The consultation is the GP’s form of work. How long a consultation should be, and what short/long consultations imply with regard to the satisfaction of patient and doctor has been much debated. The aim of this thesis was to study consultations with regard to content and time consumption in a short term and long term perspective. Three studies were carried out. 1. Consultations with the members of a group of GPs were investigated, where patients and doctors separately assessed different aspects of the consultation, and their ratings were related to the real length of the consultations. The following questions were posed: Was there time enough? Could the patient tell the doctor about her/his problems? Were the problems physical or psychological? 2. Nurses at the primary care health centres were interviewed about their considerations in booking short or long appointments for the patients. 3. Patients who frequently attended one health centre during one year and consumed much time were studied. Quantitative and qualitative methods were used. The results of the first study (Papers I-III) show that the average length of the consultations was 21 minutes; there was considerable variation (ranging from 3 to 60 minutes). (About 600 consultations with 7 male doctors were registered in two batches). The doctors’ mean consultation length also varied widely, from 13-28 minutes. Consultations dealing with psychological problems were longer than those dealing with physical problems. Older patients had longer consultations than younger patients, and female patients had somewhat longer consultations than male patients. The patients were generally more satisfied with the consultations than the doctors were, and there were no clear affinities between long consultations and high satisfaction. Male patients and patients with physical problems mainly received short consultations, whereas patients with ”mixed" problems and older patients received long consultations. The single factors most decisive for the length of a consultation were ‘the doctor factor’, the character of the problem and the age of the patient. "Good” consultations (operational definition) were associated primarily with ‘the doctor factor’, and the real length of the consultations was less important. The interviews with ten experienced primary care nurses (Paper IV) showed that the nurses worked in two perspectives: in the ”immediate” perspective, appointments were booked according to rules which directly impacted the length of the visit, and in the "reflective" perspective, appointments were booked with a view to the quality of the work at the health centre and the long-term time consumption. Other factors of importance were the patient’s age and problem(s), the doctor’s experience and working style, and the current situation at the health centre. Frequent attenders (FAs) at one health centre (Paper V) were compared with a contrast group of matched patients (CPs). The FAs represented 1.7% of the population of the catchment area and made 15% of the visits. The FAs were a heterogeneous group where small boys, women of working age and pensioners of both sexes were overrepresented. The FAs had higher consultation frequency than the CPs during the year of investigation, but few remained FAs for longer periods. The FAs had more problems and more complex problems than the CPs. Complaints regarding the musculo-skeletal organs, and psychosocial problems were common among these patients, often in combination. The present work thus shows that longer consultations do not naturally imply higher patient satisfaction. Other factors than the time factor, in particular ‘the doctor factor’ seem to be more important. ‘The doctor factor’, the characteristics of the patients, the type of problem and the situation at the health centre also have a bearing on consultation length and time consumption in a short-term as well as long-term perspective. The implications of these factors and their relative importance are discussed, but further studies of certain issues, such as ‘the doctor factor’, are necessary. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser.</p> / digitalisering@umu

<p>Diss. Umeå : Umeå universitet, 1998, härtill 8 delarbeten.</p> / digitalisering@umu

This study explores the phenomenon of the informal medical consultation, a communication event in which an individual asks for medical information, advice, or care from an off-duty health professional with whom the individual has no formal patient-provider relationship. Using surveys and interviews, the study describes these consultations from the perspective of the health care professional and the informal patient. The study explores foundational theories that offer explanations for the phenomenon. The theories considered include social support, decision-making, social exchange, perceived partner responsiveness to needs, and uncertainty management. This study suggests health care providers perceive informal medical consultations to be more problematic than do the informal patients who consult them. The problematic nature of informal consultations increases as the type of request moves from purely informational to a request for treatment. Informal patients do not perceive this distinction. The informal patient’s motivation to pursue an informal consultation instead of a formal consult is affected by the relationship with, trust in, and access to the informal consultant. The willingness of the informal consultant to engage in an informal consultation is affected by the relationship with the informal patient, the type of request made, and perception of risk/benefit for both the provider and the patient. The study supports the idea that informal medical consultations are potentially problematic within the current medico-legal-ethical environment. Alternately, these consultations may be viewed as offering positive contributions to the health and well-being of informal patients. The study suggests translational research is needed to guide health professionals in considering requests for informal medical consultations.

Universitäten treten im Zuge der demografischen Wende in einen Wettstreit um Studierende. Fasst man die Universität in diesem Sinne als Unternehmen, Studiengänge als Dienstleistungen und die Studierenden als Kundinnen und Kunden dieser Dienstleistungen auf, rückt die Sicherung und Weiterentwicklung der Qualität des gesamten Studienumfelds in den Mittelpunkt der Betrachtungen. Qualität wird hier in erster Linie als customer satisfaction verstanden, also als Zufriedenheit der Studierenden. Diese wird dabei wesentlich von der Güte von Informations- und Beratungsangeboten beeinflusst. Im vorliegenden Projektbericht stellen wir in diesem Zusammenhang das Nutzungsverhalten und die Zufriedenheit von Studierenden in Bezug auf Beratungs- und Informationsangebote der Universität Leipzig zu verschiedenen Zeitpunkten ihres Studiums dar. Wir beziehen uns dabei im Wesentlichen auf Lehramtsstudierende in verschiedenen Phasen ihres Studiums, greifen aber auch auf eine Vergleichsgruppe von Studienanfängern zurück, die kein Lehramt studieren.

In the new democratic dispensation, the Gauteng Education and Training Council (GETC) is the first statutory council instituted in South Africa, allowing civil society to participate in education policy-making. Against this background, this study explored the policy process and the participation of stakeholders. A literature study investigated the theory on policy and the participation of civil society in the policy process. The inception of the GETC was fully documented and a qualitative study undertaken to determine the role of the GETC in education policy-making. Data gathering was done mainly through semi-structured interviews with GETC members. The data was analysed, discussed and synthesised. The major findings were that stakeholders valued the opportunity to participate and members had high expectations of the contribution they could render in the policy-making process. Although most members had a good grasp of the policy process, lack of administrative resources and participative skills founded in the exclusion of large segments of society from partaking in such consultative structures in the past, was evident in some organisations. The function of the Administrative Secretary is deemed important in facilitating the functions of the GETC and training for this incumbent was emphasised. The lines of communication between the GETC and the Member of the Executive Council (MEC) need to be clearly structured in order to expedite the movement of documents between them. The MEC needs to be more visible to GETC members. The GETC, MEC and the Gauteng Department of Education (GDE) have to explore ways and means of establishing a sound relationship to serve the cause. Consensus between the GETC and the GDE should be reached regarding the role and place of the GETC in the GDE Policy Route. Areas for further investigation that would enhance the role of the GETC in the policy-making process have been identified. The study concluded that the GETC renders a valuable contribution empowering citizens to become involved in formal participative structures which will contribute towards broadening the basis of acceptance of responsibility for education, by society This will assist in attaining its declared vision to improve the level of education in South Africa.

The practice of environmental assessment (EA) in Ontario, Canada and elsewhere has been criticized for resulting in projects that are not necessarily “good” for the environment or society, but simply “less bad.” In Ontario, the ongoing erosion over time of meaningful public involvement in the EA process is seen as a major reason for the degradation of EA practice from something closer to its idealistic purpose of creating “sustainable” development down to its current state, as many have suggested, as an administrative process to ensure legislated minimum requirements (for action or outcome) are met. Nonetheless, the EA process in Ontario continues to offer one of the best legislated processes available for addressing the potential negative impacts associated with public projects in the province. Ontario’s streamlined Class EA process allows for routine, low-impact public projects to proceed without ministerial review so long as certain minimum standards for technical review and public consultation are met. It also includes a mechanism for stakeholders to request ministerial review should a stakeholder believe a substantive or procedural error or oversight has occurred during the study. This mechanism, called a Part II Order request, has been invoked in recent years for multiple reasons in addition to correcting substantive or procedural errors or oversights. This research asks why stakeholders request Part II Orders. Through review and coding of Part II Order request letters from various projects across Ontario, and conducting detailed case studies of projects for which Part II Order requests were made in the Greater Toronto Area, it was determined that the two most commonly-found issues in the Part II Order letters were related to stakeholders feeling distrustful of the proponent or the EA process, and stakeholders feeling as though they were not adequately engaged in public consultation activities for the EA study. The case studies examined these themes in greater detail, and found that these two issues were intertwined with issues of stakeholder power and control. The research findings suggest that EA outcomes can be improved by altering public consultation activities to provide stakeholders with greater control over the decision-making process in a transparent manner so that stakeholders are aware not only of the perspectives of the proponent, but also those of other stakeholders.

Bakgrund: Socialstyrelsens nationella riktlinjer ger rekommendationer om metoder för att förebygga sjukdom genom att stödja människors förändring av sina levnadsvanor. Alla kvinnor ska erbjudas ett tidigt hälsosamtal vilket är av stor vikt för att identifiera ohälsosamma levnadsvanor. I arbetet med att motivera patienten till förändring är motiverande samtal (MI) en beprövad samtalsmetod som barnmorskan kan använda i samtalet med den gravida kvinnan. Effekterna av motiverande samtal har visat sig ha en gynnsam verkan på flera hälsorelaterade beteenden såsom bruk av alkohol, tobak och andra droger, kost och fysisk aktivitet. Syfte: Syftet med studien var att undersöka barnmorskors erfarenheter av och inställning till hälsosamtal i tidig graviditet. Metod: Studien var empirisk och har en kvalitativ ansats och bygger på åtta enskilda intervjuer. Datamaterialet analyserades med innehållsanalys enligt Graneheim och Lundman (2004). Resultat: I resultatet framkom sex kategorier som besvarade studiens syfte.  Kategorierna heter; tidig flexibel handläggning, intresserade och positiva till hälsosamtal, tidigt hälsosamtal är en vinst, barnmorskorna hade olika åsiketer om behov av utbildning, stor variation i genomförande av hälsosamtal och resurstillgång påverkar hälsosamtalets kvalitet. Slutsats: Det som framkom av studien var att tidsbristen är en avgörande faktor för  arbetet med hälsosamtal. Barnmorskorna hade delade uppfattningar om utbildningen som gavs var tillräcklig eller inte. En stor vinst sågs med tidigt hälsosamtal för både barnmorskan och den gravida kvinnan. Mer specifika riktlinjer och utbildningar bör därför finnas eftersom övervikt är ett växande hälsoproblem idag. / Background: The guidelines of the National Board of Health and Welfare provides recommendations on methods on how to prevent illness by supporting people to change their lifestyles. All women should be offered an early health dialogue which is of great importance to identify unhealthy habits. Motivational interviewing is a proven method that the midwife can use in the effort to motivate the pregnant woman. The effects of motivational interviewing has been shown to have a beneficial effect on several health-related behaviors such as use of alcohol, tobacco and other drugs, diet and physical activity. Objective: The aim of this study was to explore midwives' experiences of and attitudes towards health interviews in early pregnancy. Method: The study was empirical and has a qualitative approach and is based on eight single interviews. The data were analyzed by content analysis according Graneheim and Lundman (2004). Results: The results revealed six categories that answered the purpose of the study. The categories are called: early flexible handling, interested and supportive of health interviews, early health consultation is a benefit, the midwives had different opinions about the need for training, considerable variation in the implementation of health consultations and resource availability affects the quality of health discussions. Conclusion: The findings of the study was that lack of time is a crucial factor in the work of health consultations. The midwives had different views on the training given was adequate or not. A large gain was seen with early health consultations for both the midwife and the pregnant woman. More specific guidelines and training should therefore be implemented because obesity is a growing health problem today.

Advances in information and communication technology and the ready availability of Global Positioning Systems (GPS) have made it possible for citizens to create information on the internet expressing their personal perceptions in the form of pictures, videos and text narratives associated with geographic locations. The term Volunteered Geographic information (VGI) was coined to describe the processes whereby non-professionals or “citizen scientists” participate directly in spatial data creation, editing and shared use. VGI offers promise as an innovative way for members of the public to participate directly in the use, production and sharing of spatial information that is relevant to issues of personal or community concern and as a means of addressing some of the issues associated with traditional public participation methods. Planners can find meaning in the heterogeneous, time-sensitive, geo-social geographic information created by citizen volunteers in a bottom-up participation process where planners give up some control over what data is collected and from whom. However, uncertainties associated with volunteered geographic information include relevance, credibility, representativeness and quality of the geographic information. This thesis investigates the opportunities and barriers to the use of volunteered geographic information as public participation in planning. A framework and methodology for collaborative quality control of VGI through multi-criteria subjective relevance ratings of the VGI by its producers and users is put forward in this thesis. The relevance rating framework for quality control of VGI is based on the use of relevance in information retrieval in information science to improve the relevance of search engine results. This concept is transferred to the quality control of VGI contributions to determine the best VGI contributions to be used in planning as public participation. A VGI web application prototype, including the subjective relevance rating system, was created and a methodology and demonstration of its use for public participation was presented.

The purpose of this study was to investigate the effect of Structured Peer Consultation Program on different dimensions of school counselors&#039 / burnout, namely, emotional exhaustion, depersonalization, and personal accomplishment. Pretest and posttest experimental control group design was used to investigate the effect of the Structured peer Consultation Program on different dimensions of burnout. To determine the percipients of the experimental and control groups Maslach Burnout Inventory was administered 55 out of a total 96 school counselors in gaziantep. 8 counselors who had higher than means score in the different dimensions of burnout participated voluntarily in the Structured Peer Consultation program as an experimental group. 8 counselors were selected as a control group. While the program was being applied to the experimental group, the control group did not receive any treatment. The Structured Peer Consultation Program continued for five weeks. In the program the meetings were held once a week and lasted for 90 minutes. One-way analysis of Covariance (ANCOVA) was used to test for significant treatment effect of the Structured Peer Consultation Program on different dimensions of burnout. The result of ANCOVA indicated that ANCOVAs examining treatment effect were significant on dimensions of emotional exhaustion, depersonalization, and personal accomplishment of burnout. It seems that there was a significant improvement in the experimental group&#039 / s burnout level compared to the control group&#039 / s burnout level. At the end of the study the findings were discussed with the relevant studies and recommendations were presented.

This dissertation examines the ways in which three Aboriginal communities in the Sahtu Region of the Northwest Territories are participating in decisions and activities related to non-renewable resource extraction on Sahtu lands. In particular, I examine local involvement in the assessment and regulation of a 1,220 km natural gas pipeline and related infrastructure, collectively termed the Mackenzie Gas Project, currently proposed for the Mackenzie Valley. Overall, this work addresses the conditions under which Sahtu Dene and Mtis participation in resource decision-making takes place; it identifies and offers a critique of some of the assumptions inherent in regulatory, environmental assessment, and consultative processes currently in place in the Sahtu region, and argues that while there has been significant progress in establishing avenues for Sahtu Dene and Mtis participation in resource decision-making, non-local epistemological underpinnings of governance, regulatory, and environmental assessment institutions and practices can hinder local participation in resource decision-making and may serve to reinforce existing power relationships between proponents, Aboriginal communities, and the Canadian state. The findings of this research suggest that there are several barriers to Sahtu Dene and Mtis participation in resource decision-making, including: 1) how environmental impacts are assessed and the associated determination of their significance in environmental assessment and management regimes; 2) the naturalization of techno-rational knowledge paradigms and legalistic discourse in environmental assessment and regulatory processes; 3) incongruent communicative practices and norms of appropriate human and human/other than-human relationships between local Dene and Mtis participants and those of large development corporations and governments; 4) divergent perceptions of the landscape; and 5) changing governance structures resulting from the Sahtu Dene and Mtis Comprehensive Land Claim. This research contributes to a growing assessment of current participatory and resource co-management processes in the Canadian north, and addresses the call for research reflecting local experiences of various participatory processes in resource management, including the often messy and contradictory positions taken by members of a diverse community.