praktyk en asmariglyn – implementering in primêre gesondheidsorg: Die vyfde doelwit van die studie is aangespreek by wyse van ‘n opname wat getoon het dat die dokters in primêre gesondheidsorg bewyse in kliniese besluitneming gebruik het, en saamgestem het met die nuttigheid en belangrikheid van bewysgebaseerde praktyk in die verbetering van die kwaliteit van pasiëntsorg in Suid – Afrika. Daar was ‘n verskil in omgang met aktiwiteite wat verband hou met bewysgebaseerde praktyke tussen die openbare – en privaatsektordokters. Daar is dus ‘n behoefte aan formele opleiding in die vaardighede en prosesse van bewysgebaseerde praktyke. Die sesde doelwit is aangespreek by wyse van ‘n opname wat getoon het dat ‘n goeie proporsie van beide openbare en privaatsektordokters in die Kaapstad- metropool wel bewus was van die asmariglyn en het spesifieke riglyn – aanbevelings aangeneem, daarop gereageer en nagekom. Daar was ‘n hoë vlak van algemene bewustheid van die asmariglyn, en aanbevelings was aangeneem in die praktyk, alhoewel daar verbeter kon word op die gebrek aan formele siekteregisters, monitering en evaluering van asmasorg, en die benutting van ‘n asma – selfbestuurplan. Die sewende doelwit is aangespreek deur kwalitatiewe navorsing wat getoon het hoe die persepsies en perspektiewe van gesinspraktisyns ten opsigte van bewysgebaseerde praktyk en die proses van riglyn – implementering bygedra het tot die ontwikkeling van ‘n konseptuele raamwerk vir die proses van riglyn – implementering. Die agste doelwit is aangespreek deur kwalitatiewe navorsing, wat hindernisse in elke stap van die implementeringsproses identifiseer het. Tydbeperkings, praktisynswerklading, gebrek aan finansiële hulpbronne, gebrek aan eienaarskap, die gebrek aan tydige organisasie – ondersteuning en praktisynsweerstand ten opsigte van verandering, was belangrike hindernisse in riglyn – implementering in ‘n reeds oorlaaide primêre sorg – omgewing. ‘n Konseptuele model is ontwikkel wat getoon het dat die proses van riglyn – implementering aangepas moet word by die geïdentifiseerde hindernisse. Die negende doelwit is aangespreek by wyse van ‘n opname wat getoon het dat die konsep van bewysgebaseerde praktyk betreklik nuut was vir kliniese verpleegpraktisyns in primêre gesondheidsorg, en het ‘n behoefte geïdentifiseer om meer hieroor te leer. Kliniese verpleegpraktisyns het saamgestem dat kliniese navorsing nuttig is in die daaglikse bestuur van pasiënte, dat hul besluitneming gebaseer moet wees op bewyse, dat bewysgebaseerde verpleging die kwaliteit van pasiëntsorg kan verbeter, dat daar ‘n plek is vir bewysgebaseerde verpleging in hul praktyke by hul onderskeie gemeenskap-gesondheidsentrums, dat bewysgebaseerde praktyk ‘n verskil sal maak in die kwaliteit van sorg van hul pasiënte, en dat bewysgebaseerde verpleegpraktyk ‘n belangrike rol kan speel in Suid – Afrika. Alhoewel die bewustheid onder kliniese verpleegpraktisyns met betrekking tot die asmariglyne swak was, het die oorgrote meerderheid verslag gegee dat hulle die pasiënte persoonlik opgevoed het oor die verskil tussen verligting – en beheerder gemeterde dosis - inhaleerders, die rookstatus van pasiënte in die verslae opgeteken het, die inhaleringstegniek aan al hul pasiënte gedemonstreer het, die vlak van beheer geassesseer het, en saamgestem dat geïnhaleerde kortikosteroïede die staatmaker van behandeling is in pasiënte met chroniese, aanhoudende asma. Slegs ‘n klein minderheid (hoofsaaklik by die gemeenskap – gesondheidsentrums waar aksienavorsing geskied) het egter begin om pasiënte van asma – selfbestuurplanne te voorsien. In die beantwoording van die sentrale vraag: “Hoe kan die proses van implementering van kliniese navorsingsbewyse, deur die voorbeeld van die nasionale bewysgebaseerde riglyne oor asma, verbeter word in die primêre gesondheidsorgsektor in die Metropooldistrik - gesondheidstelsel van die Kaapstad – metropool?”, kom hierdie tesis tot die gevolgtrekking dat die proses van riglyn – implementering in die primêre gesondheidsorg verbeter kan word deur ‘n in – diepte begrip en sistematiese benadering tot die hele proses. ‘n Konseptuele raamwerk word voorsien as ‘n model wat poog om te lei en sin te maak van hierdie proses van riglyn – implementering. ‘n Stapsgewyse benadering word aangebied en verskaf ‘n opsomming van die hoof – navorsingbevindinge. Die model toon dat die aanvanklike proses van bewyse – skepping nie slegs navorsingbewyse van hoë kwaliteit moet oorweeg nie, maar navorsingbewyse moet inkorporeer wat relevant is tot die bepaalde konteks van sorg. Boonop toon die model dat riglyn – ontwikkeling inklusief behoort te wees, en behels dit ‘n wyer spektrum van rolspelers sowel as pasiënte; dat riglyn – kontekstualisering, verspreiding en implementering versigtig beplan behoort te word. Spesiale oorweging moet gegee word aan plaaslike besluitneming oor die aanneming of prioritisering van spesifieke aanbevelings as deel van volgehoue kwaliteitverbeteringsiklusse, en die omskakeling van gepubliseerde riglyne na praktiese hulpmiddels vir praktisyns om te gebruik in die konsultasiefase, alvorens verspreiding daarvan plaasvind. Implementering behoort te verwag dat lede van die primêre gesondheidsorg sal verskil in hul gereedheid om te verander, en dat strategieë doelbewus die beginsels van gedragsverandering sal insluit en ‘n gevoel kweek van eienaarskap, keuse en beheer oor plaaslike aanneming van die riglyne. Akademiese sentrums, soos universiteite en professionele liggame, het ‘n rol om te speel in die identifisering, gehalteversekering en sintetisering van die bewyse, en om insette te lewer in die riglyn - ontwikkeling. Hulle kan ook behulpsaam wees deur praktiese hulpmiddels te innoveer en te evalueer as deel van die kontekstualiseringfase, en om deurlopende opvoeding te verskaf gedurende implementering as deel van hul sosiale verantwoordelikheid. Die gesondheidsorg – organisasies moet onnodige vertragings in riglyn – implementering voorkom deur te verseker dat beleid, bronne en aanbevelings in lyn is gedurende die kontekstualiseringsfase; dat hindernisse wat teëgekom word, regdeur die hele proses hanteer word, en dat volgehoue monitering en evaluering van kwaliteitsorg plaasvind. Gevolgtrekking Hierdie navorsing het van verskillende metodes en innoverende deelnemende aksienavorsing gebruik gemaak om die gaping tussen bewyse en praktyk te sluit. ‘n Nuwe konseptuele model vir riglyn – implementering word aanbeveel vir gebruik om behulpsaam te wees met die implementering en kennis -translasie in primêre gesondheidsorg plaaslik, nasionaal en in soortgelyke lae - en middel - inkomstelande in Afrika.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / PROJECT AIM The aim of this qualitative cross-sectional descriptive study was to test the comprehensibility of the preliminary Food-Based Dietary Guidelines for healthy children aged 1-7 years. Objectives included assessing exposure to Food-Based Dietary Guidelines, assessing comprehension of the proposed Paediatric Food-Based Dietary Guidelines (perceptions, interpretation and understanding of terminology, concepts and descriptions), and assessing whether the guidelines can be used in meal planning. METHOD The proposed study was submitted to the Committee for Human Research, Faculty of Health Sciences, Stellenbosch University, and was subsequently approved. Focus group discussions were used to collect data. The discussions were facilitated by the investigator in either English or Afrikaans, according to a predetermined discussion guideline. Mothers with children aged 1-7 years old voluntarily participated in the study. With permission from the Department of Education, mothers were contacted via randomly chosen pre-primary schools, crèches and playgroups. Focus groups were formed on the basis of language and socio-economic status (SES), using randomly selected suburbs to represent lower, middle and upper SES groups. Sixteen focus groups were conducted: 2 pilot groups, 1 English and 1 Afrikaans lower SES, 3 English and 3 Afrikaans middle SES groups, and 3 English and 3 Afrikaans upper SES groups. RESULTS A total of 76 mothers participated in the study. On the whole, the mothers understood the proposed Paediatric Food-Based Dietary Guidelines as intended by the Paediatric Working Group. The rationale behind the guidelines was not always known, but grasped once explained. No substantial differences were found between English and Afrikaans data. Differences were found between SES groups, with the highly educated upper SES groups having a better understanding of the nutritional information than the other groups. In all groups, mothers suggested that slight changes be made to the wording of the guidelines, and that examples and additional information be given along with each of the guidelines. Overall they agreed that the proposed guidelines might prove to be useful. CONCLUSION The proposed Paediatric Food-Based Dietary Guidelines were well received by the mothers in the focus groups. The target population which would most benefit from these guidelines would be the less educated, lower SES groups, as more highly educated mothers seem to already have greater exposure to nutritional information. This study shows that once the guidelines have been modified, they may be used as a comprehensive guide for nutritional education.

Dissertation submitted in fulfilment of the requirements for the degree Magister Technologiae: Quality in the Faculty of Engineering at the Cape Peninsula University of Technology 2008 / Increasing customer demand for quality products and services have virtually forced organisations to adopt quality in every aspect of their business enterprises. Due to dynamic technological, political and economic changes in the world of business, the science of management is volatile. Higher Education Institutions are service providers and the customers thereof should be the focal point of their existence, requiring very specific structures to manage service quality within the various areas of application. After extensive research on customer complaint behaviours, the value of customer complaints have been highlighted, as it leads to useful insight into critical aspects pertaining to service organisations. Some customers 'pre-plan' complaints, and this act has been labeled as 'faked complaints'. This may lead to the organisation obtaining an image of service failure, however this is not a true representation of the organisation, thus impacting adversely on the efficiency of the organisation. The primary research objectives of this study are the following: ~ To identify key drivers underpinning complaints at the Cape Peninsula University ofTechnology (CPUT), in terms of service delivery. ~ To determine if management has a strategic focus on the quality of service to students at CPUT. ~ To demonstrate the impact that management has on the quality of service delivery. ~ To improve customer service at CPUT by minimizing complaints. It is anticipated that the research will lead to an improvement in the current state of service delivery at CPUT. By identifying and providing possible solutions to customer complaints and addressing problem areas, the research in addition should lead to improved communication between departments and communication between CPUT and its customers (students).

Each chapter has its own summary / Each chapter has own summary / Industrial and Organisational Psychology / M. Com. (Industrial and Organisational Psychology)

Submitted in fulfilment of the requirements of the degree of Master of Engineering - Chemical, Durban University of Technology, Durban, South Africa, 2015. / Industrial wastewater containing organic compounds and/or substances is an increasing problem due to its increasing toxic threat to humans and the environment. The removal of organic compounds has become an imperative issue due to stringent measures that are introduced by the Department of Environmental Affairs in South Africa to enforce regulations concerning wastes that emanate from petrochemical industries. Thus, wastewater containing these compounds must be well understood so as to device adequate treatment processes. In this study, the adsorptive capacity of PAD 910 polystyrenic resin originating from China and granular activated carbon (GAC) was evaluated for the removal of benzene, toluene, ethylbenzene and isomers of xylene (BTEX) from an aqueous solution. Batch studies were performed to evaluate the effects of various experimental parameters such as mixing strength, contact time, internal diffusion, adsorbates and initial concentration on the removal of the BTEX compounds. The experiments were conducted at the mixing strength of 180 rpm, in order to comfortably assume negligible external diffusion. The equilibrium isotherms for the adsorption of the adsorbates on the PAD 910 polystyrenic resin were analyzed by the Langmuir, Freundlich and linearized Dubinin-Radushkevich models at a pH of 5.86. The Langmuir model fitted the data adequately; this result was supported by the work done by Site (2001) which concluded that the Langmuir is the most practical model in representing the adsorption of aromatic compounds. The Langmuir model indicated that resin has the highest adsorption capacity of 79.44 mg/g and GAC has 66.2 mg/g. Resin was found to adsorb 98% of benzene, 88% of toluene, 59% of ethylbenzene, 84% m-;p-xylene and 90% o-xylene at an initial concentration of 14.47 mg/l. BTEX adsorption was a two-stage process: a short, fast initial period then followed by a longer, slow period corresponding to the intra-particle diffusion of BTEX molecules in macropores and micropores. The adsorption capacity was determined by total surface area accessible to BTEX and the availability of active surface chemical groups. The dependence of adsorption capacity on the surface of the two adsorbents and temperature was observed, suggesting the chemical nature of the BTEX adsorption. The interaction between BTEX/activated carbon was however weak and energetically similar to that of hydrogen bonds. Generally, BTEX adsorption was an exothermic process that combined physisorption and chemisorption. The PAD 910 polystyrenic resin had a greater specific surface area (SSA) of 1040 m2/g which yielded in higher capacity compared to GAC which had a low SSA of 930 m2/g. The normalized adsorption capacity was found to be higher for PAD 910 polystyrenic resin than GAC (0.66 and 0.27 mg/m2 respectively) which suggests that the resin has a good potential of the adsorbent for removing BTEX compound compared to GAC. Fixed bed columns were used to evaluate the dynamic adsorption behaviour of BTEX/PAD 910 polystyrenic resin through a dynamic column approach. The performance of small-scale fixed bed columns, each containing PAD 910 polystyrenic resin and the other containing GAC were evaluated using 14.47 mg/L of BTEX concentration. The columns with 32 mm diameter, studied bed depths of 40, 80 and 120 mm and flow rate of 6 ml/min were used in order to obtain experimental breakthrough curves. The bed depth service time (BDST) model was used to analyze the experimental data and design parameters like adsorption capacity, adsorption rate and service time at 20% and 60% breakthrough. BDST was also used to predict the service times of columns operated under different influent concentrations and flow rates to produce theoretical values that were compared to the experimental values. Adsorption model by Dubinin and colleagues (Dubinin, 1960), based on the theory of volume filling micropores was used to fit the measured adsorption isotherms. Agreement between the modelled and experimental results for GAC and PAD 910 polystyrenic resin using Dubinin-Radushkevich equation generally improved with increasing the surface area and produced reasonable fits of the adsorption isotherms for both GAC and PAD 910 polystyrenic resin. Granular activated carbon had a lesser performance compared to the PAD 910 polystyrenic resin, in terms of kinetic studies, and this finding was attributed to the pore structure which made accessibility of BTEX molecules more difficult in this study. The results indicate that PAD 910 polystyrenic resin show potential as an adsorbent for removing low concentrations of BTEX from wastewater. It is suggested that necessary treatment of GAC might improve the performance of this adsorbent by creating more mesopore volume and fraction which is essential to enhance adsorption rate. A substantial different SSA could be achieved through high porosity development in GAC by using templating method with a higher potassium hydroxide mixture ratio.