O trabalho em saúde é uma prática social que sofre alterações do contexto e se conforma nos encontros entre usuário e trabalhador, e nesses encontros necessidades de saúde emergem, o que demanda a inserção de novos saberes e tecnologias. A fitoterapia é uma tecnologia que tem sido inserida nos serviços de saúde e constitui uma ferramenta para o trabalho, mesmo não fazendo parte das tecnologias do modelo biomédico. O objetivo do trabalho foi analisar os fatores envolvidos na implementação da política de plantas medicinais e fitoterápicos na rede de saúde que a fazem entrar ou não na rotina de trabalho dos profissionais da saúde. Trata-se de um estudo qualitativo que se deu em duas fases, análise documental e estudo de caso. Os materiais analisados na primeira fase foram: os planos de saúde e relatórios anuais de gestão, leis, portarias, e um trabalho de conclusão de curso, referentes aos municípios de Fortaleza, Rio de Janeiro e Vitória. O estudo de caso foi realizado em Vitória, de janeiro a fevereiro de 2016, foram realizadas entrevistas em duas USFs com trabalhadores de ESF e usuários, além dos dois responsáveis técnicos do programa de fitoterapia do município, totalizando 41 participantes. O material obtido no estudo de caso foi submetido à análise de conteúdo na modalidade temática e discutido à luz do referencial conceitual, do trabalho em saúde como produção social. Os fatores que favorecem a implementação da fitoterapia segundo os dados encontrados foram: 1) Contexto favorável; 2) Ter governabilidade; 3) A perspectiva ampliada de saúde e do serviço; a percepção sobre o papel no trabalho e a percepção dos hábitos de cuidado da comunidade; 4) Ter conhecimento científico acerca do tema; ter conhecimento sobre o programa e a cultura/conhecimento familiar de utilização de plantas medicinais; 5) Identificar benefícios da fitoterapia e 6) Estrutura e insumos que viabilizem o programa. Os contextos internacional, nacional e municipal favoreceram a atuação de líderes/empreendedores na inserção da fitoterapia na saúde, e o encontro com gestores sensibilizados viabilizaram os programas. No campo da assistência, a fitoterapia consegue espaço no trabalho dos profissionais que têm percepção ampliada de saúde e que compreendem seu papel, e o da unidade no processo saúde-doença. A responsabilização pelo usuário e comunidade mobiliza o trabalhador a buscar ferramentas que respondam às suas necessidades de saúde, e é nesse contexto que a fitoterapia é acolhida como ferramenta de trabalho. O conhecimento sobre as ferramentas de saúde oferecidas pelo município, como a fitoterapia, e o conhecimento sobre a prática favorecem sua inclusão na rotina de trabalho. O interesse pela prática é influenciado por experiências de uso e emprego bem-sucedidos da prática. A fitoterapia não é uma ferramenta de trabalho típica do modelo biomédico, mesmo assim tem conseguido alcançar esse espaço de forma institucionalizada, tanto servindo à lógica daquele modelo ou sendo usada como um instrumento para o cuidado integral. A busca por ferramentas holísticas de cuidado em última instância são para contribuir na superação da lógica biomédica / The health work is a social practice subject to changes depending on the context, and is formed in the encounter between user and workers. In such encounters, health needs emerge, which requires the insertion of new technologies. The use of herbal medicines (phytotherapy) is a technology that has been inserted in health services and constitutes a tool for health work, even though it is not part of the set of health technologies of the biomedical model. The aim of this study was to analyze the factors involving the implementation of the policy related to the use of medicinal plants and herbal medicines in the health system, the factors that integrate or not its use in health professionals\' work project. It is a qualitative study that took place in two phases: documentary analysis and case study. The analyzed materials were health plans and annual management reports, laws, resolutions referring to the Brazilian municipalities of Fortaleza, Rio de Janeiro and Vitória. The case study was carried out in the city of Vitória, from January to February 2016, and data were obtained through interviews conducted in two Family Health with workers from the Family Health Team and users attended at the unit. There were also two technicians responsible for the phytotherapy program in the municipality, totaling 41 participants. The material obtained in the case study was submitted to content analysis in the thematic modality and was discussed based on the conceptual framework of health work as social production. The factors favoring the implementation of herbal medicines in the health care were: 1) Favorable Context; 2) Having Governability; 3) The broader perspective of health and service; the perception about the role in work and the perception of the community care habits; 4) Having scientific knowledge about the subject; knowledge about the program and also the culture/family knowledge of the use of medicinal plants; 5) Identification of the benefits of herbal medicines and 6) Presence of structure and inputs that make the program possible.The international, national and municipal contexts favored the performance of leaders/entrepreneurs in the insertion of herbal medicines in the health care network, and the encounter with sensitized managers made possible the establishment of the programs. In the field of assistance, herbal medicines have conquered space in the work projects of professionals who have expanded perception of health and who understand the health service role and their own role. Knowledge about the health tools offered by the municipality, such as herbal medicine, along with the knowledge about its practice favors its inclusion in the work routine. Interest on the practice is influenced by experiences of use and successful practices. Phytotherapy is not a working tool from the biomedical model in health care, yet it has managed to achieve this space in an institutionalized way, either serving the logic of that model or being used as an instrument for the offer of comprehensive care

Die Schulmedizin ist zwar das offizielle und anerkannte Gesundheitssystem in Tunesien, jedoch findet der Beobachter zahlreiche traditionelle und moderne alternative Heilmethoden, die miteinander koexistieren. Dazu gehört die spirituelle Heilung bzw. die tibb ruhani, die im letzten Jahrzehnt zunehmend eine zentrale Stellung im „health seeking behavior“ der Jugendlichen eingenommen hat. Viele der älteren Heilpraktiken standen in der Öffentlichkeit im Schatten der Schulmedizin und des offiziellen Islam. Dabei spielte der Bezug auf die religiösen Texte und die übernatürliche Welt und ihre Kräfte sowie auf die traditionelle Medizin eine wichtige Rolle. Meine zehnmonatige Feldforschung bzw. meine Interviews mit den Jugendlichen zeigen die Bedeutung der spirituellen Heilung für diese Altersgruppe, die Heilung von ihren Krankheiten und Lösung für ihre sozialen Konflikte und Probleme sucht. Auch die Medien richten heute mehr Interesse auf diesen Bereich, in dem sie eher kritische Artikel darüber veröffentlichen und die Werbung der Heiler publizieren. Diese Ambivalenz zeigt, dass der Umgang mit der spirituellen Heilung in der Öffentlichkeit einen interessanten Wandel erlebt. Die Bedeutung der traditionellen Medizin und der volksislamischen Heilpraktiken war zwar immer in der Gesellschaft verankert, blieb allerdings bis jetzt nur im Hintergrund. Eine Transformation und eine öffentliche Anerkennung erhalten sie erst durch die moderne spirituelle Heilung. Die mediale Präsenz der spirituellen Heilung zeigt, dass Krankheit und soziale Konflikte nicht mehr als lediglich die Privatsphäre betreffen. Dies impliziert eine staatliche Strategie als eine Art Sicherheitsventil für die sozio-wirtschaftlichen Probleme vor allem der Jugendlichen (Arbeitslosigkeit, Perspektivlosigkeit, Migrationswunsch) und ebenso gegenüber dem politischen Islam. Abschließend ist die spirituelle Heilung ein fester Bestandteil des medizinischen Pluralismus in Tunesien geworden und es bestehen Bestrebungen, mit der Schulmedizin zu kooperieren. / In addition to modern medicine, traditional medicine plays an important role in the medical system of Tunisia. There are different healing methods which characterize the medical landscape of the country and they coexist in an interesting way. This variety has a remarkable impact on the health seeking behavior of the Tunisians and especially of the younger generations (17-30), who have become increasingly interested in spiritual healing (tibb ruhani). This healing method deals with illnesses including modern methods of treatment and, additionally, it focuses on a number of issues and problems which concern this age group such as social conflicts, unemployment and migration. The image of spiritual healing has changed considerably over the past ten years. This transformation has led to a new understanding of illness and healing and to the development of new strategies regarding the health seeking behavior. Spiritual healing is based, on the one hand, on religious texts, the supernatural world and its agents and, on the other hand, on traditional healing methods and modern medicine. Up to recently, the traditional healing methods only played a marginal role in the medical system and they were hardly attractive to the young generations. My fieldwork, however, clearly shows that spiritual healing has deeply aroused the interest of this age group and, at the same time, it has met with public recognition. The mass media have also become interested in the phenomenon of spiritual healing and are publishing increasing numbers of articles about the spiritual healers and their methods and by giving them the opportunity to participate in a variety of TV-shows. This new attitude towards illness, healing and social problems underlines that these topics are no longer private concerns. The spiritual healing has incorporated the current social and economic transformations. The healers have become important contacts for this age group who consult them to find adequate solutions to a wide range of their concerns. The government profits from this new role of the spiritual healing and it uses it for various purposes such as to alleviate social tensions. The importance of the spiritual healing in Tunisia is also underlined by the serious attempt to develop an official cooperation between spiritual healing and modern medicine.

<p>Den här studien fokuserar på komplementärmedicin ur fyra informanters perspektiv och med kopplingar till aktuella vetenskapliga diskussioner och strömningar. Bakgrunden till studien är en ökande användning av komplementärmedicin i samhället och livliga debatter kring dess vetenskapliga status. Syftet är att genom kvalitativa metoder belysa viktiga aspekter av informanternas användning av komplementärmedicin. Mycket uppmärksamhet ägnas åt informanternas syn på de olika metodernas effektivitet, hur denna definieras och vilka konkreta resultat informanterna strävar efter eller upplever.</p> / <p>This study focuses on complementary medicine from the perspectives of four informants, and with reference to topical scientific discussions and currents. The background of this study is to be found in the growing use of complementary medicine in the society. The main goal is to shed light on important aspects of the informants’ use of complementary medicine. Much attention is focused on their views regarding the efficacy of the various methods, how it is defined and what concrete results they are striving for, or experiencing.</p>

Objective: To explore differences between conventional medicine (COM) and complementary and alternative medicine (CAM) regarding the attitude toward and the perceived use of shared decisionmaking (SDM) from the health professional perspective. Methods: Thirty guideline-based interviews with German GPs and nonmedical practitioners were conducted using qualitative analysis for interpretation. Results: The health professional–patient-relationship in CAM differs from that in COM, as SDM is perceived more often. Reasons for this include external context variables (e.g. longer consultation time) and internal provider beliefs (e.g. attitude toward SDM). German health care policy was regarded as one of the most critical factors which affected the relationship between GPs and their patients and their practice of SDM. Conclusion: Differences between COM and CAM regarding the attitude toward and the perceived use of SDM are attributable to diverse concepts of medicine, practice context variables and internal provider factors. Therefore, the perceived feasibility of SDM depends on the complexity of different occupational socialization processes and thus, different value systems between COM and CAM. Practice implications: Implementation barriers such as insufficient communication skills, lacking SDM training or obedient patients should be reduced. Especially in COM, contextual variables such as political restrictions need to be eliminated to successfully implement SDM.

Den här studien fokuserar på komplementärmedicin ur fyra informanters perspektiv och med kopplingar till aktuella vetenskapliga diskussioner och strömningar. Bakgrunden till studien är en ökande användning av komplementärmedicin i samhället och livliga debatter kring dess vetenskapliga status. Syftet är att genom kvalitativa metoder belysa viktiga aspekter av informanternas användning av komplementärmedicin. Mycket uppmärksamhet ägnas åt informanternas syn på de olika metodernas effektivitet, hur denna definieras och vilka konkreta resultat informanterna strävar efter eller upplever. / This study focuses on complementary medicine from the perspectives of four informants, and with reference to topical scientific discussions and currents. The background of this study is to be found in the growing use of complementary medicine in the society. The main goal is to shed light on important aspects of the informants’ use of complementary medicine. Much attention is focused on their views regarding the efficacy of the various methods, how it is defined and what concrete results they are striving for, or experiencing.

Herbal medicines remain integral part of indigenous health care system in Ghana. Most conventional health medicines are directly or indirectly derived from plants or herbs. Despite its significant role in modern medicine indigenous herbal practices has been on the low light for some time due to perceived antagonistic relationship that exists between practitioners of herbal medicine and their counterpart in the conventional system. Using an indigenous knowledge discursive framework, the thesis examined the relevance of herbal medicine to the contemporary Ghanaian society. The thesis also examined the tension between the indigenous herbal practitioners and their orthodox counterparts. The thesis noted that for health care system in Ghana to be effective, there is a need for collaborate relations between these two practitioners. Also, it was noted that for health care system to be effective in Ghana, spirituality has to be central in the works of the herbal practitioners.

Herbal medicines remain integral part of indigenous health care system in Ghana. Most conventional health medicines are directly or indirectly derived from plants or herbs. Despite its significant role in modern medicine indigenous herbal practices has been on the low light for some time due to perceived antagonistic relationship that exists between practitioners of herbal medicine and their counterpart in the conventional system. Using an indigenous knowledge discursive framework, the thesis examined the relevance of herbal medicine to the contemporary Ghanaian society. The thesis also examined the tension between the indigenous herbal practitioners and their orthodox counterparts. The thesis noted that for health care system in Ghana to be effective, there is a need for collaborate relations between these two practitioners. Also, it was noted that for health care system to be effective in Ghana, spirituality has to be central in the works of the herbal practitioners.

Various forms of complementary and alternative medicine (CAM) are increasingly being used in the United States and globally over time. Among CAM, natural products, including herbal medicines, are the most used type. However, the increase in the use of CAM has gone on with minimal or without a corresponding increase in the rate of disclosure of use to the health care providers. The theories of care-seeking behavior and the behavioral model of health services use guided most of the study. Data from the 2012 National Health Interview Survey were analyzed to determine the health factors that affect the nondisclosure of herbal medicine usage by respondents (N = 423) who used herbs as their first choice of CAM therapy. Data were analyzed using descriptive statistics and a binary logistic model. About one quarter of herb users did not disclose their use of herbs to the health care provider. Nondisclosures were likely to be associated with herb users who also used homeopathy and those who used herbs to treat diseases that are usually short-term. The nondisclosure rate of the use of CAM, including herbal therapy, remains a recurring concern. As part of the practical implications, the study creates and supports the awareness of health factors associated with CAM and herbal medicine use nondisclosure issues that inform health professionals about mitigating the problem and improving health practice and medical consultations.

See title file for abstract / Educational Studies / D. Ed. (Psychology of Education)

Historically the trend in health care has been the domain of health care professionals such as doctors, nurses and other professionals from the medical fraternity. This created the separation between the mind and body, due to the diagnostic and treatment origins being segregated. This thesis addresses the idea that psychological processes have significant impacts on our physical health {and visa versa). It establishes the notion that health care needs to be understood holistically, from a broader systemic perspective, expanding the working model of health. The second chapter of this thesis addresses the power of the mind and the connection between the mind and body. It establishes the importance of beliefs and perceptions and the huge effect this has on people and their lives. How we choose to perceive a situation will give that situation meaning. The meanings that we give to events usually depict how we will see and respond to that event, sometimes more than the actual event itself. It explains the importance of the mind (psychological issues) as well as the body (physiological issues) when understanding and dealing with health and wellbeing. The following chapter discusses the historical developments of physical and mental health; from Hippocrates and Descartes to a modern holistic approach and attitude. Behaviour Medicine6, explicitly recognises that mind and body are intimately interconnected and that an appreciation of these interconnections and their scientific study is an interdisciplinary field, uniting the behavioural sciences with the biomedical sciences; in the hope that the cross fertilization will yield a more comprehensive picture of health and illness. The 'biopsychosocial model'7 provides a theoretical framework, explaining how an awareness of biological, psychological and social process are all important in understanding disease and recovery, supported by systemic principles. The scientific research and practical implications of psychoneuroimmunology8 (PNI) takes this biopsychosocial model one-step further. It describes how thoughts, perceptions and emotions have interchangeable influences with brain chemistry, which in turn influences the body and neurological systems1 particularly immune system functioning. The concept that we all have an inner ability /intelligence to heal ourselves is also detailed. Miller (1997: 350) discusses this notion, stating that we all have "a healer within." He states that this inner healer can be awakened in order to participate in "our deep healing.11 He claims, "This vital essence has been with us since birth ... Its function is to maintain homeostasis (internal balance). As humans, we can1 through our ability to change our images and beliefs, enhance, or inhibit the power of this inner healer." The concepts discussed thus far in the thesis are then demonstrated practically. The relationship between stress and health is examined and practical ways to maintain a healthier lifestyle is detailed. The researcher then introduces a South African company that is currently working in the field with the concepts of mindbody medicine and psychoneuroimmunology. This led the researcher to find a philosophical container in which to hold the holistic mind body theories and concepts. Anderson & Carter (2003: 222) states, "Social work distinguishes itself by exploring the 'person-environment fit'. This is an area in social work where constructivism may prove supportive. Such an emphasis increases the likelihood that diverse voices and points of view are integrated in social work theory and practice." Therefore/ a constructive epistemology/ philosophy in which meaning is intimately connected with experience, is expanded upon. The mind/body theory and concepts are then linked to Constructivism and Personal Construct Theory (by George Kelly). Constructivism postulates that we all create and interpret our own meaning systems, which become our subjective realities. The link to mind body medicine is pertinent in that both constructivism and mind body medicine share similar ideologies about how realities are construed, and how this in turn effects treatment of disease and maintenance of wellbeing. Cybernetic complementarities then expand our understanding of the mind and body connection in a monolistic framework, where mind and body are recursive partial arcs of a holistic health care system. Constructivism therefore integrates eastern and western concepts, cementing all the concepts used in this thesis, in a holistic manner. It also helps us to understand how some of the mind body techniques may be working within the mind body realm. Given the unique needs of a changing and developing society, as found in South Africa, there is a need to be creative and find alternative ways to cope with our societal stresses and daily occurrences. This is where the researcher feels that the social work profession needs to be involved in working and contributing to our health care services. The development of medical social work is detailed and the latest social work definition discussed. It is reveals how contents of the definition of social work are relevant and are a pertinent fit with mind-body approaches to health and wellbeing. The researcher debates the role of social workers in this field of health care. It is then proposed, in the detailed discussion, that social workers practising in this field should be known as Health Care Social Workers. This field of holistic health care has many proposed strengths and implication, for both Health Care Social Workers and other health care professionals. It will naturally also present challenges that need to be considered and contemplated. The final chapter of this thesis examine these strengths and challenges and their therapeutic implications. The researcher concludes by demonstrating that the literature study on holistic mind and body approaches matches her objectives from the first chapter. / Social work / M.A. (Social Science with specialisation in Mental Health)